Initiating change for sustaining Mother Earth

Introduction

The drive from Auckland to Wanggeri in Northland, 160 km north, was a scenic one reminding me of the calm and quiet green farmland of North Wales punctuated with hills of primary forest and windy roads lined by well cropped grass on the kerb. Watching the flowering dandelions on the edges with wild white lilies kept me away from dropping asleep after the 10 hour flight. The air was fresh as it whiffed through the slightly wound down quarter glass of the car, air conditioning was not needed; it was spring time. Although rain was forecast we were surprised by the sunlight and brightness of the sky with periodic shut out as the cloud laden with rain drop passed through. After two hours we were at our destination, again taken up by the cleanliness of the place and the general concern for civic mindedness. 

The city council must have been efficient in upkeep of the surroundings as the grass along the roads were no longer than six inches. This was fern country and one could count numerous types of ferns ranging from bushes to trees mimicking palms. The pattern of the leaves gave way to the nomenclature, whether they we single lobed or multilobed leave, if the branches tapered as they drew towards the terminal edges and if they were flat or filmy in character.

People in the city were all aware of the ozone layer and kept reminding us to apply sun lotion to protect our skins. The winds were strong and chilly from time to time as the east coast was open to the Antarctic. Cycling is encouraged and pollution is to be kept to a minimum. Home prepared bread, celery and lettuce came from the back garden. Fried food and takeaways are frowned upon and children are encouraged to stop snacking. Milk is expensive although produced in the country as there is little subsidy from the government.

 The Kyoto Protocol

I needed to update myself, but I am not sure if the US and Australia have signed the Kyoto Protocol as climate change is real and our Mother Earth will inevitably become barren devoid of humans and plants by the next century if conservation of energy is not put in place, war and destruction are not stopped, when oil as a source of energy runs out and food production does not increase. We have ourselves to blame as we take the environment for granted and many  make little effort in moving away from depending on liquid petroleum and don’t educate ourselves and the young how we should correct the inequity in resource allocation and utilization worldwide.

The Transition Initiatives

‘The age of STUPID’ portrays the reality of pending disaster as Pete Postlethwaite’s documentary film (which was nominated for an academy award) rapidly dashes across the globe bringing up valid points that is destroying the planet. We were made to watch this movie borrowed from the city library. You could borrow almost everything from toys for children, magazines and periodicals large print books for the elderly and fiction novels. The archivist in Pete (the movie) brings us to the year 2055 and relents as to why we did not see the warning signs of destruction and why we did not change our current consumption of both energy and food practices. The minuscule steps taken reluctantly by governments in the right direction in attempting to save the planet are marred by greed and corrupt practices in the name of progress and development. Huge housing development and industrialization are clear testimony of deforestation (without reforestation) and environmental destruction. China is apparently draining resources and energy of the world at a rapid rate and much of this is related to relocation of Western industry hoping to make huge profits from low costs of production. When we hear about businessman stating he has made his money from being a developer, cynicism relates to the activities of such people, ‘are they developers or destroyers?’

Picking up a book entitled ‘The Transition Handbook’ by Rob Hopkins in Wanggeri (pronounced Fangarey) in Northland (New Zealand); I found it a hard book to read. There were so much revealing facts that lay the forum straight, the way to doomsday. But there is so much sense in it that I could not resist putting it down. Two terms comes out clearly i.e peak oil and climate change. Would you believe that almost everything we touch or feel converges on oil, let it be cosmetics, furniture, food or cooking. The historical origin of oil is worth repeating. Formed from zooplankton and algae, both of which are found on the ocean floors millions of years ago got deeper and deeper surviving the effects of global warming over millions of years. Buried so deep down chemical transformation caused them to become what we now know as oil. Natural gases, on the other hand, though formed through similar processes had their origin from the remains of vegetation. It was formed as a result of excess heat forming as a result of its proximity to the Earth’s core –crust. This brings in the concept of fossil fuel. Hopkins provides so much practical information that I feel should be part of everyday life, we need to share such information with our children who would be clearly be throttled by 2055, devoid of clean air, oxygen, vegetation, global warming and a lack of food supply!

The bare facts

A tank full of petrol (40 Litres) is said to be equivalent to four years human manual labour. Hopkins continues to give us simple facts like the energy to maintain a US citizen is equivalent to 50 people continuously cycling back and forth in the backyard, day and night! Jonathan Porritt has succinctly put his views on state governance as ‘What is remarkable is the failure of politicians to start planning in any way for this inevitable transition, or even to start preparing their electorates for this transition’. Our reliance on oil will spell disaster if we do not make a concerted effort to address its expected natural depletion by 2050.

The thought that climate change is for real is not realised in Malaysia where the rat race is on and children are taught to take up politics and business if they want to be progressive and to get their Porsche and get jet setting. The lifestyle change is apparent as eating out is fashionable and food stalls are open 24 hours a day. We hang out, so to say, and having a drink at all times is on. Throw in the new breed who don’t’ mind departing with RM 15 for a cup of coffee or RM 11++ for a mee Bandung in a Kopitiam outlet. We do not feel that there is food shortage worldwide and many thrive (or don’t thrive) for less than US$1/- a day!

The Green Book

The expressed feelings of wanting to do something for the community and the environment appear to be left to a few activists who seldom get into the limelight. Few know that talcum powder should be banned but the industry has too much to lose so we advise citizens to avoid using it even though linkage to cancer and lung disease has been known for over three decades. Self-reliance is not new to us as the second Prime Minister; Tun Abdul Razak introduced the ‘Green Book Plan’ in the early seventies when households were encouraged to grow their own green vegetables. This was indeed a wonderful plan, but it fell by the wayside not long after. Today we import vegetables from Thailand and China and worry about the use of pesticide. Tons of food we consume are imported which tells us a story, a story of a lack of resilience, the lack of wanting to be self-sufficient and the need for oil to grind the system.

Winston Churchill (quoted by Hopkins)) had this timely statement, when the internal combustion engine was introduced, ‘I have always thought that the substitution of the internal combustion engine for the horse marked a gloomy milestone in the progress of mankind’ (1954). Machine and computers have taken on several tasks and contribute to pollution endangering the environment. Transport is by far one of the largest consumers of oil and contributes to enormous amount of pollutants. It is an undeniable truth that development has paved the way to the threatening effects seen today to climate and environment. We have been party to this destruction by seeking more funds to build faster lanes and improved urban transport. Walking to school is a no go as the roads are not safe and parents are fearful of child kidnapping! We look for school buses to send our children, vehicles which have seen better days. It is perplexing how such old junks have been permitted to ply the roads emitting enough carbon monoxide to maim a few thousand persons a year.

Getting children and youths involved

How do we educate our children about ways and means to save this planet? Should we permit educationists to draw new curricular to ensure children of today are well versant in maintaining a sustainable environment. Focussing on conventional curricular which sets our children to obtain high marks would not create much awareness.

 It has been said that Governments of the day do not lead but respond, in other words they are reactive and not proactive.  Is this true? If this is true, it appears that the local community needs to take the lead in creating communities that care. Care about the ill effects of globalization of industry and economy, care about the carbon emission and care about why children in Africa and the war torn countries must suffer hunger and death while obesity is an issue in developed countries. Pete Postlethwaite’s ‘Age of the STUPID’ has an animated cartoon which diminishes the wealth and eases  access to energy and luxury in Western countries and increases that for those in need in Africa and Asia  so as to establish equity in all aspects of life.

