by Salman Hameed

The Chronicle of Higher Education has an interesting short piece that points to the International Islamic Centre for Population Studies and Research at Al-Azhar University (tip from Laura Sizer). In some ways, it is a good sign that Al-Azhar has taken a progressive stance on issues like population control, stem cells and in-vitro fertilization (IVF). Compared to this, the Catholic Church seems to be set in the medieval times. But on the other hand, I also feel that it is a problem that all of these issues have to be filtered through religious scholars. Indeed, the same university went against the donorship of sperm and eggs for reproduction. Nevertheless, we can applaud the positive steps while being on guard against any regressive actions:

Gamal Serour, founder of the International Islamic Center for Population Studies and Research, is well practiced at this balancing act. 

Dr. Serour, who is also a professor of obstetrics and gynecology, views his position within al-Azhar as ideal for "overcoming religious obstacles to the improvement of women's health." 

When he founded the center, in 1974, many Egyptians believed that contraception was forbidden by Islam, and that family planning was a Western conspiracy to weaken Muslim nations, he says. 

"Everybody used to look at this center as the center of kuffar, nonbelievers," Dr. Serour says. It was "the center which is implementing the policies of the West, the center which is working to limit the population growth of the Muslim world." 

But "when we gradually produced the information and told people what problems we have, ... you will not believe me, but our religious leaders were much more progressive than we reproductive-health physicians." 

Scholars of religion at al-Azhar embraced the principles of family planning and approved most forms of contraception (permanent ones, like vasectomies, are allowed only in cases of medical necessity). They declared stem-cell research and in-vitro fertilization to be in accordance with Islam. On the other hand, they forbade surrogacy and donations of sperm and eggs. 

"People in Egypt and the Muslim world, ... religion plays an important role in their life," says Dr. Serour. "You have to be knowledgeable about this. You cannot escape from it, because people ask you: Is it haram [forbidden] or halal [permitted]?" 

Rather than viewing the religious framework at al-Azhar as a constraint, Dr. Serour argues that it has bolstered the effectiveness and reach of his work. The population-studies center is among the university's most active research institutes. It operates a clinic for the surrounding neighborhood; carries out training for doctors and outreach to imams; holds clinical trials supported by pharmaceutical companies; and sponsors regional conferences.

And it seems that Dr. Serour is also aware of the potential challenges:

For the time being, Dr. Serour isn't worried that Islamist fundamentalists who might be hostile to his work—many regularly inveigh against the teaching of reproductive health—will gain control of the campus. 

"If they got ahold of al-Azhar University, and the al-Azhar institutes, and the office of the grand imam of al-Azhar, there might be a change in policy," he says. "Not because al-Azhar is doing something against Islam," but because they are misinformed about reproductive health and about religious teachings. The only way to change their views, he says, is to educate them. 

Read the full article here.

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by Salman Hameed

There are only three counties left with active polio cases: Pakistan (58 cases last year), Afghanistan (37 cases) and Nigeria (121 cases). This is a disease that has no cure, but can only be prevented. But alas, it seems that it may be harder to eliminate it from theses last few countries. Last month, nine polio workers, mostly women, were killed in different cities in Pakistan. The effort is back on with increased security, but one of the security policemen was killed late last month.

Now comes the news that 9 female polio workers have been killed in northern Nigeria:

Nine female polio vaccinators have been killed in two shootings at health centres in northern Nigeria, police have told the BBC. 

In the first attack in Kano the polio vaccinators were shot dead by gunmen who drove up on a motor tricycle. 

Thirty minutes later gunmen targeted a clinic outside Kano city as the vaccinators prepared to start work. 

Some Nigerian Muslim leaders have previously opposed polio vaccinations, claiming they could cause infertility. 

On Thursday, a controversial Islamic cleric spoke out against the polio vaccination campaign, telling people that new cases of polio were caused by contaminated medicine.
Such opposition is a major reason why Nigeria is one of just three countries where polio is still endemic. 

But this is believed to be the first time polio vaccinators have been attacked in the country.

It is tragic for the children there and it is tragic for the workers. Especially, what have the workers done to die like that? It is suspected that Boko Haram is behind the attacks. The name of the group literally means "Western Education is Forbidden" in Hausa language. According to the Wikipedia entry on this group, they oppose man-made laws and modern science. There you have it. I have no idea, but I'm curious to know if they use any modern medicine at all - from drugs against malaria to simple antibiotics.

In any case, read this polio story here.

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by Salman Hameed

More grim news: Seven health workers, including six women and one male medical technician, were killed today. I don't know if this was related to polio vaccination or not - but certainly they were targeted for being health workers for an NGO.

The polio campaign is in tatters after the killing of several health workers in Karachi and near Peshawar. Polio has been eradicated from much of the world, and only a handful of places are left with live cases (see earlier posts here and here). Even the Taliban were on board for the vaccination - despite their mistrust of anything western. However, there is now a reaction to the news that CIA used a vaccination ruse to (unsuccessfully) obtain the DNA of Osama Bin Laden's family members to confirm his presence in Abbottabad (see earlier post: Polio may be the winner between the Taliban and the CIA). The Taliban actions against the health workers are indeed despicable. However, the use of a vaccination program by the CIA is also appalling, and they will share an equal blame if polio spreads again at a wider scale.

So what to do? This will never happen, but it will be a start if President Obama offer an apology for endangering the lives of health workers in Pakistan because of CIA's half-brained scheme. But more importantly, he should make a public statement that the US will not use any health workers for the purposes of spying. These health workers should be considered neutral parties. Maybe - and just maybe - the Taliban may allow vaccinations to happen in peace.

In the mean time, here is a thoughtful article in the New York Times on polio vaccinations, and it talks about these challenges:

How in the world did something as innocuous as the sugary pink polio vaccine turn into a flash point between Islamic militants and Western “crusaders,” flaring into a confrontation so ugly that teenage girls — whose only “offense” is that they are protecting children — are gunned down in the streets? 

Nine vaccine workers were killed in Pakistan last week in a terrorist campaign that brought the work of 225,000 vaccinators to a standstill. Suspicion fell immediately on factions of the Pakistani Taliban that have threatened vaccinators in the past, accusing them of being American spies. 

