Sunday, January 27, 2013

Suffering and Sovereignty

I was saddened to hear today of the large fire in a Brazilian nightclub last night in which 233 people died.  These tragic events occur every few decades; within my living memory there was the Beverly Hills Supper club fire (in Kentucky) in 1977 where 165 people lost their lives and the Station Fire (in Rhode Island) in 2003 resulting in the deaths of 100 people.  However, the largest such fire occured many years ago a few blocks from where I did my General Surgery residency.

The Cocoanut Grove was a large nightclub located just south of the Boston Commons and Gardens.  It was in 1942, November, nearly a year after the beginning of World War II.  As in most of these fires, when investigators look into them they usually find two things, a crowd over the legal capacity of the building and code violations.  It is estimated that the night of the fire, more than a thousand customers were packed into a building rated for 460 occupants.  There were many flammable decorations throughout, and the fire consumed the building rapidly.  The exact cause is not known, although a busboy may have struck a match that ignited an artificial palm tree as he tried to see in the dark to change a light bulb that he had dropped.  As panicked customers sought to get out, most tried to escape the same way they came in, through the front entrance which was a single revolving door.  They rushed both sides of the door, preventing it from rotating in either direction.  Other exits were bolted shut and a large plate glass window was boarded up.  Other doors that could have been used opened inward, which were jammed as people tried to rush out.  The firefighters had the fire out in about an hour. Four hundred and ninety-two people died.

Many of the victims were taken to the Massachusetts General Hospital, not too far away.  I did my residency there beginning in 1985, and there were still some older surgeons there who remembered the fire and its aftermath.  There were new and experimental treatments that were tried.  Up until then, the standard treatment for burns was tannic acid, which created a scab-like crust to serve as a barrier to infection.  However, physicians at the MGH used petroleum jelly and gauze, which was much gentler to the damaged tissues.  Sulfa was the only real antimicrobial treatment widely available at the time, but the medical teams were able to get hold of some penicillin as well.  Blood banks and transfusions were in their infancy, but were utilized to help the surviviors. 

The seventieth anniversary of the fire was last November 28th.  In October, the Boston police department released the transcripts of the witness interviews, and below is a link to that site, where you can hear in their own words the survivors tell of that terrible night.  Today, the site of the Cocoanut Grove is a parking garage, part of a hotel complex. 

It is always difficult for us to take our human tragedies and understand where they belong in God's sovereign plan.  Many believe that God is absent or uninvolved with these events.  We struggle to see His hand in the events that cause so much suffering.  I would not even begin to try and explain why God allows suffering.  In fact, in my new book, Surviving the Suffering, I go to great lengths to not tackle that problem.  Many people, much smarter than I, have tried to sort that out over thousands of years.

There is precedent for God using fire to destroy the wicked, as he did in Sodom and Gomorrah (Genesis 19), but I do not believe that is true of these fires.  We live in a fallen world, where imperfect people sometimes do things that lead to tragedies.  There were many mistakes made in the Cocoanut Grove disaster, from overcrowding to flammable decorations to blocked exits.  God knew of all of these, as He knew that the busboy would drop the lightbulb in the dark.  I am not so cynical as to believe that the only purpose God had for that fire was to lead to better fire codes.

These tragedies have a Godly purpose that we will not understand in our lifetime.  Joseph was sold into slavery, and falsely imprisoned, only to become the leader of Egypt years later.  The famine that struck the region led to the Israelites moving to Egypt under Joseph's protection, where they would grow in number and "were fruitful and increased abundantly, multiplied, and grew exceedingly mighty" (Exodus 1:7).  However, it took brutality on the part of a new Pharaoh and his taskmasters to make the Israelites desire to return to their land.  "And they made their lives bitter with hard bondage" (Ex 1:14) led to "Then the children of Israel groaned because of the bondage, and they cried out" (Ex 1:23).  These cruelties, slavery, imprisonment, famine, and brutality, were tragedies that led to the foundation of Israel in the Promised Land. 

As individuals, we must try and examine our lives to see what God is doing with us and for us when we suffer.  He has a plan for each and every one of us.  We may not understand God or His ways, and to try to dissect out His sovereign will would be like the paramecium looking back up from the microscope to analyze the person on the eyepiece.  What we do know, however, is the Word that He has given us, and those things He has told us are as immutable as the physical laws of the univese.  We know that He works all things for good to those who love Him (Romans 8:28), and He hears us in our suffering.  As for the Israelites in Egypt, "So God heard their groaning, and God remembered his covenant with Abraham, with Isaac, and with Jacob.  And God looked upon the children of Israel and God acknowledged them."  We cannot know the Master Plan;  we must be certain that we know that He hears us, loves us, and cares about us. 