It would be futile not initiating the positive approaches that are in vogue in UK, Australia and New Zealand. Having read Hopkins’s book ‘The Transition Handbook’ I thought it is worthwhile incorporating much of what is written in this column. In Chapter 8 he addresses Transport, Energy and Housing briefly. Private car ownership should be reviewed so as to give way to pedestrians and cyclists with a re-prioritization of trams and buses using biofuel and alternative sources of energy. Car clubs have been introduced so that no one owns a car. Rural communities are re-organizing themselves to be self-sufficient in both employment and production. This would curtail immigrant labour and would lead to increased productivity of human capital within the nation. Can we see that age limits for employment should not be the order of the day.Grandads would be employable in McDonalds if they are active and willing? Supermarkets need not depend on foreign cheap labour if the senior citizen can work or permitted to take on jobs.

We have always been complaining of increasing fuel prices and air travel. Hopkins’ positively impresses on that cheap air travel is not cheap. We need to review our perceptions of what a holiday should be, flying off to Bali and Aurora or to curtail fuel costs by visiting the local resort or go hiking up a hill in the vicinity? He aptly includes H.G Well’s comment, ‘When I see an adult on a bicycle, I have hope for the human race’. The UK apparently has been able to reduce energy consumption by 50% with an equal increase in renewables through carbon rationing based on Tradable Energy Quotas since 2010. Each citizen and business is assigned a carbon allowance with a yearly reduction in the quota. This has literally made citizens live within their assignment. Solar power and wind turbines have led to better fuel use in the domestic front since 2010. Tidal power and biomass fuel have both contributed to reduction of domestic fuel consumption.

Energy efficient houses are now in vogue. The PassivHaus concept is used where locally sourced biomaterials are used in construction. Solar heat and even occupants’ body heat are used as renewable energy. New buildings are designed to use such locally sourced materials including energy conserving concepts. Communal building would not be too far in the future where facilities would need to be shared rather than have dedicated sites. Can we imagine that you will need to use the communal cooking facilities using your carbon quota should you want to cook a meal in future? Condominiums have adopted concepts of shared entertainment outlets and swimming pools with acceptance. It would not be long before one placed restrictions on villas and extravagant living if carbon quotas come into vogue. John Ruskin’s states (Hopkins) ‘when we build, let us think that we build forever. Let it not be for the present use alone, let it be such work as our descendants will thank us for.’ 

Reminiscing the past

When I was in early secondary school we were taught the usefulness of the coconut trees in that every part of the palm could be utilized. Apart from the coconut used for extracting cooking oil, we could use the husk for fuel and for cushion. The coconut shell could be made into a container or used for fuel. The trunk could be used for fuel and the leaves were dried for making brooms. Nothing was wasted. A similar role for the oil palm plant was explained.

Menkuang leaves were used to pack our mee goring as plastic paper and Styrofoam were not available then. We used kerosene for our oil lights and the empty cans were used as ‘metal pails’ to carry water from the village well which never went dry.

However, two years later, when I was in Form 5, I was made to understand that it was not profitable to grow coconut in plantations because of the difficulty of plucking the coconuts. There were no workers willing to take on this job. They were also not as profitable as oil palm. That breathed the death knell for coconut in Malaysia. Plastics replaced coconut husk as cushioning materials in the furniture industry. The plastic broom replaced homemade brooms made from coconut leaves. Not long after we were paying some RM 3 for a coconut drink; largely imported!

Ironically the Lincoln hemp building company in the UK was awarded recently for innovation in building as they devised a hemp based building material. One environmentalist once wrote about the danger the water hyscene causes. This green water plant grows at a rapid rate covering most ponds and rivers like cancer. Little research I know of is focussing on this plant with succulent leaves and pink flowers cum parasite. If we could work on the use of the fibre drawn from water hyscene so as to make some biofuel, we could curtail the spread of this plant parasite!

Oddly these imperatives are being exemplified with facts and figures but prudent and responsible living would have not got us into this state of emergency where initiatives have to be in place to ensure continued survival of humans, animals and plants. Rationing is not new to me as I have gone through life when daily food on the table and a roof over the head were issues to contend with in my earlier age. We used to divide our daily food quota so that each of us gets that slice of bread or that number of cream crackers.

The day I entered medical school the May 13, 1969 racial riots broke out in Kuala Lumpur. We were all confined to the University Malaya campus. Most of us were freshies and had left home for the first time in our lives. But we had collected ourselves to adapting to the new environment and equally, to new friends. At the Fifth Residential College where I had taken residence, we were fed at the college dining hall for the first three days after the curfew and one evening were called together for an address by the Master of the College. We were told what the curfew meant, that we were not to leave the campus grounds, that classes would not begin till more news was available and how we were to take responsibility in maintaining the college premises and self as no workers were expected to come to clean the toilets except for those already in the premises. Food stock will run out if the curfew extended and we were to be prepared for food rationing of fried rice with ikan bilis. Medical students were to help out at the University Hospital as they were in need of helpers in the cleaning sector and kitchen. Blood was also needed and volunteers were requested to submit their names to the Master of the college.

Permaculture

The movie, ‘Age of the STUPID’ needs to be seen by all as it summaries the goings on that are destroying Mother Earth. Clips on abuse of energy and food by some developed countries, plight of the illiterate and the overpopulated areas, the need for access to healthcare, the ugly oil magnate and the reason for the invasion of some oil producing countries by ‘war lords’ are clearly exemplified using multiple clips of life and hardship from various parts of the world.

Permaculture is a term seen in Holkin’s book which is a ‘conscious design and maintenance of agriculturally productive systems which have diversity, stability and resilience of natural ecosystems. It is a harmonious integration of their food, energy, shelter and other material and non-material needs in a sustainable way! (Graham Bell)’. David Holmgren has categorized some basic permaculture principles. These include the power of good observation so as design well for energy intensive solutions. As energy passes through our natural systems ways and means should be incorporated and developed so as to trap such energy. One principle to trap human urine for adequate nitrogen production for fertilizer. Compost and woodpiles are means of re-utilizing energy. Whatever measure taken should be productive. In one initiative, vegetable farming in UK in urban sites beside maintaining the lawn and growing flowering plants, produced gave incredible rewards.

Self-regulation and feedback permits sustenance and maintenance that is energy efficient. Using a well-designed eco-system overall where weeding, use of pest control and fertilizer would be in wanton. Renewable resources and services like soil aeration with worms and retaining soil by growing trees are welcome approaches. Reducing or producing no waste is a measure one can adopt through system design. Utilizing cycling methods rather than linear ones is the way to go. Trapping rainwater in our country should be part of housing designs. Seeing our daily chores from a wider perspective permits the design of new patterns of work. This underscores the need for diversity and creativity so that we can respond to change in a systematic way that contributes to the sustaining the environment and eco-system.  A local newspaper, The Wanggeri Leader, had a movement that was educating children in school on how to manage e-waste. Reading on, there is much to be concerned about what happens to the old computers we leave with the ‘old newspaper man’. The scrap metal collector dumps them on to central collection centre and then we don’t know what happens to all the plastics and metal that goes to making the computer. Restoring old computers for use in those in need is an option that is promoted by some NGOs. Concerted efforts need to be taken that computer based gadgets last for longer periods than what appears to leach out resources today when leaders in the industry come out with new additions and modifications ever so fast to catch the eyes of the ‘trendy’. I still remember the days when my uncle used to have a Grundig radio that ran on a battery the size of a loaf of bread when electricity was not available. As the battery ran out the melodious songs became slower and eventually stopped. Then he would remove the dying battery and ‘dry’ it out in the sun for a few hours hoping to get a few more days of use!