Polio eradication officials have promised to regroup and try again. But first they must persuade the killers to stop shooting workers and even guarantee safe passage.
That has been done before, notably in Afghanistan in 2007, when Mullah Muhammad Omar, spiritual head of the Afghan Taliban, signed a letter of protection for vaccination teams. But in Pakistan, the killers may be breakaway groups following no one’s rules. 

Apart from the CIA ruse, the article also points out the general mistrust in the northern areas of Pakistan:

Even in friendly areas, the vaccine teams have protocols that look plenty suspicious. If a stranger knocked on a door in Brooklyn, asked how many children under age 5 were at home, offered to medicate them, and then scribbled in chalk on the door how many had accepted and how many refused — well, a parent might worry. 

In modern medical surveys — though not necessarily on polio campaigns — teams carry GPS devices so they can find houses again. Drones use GPS coordinates. 

The warlords of Waziristan made the connection specific, barring all vaccination there until Predator drones disappeared from the skies. 

Dr. Bruce Aylward, a Canadian who is chief of polio eradication for the World Health Organization, expressed his frustration at the time, saying, “They know we don’t have any control over drone strikes.” 

The campaign went on elsewhere in Pakistan — until last week. 

And there are all other rumors about vaccinations:

The fight against polio has been hampered by rumors that the vaccine contains pork or the virus that causes AIDS, or is a plot to sterilize Muslim girls. Even the craziest-sounding rumors have roots in reality. 

The AIDS rumor is a direct descendant of Edward Hooper’s 1999 book, “The River,” which posited the theory — since discredited — that H.I.V. emerged when an early polio vaccine supposedly grown in chimpanzee kidney cells contaminated with the simian immunodeficiency virus was tested in the Belgian Congo. 

The sterilization claim was allegedly first made on a Nigerian radio station by a Muslim doctor upset that he had been passed over for a government job. The “proof” was supposed to be lab tests showing it contained estrogen, a birth control hormone. 

The vaccine virus is grown in a broth of live cells; fetal calf cells are typical. They may be treated with a minute amount of a digestive enzyme, trypsin — one source of which is pig pancreas, which could account for the pork rumor. 

In theory, a polio eradicator explained, if a good enough lab tested the vaccine used at the time the rumor started, it might have detected estrogen from the calf’s mother, but it would have been far less estrogen than is in mother’s milk, which is not accused of sterilizing anyone. The trypsin is supposed to be washed out. 

In any case, polio vaccine is now bought only from Muslim countries like Indonesia, and Muslim scholars have ruled it halal — the Islamic equivalent of kosher. 

And ultimately, we all have to deal with this:

Reviving the campaign will mean quelling many rumors. It may also require adding other medical “inducements,” like deworming medicine, mosquito nets or vitamin A, whose immediate benefits are usually more obvious. 

But changing mind-sets will be a crucial step, said Dr. Aylward, who likened the shootings of the girls to those of the schoolchildren in Newtown, Conn.  

More police involvement — what he called a “bunkerized approach” — would not solve either America’s problem or Pakistan’s, he argued. Instead, average citizens in both countries needed to rise up, reject the twisted thinking of the killers and “generate an understanding in the community that this kind of behavior is not acceptable.” 

Read the full article here.

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by Salman Hameed

Polio cases are now left in only 3 countries of the world. There is a chance of polio's comeback if it is not eradicated completely (see this earlier post: Pakistan's polio eradication problem). And things may not be looking good. The fact that the CIA used a fake vaccination program to get information about Osama bin Laden was bound to have an impact at some point on the very real vaccination projects in the northern areas of Pakistan. And sure enough, now the Taliban are blocking vaccinations to demand an end to drone strikes:

The commander, Hafiz Gul Bahadur, said that the vaccinations would be banned until the Central Intelligence Agency stopped its drone campaign, which has been focused largely on North Waziristan. 

Mr. Bahadur said the decision had been taken by the shura-e-mujahedeen, a council that unites the myriad jihadi factions in the area, including Taliban, Qaeda and Punjabi extremists.

The announcement, made over the weekend, is a blow to polio vaccination efforts in Pakistan, one of just three countries where the disease is still endemic, accounting for 198 new cases last year — the highest rate in the world, followed by Afghanistan and Nigeria.

The tribal belt, which has suffered decades of poverty and conflict, is the largest reservoir of the disease. A Unicef spokesman said health workers had hoped to reach 161,000 children younger than 5 in a vaccination drive scheduled to begin on Wednesday.

That is likely to be canceled, at a time when officials felt they were making progress. So far this year, Pakistan has recorded 22 new polio cases, compared with 52 in the same period last year.

The Taliban announcement is also likely to rekindle controversy surrounding Dr. Afridi, who was recently convicted by a tribal court and sentenced to 33 years in prison.

In March and April 2011, Dr. Afridi ran a vaccination campaign in Abbottabad that was intended to determine covertly whether Bin Laden lived in a house in the city. Dr. Afridi failed to obtain a DNA sample, a senior American official said, but did help establish that Bin Laden’s local protector, known as the “courier,” was inside the Bin Laden compound.

Dr. Afridi was arrested three weeks after an American Navy SEAL team raided the house on May 2, 2011, and killed the Qaeda leader.

American officials said Dr. Afridi had been working with the C.I.A. for several years, at a time when he was leading polio vaccination efforts in Khyber Agency, a corner of the tribal belt that harbors a rare strain of the disease. 

What a shame on all accounts! Polio and the a generation of kids growing up there are just a collateral between the Taliban and the CIA. 

Read the full story here.

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by Salman Hameed

Stem cell research shows up Presidential politics here in the US. But it has been going on in Malaysia, Turkey, Egypt, Iran, etc. Even embryonic stem cell research - the bone of contention in the US - is progressing without controversy in some of these Muslim countries. In case, you are interested, you can check out the official Malaysian Guidelines for Stem Cells Research and Therapy (pdf) and it also has a section on ethnics.

