Poem - Just a breath of Freedom (4 Nelson Mandela)

by Tupac Shakur - from 'the rose that grows from concrete'

Just a breath of Freedom (4 Nelson Mandela)


Held captive 4 your politics
They wanted 2 break your soul
They ordered the extermination
of all minds they couldn't control
4 u the fate was far worse
than just a brutal homicide
They caged u like an animal
and watched u slowly die inside
As u Breath your first air of freedom
On the day you became a free man
Raise your Regal Brown in Pride
4 now you R in God's Hands
The life of many were given
So that day would one day come
That the devils in Power in Pretoria
would pay for the evil crimes they've done.

Poem: Sometimes I cry

by Tupac Shakur - from 'the rose that grows from concrete'

Sometimes I cry


Sometimes when I'm alone
I cry because I'm on my own
The tears I cry R bitter and warm
They flow with life but take no form
I cry because my heart is torn
and I find it difficult 2 carry on
If I had an ear 2 confide in
I would cry among my treasured friends
But who do u know that stops that long to help another carry on
The world moves fast and it would rather pass u by
Than 2 stop and C what makes you cry
It's painful and sad and sometimes I cry
and no one cares about why.

The government's silence over attacks on Muslims is worrying, and divisive

The police have performed well following the recent terrorist attacks on Muslims, but from the politicians … nothing

http://www.guardian.co.uk/commentisfree/2013/jul/22/government-silence-british-muslims-attacks

• Nesrine Malik
• guardian.co.uk, Monday 22 July 2013 11.27 BST

Last week, a nail bomb partially exploded at a mosque in the West Midlands – the fourth attack in two months on mosques in Britain during Friday prayers. A suspect in one of those attacks is also being questioned in connection with the killing of Mohammed Saleem, a Muslim pensioner in Birmingham, who was stabbed to death as he returned home from prayers. The police response to these attacks has been heartening, but the silence from government, and the establishment in general, has been deeply worrisome.
When Lee Rigby was murdered, politicians of every stripe scrambled to condemn and reassure. Cobra, the country's top emergency response mechanism, was convened under the home secretary, Theresa May. David Cameron reassured Britons that "we will never buckle in the face of terrorism". Compare this with near-silence that greeted the recent mosque attacks. Muslims have become accustomed, almost resigned, to media double standards – there is no example starker than the wildly different coverage of Rigby and Saleem's killings. But the failure to mobilise, condemn and reassure on the part of the political class is potentially far more dangerous.
It suggests not only that a Muslim life is less sacred than a non-Muslim one, but that Muslims do not have the same rights as others to be reassured. That attacks on them are attacks on a minority, and not on British citizens.
The significant (and some would say disproportionate) political and intelligence engagement in the wake of the Rigby murder wasn't entirely for practical purposes. Strong rhetoric combined with a show of force is a necessary response on behalf of a government in order to calm and instil a sense of safety in its citizens. The same sense of duty and urgency when British Muslims come under fire has not been in evidence.
The job of sorting out the backlash has been left to policing – of English Defence League rallies, mosques, and the investigation and following up of crime. It's as if Muslims were only a troublesome minority to be protected at the begrudging expense of the taxpayer. It has been local community leaders, and Muslim MPs, that have anchored the response, thanking the police and appealing for calm. This is not enough.
While policing may be practically effective, the failure of senior politicians, ministers, and No 10 to add to it the soft power of language, to denounce assaults and comfort Muslims as British citizens, is inimical to the cause of integration. It serves both to aid radicalisation of Muslim youths, a state brought about by a sense of otherness and marginalisation, and to instil the feeling that Muslims are Muslims first, and Britons second. This not only alienates Muslims, but entrenches the view that they are second-class citizens – effectively fair game.
The extent of Cameron's engagement as head of state reaching out to a concerned populace has been to comfort others vis-a-vis a Muslim threat, something for which he has been applauded.
Muslims are not members of a minority that should be grateful Cameron magnanimously declares it not a threat. They are British citizens who are increasingly under more urgent and immediate risk of terrorist attack than others.
These are not the everyday hate crimes that we have sadly become inured to, and which are faced by all religious minorities. Jews in the UK, for example, have for years experienced antisemitic attacks including desecration of holy sites and abuse of religious figures. In this most recent wave of targeting Muslims, however, we are not simply talking severed pig's heads and swastikas, but violent terrorist crime that aims to maim and claim lives. To some extent the disproportionality of the response can be attributed to the fact that Britain has suffered a scarring terrorist attack perpetrated by Muslims, and foiled others in the making. But the government is there to serve its citizens equally. Do we have to wait until it is too late, until scores of Muslims have died in a counter-attack, before the political class turns the juggernaut of complacency around?
The constant refrain is that Muslims are an insular minority that poses an integration challenge, existing on the fringes of British life. But when they are consistently treated by different standards in terms of their rights as citizens to security and succour, it only confirms that the fringe is where they belong.

The Desmonds (!)

If I ever get round to clothesmaking...

.... and need to alter sleeves

http://dorcassmucker.blogspot.co.uk/2013/04/tutorial-altering-sleeves-that-bug-you.html

'the economics of recess'

sauerkraut and stuff

http://www.thekitchn.com/recipe-stuffed-cucumber-kimchi-oi-sobaegi-kimchi-recipes-from-the-kitchn-191071

http://www.wildfermentation.com/making-sauerkraut-2/#comment-13842

http://www.wildfermentation.com/searching-for-koji-in-paraguay/

http://www.wildfermentation.com/bold-experiments-in-vegetable-fermentation/

http://waterandwool.blogspot.co.uk/

Walking wounded

A documentary well worth watching. Much respect to Giles Duley - and to Channel 4 for showing this.

http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline

http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline/episode-guide/series-1/episode-1

http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline/4od

elderflower and fermented vegetables (pickles and brine)

http://www.telegraph.co.uk/gardening/plants/10117751/In-praise-of-the-elderflower.html

By Mark Diacono

7:00AM BST 15 Jun 2013

'

However, the flavour that the flowers impart is universally loved, brightening everything it comes into contact with. The flowers are at their best on a sunny day, when their muscat aroma is at its headiest. Pinch or snip the heads from the bush at the first joint. Use them immediately for the fullest flavour or dry them by laying them, flowers down, out of the sun for a day. Once dry, shaking releases the flowers from the stems.