More Initiatives

John Croft founded the ‘Gaia Foundation of Western Australia ‘developing the “Dragon Dreaming’ method. The four stages of his method are:

·         Dreaming and visioning

·         Planning

·         Doing

·         Celebrating and evaluating

Apparently only 1% of the dreamed project took on after the initiation. But it did not matter. What was important was to begin the awareness campaign, to be clear that the impetus for success comes from the two or three people who initiated this project that would contribute effecting change and reduce energy needs. We see that corporations of today have initiated CSRs but to what extent they have succeeded vary.  Each project initiated by Transition Initiatives of Hopkin and John Croft emphasize that the  members should make their  own decision with organizations like local councils and state government only facilitating rather than driving them. The ultimate aim in all transition projects and proposals is to make them truly community led . It may seek support from local authorities but the aim is to be independent of coercion and stipulation.

Mick Winter (Hopkin), in his book Peak Oil Prep states that state governments ‘stay out of local governments’. It is the fear of initiators that such projects would be suppressed by the authorities but apparently this is not true as people in power may favour such projects and learn from initiators of such projects to influence and inspire their proposals and policies for energy conservation and various other developmental projects like housing, population growth, food production, public transport and housing.

Conclusion

The trip to New Zealand has made me read more on Sustaining the Environmental and conservation of energy through little moves and changes in life style. Mahatma Gandhi made salt from the sea when the British began rational salt in India. When one is pushed to a corner creativity and innovation begins. Climate change and the depletion of oil are both occurring and if the citizens of the day do not take heed we will commit ‘suicide’. It is our duty to educate the young and the old that we should not take things for granted and that we have to be part of Transition Initiatives in order to leave a liveable planet for the future generation. Recycle, re-use and renew today.

References

1.       Hopkin R The Transition Handbook Finch Publishing, Sydney 2008

2.       Croft J ‘Gaia Foundation of Western Australia ‘Four stages that any project will go through’ pp. 241-243

3.       Winter M, Peak oil Prep pp. 147

Becoming a developed nation

Getting set to go

Assigned to go to a meeting in Cambridge I had to make preparations sorting out the trip details and finding out about the temperature and weather as that would dictate the type of clothes I was to pack. It has become a chore getting packed as I also have to anticipate the numerous checks I have go through at the airport. Well aware of the long queue when one comes through Heathrow Airport I waited patiently as I moved the first barier (whihc said 'approxiamtely half hour to immigration' . As I would be coming in at half seven am and would not be check into my hotel in Cambridge till after 2 pm, I thought I should take a slow ride using the National Express Bus.  Online booking was easy but stipulated I should take an insurance, so there I was, down a further pound!

The National Express stated it was a direct run, so I thought I could get a good ride and hopefully I could doze off after the 14 hour flight into London. Autumn was setting in as the leaves of most of the trees lining the M1 Highway had browned. There were miles and miles of farmland but they had been closely shaved off the turf. Bales of hay were steeped up on the edges creating a blanket of brownness over the once green fields. Strong winds made the few trees I saw bow in one direction while the sky was overcast with thick clouds. The sun peeped in between occasionally, as the bus trotted along.

I did not know there would be four stops on the way but that was okay, at least I got to know where Luton Airport was and the little towns littered along the way, with their quaint steeples and uncanny brick walled houses devoid of colour or plaster.

I did not have an idea where I should drop off in Cambridge as there were two stops and I had selected to hop off at Trumpington Park & Ride station. When I arrived at the latter it looked like as if I was still out of town and I sheepishly told the driver if I could not get off here and if he knew where  Hills Road was (where my hotel was located). He answered in the affirmative but permitted me to ride into town with the remaining passengers, the last stop.  A taxi ride brought me gingerly to the steps of the hotel, so I did not have to struggle too much with my luggage.

Planning to move around Cambridge

Planning to move around in a new place, finding the cheapest means of transport, reasonably priced restaurants and how to operate the washing machine have become a bit cumbersome at my age. Going through the internet to locate sites of interest is often so easy for the young of today. It has always been a problem for me - reading maps that don’t stay in one page but requiring a great deal of scrolling tends to make me lose orientation. I look forward for some saviour to help me trace the shortest route on a printed hardcopy. The GPS is something I have to get a hold of.  This statement comes about as the young man at the counter in the hotel told me I could have access to the internet though the free WIFI  –I-Cloud, while I was in the hotel.  Planning to sort the internet access at night I planned to work out the times of the bus rides after dropping my bags in the allocated room.

The last time I had been to Cambridge was some 15 years ago when a scientific meeting was held at Selwyn College. As all had been planned then, and we had to reside in the college premises, I did not venture on my own except go to the River Cam to view the weeping willows, a sight one should not miss in Cambridge.

The bus rides to my meeting site was both educative and informative as one could observe the behaviour of the local people and also that of foreigners, many being students checking into the colleges as the new academic year was beginning.

Learning and leaning

In between boring deliberations on how to detect holes in condoms and what should be acceptable for clinical trials so that manufacturers of non-hormonal contraceptives will not find the ISO too stringent, I managed to escape into the city for the usual walkabouts in this University City built in the 1200s.

The King’s College has not changed much; in fact all the colleges have the same outlay with a large quadrangle of well-trimmed lawn and four storey buildings as if stacked like matchboxes with closed windows arounf the quandrangle. There are signs all over the qunadrangle , ‘No entry to visitors’. I was told that only the Master of the College is permitted to walk on the grass! Further down the road was St John’s College with a distinct sign at the entrance ‘Entrance fee for visitors’!
An uncanny remark by a British born Indian youth protesting to his friend pushing a bicycle caught my ear, 'Ridiculous them chargeing entrance fees to enter into the qunadrangle of St. John's College'!

The Round Church further down the road was yet another heritage building. As I was tracing myself back along St. John’s Street a young man stopped me asking me for directions to St. John’s College! He would not have known that I had discovered the site not 15 minutes earlier as he thanked me, hurrying along, as I pointed out the direction with an air of confidence.

The ‘Corpus Clock’ at King’s Parade in Cambridge shows a giant grasshopper clawing its way minute by minute to keep time shown on a 24 carat gold face shield illustrating both technological advance and creativity in line with development in this otherwise city well known for its traditional approach to excellent tertiary education. Just on the left,  opposite St Benet’s Church, owned by the Corpus Christi College is the Eagle Pub, established in the 1400’s as Eagle and Child which was in close proximity to the Cavendish Laboratory in the 1950s, where Watson and Crick, the Nobel Prize winners (discovery of the DNA double helix) used to have their meals and drinks. Apparently this pub was the largest inn then and was patronised by these Nobel laureates frequently. A blue plaque hangs over the entrance reminding visitors of the historic event of the discovery of the double stranded DNA, even if one does not know what DNA stands for .

The contrast in style in these  landmarks is the demonstration of collective pride exhibited by the residents of Cambridge; the need to recognise the effort of others so as motivate readers to move on in life, modern or traditional. The short five day trip to Cambridge made me realise the sense of sensibility that was apparent everywhere. The developed nation status is not about being able to put up the tallest building and having the highest per capita income alone. It is about sustaining a social state of caring for its citizens and maintaining a safe place to live in.