Now here is a news item about four women stem cell researchers from Qatar (tip from Don Everhart):

One of the first steps taken by the collaborations was to form the International Programme on Stem Cell Science and Policy, charged with examining the ethical and religious issues involved in stem-cell science, relevant to Arab culture, and engaging with local communities. Five years on, the plan is bearing fruit. 

Hamda Al-Thawadi, Halema Al-Farsi, Heba Al-Siddiqi and Sarah Abdullah joined the Qatar Science Leadership Program (QSLP), a QF initiative that aims to groom Qataris to take leading roles in Qatari science and one day steer its ambitious national programme of research. 

The QSLP sends students to train at some of the best universities in the world. And 2011 saw Al-Thwadi and Al-Farsi go to one of France's largest universities, University Paris-Sud 11, Al-Siddiqi go to Harvard Stem Cell Institute in Massachusetts and Abdullah go to the University of Cambridge in the UK. 

At the Qatar International Conference on Stem Cell Science and Policy held this past week in Doha, Al-Thawadi, Al-Farsi and Al-Siddiqi presented their research on ovarian cancer and obesity-related diseases. Al-Thawadi practiced medicine for two years before applying for the QSLP. "In the past there was only one path for a medical doctor, treating patients. But when QF started this programme, they created a new path for doctors or graduates interested in science," she says. "This is a perfect chance for Qatar to create home-grown researchers."

And Al-Siddiqi is a co-author on a paper published in Nature Cell Biology just this past month:

The first research paper Al-Siddiqi's co-authored was published in Nature Cell Biology in February 2012. "It felt amazing, especially after all the hours of hard work," she says.
Al-Thawadi and Al-Farsi decided to work on ovarian cancer as it is highly prevalent in the Middle East. Al-Thawadi incubated cancer cells in culture with Protein C, a coagulation factor, to test its effect on thrombosis of ovarian cancer cells, which led to a significant increase in metastasis. "This gives us a clue to outline preventative measures for thrombosis in ovarian cancer patients," she explains.

This is actually pretty neat! Read the full article at Nature Middle East.

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This is a weekly post by Nidhal Guessoum (see his earlier posts here). Nidhal is an astrophysicist and Professor of Physics at American University of Sharjah and is the author of Islam's Quantum Question: Reconciling Muslim Tradition and Modern Science. 

In January 2011, the Pew Forum on Religion & Public Life (PFRPL) released a report on ‘The Future of the Global Muslim Population’. In it, PFRPL looks at demographic trends in 44 Muslim-majority countries and considers the importance of various factors, such as: levels of education (of women), economic well-being (GDP per capita), contraception and family planning, etc.

In July 2010, I had written a post here at Irtiqa on the ‘Population Explosion in the Muslim World’ using World Bank statistics, from which I stressed the doubling of populations over the past 30 years in large and important countries like Algeria, Egypt, Iran, Pakistan, and Malaysia, and the tripling of Saudi Arabia’s population in the past 30 years.

In that piece I also cited some interesting statistics provided by the World Bank regarding the usage of contraceptives in various countries. And I discussed the question of birth control and Islam.

This PFRPL report first puts the global Muslim population’s growth in perspective, noting that in 1990 it totaled 1.1 billion, thus representing 19.9 % of the world’s population), in 2010 it was 1.6 billion (23.4 %), and in 2030 it will be 2.2 billion (26.4 %).

It also notes that while today Indonesia (with about 205 million people) is the largest Muslim-majority country, followed by Pakistan with some 180 million, in 20 years Pakistan will have largely overtaken Indonesia with 256 million compared with 239 million, and Afghanistan and Iraq will have climbed to the top 10 list (of Muslim-majority countries) with 50 and 48 million people, respectively (a rather scary prospect, if you ask me).

An interesting section of the report presented the state of contraception and abortion in Muslim countries.

First, a comparison of birth-control usage rates is given between Muslim-majority countries and non-Muslim countries, the latter group being divided into “less developed” and “more developed”. Here’s the data table presenting the percentages of married women (ages 15 to 49) using some form of birth control:

Interestingly, the two Muslim countries where birth control is used most are Iran (73 %) and Turkey (71 %), much higher than the world average of 61.3 % and about the same as in the USA (73 %).

Even more interesting is the section dealing with abortion. The report notes that:

Many Muslim-majority countries do not collect or do not publish data on the frequency of abortions. The partial data that are available do not allow for reliable comparisons of abortion rates in Muslim-majority countries with abortion rates in other countries. However, many Muslim-majority countries either forbid abortions or allow them only under tight restrictions.

The report then gives a neat table summarizing the abortion laws in Muslim-majority countries:

The spectrum of attitudes, policies, and laws in the Muslim world is fascinating on this (contraception and abortion) issue as on many others.

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I have written several times about the problem of polio eradication in Pakistan (for example, see here, here, here, and here). There are many reasons for problems with full vaccination programs: war, opposition to western medicine, and the inaccessibility of some parts of the northern Pakistan. But here is a reminder, that this is not a local problem. It looks like polio has reappeared in China after complete eradication. And it seems that it jumped from Pakistan. From last week's Science:

After more than a decade without a case, China is grappling with an outbreak of wild poliovirus. The Chinese Ministry of Health confirmed the disease in four young children in Hotan Prefecture, Xinjiang province, in western China, who became paralyzed between 3 and 19 July. It's another major blow to the Global Polio Eradication Initiative (GPEI), which had hoped to stop wild transmission of the crippling virus by the end of next year. 

Genetic analyses have confirmed that the newly detected type 1 virus jumped the border from Pakistan, where conflict and inhospitable terrain have hampered efforts to vaccinate children. Cases in Pakistan have soared to 72 this year, up from 39 this time last year. Just 2 months ago, GPEI's Independent Monitoring Board warned that Pakistan's epidemic could jeopardize the entire global effort. China will launch an emergency campaign to vaccinate 4.5 million children in the immediate area in early September, according to GPEI.

Hope it gets contained. 