They'll retain much of their early summer flavour and scent in an airtight container. There are so many ways to get the best out of them. They are spectacularly good tempura-battered, deep-fried and dipped in cinnamon sugar or, as Stevie Parle suggested in this paper last year, with salt, sugar and chilli. ...'
'
FLOWER RECIPES

Elderflower cordial recipe

About 25 elderflower heads

Pared zest of 4 unwaxed lemons, plus the juice

900g sugar

Shake the flowers to dislodge any insects but don't bother washing them.

Strip the flowers from the stems with a fork and place in a bowl together with the lemon zest. Pour 1.5 litres of water over, cover and leave overnight.

Strain through muslin into a saucepan. Add the sugar and lemon juice, warm and stir to dissolve the sugar, then simmer for a couple of minutes.

Pour into sterilised bottles and seal. Dilute to taste when drinking, and keep in the fridge once opened.

Gooseberry and elderflower fool recipe

500g gooseberries

4 tbsp caster sugar

2 strips of lemon zest

12 medium heads of elderflower

300ml double cream

Put the gooseberries into a pan with the sugar, lemon zest and a few splashes of water.

Fork the elderflowers from the stems into the pan. Heat gently until the gooseberries begin to break up, then simmer for 15 minutes or so, stirring occasionally.

Push the pulpy mush through a sieve and leave to cool completely.

Whisk the cream until soft peaks form, then fold it into the purée. It's good either left as a ripple or blended gently into a relatively homogenous whole.

Refrigerate for a couple of hours before serving.

Top with cooked crumble topping or toasted hazelnuts if you fancy.

BERRY RECIPES

The purple-black berries ripen at the end of summer, and, while high in vitamin C and a treat to behold, are not wildly adaptable in the kitchen. I know of only two really fine recipes, but both are special.

Elderberry juice

Cook 1kg of berries in a little water until they break down, pass through a sieve and add sugar until it reaches a sweetness you like.

It should taste akin to, but much better than, cranberry juice.

Pontack sauce

This is a centuries-old dark, pungent spicy sauce for game, slow-roasted pork and for adding depth to stews.

Warm 500g of berries stripped from their stalks with a fork, 150g of sugar and 500ml cider vinegar in a pan until the sugar dissolves.

Add 250g finely chopped shallots, four allspice berries, six cloves, a good grating of nutmeg, two blades of mace, 1in of finely chopped ginger, a pinch of salt and a tablespoon of black peppercorns and simmer until it reaches a glossy syrup.

Pass through a sieve and bottle. It will keep for years. '



http://www.telegraph.co.uk/gardening/9681309/How-to-ferment-autumn-vegetables.html

By Sarah Raven.

6:30AM GMT 16 Nov 2012

 

Sometimes it’s difficult to know what to do with certain vegetables at this time of year. Not so much the cabbages, parsnip, kale and leeks – they’ll be fine outside whatever the weather – but there are others that don’t last so well in the frost and rain. Some of these are brilliantly suited to fermenting. This is the process of preserving raw vegetables in brine, to eat through winter and spring. You can use any brassica: cauliflower, brussels sprouts, broccoli or cabbage. It also works brilliantly with apples, peppers and many of the roots: carrots, onions, beetroot, turnips, jerusalem artichokes and celeriac. Many of us have trugfuls of these which need using up.

We’re unusual among vegetable-growing cultures in that we don’t have a tradition of fermenting our autumn veg. If you visit homes in France (where fermented cabbage is called choucroute), all over Northern Europe – Germany, Holland and Scandinavia, as well as Eastern Europe – Poland, Russia, Lithuania, Hungary and Romania – many gardener/cooks will be busy setting up their fermenting pots right now to make sauerkraut and fermented root veg. Farther east, you’ll see the same tradition in warmer climates, with kimchi and brined sour pickles all through Asia – China, Japan, Vietnam, Malaysia and, most of all, Korea, where they eat kimchi with almost every meal. In fact, in Asia they grow lots of winter radish, daikon or mooli, specially to ferment them, along with burdock (or gobo). I’m now adding them to my sowing list for next year.

Nutrient rich

As well as a neat way to store veg, fermenting is nutritious too. You’re not cooking but preserving the veg in their raw state, which maintains high levels of vitamin C and breaks down many vitamins and other nutrients into more easily digestible forms.

Captain Cook was recognised by the Royal Society for having conquered scurvy among his crew by sailing with large quantities of citrus fruit and sauerkraut. On his second circumnavigation in the 1770s, 60 barrels of sauerkraut lasted for 27 months and not a single crew-member developed scurvy, which had previously killed huge numbers on long trips.

Make a good mix

David uses a mix of four types and colours of carrot, so they look as good as they taste. The yellow carrot is 'Solar Yellow’, the orange 'Nantes’, the purple 'Cosmic Purple’ and the white, an Australian variety with a very sweet flavour, 'Belgian White’ (from an Australian seed company called Diggers, diggers.com.au). The organic carrots (or cabbage, or a mix of both) are grated – no need to peel – and then two handfuls at a time are packed into the ceramic crocks. These are quite expensive to buy (see source below). A food-grade plastic bucket is fine as an alternative. Scatter a handful of unrefined, pure sea salt (with no added iodine as it would kill the all-important micro-organisms which cause the ferment) and a couple of good pinches of freshly grated ginger (or caraway and juniper berries with cabbage).

The first batch is tamped down with a large pestle, or you can use your fist, to help force out the water, before you repeat the next layer, and so on, until you get near the top. A 7.5kg (16.5lb) crock like David’s will easily fit the 5kg (11lb) organic carrots we have harvested for this batch, mixed with 125g (4.4oz) ginger and 200g (7oz) unrefined, pure sea salt.