Sustaining a safe environment

Being environment friendly the buses boast of being fuel efficient and low emission. Drivers are pleasant in assisting people into their vehicles and it is so heartenin  to hear both locals and visitors thanking the driver each time they alight at the end of the journey. Professionalism is at its best in these dedicated workers who pride over efficiency and accountability. Timeliness is in built and if the UNI-4 bus is expected to arrive at the stop at 0740, it does come in time (+/- 2 minutes). Walking 20-30 minutes to their destination is not uncommon and I have not seen that many bicycles in Cambridge since I read that China had the largest number of bicycles in the world. I see the shift in the re-awakening of citizens in this city  bicycling to work compared to automated travel e look for in our country!

It was in the sixties when I cycled to school that I always wanted to know where the nearest bicycle repair shop was before I went on my destination. The commonest problem then was a bicycle puncture. I remember vividly the Chinese bicycle shop owner who had a small wooden stool to sit and a metal cross bar made from metal pipes to hang the bicycle over its cross bar so that he can freely wheel the punctured tyre. He would exteriorise the outer tyre so as to deliver the inner rubber tube; completely get it out of the rim and re-inflate to detect where the puncture was by dipping the inflated inner tube systematically in an old half cut metal drum filled with murky water. Once the puncture site was recognised, this area was dried with an old rag, and then sandpapered before glue was applied with his finger. A pause followed as the glue dried and an e patch of rubber cut from old inner rubber tubes was placed over the site to fix the puncture.

It was pleasing to see a number of bicycle repair shops in Cambridge; the clock appears to have been wound  back!  It is not so back in Malaysia where the youths of today either want a car or a motorbike. One afternoon, as I was riding the bus to my meeting site, I overheard two youths , clearly from one of the EU countries (probably Spain) who had just been admitted to one of the colleges in Cambridge discussing in depth about which bicycle to buy and if a second hand one for 140 British Pounds was a good buy. The conversation went on to the cost of the course and how to get the best deal with sharing accommodation. As the European economic squeeze is being felt by everyone , Britain is not spared and the common man on the street is  aware of getting the best deal, how to get a bank loan for the university course and what the job opportunities will be available in the long run. Two of the women delegates at the meeting I was in were lamenting about the how the children will cope after they graduate, will they have a job, how are they going to afford a mortgage to purchase the first house and are the banks safe to look after their deposits.

Caring for the maimed and ill

The politicians are the target of all newspapers. There is so much talk about how millions of pounds were lost because of a failed railway project and how the National Health System is slowly being given less money to run the healthcare system. Britain had one of the best health care systems in the world, a system born after A.J. Cronin’s book, the Citadel. Developed countries have thrived well over decades as healthcare; education and housing were all taken care by the government of the day. The Scandinavian countries have such an enviable and excellent social system that one does not mind paying taxes during their active working lives as they would be looked after in their retirement years.

Conclusion

Developing countries will need to strive to developed status by getting the priorities right- education is about responsibility to the environment and accountability to a safe and fair system for the people. Rapid technological advances have advantages in precision and efficiency but  a cost- eco-friendly approaches are mandatory. If one is save the world, producing graduates ready for the market should be the aim, healthcare should be affordable and accessible to all and agriculture and food should be given reasonable place in any budget drawn by governors of nations.

Sivalingam

7th Oct 2012

6^th Oct 2012

Deschooling Society, Unschooling Schools and Institutional Neurosis

Introduction

The morning is not complete without interaction with patients and doctors. I continue to share what I feel about medical education with younger specialists and doctors whenever the opportunity arises. My observations are rendered irrelevant as medical care has evolved to take new dimensions .The impact of technology is now seen in the forefront of diagnosis and care; little do we see reasoning and how clinical skills helps in arriving at a diagnosis. Although I want to hold onto the old adage of great clinicians like Osler and even the teachers I learnt from in medical school some 40 years ago, holistic care appears to be relegated to the back as the patient is compartmentalized into systems and organs. In medicine, variety is not the spice of life. If I am a patient I do not want to be ‘processed by different specialists and doctors ‘for me to get appropriate care. I don’t want the imaging department and the laboratory to dictate what my diagnosis is. But I can just lament as two generation have come in since I started practising medicine.

Ritualism and Social Oppression

The ritualistic ward round I see today is no longer relevant to me as I walk through the wards. I choose to go and see a patient who appears to require some counselling or clarification about her ailment. It is not uncommon for many patients to declare they do not know why a surgery is to be done though they have consented to it; a combination of fear, wanting to know more from a third person and inadequate understanding as a result of language are often the reasons.

I sense a commonness and personal alchemy when I read the commentary by James Drife, Emeritus Professor of Obstetrics and Gynecology at Leeds lamenting  and reminiscing the 40 years he had been with the National Health Service in the UK , quoting Alan Bennett ‘s play (1968), ‘our generation was sick and tired of hearing our elders reminiscing’.  But he goes on to say that much has changed in caring for the sick, for the better or worse is debatable. Certainly it has become costly to fall sick as medical insurance companies and managed care are now part of modern medical care.

Talking of ward rounds, what do we see today, the consultant does a wiz round, and if he is not available, patient care slowly shifts to the second rank of young specialists and medical officers who are at various stages of training? At times it is comical to view the scene when two to three specialists walking through the ward from bed 1- bed 48 rather predictably with another 3 trainee doctors and perhaps 5-6 interns.  No indication of personalization or prioritization can occur with such a large troupe! Additions in the bed head ticket like ‘patient not in bed’ (because she has gone to the toilet)   throws the responsibility of care on the patient!  An authoritative prescriptive command as to what is to be done for the patient after being told about the case, a wry comment and the procession moves to the next bed, a clear sign of paternalism and ‘I am in charge’ attitude.  A path of least resistance is taken as the junior most doctors quickly scribbles on the patient’s notes, whatever he/she gathers from the encounter, without comment or clarification. The entry could be ‘change antibiotic, get MRI done, and trace the urine results. He rushes to the next bed just in time, as the procession would have moved on not waiting for him to complete the task of entering the wise words uttered; ready to scribble again! I am reminded of Omar Khayyam’s ‘…the moving finger writes and having writ moves on…’

What has happened to professionalism and patient care today? It worries me a great deal. How do we teach empathy and social interaction? What has the medical curriculum done in developing the professional today. Something is missing here, old I may be, but there is gap, a missing link. Something has happened to society and what appears apparent.  Is it the education system?

Institutional Neurosis

Many a time, I drop in later in the morning after the routine ward rounds are over as the resident and house officers are left to complete the tasks of the day, clerking new cases, performing discharge summaries, getting appointments from radiotherapy etc. Last Wednesday, two days after the Hari Raya break , the ward was literally empty. One medical officer was at the nurse’s counter with four house officers. I thought I could share my wisdom and hence came around attempting to evoke some enthusiasm in in each of them. The severe disappointment was a lack of appropriate response to almost all the questions I asked although they had all just recovered from a consultant’s ward round. Doctors today work hard but they could make it more productive and efficient if we got rid of redundancy of reviews, progressive approaches and continuity in care. Ritualism does not give rise to quality care. When a senior doctor is assertive and does not provide for deep discussion, we lose out in exploratory learning. We are task oriented and we get jobs done and fail to give complete care.  