On a related note, I just saw Contagion. It is quite good and apparently, quite realistic. An epidemiologist, Ian Lipkin, was their science advisor, and he spent 20 days on the set, making sure that things are portrayed in a realistic sense. Even the virus they concocted for the film has some roots in an actual virus that killed about a 100 people. In fact, check out his recent oped in NYT, The Real Threat of 'Contagion', about the movie and a very real threat of a global pandemic. It is not an amazing film, but quite decent. Go check it out.                        

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by Salman Hameed

Pakistan had successfully reduced the polio cases to 28 in 2005, down from 1155 in 1997. But now it seems that there is an increase again. Last week's Nature has a short piece on it:

Pakistan is one of four countries in which polio is still endemic (see 'Stubborn holdouts'), but with 144 confirmed cases in 2010, it is the only country in which polio is making a comeback. The worsening situation in Pakistan could put gains elsewhere at risk. "As long as there's polio in any one country it's a threat to every country in the world," says David Heymann, chairman of the board of the UK Health Protection Agency and a former assistant director-general of the WHO involved in polio eradication.

The issue of polio eradication is a worldwide issues, and if it holds out on one place, there will always be a chance for its spread again. It is unclear what is the cause of this resurgence in Pakistan again - but climate and population density are two of the issues mentioned in the article. Couple of years ago, there was also a reaction against vaccination campaigns in the northern areas of Pakistan - and that may have exacerbated the situation as well (see Between Fatwas and Polio and "Infidel Vaccine: Polio Vaccination Controversy in Pakistan). But now there are cases in other parts of the country as well. One of the new problems now in containing the disease may be related to the decentralization of the health ministry - and I hope this doesn't end up as a self-infected wound:

Pakistan's government has not ignored the problem. In January, the country rolled out an emergency action plan, with the goal of halting virus transmission by the end of 2011. The plan seeks greater accountability at all levels of government to boost immunization rates, and it calls for health officials to work with the military and local leaders in tribal areas to build support for vaccination. Frustrated with the lack of progress reported at the April meeting, President Zardari also ordered an investigation into recent polio outbreaks in Sindh and Balochistan, and formed a new oversight committee to keep him personally informed about eradication efforts.

Yet some fear that looming constitutional reforms could make it harder for Pakistan to exterminate polio. The country is set to devolve its Ministry of Health by the end of June, part of a long-delayed move to transfer more power to provincial governments. Bill Gates, whose Bill & Melinda Gates Foundation in Seattle, Washington, funds polio eradication programmes, has expressed concern about the changes directly to Zardari. Sania Nishtar, a health-policy expert who heads Heartfile, an independent health-policy think tank in Islamabad, worries that without a central health authority to coordinate international donors' efforts and vaccine procurement and distribution, Pakistan's polio campaign will suffer.

Read the full article here (you may need subscription to access it).

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Francis Collins has become an interesting figure for debates over science & religion. He is an outspoken Evangelical christian as well as the director of the National Institutes for Health (NIH), and his professional credentials are impeccable. After leading the Human Genome Project, he went on to write a book The Language of God. When Obama appointed him as the director of NIH, many questioned this choice - since Collins believes in at least some (past) religious miracles, and questioned if he should be in one of the most prominent posts for American science. I think this was a good choice purely from a professional view point. Now there is an interesting article about Francis Collins in last week's New Yorker. Apart from talking about the controversy over Collins' appointment and his journey to Christianity, the article also does a nice job of addressing the recent stem-cells ruling that has halted federal funding for embryonic stem-cells research. Hopefully, this ruling will get reversed, but the Congress may have to step in for this one. Here are some bits from the article about the reaction to Collins' appointment and about his upbringing:

When the geneticist Francis Collins was named director of the National Institutes of Health, last summer, he became the public face of American science and the keeper of the world’s deepest biomedical-research-funding purse. He was praised by President Obama and waved through the Senate confirmation process without objection. There also came a peer review of a sort that he’d never experienced, conducted in the press and in Internet science forums. Collins read in the Times that many of his colleagues in the scientific community believed that he suffered from “dementia.” Steven Pinker, a cognitive psychologist at Harvard, questioned the appointment on the ground that Collins was “an advocate of profoundly anti-scientific beliefs.” P. Z. Myers, a biologist at the University of Minnesota at Morris, complained, “I don’t want American science to be represented by a clown.”

Collins’s detractors did not question his professional achievements, which long ago secured his place in the first rank of international scientists. As a young researcher at Yale, Collins conceived a method of hastening the laborious process of hunting disease-causing genes by skipping across long stretches of chromosomes until the suspect gene’s neighborhood was located. As an assistant professor at the University of Michigan, in the nineteen-eighties, he and collaborators at the University of Toronto employed this method to find the gene that causes cystic fibrosis and, a year later, the genetic flaw responsible for neurofibromatosis. These breakthroughs brought him fame and, eventually, the job of director of the Human Genome Project, which promised to revolutionize medicine by identifying and mapping all the approximately twenty thousand human genes that code for protein.

... 

President Obama’s choice of Collins for the N.I.H. touched a nerve. The George W. Bush era had been an extraordinarily fractious time in public science, beginning with Bush’s first prime-time address to the nation, in which he announced restrictions on embryonic-stem-cell research. That move, and others that followed, convinced Bush’s critics that the religious right had become the final arbiter of public policy, an impression that Bush seemed little inclined to dispel. “Well, we thought we’d seen the last of the theocracy of George W. Bush, but it apparently ain’t so,” Dr. Jerry Coyne, a University of Chicago professor, wrote when Collins was appointed. “I am funded by the N.I.H., and I’m worried. Not about my own funding (although I’m a heathen cultural Jew), but about how this will affect things like stem-cell research and its funding.” 

A year later, Obama’s appointment of Collins seemed an inspired choice. The President had found not only a man who reflected his own view of the harmony between science and faith but an evangelical Christian who hoped that the government’s expansion of embryonic-stem-cell research might bring the culture war over science to a quiet end. On August 23rd, however, Judge Royce C. Lamberth, of the Federal District Court for the District of Columbia, halted federal spending for embryonic-stem-cell research, putting hundreds of research projects in limbo and plunging the N.I.H. back into a newly contentious national debate. 