If making sauerkraut, mix 2kg (4.4lb) sliced cabbage with three tablespoons of salt.

For an Oriental kimchi with a bit of chilli heat, leave the veg in chunks or slices for a textured, crunchy mix. Inter-layer the vegetables with a paste made from garlic, ginger, onions and deseeded chillies, with or without horseradish. Cover with brine made from about 1 litre of water to three tablespoons of salt. Don’t bother with the pestle.

Each crock is supplied with a pair of “stones”, ceramic discs which prevent everything from floating to the top as the water exudes from the vegetables. Exposure to the air would turn them mouldy, but the stones prevent this, slotted in to the top of the jar to weigh everything down. Boil the stones in soda crystals to sterilise them between each use. If you’re using a plastic bucket, a plate chosen to fit just inside the bucket and weighed down with a large glass bottle filled with water can replace the stones.

Finally, replace the ceramic crock top and fill the top gully with water to keep the inside sterile, or cover the whole thing with a cloth. Press down the weight whenever you walk past until the brine rises above the stone (or plate), usually within 24 hours. The whole fermentation process begins and you’ll start to see it bubble away. The pot can become quite warm within two to three days, so is best placed somewhere cool – in the cellar or a larder if you have one. Check the mix every day or two. Discard any bloom or mould on the top and taste the veg.

As time goes on, the flavour strengthens, but it generally takes a couple of weeks to be ready for the first tasting and will then store well for months if kept cool.

Spoon out a saucer at a time, packing the rest down carefully, re-weighting it and leaving it for a later day. I worried that the whole thing might go too far and rot and become poisonous, but the saltiness of the brine protects against putrefying micro-organisms in the early stages and favours the growth of the desired strains of bacteria – lactobacilli. Once underway, the acidic environment created by the fermentation is inhospitable to bacteria associated with food poisoning (such as salmonella and botulism), so it is safe.

I have one pot on the go now and I’m off into the garden this afternoon to gather the last of my beetroot to create another. So why not take another look at your unused vegetables, and enter the brave new world of fermenting. One bite, and you’ll pick up the habit for life.

http://www.sarahwilson.com.au/2012/04/how-to-ferment-vegetables/

Sobering...

'Growing up poor'. Short documentaries on the reality for some of our youth (UK).

http://www.bbc.co.uk/iplayer/episode/b01s4vw3/Growing_up_Poor_Learning_Zone_Wesleys_Story/

http://www.bbc.co.uk/iplayer/episode/b01s4vw1/Growing_up_Poor_Learning_Zone_Shelbys_Story/

http://www.bbc.co.uk/iplayer/episode/b01s4vvz/Growing_up_Poor_Learning_Zone_Frankies_Story/

http://www.bbc.co.uk/iplayer/episode/b01s4v16/Growing_up_Poor_Learning_Zone_Ambers_Story/

For any young people reading - your childhood and teenage years are such a short time, and then the realities of adulthood await you. It is tough, in more ways than you can imagine, but it can also be fulfilling, in more ways than you can imagine.
You may not believe me, but your time in school is a relatively protected existence. It will not always be this way. Use this time, don't lose it. People go on about how important education is, and doing the absolute best you can when education is without payment. But they go on about it because it is a key. A key that you don't really quite understand the value of until you are out of school, and out in the big, adult world. Work hard for that key. Achieve that key. Who knows what doors it could open for you. You'll still need to figure out your way to the door, and choose a door to enter, but the key is the first step to getting there.
Get that education, strive for it and be proud. You may or may not be in contact with your classmates in the several months after finishing school, but you certainly will be left with the marks of your studies for a lifetime.
Education is the first step to preparing you for the big, wide world.


http://www.bbc.co.uk/i/b01s4vw3/

summer drinks

http://www.thekitchn.com/farmers-market-fresh-5-non-alcoholic-summer-drinks-173953

http://www.thekitchn.com/10-refreshing-nonalcoholic-drinks-from-around-the-world-recipes-from-the-kitchn-190928

The broader view...

http://www.guardian.co.uk/lifeandstyle/2012/dec/22/letter-to-husbands-physiotherapist?INTCMP=ILCNETTXT3487

'A letter to … my husband's physiotherapist

The letter you always wanted to write

 

The Guardian, Saturday 22 December 2012

 

Perhaps you are just doing your job. You're putting your many years of training and experience into practice and earning a good living. But your nine o'clock client happens to be my husband of 17 years. A man I've watched change from cocky, bronzed watersports instructor to someone who now has a blue badge for his car and needs two sticks to walk. My husband, who used to be so adventurous and spontaneous, who now wants to phone ahead, to check if there's a ramp, a handrail, a lift …

I know you haven't approached my husband as your run-of-the-mill tennis elbow or RSI case. You've taken him on as a bit of a project and a challenge for yourself. He's offering you a chance to see someone improve over a longer period of time than usual. You've read up on his condition and thought hard about how best to approach it and, as I've seen the improvements in him, I've been so grateful to you.

Over the years since my husband was diagnosed, the consultants have only seemed to him to be interested in the academic side of his condition. The painful quadriceps biopsy was meant to provide an accurate diagnosis by the identification of a specific gene. But it didn't. They were left with a puzzle – my husband had muscular dystrophy but which type? He became an interesting case for the doctors to report to their medical journals – someone to be poked and prodded, photographed, filmed and talked about.

It's been so good for my husband to have someone believe that his body's not totally beyond hope. There's been no one until he came to you that has shown him that some of his muscles can be improved. You've made him work hard on his core muscles and have given him much needed stability. As someone for whom falling over was a painful "occupational hazard" of everyday life this has made a huge difference. He hasn't fallen over now for more than six months. It's not just this newfound confidence that this gives him that I'm grateful for, you've given him back a little bit of the pride in his body that he used to have. For the first time in years, he's thinking of improvements not deterioration.