Working in an institution for a period of time promotes ‘ordering’, following routines and fulfilling the work plan prescribed to complete the task. What I am amazed is the lack of breath and depth in knowledge of doctors today. Education in schools has done something ‘terrible; that after completing 5 years of medical education, they lose out on enthusiasm and the goings on outside the field. I am generalizing here but few doctors in their junior years , whom I have asked know  current affairs, the plight of the oppressed in other countries, what countries are in Africa, the ancient civilizations, who invented the television and what the Annual Budget released by the Prime Minister in Parliament means to the consumer.  Good citizenry is required of these young professionals to pave the path to freedom of thought, to be innovative and have great imagination to work to develop a utopian world.

When I was a student in the Psychiatric ward, Dr Teoh J I talked to us about ‘institutional neurosis’, where long staying patients go into a state of apathy, are submissive and lose interest in the surroundings. Enforced loneliness and loss of cognition contribute to a particular attitude and appearance they take.  An exploratory article on the subject is written by Russell Barton (1966). Sometimes, I wonder, does this only occur to psychiatric patients only!

Deschooling Society and Unschooling schools

I mentioned that these bright kids who entered medical school with such enthusiasm and vigour go through five years of doctrinated learning and evaluations, assessments, examinations and information that appears to nullify that initial ‘oomph’ at the end of the curriculum. Quite a few students give a sigh of relief when they get the final professional examination results, ‘No more reading and examinations anymore’.  

Education was a sign of development and has been in vogue since the 17-18^th century.  Today compulsory education is in force in most countries of the world. Responsible governments ensured that premises were available for children to be educated in which eventually grew into schools and institutes. Today schooling is big business and private education is very expensive but much sort after.

However, how do schools prepare for the future is the question. At least 12 years of formal education is in place excluding the few years spent in pre-school. The first and best teacher is mum, but with the promotion of pre-schools, the responsibility of learning has shifted to teachers and formal education. Are we in the right direction? That may be a point for discussion in a different forum.

In 1964 John Caldwell Holt was vocal when he wrote ‘How children fail’ and commented on the ‘pressure adults exert on children’ because of schooling.  Later, in 1967 he wrote another treatise on ‘How children learn’.

Schools have faults which need to be addressed today. Ivan Illich has written and discussed ‘Deschooling society’ to get out of the ritualism and the oppressive effects schooling has on learning. He has discussed about the ineffectiveness of institutional education and that self directed education should be promoted; new educational funnels need to be created. Current computer mediated education is making resources available at any time and at any place. Whoever wants to learn can access knowledge. Although the school is now said to be the ‘new world religion’ and is the fastest growth market we should be concerned about social polarization in multicultural regions, social degradation as a uniform curriculum is prescribed in a ‘one fits all’ approach. Institutionalizing values have their setbacks as new cultures and behaviour develops. Education philosophers are concerned about being socially powerless and getting into a state of psychological impotence.

When I was in secondary school I was taught about the Norman invasion of England. My history teacher spent hours emphasizing the impact the feudal system had on society where the peasants were exploited by the landlord. That system pulverised the very individuality of the peasant. Should we now be concerned about the new dimension schools have in directing the young mind in meeting set curriculum? We all went though a similar system. The good side was that we socialized to a good extent, we had teachers as role models and education gave us the breath to appreciate life. But I still can’t understand the relevance of learning additional mathematics and giving me a test on geography when I wanted to become a doctor. I firmly believe that we do not need the matriculation or Form Six classes to go to university. I am sure many would agree with me that they would have done their professional education just as well without the Intermediate classes!

Unschooling schools permits natural learning and intentional learning. Home schooling was for the elite in Victorian times but has now come to stay. Most times the parent becomes the mentor in home schooling. The concept of Unschooling as in home schooling is different from deschooling society which is advocating anti-institutional school.

Ritualization and following the words of contemporary theologians would not permit imagination and innovation. The ‘helpless’ student needs to take a broader perspective of education and not be bent in achieving grades and attain mastery of definable skills and behaviour. Although personal growth is not a measurable entity, one can evaluate the final school product and determine how effective he is as a professional, citizen and contributor to society’s needs.

Of course several factors impact on the concepts and the way forward would be difficult to conceptualize till basic needs of society is met i.e food and shelter, protection from harm and a safe environment . Education is fundamental to progress of a nation but there is a need to determine if the process of education is producing the intended products.

Conclusion

I have tried to look at the product of one profession I am familiar with and desire that the education curriculum, whether it is primary, secondary or tertiary be re-looked.  I am of the opinion that society needs to have a dynamic curriculum so as not lend to intellectual schizophrenia.  We do not want to produce professional s and citizens who lack motivation and show severe signs of working within restricted horizons. It is clear that increasing passivity would lead to lack of productivity and cooperation. In fact it may lead to destruction of culture and progress. Institutional learning is not the only means of education. The desired outcomes need to dictate how education should be accessed and leant.

Sivalingam Nalliah

31 Aug 2012

The Root of Empathy

Introduction

Working with medical students permits me to reflect on my own days where I looked for a friend and counsellor in my formative years in medical school. That is the time where the metamorphosis occurs from adolescence to adulthood. The kind and learned Moses Christie Karunairatnam, our Biochemistry lecturer, struck me as a scholar who wanted to share his wisdom and kindlness, truly living to the Tamil interpretation of his name ( Karunai- kindness!). I could approach Dr Tan who was our Physiology lecturer who was easy going and not confronting. The founder Dean held himself above all others and was revered as the icon of medical education. He had to be the Dean and nothing else, befitting all the attributes of a head teacher you would have read in Tom Brown Schooldays.

To be a professional taking care of the sick and maimed, one needs role models and have an innate feeling for the less fortunate. Empathy is one attribute that needs to be exhibited, something I recognised in many of my teachers, whether in medical school or in primary and secondary schooldays. Now, we do research in empathy, although I had falsely accepted that empathy comes with those who take up the profession of doctoring. It pains me to see how rapidly the scenario has changed and less time is spent to express this trait in our daily duties.

Empathy and Compassion

Language is a beauty in that one can express thoughts and what we want to communicate in words. We often ponder if there is a difference  between compassion and empathy. Well, there is a difference. The word ‘compassion’ is derived from Latin to mean ‘to bear with or to suffer with’. Empathy is slightly different and is taken as a component of ‘compassion’ to mean ‘enter into or maintain a relationship to caring’.

In the Hindu faith Ahimsa is widely used to refer to ‘God quality within a person’. Ahimsa was advocated by the great Mahatma Gandhi in his non-violent movement for Independence of India. Compassion is central to Buddhism where the Buddha professed ‘absolute compassion of all creation (Karuna’). The Judeo-Christian sect also maintains compassion as a manifestation of God’s love and mercy.

Clearly empathy is the recognition of others suffering ; how one perceives the wants, needs, sufferings, feeling and emotions by putting oneself in the other’s shoes. There is a deep connection that goes beyond sympathy and intense resonance is experienced in understanding the emotional changes in the other person.  K.R Eister, in his treatise, ‘The Psychiatrist and the Dying’ moves to advice the caregivers ‘to give themselves selflessly to the dying as a free gift of love’.

Ernest Hemingway quotes’ ‘when people talk, listen completely. Most people never listen’. This is a call for giving a ear to the needy and sick.  Aristotle, the Greek philosopher once said, ‘to perceive is to suffer’. The novelist J.Scott Fitzgerald quotes, ‘when you feel like criticizing anyone, just remember that all the people in this world hadn’t had the advantage that you’d had ‘.