At the N.I.H., the ability to deal with controversies, as a generation of Collins’s predecessors learned, matters at least as much as credentials; political combat comes with the job. Collins does not seem a likely combatant. His physical aspect—gray mustache and hair (cut in an early-Beatles mop top), thin-rimmed eyeglasses, and a distinct pallor—suggests a man best acquainted with a sunless existence in some laboratory. Yet, in a relatively colorless town, Collins has come to be known as something of a character, a model of geek cool. He likes big, noisy motorcycles, and, despite a mild manner, he is famously unself-conscious. At the unlikeliest moments, he will strap on a guitar and accompany himself in song, often a tune he has composed for the occasion.

Okay - I knew about his motorcycle, but not about his singing. But he has a quite an interesting background:

The man who holds the most powerful job in American science came from an unusual background. During the Depression, Collins’s parents, Fletcher and Margaret Collins, became part of a short-lived West Virginia project—sponsored by Eleanor Roosevelt, and with financial help from Bernard Baruch—that attempted to create an ideal community for a group of impoverished miners near Morgantown.

Fletcher was the project’s music director, with the mission of helping the homesteaders recover their cultural heritage. He had a gift for coaxing from the mountain people the nearly forgotten old fiddle tunes, folk songs, and square-dance calls that had been, he wrote, “very much in their blood,” but “layered over by coal dust.”

After the war, the Collinses bought a ninety-four-acre farm in the Shenandoah Valley, near Staunton, Virginia, determined to derive a livelihood from the land without modern agricultural machinery. They kept chickens, sheep, cows, and two workhorses, who pulled the plow and old wagon that carried the harvest from the hilly fields to the barn. The four Collins children, all boys, served as farmhands, collecting eggs, milking the cows, and shucking corn. When the alfalfa needed to be mowed and baled, amused neighbors would stop by with their tractors and help out. Once a week, the family drove into Staunton, where Margaret’s parents lived, and the boys had a bath; in the summertime, they bathed in the cow trough. After a few years, Fletcher took a position as drama instructor at the local women’s college, Mary Baldwin (“My cash crop,” he’d say), but the family was relatively poor. The younger boys wore their brothers’ hand-me-downs, and by the time the clothes reached Francis, the youngest, they were threadbare.

The Collinses’ household, known as Pennyroyal Farm, became the center of a vibrant arts community in Staunton. (It’s still thriving.) “Musicians would come and crash there for a couple of weeks because they’d run out of money,” Collins recalls. “They’d play great music, and then finally they’d move on.” Bob Dylan was among those who came to Pennyroyal. “Margaret and Fletcher were sort of hippies before there were hippies,” the singer Linda Williams recalls. “They were back-to-the-landers, and saw things the way people did in the seventies, only they’d done it in the thirties.”

For Francis, it was an enchanting, if arduous, childhood, part Boys’ Life and part Woodstock. He could set a barn door and knew how to predict weather by reading the sky over the distant Alleghenies. He did not see the inside of a schoolroom until sixth grade, because Margaret taught her boys at home. “There was no schedule,” Francis recalls. “The idea of Mother having a lesson plan would be just completely laughable. But she would get us excited about trying to learn about a topic that we didn’t know much about. And she would pose a question and basically charge you with it, using whatever resources you had—your mind, exploring nature, reading books—to try to figure out, well, what could you learn about that? And you’d keep at it until it just got tiresome. And then she’d always be ready for the next thing.”

Read the full article here. 

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This is a weekly post by Nidhal Guessoum (see his earlier posts here). Nidhal is an astrophysicist and Professor of Physics at American University of Sharjah

Let’s continue a bit with themes related to Ramadan (at least partially). The month is almost half over, and we are now well settled into a different lifestyle, especially with regard to eating habits. Our intakes (types and rhythms) have changed; our metabolisms have changed. In particular, consumption of meats and sweets has increased, at least in the places I am familiar with.

I don’t have any statistics on the consumption of meat in the Arab-Muslim world, and I am sure it varies between very low levels in famine-stricken and poor lands like Somalia, Niger, and Bangladesh, and extremely high levels in opulent and traditionally carnivorous places like the Arab Gulf. But I can offer two personal observations: first, the general populations of the Arab-Muslim world have largely increased their consumption of meat (this is due to the rise in standards of living and the greater and cheaper availability of meats), and secondly that some segments of the population, the more highly educated and perhaps western influenced groups, have lately started to shun meat or at least reduce their consumption of it; now vegetarianism has started to be discussed and even advocated. (According to Wikipedia, in January 1996 the International Vegetarian Union announced the formation of the Muslim Vegetarian/Vegan Society.)

Recently, in Jordan and in Egypt, advocates of vegetarianism participated in consciousness-raising events organized by the global animal rights group People for the Ethical Treatment of Animals (PETA). In the Amman, Jordan event, one lady covered herself with lettuce leafs and marched with others (see the accompanying picture, where the sign reads “'Let vegetarianism grow on you” – literally). Most interestingly to me is the fact that the lettuce-clad lady wears the hijab (the Islamic hair-covering dressing style). Although the activists tried to emphasize environmental and economic concerns and animal treatment issues, not to mention the presumably healthier aspects of vegetarianism, the general reactions to the PETA events were quite negative in both Amman and Cairo. The Arab world, it seems, is not quite mentally ready to embrace vegetarianism, and again we find religion to some extent related to this.

So, what about the religious perspective? Going vegan or vegetarian (the difference is not important here) is obviously a personal issue, one which each one of us should decide on one’s own, but as always in the Muslim culture, the “position of Islam” is often asked. And indeed, one finds in the “Ask the Scholar” section of IslamOnline, a Q & A on this topic in which one reads:

First of all, it should be clear that one should not think that it is better to abstain from eating meat, that doing so will be rewarded, or that being a vegetarian is closer to Allah than not, and so on. It is not permitted to draw closer to Allah in this way.