You've not offered him a miracle cure. Ramps, handrails and lifts are still the norm for us. But for the confidence and pride you've returned to him, I'm very thankful.
Keep up the good work.

A happier wife '

Around the world in 80 diets

http://www.dailymail.co.uk/news/article-2319825/The-great-global-food-gap-Families-world-photographed-weekly-shopping-reveal-cost-ranges-3-20-320.html

http://www.telegraph.co.uk/foodanddrink/foodanddrinkpicturegalleries/8198839/What-I-Eat-Around-the-World-in-80-Diets-by-Peter-Menzel-and-Faith-DAluisio.html

http://www.time.com/time/photogallery/0,29307,2037749,00.html

http://www.npr.org/blogs/pictureshow/2010/08/10/129107806/whatieat

http://www.huffingtonpost.com/louise-mccready/what-i-eat-around-the-wor_b_706799.html

http://www.amazon.co.uk/What-Eat-Around-World-Diets/dp/0984074406

'nursing the nation' by Molly Case

The reality of unrestricted capitalism...

BBC documentary - toughest place to be a binman

http://www.bbc.co.uk/i/b01s5bvm/

The new NHS...

David Lock: A new and very different type of NHS in England - short blog entry/article well worth reading.



http://blogs.bmj.com/bmj/2013/04/02/david-lock-a-new-and-very-different-type-of-nhs-in-england/?utm_medium=email&utm_campaign=7529&utm_content=BMJ%20-%20What%27s%20New%20Online&utm_term=David%20Lock%3A%20A%20new%20and%20very%20different%20type%20of%20NHS%20in%20England&utm_source=Adestra_BMJ

'There are a multitude of voices to explain why the marketisation of the NHS will be a disaster, and they are almost certainly right. But – I say with my tongue firmly in my cheek – there is a silver lining to every cloud. It will be a bonanza for lawyers. Every contract will be crawled over by lawyers, disputes will be far more common, and m’learned friends will be fully engaged and well rewarded. But all this comes at a cost. The NHS has traditionally spent about 6% of its annual spend on administrating the system. A market system, such as in the US, spends vastly more. A study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of US healthcare dollars went to healthcare administrative costs, nearly double the administrative overhead in Canada, on a percentage basis and vastly more than the NHS’s paltry 6%.'

obesity

http://lifeinthefastlane.com/2013/04/work-life-balance/

Films worth watching

Monsieur Lazhar Zabana!

BBC world service heart and soul podcast - muslim white female

a bit like where's Wally...

but with wildlife pictures...

http://uk.news.yahoo.com/photos/can-you-see-what-it-is-yet-amazing-camouflaged-animals-slideshow/

try to find the animals! answers at the end!

a couple below to wet your appetite...

1. 

oregano oil

http://www.nytimes.com/2012/12/26/science/chicken-farms-try-oregano-as-antibiotic-substitute.html?src=me&ref=general

In Hopes of Healthier Chickens, Farms Turn to Oregano

Jessica Kourkounis for The New York Times

Chickens raised for Bell & Evans, like these in Pennsylvania, eat feed laced with oregano oil.

By STEPHANIE STROM

Published: December 25, 2012

FREDERICKSBURG, Pa. — The smell of oregano wafting from Scott Sechler’s office is so strong that anyone visiting Bell & Evans these days could be forgiven for wondering whether Mr. Sechler has forsaken the production of chicken and gone into pizza.

Jessica Kourkounis for The New York Times

The experience of Scott Sechler, Bell & Evans’s owner, with using oregano oil led to a test at Country View Family Farms.

Oregano lies loose in trays and tied into bunches on tabletops and counters, and a big, blue drum that held oregano oil stands in the corner. “Have you ever tried oregano tea?” Mr. Sechler asked, mashing leaves between his broad fingers.

Off and on over the last three years or so, his chickens have been eating a specially milled diet laced with oregano oil and a touch of cinnamon. Mr. Sechler swears by the concoction as a way to fight off bacterial diseases that plague meat and poultry producers without resorting to antibiotics, which some experts say can be detrimental to the humans who eat the meat. Products at Bell & Evans, based in this town about 30 miles east of Harrisburg, have long been free of antibiotics, contributing to the company’s financial success as consumers have demanded purer foods.

But Mr. Sechler said that nothing he had used as a substitute in the past worked as well as oregano oil.

“I have worried a bit about how I’m going to sound talking about this,” he said. “But I really do think we’re on to something here.”

Skeptics of herbal medicines abound, as any quick Internet search demonstrates. “Oil of oregano is a perennial one, advertised as a cure for just about everything,” said Scott Gavura, a pharmacist in Toronto who writes for the Web site Science-Based Medicine. “But there isn’t any evidence, there are too many unanswered questions and the only proponents for it are the ones producing it.”

Nonetheless, Mr. Gavura said he would welcome a reduction in the use of antibiotics in animals.

At the same time, consumers are growing increasingly sophisticated about the content of the foods that they eat.

Data on sales of antibiotic-free meat is hard to come by, but the sales are a tiny fraction of the overall meat market. Sales in the United States of organic meat, poultry and fish, which by law must be raised without antibiotics, totaled $538 million in 2011, according to the Organic Trade Association. By comparison, sales of all beef that year were $79 billion.

Still, retailers like Costco, Whole Foods and Trader Joe’s, as well as some restaurant chains, complain that they cannot get enough antibiotic-free meat.

Noodles & Company, a fast-growing chain of more than 300 restaurants, recently added antibiotic-free pork to the choices of ingredients that customers can add to their made-to-order pastas. It ensured its supply by ordering cuts of meat that were not in relatively high demand and by committing in advance to buy a year’s worth, said Dan Fogarty, its executive vice president for marketing.

“We’re deliberately voting with our pocketbooks,” he said.

In a nationwide telephone survey of 1,000 adults in March, more than 60 percent told the Consumer Reports National Research Center that they would be willing to pay at least 5 cents a pound more for meat raised without antibiotics.