The Revered Gautama Buddha upheld the need to empathise by this famous quote,

‘Resolve to be tender with the young, compassionate with the aged, sympathetic with striving, and tolerant with the weak and wrong. Sometime in your life, you will have been all of this’.

Mahatma Gandhi, the most tolerant human I have read about, in his Godly statements commented, when Hindu and Muslim religions divided India  into two countries  during the struggle for Independence, “I call him religious he who understands the suffering of others”.

Medical Student’s Feedback

When my mentees or protégés  go away from the medical school curriculum to do their electives, they need to do a rotation in a field that is different from the normal curriculum. I often persuade them not to get stuck with a large hospital getting impressed with more application of technology but go out into society so as to appreciate the needs of the community. Quite a few students  have been advised  to change their initial proposals to areas I thought would benefit them more as far as empathy is concerned. On the otherhand , I did not have to counsel a few, as I could see this innate trait inherent in some of them; that  feeling they want to serve and share. I was particularly impressed by one shy female student who  often expressed the lack of confidence she had with her spoken  English Language. She wanted some experience in rural health close to her hometown in Sarawak. I guided her how she could maximise her experience by working with the allied health staff. But I also persuaded her to read some books written by doctors expressing humanism to improve her English Language. I requested her to give me a  report on the works of the writers she had read. What I got was an amazing reflective report on the works of Albert Schweitzer, the Nobel Peace Prize winner who worked relentlessly looking after the sick in a small hospital in West Africa, Anton, the Russian novelist who had been a doctor expressing the emotive trauma he had suffered through his stories about mental institutions and poverty and the author of the Sherlock Holmes series (Arthur Conan Doyle) , himself a retired ophthalmologist.

Another student elected to work with children who had hearing impairment and she was compassionate in her report elucidating the details of educating these ‘challenged ‘ children and the dedication and commitment of the teachers who clearly were limited by both expertise and facilities. The same student went  on to do an attachment in a distant village in Nepal where a small 30 bedded hospital with a visiting doctor (weekly) nursed and cared for leprosy patients and those with neurological damage due to spinal injury. Again the student was more than compassionate in her longing to serve the disadvantaged and how lack of funds and medical expertise did not stifle the existence of the hospital. She was passionate in her expressions of caring despite language being a barrier to communication.

Is empathy a trait or can it be taught?

Western culture has been taunted as nurturing the stereotypical belief that women are more emotional than men and this being related to masculinity and feminity. The fallacy is that women are able to express and communicate their emotions to others better compared to men. The masculine male is expected to supress and control his emotions leading to the often quoted statement, ‘boys don’t cry’. Did we not see the emotions expressed by Andy Murray when he lost the much needed Wimbledon Tennis championship to Roger Federer this year?  When Murray won the Olympic Gold medal, beating Federer convincingly in front of the British crowd, did we not empathise with him, let aside Murray expressing his emotions openly. Boys do cry!

Although research into empathy shows that female doctors appear to be more empathetic than male doctors, this is not a universal phenomena. Empathy appears to be a trait although we do feel it can be taught as we grow and understand human relations.

The empathy culture

For successful communication the Japanese have ‘omoiyari’ as a core value which refers to harmonious relations. It is intuitive and is a kind of indirect communicative style inculcated in the culture. The closest translation of ‘omoiyari’ is empathy. It is an understanding of unexpressed feeling, desires and thoughts. It is meaningfully expressed as kind and caring and is incorporated into the educational curriculum apart from it being part and parcel of the Japanese culture.

A Japanese medical student of mine (the only one) has been in communication with me over the last 2 years as  my mentee and I see in him all the attributes of empathy. He expresses this humanistic aspect in whatever communication he has with me, sharing his feelings along the way. Recently he lost his grandmother to illness but the poignant expression of empathy, the guilt of not being able to be with her the last few days, the satisfaction of having spent a couple of days a week before her passing is testimony of the ‘omoiyari’ feelings.

In the USA social and emotional learning has been revitalised through programs like ‘Root of Sympathy’. The Institute of Learning and Brain Sciences in Washington, Seattle has initiated the ‘Seeds of Empathy Program’ for the 5 year olds and ‘Root of Sympathy’ for the 9 year olds. The NoVo Foundation is a promoter of societal transformation to encourage social and emotional learning.

Empathy, though may be a trait, needs to be taught as the world has become compartmentalized by job descriptions and skills containment. The supervisor wants the products to come with zero defect and mechanization and computerization that goes with current job descriptions, neither permits nor desires one  to evaluate the feelings of employees and staff. Key performance indices count for  bonus and not empathy. Socialization skills are reduced to completion of work measured by indicators and timelines. The term ‘societal control’ is offensive as it affects empathy. Today industry and organizations continue to program the human to perform and produce leaving the soft skills to lie by the side leading to stress, conflict and destruction of human value and morality. The threatening elements of mother earth’s environment can be traced back to a lack of empathy. Human aggression at work and play and a lack of regard for authority and societal norms clearly points to a lack of moral instruction and empathy for others.

Can Empathy be learned?

The common situation observed when aggression sets in, is that one gets upset and loses himself ; at this stageb one can say that empathy is sacrificed. As empathy is central to humanity one needs to explore if empathy can be learned. Experiments on animals show that empathy is not only seen in humans alone but also in animals.

In one experiment ,monkeys who are rewarded with food if they completed an electric circuit were induced to press the bar twice to get double the reward (food). But in the process of getting more food another cohort of monkeys nearby were made to suffer pain should the experimental group of monkeys pressed twice to get double the food. On seeing their fellow monkeys suffering pain, the experimental monkeys refused to press the bar even once, preferring to starve! Similar experiments have also been done on mice. Several observations by naturalists point to this phenomenon among the animal kingdom. With such innate behaviour can we imaging how cruel people are when they kill and maim in the various conflicts involving humans throughout the world?

Animals can’t be very different from humans as they too reproduce and mind their young. They protect and feed and show their feelings too difficult for humans to understand.

Recently an article appeared in Science (2010; 328:633-636) declaring  the frog to closely resemble the human as far as human genome are concerned- the  frog is a ‘kissing cousin’. This then reminds me  the fables I read that  of the forg turning into a prince on being 'kissed '. Now I wonder if it was a fable! The amphibian’s genome ( Xenopus tropicalis) resembles that of humans.  Apparently 80% of the human genes associated with diseases is found in this species. Hence, exhibit some empathy when you feel like destroying a frog in the garden the next you spot one,  consider kissing it!

If psychological learning theories are true to understanding the human mind then Behaviourism, Cognitivist and Metacognitivism should impact on how we can learn humanism and empathy. Parents as role models have a huge impact on the growing child. They could influnece the young in empathy and compassion. The environment has an enormous impact on how emotional intelligence is nurtured. I would opine that empathy can be taught and behavioural conditioning would contribute to successful adoption of empathetic approaches.

John Hurt gave a real –to- life performance in the movie,  ‘The Doctor’. This arrogant surgeon became an empathetic person after he fell victim to cancer and learned about humanism from a fellow young girl who eventually succumbed to blood cancer. I encouraged one medical student to see that movie and she wrote a moving commentary of the finer aspects of compassion and empathy.

Is Empathy in our Genes?

We talked about human traits that navigate us through emotions and empathy. Are there genes we have that controls empathy and stress. One hormone called ‘oxytocin’ which is so vital in parturition and breast feeding is now thought to be beyond it being a ‘love hormone’. It now looks like kindness, love, caring and feeling for others is genetically ‘wired’. Oxytocin has a great influence on social and emotional processing.