…

Dr. Muzammil H. Siddiqi, former President of the Islamic Society of North America, states:

“Allah has created some animals for our food as Allah says in the Qur'an in surat an-Nahl, 'And cattle He has created for you. From them you drive wont and numerous benefits and of their meat, you eat.' (An-Nahl: 5-8)

Muslims do recognize animal rights. Animal rights means that we should not abuse them, torture them and when we have to use them for meat, we should slaughter them with a sharp knife, mentioning the name of Allah. […]

So, Muslims are not vegetarians. However, if someone prefers to eat vegetables, then he is allowed to do so. Allah has given us permission to eat meat of slaughtered animals, but He has not made it obligatory upon us.”

Muslim advocates of a more vegetarian lifestyle insist that the issue is not a religious one and that it is a serious mistake to discuss it in terms of halal (permissible) and haram (prohibited). They further claim that Prophet Muhammad himself preferred vegetables and only rarely ate meat and that some of the great figures of Islamic history, particularly Sufis/mystics like Rabi`ah al-`Adawiyyah, were vegetarians.

Perhaps a compromise of moderation could satisfy everyone, or at least most people, from all perspectives: health, economics, environment, animal treatment, etc. And in the Ramadan spirit of remembering the poor and feeling their hunger and their needs, perhaps some of us should make a conscious effort to reduce our daily consumption of meat to a minimum and donate the difference.

See earlier posts:

Ramadan Aps, High-tech Islam

For a real Islamic Calendar

Ramadan by CCD

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Last week's Science has a review of an interesting book: Miracle Cures - Saints, Pilgrimage, and the Healing Powers of Belief by Robert A Scott. Instead of simply debunking them, the author takes a sociological approach to the topic and traces the reasons why people sought these cures, and, perhaps more importantly, why did they often feel cured. Yes, of course, the placebo effect is one of the reasons, but the books appears to go deeper than that:

Scott (Center for Advanced Study in the Behavioral Sciences at Stanford University) does not set out to debunk or substantiate these claims of miracle cures, but rather analyzes them from a sociological point of view. In this he succeeds. The book's first chapters set the stage in Christian Europe with detailed descriptions of medieval life, conditions of poverty, malnutrition, poor hygiene, and crowding. He suggests that these could have led to and fostered the many ills rampant in the population, which he surveys. Once the stage has been set, Scott introduces the characters in the drama: the saints to whom medieval people turned for help and salvation. There are several ah-ha moments in the book when these characters are seen through a sociologist's eyes. Thus, it appears that medieval Christians accepted as fact that there were certain things that saints could do and other actions that lay beyond their powers. For example, they could cure blindness but could not reattach a limb. Scott also deconstructs the system by which miracle cures and sightings of apparitions were disseminated. He likens that to a modern public relations campaign, in which it is always humans who do the disseminating. In comparing the process to our modern publicity machines, Scott does not disparage the system or the event, but simply analyzes the methods involved.

I think it is great that he places these in a historical context. And here is a bit about the reasons why people went on pilgrimages. I like all the range of motivations, and ultimately, it is of no surprise that people have diverse reasons for embarking on such a long journey:

The author similarly analyzes the why and what of pilgrimages: why would an individual undertake such a daunting task, when in those times going on a pilgrimage was no small feat, involving extensive preparation and considerable risk? Scott suggests a variety of motivations, which range from the serious (seeking cures for illness, escaping dire circumstances, the draw of the supernatural, and devotion to their faith) to the mundane: "an excuse to travel" or "the prospect of a partially subsidized vacation!" Such insights allow the reader to relate to the material and understand it in more personal terms.

After discussing the placebo effect, the author also looks at other reasons that may be responsible for a person feeling better:

This is not to say that Scott dismisses all such miracle cures as just the placebo effect. He devotes three chapters to discussing the effects of stress on illness, belief on healing, and the social world on both. These provide an excellent summary of the modern body of work that in recent years has elucidated not only that the mind and emotions have a very powerful effect on health and illness but also how this effect occurs.

Taken together, the structure Scott provides—outlining exactly how medieval pilgrims left oppressing situations and were then exposed during their journey to social support, clean water, and fresh, healthy food—makes a strong case for the effectiveness of the simple act of going on a pilgrimage as a healthy endeavor, which could have begun the course of healing. The added power of belief in healing, through the placebo effect and the many nerve chemicals and brain hormones released in such states, almost ensures that people who engaged in such activities would feel much better, if not be cured from illnesses that would today be considered "self-limiting" under the right circumstances.

Implicitly, Miracle Cures suggests that a parallel situation might be propelling some of the resurgence of modern-day seeking of spiritual solutions for physical ills. Although the physical conditions fostering illness in the developed world today are a far cry from those in medieval times, we are certainly exposed to a vast array of emotional stresses, which may trigger or worsen many illnesses. The power of belief and the lifestyle and social changes that go along with it may indeed assist many in their search for healing.

Okay, this books sounds very interesting. However, I hope the book also devotes some space to modern pilgrimages, where people get sick from exposure to germs and other diseases that their bodies are not used to. Some of the rituals associated with holy sites involve drinking water - sometimes sharing the pool with hundreds of people at the same time. Or a gathering like the Hajj, where each year 2 million people gather together from countries around the world. In modern times, are we also looking at pilgrimages as "anti-cure"?

Read the full review here (you may need subscription to access it). Also, if you are interested in these issues, you should definitely check out Tom Rees' blog, Epiphenom. 

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The name of Yanomamo is often associated with controversies in anthropology (see here and here). But for a change, here is a positive step being taken to repair some of the relations with the Yanomamo tribe: Researchers will return 40-year old blood sample taken from the tribe members. From Science:

Now, in an agreement being worked out by Brazil, he and others are pulling tissue samples out of storage and preparing to have them shipped back to the jungle.

Weiss says he accepted the vials years ago as a favor to his postdoctoral adviser James Neel, who was retiring and wanted them preserved. Along with cultural anthropologist Napoleon Chagnon, Neel collected the samples from the Yanomamö in Brazil and Venezuela during fieldwork in the 1960s and early 1970s, and they've been stored since then in labs around the United States. (Neel died in 2000.) Weiss and others will be releasing parts of their collections to the Brazilian Embassy in Washington, D.C., which in turn will escort them back to Brazil and the Yanomamö tribe. Venezuela has not asked for samples taken from its Yanomamö tribes, Weiss says.