“Before, it was kind of a nice little business, and while it’s still microscopic in the grand scheme of things, we’re seeing acceptance from retailers across the country, not just in California and on the East Coast,” said Stephen McDonnell, founder and chief executive of Applegate, an organic and natural meats company.

Mr. McDonnell said a confluence of trends, from heightened interest in whole and natural foods to growing concerns about medical problems like diabetes, obesity and gluten allergies, were contributing to the demand for antibiotic-free meat.

There is growing concern among health care experts and policy makers about antibiotic resistance and the rise of “superbugs,” bacteria that are impervious to one or more antibiotics. Those bacteria can be passed on to consumers, who eat meat infected with them and then cannot be treated.

In November, the Centers for Disease Control and Prevention and 25 national health organizations and advocacy groups issued a statement on antibiotics that, among other things, called for “limiting the use of medically important human antibiotics in food animals” and “supporting the use of such antibiotics in animals only for those uses that are considered necessary for assuring animal health.”

In 2011, there were several prominent recalls involving bacterial strains that are resistant to antibiotics, including more than 60 million pounds of ground beef contaminated with salmonella Typhimurium and about 36 million pounds of ground turkey spoiled with salmonella Heidelberg.

Consumer Reports released a study last month that found the bacteria Yersinia enterocolitica in 69 percent of 198 pork chop and ground pork samples bought at stores around the country. Some of the bacteria were resistant to one or more antibiotics.

Analysis of Food and Drug Administration data by the Center for Science in the Public Interest found that 80 percent of all antibiotics sold in the United States are used in animals. The majority of those antibiotics are used to spur growth or prevent infections from spreading in the crowded conditions in which most animal production takes place today.

The European Union has banned the use of antibiotics to accelerate growth, and the European Parliament is pushing to end their use as tools to prevent disease as well.

The oregano oil product Mr. Sechler uses, By-O-Reg Plus, is made by a Dutch company, Ropapharm International. In the late 1990s, Bayer conducted trials on the product, known as Ropadiar in Europe, comparing its ability to control diarrhea in piglets caused by E. coli with that of four of the company’s products.        

 In all four test groups, Ropadiar outperformed the Bayer products. “Strange but true!” Dr. Lucio Nisoli, the Bayer product manager, wrote in his report on the trial. “Compared to the various anti-infectives, with Ropadiar I have obtained much more effective and quicker results. Furthermore, piglets treated with Ropadiar look much more healthy and were not so dehydrated and wasted.”

Jessica Kourkounis for The New York Times

Over the last six months, about 5,000 pigs at Country View Family Farms have eaten feed laced with By-O-Reg after being weaned from their mothers.

Astrid Köhler, a spokeswoman in Monheim, Germany, for Bayer Healthcare’s animal health business, confirmed that the company had done the trial but said that “in further evaluations the results of the first study could not be replicated with the same species, nor with other species.”

Other testing is rare. A test of oregano oil on four small farms in Maine, which was financed by a $9,914 grant from the Agriculture Department, found it was effective in controlling the parasites and worms that afflict goats and sheep.

Dr. Harry G. Preuss, a professor of physiology and biology at the Georgetown University Medical Center, studied the effectiveness of oregano oil on 18 mice infected with staph bacteria. Six mice were given oregano oil, and half survived for the full 30 days of the treatment. Six received carvacrol, regarded by many experts to be the antibacterial component in oregano, in olive oil, and none of them survived longer than 21 days. Six other mice received only olive oil and died within three days.

The study, which was underwritten by a company, North American Herb and Spice, and presented at a meeting of the American College of Nutrition in 2001, was repeated and all those findings were corroborated, Dr. Preuss said.

Dr. Preuss said he had applied to the National Institutes of Health for financing of a larger study, with no luck so far. “This is really promising, particularly when you consider that we are facing a crisis in our hospitals and health systems with the increasing resistance to antibiotics,” he said.

After hearing about Bell & Evans’s use of oregano oil, Bob Ruth, the president of Country View Family Farms, a Pennsylvania-based company, decided to test it on some of his pigs. Over the last six months, about 5,000 pigs have eaten feed laced with By-O-Reg after being weaned from their mothers.

“The preliminary results are encouraging, but we need to be sure it’s giving us the results we need to give us the confidence to start using it more broadly,” Mr. Ruth said.

Mr. Ruth and Mr. Sechler warned that using oregano oil to control bacterial infection also requires maintaining high standards of sanitation in barns where animals are sheltered, as well as good ventilation and light, and a good nutrition program.

After a chicken flock leaves a barn at Bell & Evans for slaughter, for instance, the facility is hosed down, its water lines are cleaned out and everything is disinfected. It sits empty for two to three weeks to allow bacteria to die off and to ensure that the rodents that carry salmonella and campylobacter are eliminated.

“You can’t just replace antibiotics with oregano oil and expect it to work,” Mr. Sechler said.        

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Follow your nose...

http://blogs.scientificamerican.com/the-curious-wavefunction/2012/11/26/the-perils-of-translational-research/

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The perils of translational research

By Ashutosh Jogalekar | November 26, 2012 |  1

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This is an updated and revised version of an article I wrote for the Lindau Meeting of Nobel laureates and Current Science magazine.

In 1969, one of the more memorable incidents in the public advocacy of science took place. The American physicist Robert Wilson was asked to testify before Congress in support of the construction of the Fermi National Accelerator Laboratory, known as Fermilab. For Wilson, building this huge machine had been a labor of love and nobody had a better background for it. He had worked on the Manhattan Project where he was the youngest group leader in the experimental division, and after the war he had become a professor at Cornell University.