Serena Rodrigues Saturn and colleagues in California (Nature) reported that character traits like openness, caring and trusting is linked to genetic variations. The oxytocin receptor incorporates a docking mechanism in operating as a hormone and neurotransmitter. If the person has a ‘2G’ variant gene of the oxytocin receptor the person exhibited better social skills and higher self –esteem compared to those with a ‘AA or AG’ allele. The latter group, in their experiments were less capable of handling stress and difficult situations .

Conclusions

Compassion and empathy are human traits which signify the ability to feel for others. Although there appears to be evidence that this trait is genetically linked, rearing of the young through role modelling and exposing them to a humanistic environment would promote this social characteristic. Culture and religiosity have an impact on exhibiting empathetic behaviour. In a just world empathy goes beyond the environment of the person to ensure sustainability of the race, environment and all living things.

Sivalingam Nalliah

18 Aug 2012

Cell talk, mischief and cancer: What has the boson got to do?

Introduction

When you are in the twilight years of your life there is so much to reflect and you also realize that so much more needs to be said and done. The oft repeated statement, ‘if I had been younger,’ keeps ringing in your ears with predictable regularity! But then you console yourself and say that there is this element of wisdom that allows you to ponder over yet to be discovered concepts and phenomena. It is at this stage of your life when you discuss the meaning of existence and confuse yourself with theology, mathematical physics and what is the origin of man.

Nearly four  decades have gone by since entering the field of Medicine and I see how the practice has changed influenced by technological advances and fragmented by  organ specific therapy and applied therapeutics based of ‘search and kill’ philosophy. Within these two weeks two of my doctor friends died of cancer and both did not discover its existence dying within a few months of diagnosis. I spent nearly 12 years treating cancer in women and went through the rudiments of diagnosis, breaking bad news, operating on many and using a combination of radiation and chemotherapy. A few lived for many years but I saw several who fell by the side, crippled and maimed by the disease. Depression and melancholy was not only experienced by the victims and family but they affected me equally.

Now I re-look at the advances in the understanding of cancer and wonder, have we understood the disease and its origin? I become more sceptical as I view current treatment with some degree of despair.

The scorn of cancer

The patient who had premalignant disease had a good lease of life. Those who had early disease had good prognosis but those with had advanced disease did not thrive for long and it pains me to see how futile attempts are made by earnest oncologist with little respect for dignity and quality of life. This reminds us of medical ethics and the right to make decisions on terminating life! Why does cancer develop in the first place?  When a disease invades to a limited extent would we call that cancer? Endometriosis can be very aggressive in penetrating the adjacent organs but we call it benign disease. Conventional teaching in pathology has categorized cancers based on the organs that are inflicted with the disease. We also have seen that some forms of cancer do not spread so quickly as others. If we take cancer of the uterus, they tend to penetrate the inner layers much more slowly than the cancers of the lungs. Cancers of the ovaries and lungs in fact are at an advanced stage when they are detected. Why is this so? Medical teaching outlines how cancers would spread directly into the neighbouring areas before permeating to the lymph nodes and blood vessels when they become more widespread.

We have been experimenting with various forms of therapy like regional removal of the tumor leaving a wide margin to more radical surgery where the entire tumor is removed  extending the surgery to removing the lymph nodes and other affected organs. If all fails or surgery is not possible then cancer drugs and radiation are employed. Having said that we continue to contemplate if the treatment given is the most appropriate because unlike exterminating infections with antibiotics, killing cancer cells has been less than optimal.

Cell talk, cell adhesion and cell signalling

Organs in the body are made of numerous cells bound together working in harmony, recognising their roles and that of others. However when the harmonious relationship breaks down due various reasons like reduced immunity and aging, the cells grow autonomously and begin to proliferate with little respect for adjacent normal cells.

Current views have moved to molecular biology and cancer biology to determine new ways of controlling and treating cancer. But have we succeeded? A scan of subjects relating to cells talking to each other, how they adhere and work in synergy and how they die eventually and are replaced is still being studied and enormous information is now available on of cell signalling. Apoptosis is regulated suicide. Key proteins cited are p120caterin which entails nuclear condensation, shrinkage of the cell with membrane blebbing and eventual fragmentation of DNA. CASPACES are mentioned as central regulators of apoptosis which play a role in cleaving cellular proteins.

Current concepts of breast cancer reviews cell biology and cell-cell adhesion much of it being related to ErB2; increased proliferation permits motility resisting apoptosis but no invasion takes place. But with loss of yet another protein, E-cadherin invasiveness of the tumor occurs. Spread of cancer to distant sites can be suppressed by amplifying the effects of ErB2 which is now the basis of using newer medication like trastuzumab. Although the explanation for a cancer of the breast remaining at its original site (in situ) or spreading to distant sites (metastasis) is much more complicated than what has been mentioned  above, experimental biologist continue to develop newer drugs to combat cancer based on an understanding of the various proteins that contribute to cell adhesion, cell signalling and apoptosis. 

Other signalling processes involved in the catabolic process are called macroautophaging or autophaging. Nutritional deprivation is inevitable in cancer. A similar but less severe state follows stress, differentiation of cells, neurodegerative disease and infection. Under these circumstances Lyoscyem in the cytoplasm degrade releasing aggregates of abnormal proteins and excess damaged organelles result. The kinase mTOR appears to be critical to autophagy induction.

Cell cycle control is essential for regulated cell growth and the process is essentially maintained in an orderly fashion because of G1/S checkpoints. The whole transition from the G1 phase of the cell cycle to permit entry into DNA synthesis (S-phase) requires different stimuli and checkpoint control (e.g. TGF-beta, replication senescence, growth factor withdrawal). Any or a combination of these factors going wrong will set off a series of misconduct and perhaps will lead to premature cell death or excess cell proliferation.

The cytoskeletal system remains another dynamic site for both regulation and adhesion between cells. The adheren junction structures both strengthen, spread, degrade and reform using various proteins establishing connections between its counterparts and adjacent cells. In what has been described as the stable model complex of cadherin, beta – cadherin is bound to actin skeleton. A whole bunch of adaptor proteins are involved including kinases and phosphatases. Key proteins cited are p120caterin. Breakdown of this process clearly upset the whole equilibrium between and within cells with disastrous consequences.

Can we stop this cancerous growth?

The destruction of cancer cells through gene modification and gene transfer has been the basis of viral oncolysis (i.e the destruction of cancer cells) using viruses that replicate themselves. Thymidine kinase coupled with herpes simplex virus has been seen to infect cancer cells killing them. This has been possible by affecting the spatial control of transcription.  

How has all this contributed to cancer biology and cancer treatment? Essentially we are beginning to get a microcellular picture of the complex array of action of proteins within the cytoplasm, nucleus, and cellular membrane, between cells and how the harmonious relationship can be maintained or destroyed.

The basis of drug development to fight disease is derived form the understanding of the functioning of normal signalling pathways. Angiogenesis is common in cancer. New blood vessels are formed in the process of cancer cell proliferation. This is not unlike what normally happens when there is an infection of when a wound is inflicted. In cancer the inductor is hypoxia, a lack of oxygenation. The hypoxia inducible factor (HIF) is a transcriptor factor that is sensitive to changes in oxygenation delivery to the cell. Normally, when the HIF is hydroxylated and acetylated (with normal concentrations of oxygen) it is transported to the nucleus where it induces expression of targeted gene products. Several growth factors like VEGF, FGF, TGF, which are growth factors will induce a cascade of signalling pathways which are responsible for several further activities which are involved in growth of blood vessels like the proliferation of endothelial cells and changes in permeability of the endothelium and cell migration. Such dynamism is coupled with changes that are induced to occur in yet another set of proteins, the extracellular matrix proteases. Several regulators will induce the tissue matrix to remodel so as to prepare to receive the migrating endothelial cells from existing blood vessel so as to form new blood vessels.