The return marks at least the third time that an indigenous group has retrieved DNA or other tissue from scientists, suggesting a shifting landscape in genetics studies on indigenous people.

There are still some interesting problems associated with the return:

Researchers and diplomats alike want to ensure that the samples are safe and free of contaminants. That's easier said than done. The usual approach—heating material at very high temperatures—would cause the vials to explode. A suggestion to sterilize some samples with bleach was rejected, says Karen Pitt, special assistant for biological resources at the National Cancer Institute (NCI), which holds 477 vials. NCI is investigating the possibility of irradiating them. "We'd like to accelerate this," says Pitt.

Still, I think this effort is a step in the right direction. Yes, there was no "Informed Consent" procedure forty years ago, but now we do have stricter procedures in place - so why not follow them more consistently. Just a few months ago, I had posted about the contentious DNA research involving the Havasupai tribe. However, in general, it seems that scientists are becoming more sensitive to issues involving indigenous tribes and is pointed out in the Science article:

Scientists are increasingly trying to accommodate demands from indigenous groups. Three years ago, the Canadian Institutes of Health Research in Ottawa released new recommendations for aboriginal research requesting, among other things, that research be of benefit to the community, that researchers translate their publications into the language of the community, and that researchers get consent before transferring samples to a colleague.

"If you have a sample in your lab, you have been loaned it, you haven't been given it," says Laura Arbour, a medical geneticist at the University of British Columbia, Vancouver, in Canada who helped craft the Canadian guidelines. Arbour, who works with Canadian aboriginal populations, believes they should be treated as collaborators and shown drafts of papers prior to publication, something she routinely does in her own genetics work.

"I don't object" to this approach in principle, says Kenneth Kidd, a population geneticist at Yale University, but it would make research "a lot more difficult." He and his wife, Judith Kidd, have amassed 3000 samples from 57 populations over the years. It would be virtually impossible to find a nomadic tribe from whom samples were collected a decade ago and share a planned publication, he says.

I think the idea of shared publication is excellent! In any case, read the full article here.
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This is a guest post by Nidhal Guessoum (see his earlier posts here). Nidhal is an astrophysicist and Professor of Physics at American University of Sharjah.

As I mentioned in Part 1, the movie You don’t know Jack pushed me to rethink the question of euthanasia within myself, and I recalled the discussions I had had many years ago on the subject with Islamically knowledgeable people, so I went and did some quick search for Islamic positions on “mercy killing”.

I expected to find some diversity of opinion, or at least a few voices looking at the question from various angles; I was surprised to find virtual unanimity among Muslim scholars against euthanasia. More than that, I was quite astonished at the weakness of some of their arguments.

First, Muslim scholars insist that suicide is strongly abhorred and outlawed in Islam, that its punishment is eternal hell, and that one who commits it will be denied proper funeral service. (One finds no discussion on the possible reasons for a suicide; it is all rejected across the board.)

Secondly, the scholars stress the fact that human life is not only sacred in Islam, it is God’s “property” and prerogative, and no one is allowed to “interfere” with His will and authority over when it should end, the precise moment of death (“ajal”) being known to God exclusively. (I will leave aside the issue of God’s omnipotence and omniscience, to what extent excludes any human will, power, or knowledge, and how a mere human could “interfere” with God’s “property” or authority over something. I will, however, point out the contradiction with some of the Qur’anic verses that the opponents of euthanasia themselves often cite: 3:145 “No soul can ever die except by Allah's leave and at a term appointed” and 16:61 “and when their term [for dying] cometh they cannot put (it) off an hour nor advance (it)”. In other words, whatever you do regarding the ending of a given life, that’s what God will have programmed…)

Thirdly, one finds repeated talk about “endurance” (accepting and swallowing one’s pain), which is highly rewarded in the life after. And surprisingly, there is quite a bit of discussion about the extent to which the treatment of a sickness is (or is not) obligatory and in which cases, and one learns that most religious scholars consider treatment to be generally non-obligatory! (We’ll see later why this point is made and how important it turns out in the argumentation.)

More to the point, a hadith (statement by Prophet Muhammad) is cited, according to which “[in ancient times], there was a man who got a wound, and growing impatient (with the pain) he took a knife and cut his hand with it, and the blood did not stop till he died. Allah said, 'My servant hurried to bring death upon himself so I have forbidden him (to enter) Paradise.' "

And that is why one finds Muslim scholars (ranging from Ayatollah Khamanei to Saudi Arabia’s late grand mufti Bin Baz) quite unanimously rejecting any consideration for euthanasia and attempting to find justifications for that rigid position. Al-Qaradawi (probably the top Islamic jurist of today), who usually tries to present “reasonable” or “balanced” views, rejects “mercy killing” and allows only for “stopping medication” if it “happens to be of no use”, when the sickness “gets out of hand”… Quite surprisingly, Al-Qaradawi adds that “the physician can practice this for the sake of the patient’s comfort and the relief of his family”!

I was also pleasantly surprised to find that an Islamic Code of Medical Ethics had been produced in 1981 in the First International Conference on Islamic Medicine held in Kuwait, and in it euthanasia was addressed quite squarely. Among the relevant pronouncements, however, one finds: “The claim of killing for painful hopeless illness is also refuted, for there is no human pain that cannot be largely conquered by medication or by suitable neurosurgery...”; “A physician should not take an active part in terminating the life of a patient, even if it is at his or her guardian’s request, and even if the reason is severe deformity; a hopeless, incurable disease; or severe, unbearable pain that cannot be alleviated by the usual pain killers. The physician should urge his patient to endure and remind him of the reward of those who tolerate their suffering.”

Finally, in an interesting recent article published in an Iranian journal of medicine, Aramesh and Shadi (2007) present the orthodox views of Islamic scholars (Shiite and Sunni), but at the very end try to show some “flexibility” by pointing to two instances where “passive assistance in allowing a terminally ill patient to die” would be permissible under Islamic law: (a) “administering analgesic agents that might shorten the patient’s life, with the purpose of relieving the physical pain or mental distress”; (b) “withdrawing futile treatment on the basis of informed consent (of the immediate family members who act on the professional advice of the physicians in charge of the case), allowing death to take its natural course.”