Wilson was a first-rate amateur architect who saw accelerators as works of art. He lovingly designed Fermilab with his own hands and, in order to add to the aesthetic appeal of the place, turned the surrounding acres into a wilderness housing bison and geese. His efforts paid off; Fermilab would become the largest accelerator in the United States and CERN’s primary competitor. In 1969 Wilson was asked to justify the expenditure for the multi-million dollar laboratory in front of Congress. The Cold War was raging, most research and especially physics research was being viewed in the context of national security, and Wilson was specifically asked what contribution the new laboratory would make to national defense. He replied in words that should be etched on the foundation stone of every center of basic research. The research, he said, had no direct bearing on national defense. Instead,

“It has only to do with the respect with which we regard one another, the dignity of men, our love of culture. It has to do with: Are we good painters, good sculptors, great poets? I mean all the things we really venerate in our country and are patriotic about. It has nothing to do directly with defending our country except to make it worth defending”.

It has nothing to do directly with defending our country except to make it worth defending. In saying these words, Wilson was appealing to the heart of what makes any country great. It is not the fancy cars, the shiny malls, the great financial houses and the cornucopia of industrial food that truly contribute to a country’s progress. At one point or another in history, Athens, Florence, Takshashila, Baghdad, Oxford, Gottingen, Copenhagen and Philadelphia were primarily known not for their wealth and the splendor of their monuments but for the unmatched wealth of ideas about science, art, economics, politics, freedom and human dignity that their citizens generated. These ideas are now the bedrock of much of modern civilization. Many of these ideas were solutions to practical problems, but most only sought to explore and push the boundaries of human creativity, curiosity, passion and tolerance. The creators and dreamers of these ideas were less concerned about their practical application and more concerned about their ability to answer questions about human origins and nature, our place in the cosmos and our relationship to other human beings.

Why am I retelling the story of Robert Wilson? Because I believe it strikes at the heart of what these days is fashionably called “translational research”. Just like physics research was being viewed through the lens of national defense in the 60s, basic biomedical studies run the risk of being viewed through the lens of translational research in the 2010s. The approach is clearly not popular among leading researchers. In 2009, Nobel Laureate Martin Chalfie gave a talk at the Lindau Meeting in which he described the great satisfaction he had gotten from doing non-translational research. Chalfie is not alone; last year I attended a lecture by another Nobel Laureate, Thomas Steitz. Steitz who won the prize for cracking open the structure of the ribosome proudly announced at the beginning of the talk that “the only kind of translation I have worked on is that orchestrated by the ribosome”. And this week in Sciencemagazine, Nobel Laureates Joseph Goldstein and Michael Brown lament the passing of the golden age of basic research at the NIH – an era which produced nine Nobel Prize winners during a single decade. As Goldstein and Brown put it, “translational research relegates basic science to a back burner…individual curiosity-driven science has been replaced by large consortia dedicated to the proposition that gathering vast amounts of correlative data will somehow provide an answer to life’s fundamental questions”.

So what is translational research? Many definitions seem to abound and Wikipedia seems to be as good a guide as any: “Translational research is a way of thinking about and conducting scientific research to make the results of research applicable to the population under study and is practised in the natural and biological, behavioural, and social sciences”. The goal of translational research especially in medicine seems to transform basic biomedical research discoveries from “bench to bedside”.

In the last few years this kind of thinking has has swamped the public discourse on science. New centers are being founded and funded whose mandate is to translate basic research into products directly benefiting humanity. The NIH, the largest biomedical research agency in the world, has also embraced a new National Center for Advancing Translational Research. The director of the NIH, Francis Collins, has not tired of pointing out the exciting advances in discovering new drugs which would be made possible by harnessing data from the human genome project. Not surprisingly, the press has eagerly jumped on the bandwagon, with reports pitching translational research and personalized medicine regularly appearing in the nation’s leading papers. Echoing leading scientists, the press seems to be telling us that we should all look forward to supporting translational research in its various guises.

All this makes the idea of translational research sound promising. And yet there must be a good reason why distinguished Nobel Prize winners like Chalfie, Steitz, Goldstein and Brown bristle at the mention of translational research. The reason is actually not too hard to discern. The problem is not with applied research per se. Nobody can doubt that applied research especially done by the pharmaceutical and biotechnology industries has saved innumerable lives in the last one hundred years. As Pasteur said, “there is science and the applications of science”, and he saw them lying on a continuum. No, there is nothing wrong with trying to turn basic ideas into applied products.

What is wrong is that translational research is being seen as a panacea that will address the flagging rate of new biomedical advances. The thinking seems to declare that if only more people were given more money and deliberately focused on direct application, we would suddenly see a windfall of new therapies against disease. This thinking suffers from two major problems.

The first problem is that history is not really on the side of translational research. Most inventions and practical applications of science and technology which we take for granted have come not from people sitting in a room trying to invent new things but as fortuitous offshoots of curiosity-driven research. Penicillin was discovered through serendipity by a most alert Alexander Fleming who was trying to plate bacterial cultures, not one trying to actually discover the next breakthrough antibiotic. Nuclear Magnetic Resonance (which in turn led to MRI) was discovered by physicists who were interrogating the properties of atoms using magnetic fields, not ones who were trying to find a method for determining the structures of organic and biological molecules. The discovery of most drugs built upon basic discoveries about human physiology and anatomy made by physicians and researchers who were simply trying to find more about how the body works. As Goldstein and Brown describe in theirScience opinion piece, NIH scientists in the 60s focused on basic questions involving receptors and cancer cells, but this work had an immense impact on drug discovery; for instance, heart disease-preventing statins which are the world’s best-selling drugs derive directly from Goldstein and Brown’s pioneering work on cholesterol metabolism. Examples also proliferate other disciplines; the Charged-Coupled Device (CCD), lasers, microwaves, computers and the World Wide Web are all fruits of basic and not targeted research.

If the history of science teaches us anything, it is that curiosity-driven basic research has paid the highest dividends in terms of practical inventions and advances. Tinkering, somewhat aimless but enthusiastic exploration of biological and physical systems and following one’s nose have been the ingredients for some of the key inventions that have transformed our lives. Radar, computers, drugs, detergents, plastics and microwave ovens were all made possible not because someone sat down and tried to discover them but because they arose as fortuitous consequences of elemental, pure research. The hype of translational research not only deflects attention from curiosity-driven basic research but also creates the illusion – and dangerously so especially in the minds of young scientists – that asking people to discover new things is the best way to generate new ideas. In fact, trying to discover new things by forcing people to discover them will only siphon off funds from those who have the actual capability of discovering these things. This is especially damning for bright young researchers who are trying to survive in an increasingly straitjacketed research milieu.