This whole process is bizarre in cancer. Host susceptibility, some abnormal trigger in perpetuating the process of cell division to take on a different pathway from that of the norm and unbalanced host-tumor relationship may contribute to abnormal proliferation and cancer. The resultant lack of cell-cell adhesion principle and bizarre cell signalling mechanisms have been implicated in an abnormal growth becoming aggressively invasive and eventually destroying the organelles and ultimately the organism.

Current treatment and are we on the right path?

Current strategies of chemotherapy is  based on cell biology; ionizing radiation appears to be rather non-selective in destroying cancer cells and to some extent normal cells leading their ability to arrest the growth of cancer cells albeit temporarily . The use of radioactive iodine in treating thyrotoxicosis and short lived radioactive substances to produce three dimensional coloured images of functioning tissues in the body in positive emission tomography have opened novel approaches to cancer treatment. The use of biomimicry principles has made it possible to  fox abnormal cells to undergo early ‘suicide’ but its extensive use in treating disease may be limited in view of the complex signalling processes in the organelles of the cell making this approach rather non-directive.

My current views are that scientists are unravelling the secrets of the goings on in cell biology at a molecular level and knowledge derived from the numerous engagement of cell metabolic pathways are being used  to direct therapy to control division of abnormal cells. However, the complexity of the pathways appears to override the fundamental steps as the simplicity of using the principles in killing bacteria with antibiotics do not seem to work in cancer biology. At this point in time we will continue to understand the numerous substrates involved in metabolic pathways and the discoveries will continue without end after the chapter on DNA was first revealed by Watson and Crick.

We got to go subatomic!

I am of the opinion that gene therapy and ionizing radiation will not be the ultimate answer in treating cancer. I can see that newer diagnostic tools will continue to be developed as we discover and understand the processes of organelle functioning but there will be huge gaps in putting the pieces together for many decades. Cancer treatment will continue to be targeted at ablative surgery, chemotherapy and radiation therapy for years to come. We will be dwarfed by the lack of understanding of cell biology and will need to take a new approach. Just as we see the role of the radiologist changing to become imaging specialist and intervention specialists, I see that the roles of physicians will become less distinct. The radiologist will eventually become therapist as they would be holding the key to tools that will target control of subatomic particles in the cell that would eventually be the point of attack in treating disease, whether it is cancer, inflammation, degenerative disease or mere senescence.

This brings me to the uproar in scientific circles of Particle Physics. Quantum physics changed our thinking and then we got confused if light is a wave! Do protons have weight? Particle physics (high energy physics) appears to be derived from the fundamental elements of earth, fire, water and air. They form the basic building blocks of matter. We learnt that the nucleus has protons and neutrons. Electrons have negative charges and there is a balance within the particle to keep the spin in place. Then sub particles were discovered in quarks, again there are u-quarks and d-quarks. More than 200 subatomic particles have been discovered forming the basis of what is called the ‘standard model’. All the particles interact with forces keeping them in harmonious motion.  Subset of second and third generation particles came into our knowledge pool (CHARM and STRANGE) and counterparts of electrons like MUON and TAU were discovered. To add on the understanding of the strange ways particle physics work, it is now agreed that each quark and lepton family has an ANTIMATTER partner (a mirror image). When particle and antiparticle get too close in this ‘double act’ they lead to annihilation. They burst with release of enormous energy (High Energy Physics). This is the basis of Einstein’s e=mc^2.

It has been over five decades that mathematical physicists have been trying to understand the origin of the universe. Since the times of the discovery of gravity, knowledge of the molecule and subatomic particles has increased to a very large extent. The Standard Model of Particle Physics does not seem to explain all the forces including that of gravity. The superstring theory remained a hypothesis with its own limitations.  

Several scientists have been throwing more light to explain the gaps we have in the knowledge of Particle Physics. Higgs in Edinburgh, Scotland theorized more than four decades ago about field points with no push or pull factor. In 1964 he put forth the idea about how massless particles acquire mass. It was then plausible to accept his views as if there was no Higgs field, quark particles would ‘flit past each other at the speed of light’. Hence some ‘invisible field ‘was present to keep all in place. It was Leon Lederman, a Nobel prize winner’ who referred to Higgs Boson as the ‘God Particle’. The acceptance of  Higgs Boson  and that all the elementary particles interact with each Higgs field hence slowing down their motion (inertia) was announced recently in CERN in Geneva. The Large Hadron Collider measuring 17 miles in length has been in in the news for the last several months illustrating the fundamentals of particle collision energy.

Why am now confusingly yarning about a multitude of areas with little coherence? I started to talk about cancer treatment I was involved in and the despair I have encountered when managing advanced disease. I went on to talk of the modalities of treatment available in surgery, chemotherapy and radiation. Then I introduced the discoveries of the goings on within the cell and cell biology. I touched on the need for cell-cell talk, cell adhesions and cell signalling. I then despondently talked about how rudimentary our tools are for treating cancer. I alluded to the role of subatomic particles when we developed newer imaging tools like PET. The standard model of particle physics could not explain everything and now we know about Higgs Field that has no pull or push factor like the other subatomic particles.

Personal Views

What I now opinionate is that cancer treatment would not be successful if we do not take it further down molecular biology to subatomic levels. Ablative surgery would not be the ultimate. Chemotherapy would be close to stagnating cell division but would not contain the cancer cells forever. Causing cell suicide and cell destruction as in radioiodine therapy would be closer to our goals.  Radioisotopes will work if we could deliver it in such a way that the difference in rate of cell growth between normal and abnormal cells could be determined with accuracy so as to deliver the exact dose. We are fully aware of the role proteins play in both normal and abnormal cells. We are also cleat that all these subcelluar material are formed from atoms. Hence  we need to  down the subatomic pathway and use the principles of Particle Physics. An environement needs to be created ,in all probabilities the Higgs Field, around potential 'mischief cells , so as to keep cells in a state of suspension and evetually control cancer. This would require very early detection  or deviation from normal cell growth. Micro nanotechnology  would be the possible approach in introducing the appropriate subatomic particle to detect  cells who have the potential to behave abnormally!

New approaches are essential as although cancer drugs have been novel in attacking programmed and abnormal cell growth, they are not good enough to cure disease in the long run. Results from years of  use of  a combination of surgical treatment, chemotherapy and radiation have not shown us the perfect way to manage cancer patients..

Conclusion

A close relation between scientist and physician is inevitable if we want to combat cancer. The way cells respond to stimuli will follow predictable pathways irrespective of conventional pathological classification. We need new taxonomy that would classify disease according to subatomic particles since all matter are related to the atom and its sub particles. Treatment of disease should be directed to the stereochemistry of proteins by developing fields of low energy which could keep cancerous cells in a state of suspension. In time to come all one needs to do is to swallow a treated sub particle which would find its way to the subatomic boson within the protein that’s gone wary so as to induce a state of suspension or impotency!

Sivalingam Nalliah

25 July 2012