The second “instance” is the same as what Al-Qaradawi mentions; the first, however, is an interesting one: basically, it says that if we are giving a patient some analgesic (e.g. morphine) with a dose that we know could result in death, then that is OK because we were trying to reduce the pain, not induce death…

What do we make of these views and arguments? While I still see some value in some of the arguments that can be brought to bear on the issue (sacredness of life, importance of not rushing to end a life just because it’s painful or distressing, difficulty in determining who qualifies for the life-ending action and when, etc.), I find many of the above arguments rather weak and forced. Many Muslim scholars, even when discussing this topic, start by stressing that “Islam is a religion of mercy” but then ignore this aspect of the issue altogether. No careful examination of the various cases and situations is made (at least not in the references I read). And I have difficulty with the logic of “you can stop the treatment, knowing it will result in death”, and “you can disconnect life-support systems if the brain is dead or the person has no chance of recovering” but you cannot inject the patient with anything that will induce death even if s/he is mentally and physically unable to function. Of course, I understand that this reasoning is built upon the earlier premises of: (a) we can’t decide to end a life, because that’s prerogative; (b) we can let a person die (on his/her own) if it seems that it is God’s will (terminal illness); (c) treatment is not obligatory…

Our modern life, with its science and other societal developments, has brought new perspectives on issues that need careful, critical, and open-minded reexamination. Rigid standpoints will not do, for there will always come situations that will render them absurd, or at least unreasonable. This does not mean one should just accept any new philosophy or position that is advocated by various voices or groups, but careful, honest, and positive thinking will always do us good.

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This is a guest post by Nidhal Guessoum (see his earlier posts here). Nidhal is an astrophysicist and Professor of Physics at American University of Sharjah.

A few days ago, I watched You don’t know Jack, Barry Levinson’s riveting biopic about Jack Kevorkian. “Dr. Death”, as he was often referred to in the eighties and nineties when he came to national attention and prominence, is brilliantly played by Al Pacino, in one of his best-calibrated performances, never showing you his acting.

Most readers will know, but perhaps some people from outside of the US may not, that Dr. Kevorkian advocated and practiced euthanasia. Within a span of about a dozen years and until he was convicted and imprisoned, he assisted some 130 people (not all of them his own patients) in ending their lives, in the process going through a dozen trials, each time getting a not-guilty verdict by showing video recordings proving that it was the patient him/herself who (literally) pulled the plug (or released the chemical that would stop the heart). He was still not satisfied, however, and in his last case, wanting “a national debate” (as he put it), he found a case where the patient could not pull the plug himself, and so he did it for him, forcing the prosecutors to accuse him of murder.

I remember the national debate, or at least the extensive media reports (including ‘60 Minutes’ and Barbara Walters) in the US in the eighties and nineties, witnessing some of it while I lived there and some of it after I left. And I remember once striking a discussion on Euthanasia and Islam with some knowledgeable friends of my father. I remember that they all rejected the whole idea of “mercy killing”, focusing on the “killing” and ignoring the “mercy” part. One of them then told me “not only is it totally haram for anyone to decide to end a life, even one’s own, at any given point in time, one must never despair that God can relieve any suffering and cure any disease…” I remember thinking “well, sorry, but as a scientist it is difficult for me to rely on miracles when I see a body disintegrating and a person suffering”, but I could not argue much.

Now, for me the movie was remarkable because it very subtly allowed me to see various aspects of the issue. There was no question, at least in my reading of it, that the movie stands on Kevorkian’s side. It goes to great lengths to show the suffering and the desperate pleading of the patients for ending their agony. It shows various cases: terminal cancer, Lou Gehrig’s disease, multiple sclerosis, Alzheimer’s, etc. It shows us the physical and psychological pain and trauma of both the patient and their loving relatives (spouses, in particular). And most of all, Kevorkian, shy, never married, totally introverted, and always believing himself to be right, is very eloquent in defending his total conviction of the validity and humanness of euthanasia, essentially presenting it as a medical service and focusing solely on the suffering and mercy aspect of the issue. The movie also does not hide his atheistic standpoint and highlights the religious motivations of his detractors.

But the more interesting part for me was to see that the movie, somewhat subtly, also shows that the decision as to who “qualifies” for euthanasia – and when – is never an obvious one. At some point, when the character played by Susan Sarandon says to Kevorkian “we need to talk” (which was euphemism for “I want to ask you for euthanasia”), he replies “oh, you’re not there yet”. In fact even in the scene (sorry for the spoiler) where he is about to assist her in the act, she appears to have no suffering at all, she is far from being debilitated (physically or psychologically), they spend quite a moment talking about themselves and some episodes in their lives; one never gets the conviction that this woman needs to be “let go”…

In some other cases, one could see that the patient has great difficulties in living (due to Alzheimer’s or sclerosis), but one does not see the urgency of ending the life; indeed, with the (strong) pain relievers or other, stronger action, one could imagine this person’s difficult life continuing, though undoubtedly with some hardship. And when we see the sadness in the eyes of the spouse or children when the person is about to “pull the plug”, one wonders if this is really – at least in such non-extreme cases – the appropriate solution.

The movie certainly forced me to think more about the pros and cons of euthanasia. I thought again about the (few) discussions I had had on the issue many years ago. I decided to go read about the Islamic views on the subject.

In the second part of this piece, I will be relaying what I found of Islamic positions with regard to euthanasia, including from top scholars/authorities like Sheikh Al-Qaradawi and references like “The Islamic Code for Medical and Health Ethics”. Here I just wanted to present my reactions to the Kevorkian movie. I remain torn between, on the one hand, the extreme suffering of some patients, with the need to show compassion and mercy, sometimes requiring the ending of a life, and between the difficulties in reaching such a decision due to the spectrum of possible cases and situations, the psychological cost of the act, and the religious views (sacredness of life, in particular) that many hold and that one needs to take into consideration.

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