The second more practical but equally important problem with translational research is that it puts the cart before the horse. First come the ideas; then come the applications. There is nothing fundamentally wrong with trying to build a focused institute to discover a drug, say, for schizophrenia. But doing this when most of the basic neuropharmacology, biochemistry and genetics of schizophrenia are unknown is a great diversion of focus and funds. Before we can apply basic knowledge, let’s first make sure that the knowledge exists. Efforts based on incomplete knowledge would only result in a great squandering of manpower, intellectual and financial resources. Such misapplication of resources seems to be the major problem for instance with anew center for drug discovery that the NIH plans to establish. The NIH seeks to channel the newfound data on the human genome to discover new drugs for personalized medicine. This is a laudable goal, but the problem is that we still have miles to go before we truly understand the basic implications of genomic data. It is only recently that we have started to become aware of the “post-genomic” universe of epigenetics and signal transduction. We have barely started to scratch the surface of the myriad ways in which genomic sequences are massaged and manipulated to produce the complex set of physiological events involved in disease and health.

And all this does not even consider the actual workings of proteins and small molecules in mediating key biological events, something which is underlined by genetics but which constitutes a whole new level of emergent complexity. In the absence of all this basic knowledge which is just emerging, how pertinent is it to launch a concerted effort to discover new drugs based on this vastly incomplete knowledge? It would be like trying to construct a skyscraper without fully understanding the properties of bricks and cement.

Chalfie, Steitz and others like them are also right to criticize the frenzy that translational research generates in the popular press. We live in an age when buzzwords are eagerly generated and assimilated by the media. These buzzwords usually run roughshod over subtleties and ambiguities and the press seldom has a taste for indulging these in the first place. Needless to say, committing national resources and public attention to translational research when most of the basics are still to be understood is an endeavor fraught with great risk and uncertainty. It would be far wiser to bolster basic research that can bring us to the brink of real application. There are places where such research is conducted. They are called universities.

Ultimately, the importance of basic research goes back to what Robert Wilson said to Congress. It has to do with the same reasons that we created the Mona Lisa, painted the Sistine Chapel, built Chartres Cathedral, wrote The Love Song of J. Alfred Prufrock and composed the Goldberg Variations. Da Vinci, Michelangelo, T. S. Eliot and Bach were all trying to find the essence of man’s soul and his relationship with the universe and with his fellow men. So were Einstein, Newton, Faraday and Darwin. They were not trying to invent a better mousetrap, but the world did beat a path to their door. Similarly, once our basic understanding of biological systems is firmly in place, translation will willingly follow. The next researcher, when asked to comment on the relevance of his or her basic studies in cell biology to translational research, should echo Wilson: “It has nothing to do directly with translational research, except to enable it”.

About the Author: Ashutosh (Ash) Jogalekar is a chemist interested in the history and philosophy of science. He considers science to be a seamless and all-encompassing part of the human experience. Follow on Twitter @curiouswavefn.

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'The Human cost of healthcare'

'Cancer Survivor or Victim of Overdiagnosis?'

From the New York Times

http://www.nytimes.com/2012/11/22/opinion/cancer-survivor-or-victim-of-overdiagnosis.html?src=me&ref=general

By H. GILBERT WELCH

Published: November 21, 2012

FOR decades women have been told that one of the most important things they can do to protect their health is to have regular mammograms. But over the past few years, it’s become increasingly clear that these screenings are not all they’re cracked up to be. The latest piece of evidence appears in a study in Wednesday’s New England Journal of Medicine, conducted by the oncologist Archie Bleyer and me.

The study looks at the big picture, the effect of three decades of mammography screening in the United States. After correcting for underlying trends and the use of hormone replacement therapy, we found that the introduction of screening has been associated with about 1.5 million additional women receiving a diagnosis of early stage breast cancer.

That would be a good thing if it meant that 1.5 million fewer women had gotten a diagnosis of late-stage breast cancer. Then we could say that screening had advanced the time of diagnosis and provided the opportunity of reduced mortality for 1.5 million women.

But instead, we found that there were only around 0.1 million fewer women with a diagnosis of late-stage breast cancer. This discrepancy means there was a lot of overdiagnosis: more than a million women who were told they had early stage cancer — most of whom underwent surgery, chemotherapy or radiation — for a “cancer” that was never going to make them sick. Although it’s impossible to know which women these are, that’s some pretty serious harm.

But even more damaging is what these data suggest about the benefit of screening. If it does not advance the time of diagnosis of late-stage cancer, it won’t reduce mortality. In fact, we found no change in the number of women with life-threatening metastatic breast cancer.

The harm of overdiagnosis shouldn’t come as a surprise. Six years ago, a long-term follow-up of a randomized trial showed that about one-quarter of cancers detected by screening were overdiagnosed. And this study reflected mammograms as used in the 1980s. Newer digital mammograms detect a lot more abnormalities, and the estimates of overdiagnosis have risen commensurately: now somewhere between a third and half of screen-detected cancers.

The news on the benefits of screening isn’t any better. Some of the original trials from back in the ’80s suggested that mammography reduced breast cancer mortality by as much as 25 percent. This figure became the conventional wisdom. In the last two years, however, three investigations in Europe came to a radically different conclusion: mammography has either a limited impact on breast cancer mortality (reducing it by less than 10 percent) or none at all.

Feeling depressed? Don’t be. There’s good news here, too: breast cancer mortality has fallen substantially in the United States and Europe. But it’s not about screening. It’s about treatment. Our therapies for breast cancer are simply better than they were 30 years ago.

As treatment improves, the benefit of screening diminishes. Think about it: because we can treat most patients who develop pneumonia, there’s little benefit to trying to detect pneumonia early. That’s why we don’t screen for pneumonia.

So here is what we now know: the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than has been previously recognized.

But to be honest, that general message has been around for more than a decade. Why isn’t it getting more traction?

The reason is that no other medical test has been as aggressively promoted as mammograms — efforts that have gone beyond persuasion to guilt and even coercion (“I can’t be your doctor if you don’t get one”). And proponents have used the most misleading screening statistic there is: survival rates. A recent Komen foundation campaign typifies the approach: “Early detection saves lives. The five-year survival rate for breast cancer when caught early is 98 percent. When it’s not? It decreases to 23 percent.”

Survival rates always go up with early diagnosis: people who get a diagnosis earlier in life will live longer with their diagnosis, even if it doesn’t change their time of death by one iota. And diagnosing cancer in people whose “cancer” was never destined to kill them will inflate survival rates — even if the number of deaths stays exactly the same. In short, tell everyone they have cancer, and survival will skyrocket.

Screening proponents have also encouraged the public to believe two things that are patently untrue. First, that every woman who has a cancer diagnosed by mammography has had her life saved (consider those “Mammograms save lives. I’m the proof” T-shirts for breast cancer survivors). The truth is, those survivors are much more likely to have been victims of overdiagnosis. Second, that a woman who died from breast cancer “could have been saved” had her cancer been detected early. The truth is, a few breast cancers are destined to kill no matter what we do.

What motivates proponents to use these tactics? Largely, it’s sincere faith in the virtue of early diagnosis, the belief that screening must be good for women. And 30 years ago, when we started down this road, they may have been right. In light of what we know now, it is wrong to continue down it. Let’s offer the proponents amnesty and move forward.

What should be done? First and foremost, tell the truth: woman really do have a choice. While no one can dismiss the possibility that screening may help a tiny number of women, there’s no doubt that it leads many, many more to be treated for breast cancer unnecessarily. Women have to decide for themselves about the benefit and harms.

But health care providers can also do better. They can look less hard for tiny cancers and precancers and put more effort into differentiating between consequential and inconsequential cancers. We must redesign screening protocols to reduce overdiagnosis or stop population-wide screening completely. Screening could be targeted instead to those at the highest risk of dying from breast cancer — women with strong family histories or genetic predispositions to the disease. These are the women who are most likely to benefit and least likely to be overdiagnosed.

One final plea: Can we please stop using screening mammography as measure of how well our health care system is performing? That’s beginning to look like a cruel joke: cruel because it leads doctors to harass women into compliance; a joke because no one can argue this is either a public health imperative or a valid measure of the quality of care.

Breast cancer is arguably the most important cancer for a nonsmoking woman to care about. Diagnostic mammography — when a woman with a breast lump gets a mammogram to learn if it’s something to worry about — is an important tool. No one argues about this. Pre-emptive mammography screening, on the other hand, is, at best, is a very mixed bag — it most likely causes more health problems than it solves.

H. Gilbert Welch is a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and an author of “Overdiagnosed: Making People Sick in the Pursuit of Health.” 

'A Shortcut to Wasted Time'

From the New York Times

http://www.nytimes.com/2012/11/23/opinion/shortcuts-in-medical-documentation.html

By LEORA HORWITZ

Published: November 22, 2012

A FEW years ago, we doctors kept handwritten charts about patients. Back then, it sometimes seemed like we spent half our time walking around looking for misplaced charts, and the other half trying to decipher the handwriting when we found them. The upside was that if I did have the chart in front of me, and I saw that someone had taken the trouble to write something down, I believed it.

Unfortunately, this is no longer the case. The advent of electronic medical records has been a boon to patient safety and physician efficiency in many ways. But it has also brought with it a slew of “timesaving” tricks that have had some unintended consequences. These tricks make it so easy for doctors to document the results of standard exams and conversations with patients that it appears more and more of them are being documented without ever having happened in the first place.

For instance, doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation.

Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.

Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click. Medicare thinks so too. This fall, the attorney general and secretary of health and human services warned the five major hospital associations that this kind of abuse would not be tolerated.

And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes.

In short, reading the electronic chart has become a game of looking for a small needle of new information in a haystack of falsely comprehensive documentation and outdated, copied text. Why do we doctors do this to ourselves? Largely, it turns out, for the same reason most people do most things: money.

Doctors are paid not by how much time they spend with patients, how well they listen or how hard they think about what could be wrong, but by how much they write down. And the rules for what we have to write are Byzantine: Medicare’s explanation takes 87 pages. To receive the highest level of payment for an office visit, I have to document several aspects of the main problem, screening questions about at least 10 organ systems, something about the patient’s family and/or social history, and/or a lengthy physical exam. In addition, I have to demonstrate that my medical decision making was very complicated, considering the number of possible diagnoses and treatments, the complexity of the data and/or the patient’s risk of serious complications. That type of visit is supposed to take about 40 minutes.

Last week, I spent 40 minutes with a patient who had just placed her mother into hospice care. My patient was distraught, not sleeping, not eating. I gave her some advice, but mostly I just listened. By the end of our visit, she was feeling much better. But I wouldn’t be able to bill much for that visit based on my documentation: I didn’t review her medical or family history, conduct a review of organ systems or perform a physical exam.

What the payment system tells me to do is to cut her off after 10 minutes, listen to her heart and lungs and give her a sleeping pill. Which doctor visit would you prefer?

Of course, I would never go back to the bad old days of lost charts, illegible writing, manual prescription refills and forgotten information. Electronic medical records help us avoid dangerous drug interactions and medical ordering errors, remind us to provide preventive care and allow us to view data as trends over time. Even copy and paste have legitimate uses.

But physicians need to be better stewards of our records so they remain useful, regardless of skewed incentives and new technology. And as a nation, we should question whether paying physicians by documentation — instead of by time spent on quality patient care — is such a great idea after all.

Leora Horwitz, a primary care internist, is an assistant professor at the Yale School of Medicine.