1.  http://archive.org/search.php?query=cocoanut%20grove%20fire%20AND%20collection%3Aamericana

Sunday, January 20, 2013

What's Your Life Worth, Anyway?

In thirty-eight states in America, if a driver runs into another car driven by a pregnant woman, and the fetus is killed, the driver can be charged with "vehicular feticide" and generally face the same penalties as for any vehicular homicide.  These thirty-eight states have fetal homicide laws in their statutes; in twenty-three of those states, the laws apply to any stage of pregnancy.  In these cases, the law looks at the death of the fetus as a crime against the pregnant woman.  But what if the woman was driving to an abortion clinic to terminate her pregnancy?

Here we see the inconsistency of thought when it comes to defining the value of a life.  In the case of the fetal vehicular homicide, the life is as valuable as any when deciding the penalties.  In the case of the abortion, it is not a homicide but a "choice" guaranteed by "privacy."  In an effort to resolve some of these confusing issues, there are movements around the United States to establish Personhood Amendments in state constitutions, which will define exactly what a "life"is.  I applaud the efforts to these groups to both define life and to value it.  However, I am somewhat pessimistic about the outcome.

It will be virtually impossible to overturn Roe versus Wade, the U.S. Supreme Court decison that forty years ago established the right to abortion in this country.  The Supreme Court decided only nineteen years later in Planned Parenthood v. Casey that those rights were firmly established and could not be overturned.  A Personhood Amendment challenge has not yet made it to the Supreme Court; they refused to hear a case from Oklahoma last year.  Time will tell if a state can successfully get an amendment passed, but I do not see the Supreme Court allowing such an amendment to curtail abortion rights in the United States.  There are hopes, however, that it will increase the awareness that the fetus is a person with rights. 

Where I am even more pessimistic is how we will value life in the future.  It may be that the fetus can be declared a person, but a person will not be worth very much, with a life of little value.  We see the declining value of life at the other end of the spectrum, with the progression of assisted-suicide and euthanasia laws around the world. 

We must make sure that we use our terms correctly as they are frequently confused.  With physician assisted suicide, the physician gives the patient the medicine, which they then administer to themselves.  With euthanasia, the physician administers the medication, a lethal injection.  Euthanasia comes from the Greek "eu," meaning "good,"  and "thanatos," meaning "death," so it means a "good or happy death."  The word did not assume its modern meaning of mercy killing until the mid 1800's.

Physician assisted suicide and euthanasia are legally in use around the world.  We would like to think that if people are going to wrest the decision of the time and manner of a person's death from God, that it will be a rare decision made only in the most dire circumstances and that certainly the person whose life is ended prematurely will be involved in the decision.  Sadly, that is not the case.

Last December, we hear from Belgium of two twins, born deaf, who were devoted to each other.  They had lived their lives together, and now at the ripe old age of forty-five learned that they were also losing their eyesight.  They decided that was intolerable, and so, even without a terminal illness or unbearable pain, requested to be put to death.  Marc and Eddy received their lethal injections on December 14, and the doctor/executioner remarked that it was, "very serene and beautiful."  Belgium, along with the Netherlands and Switzerland, allow physician assisted suicide in non-terminal cases.  Belgium is also looking at getting laws passed that would allow for euthanasia in those with dementia or children with disabilities as long as the other family members give consent.

Certainly nothing like that could happen in any other civilized Western society, right?  But in the United Kingdom, with the National Health Service that gives them so much pride, there is the "Liverpool Care Pathway."  When the health care team decides that you are "dying," then you can be put on the Liverpool Care Pathway, wherein food and water and medicines are withheld as part of palliative care.  Approximately 130,000 people a year are put on the LCP, but it turns out that of the patients who are conscious, about half of them are never told that they are on the fatal pathway, and in one-third of the cases, the families are not told.  The NHS is divided into "trusts" which provide the health care for a geographical region, and they can save a lot of money by prematurely ending the lives of those with illness (usually within 29 hours!).  In fact, the trusts received 30 million pounds to put more patients on the Pathway. Still, British Health Secretary Jeremy Hunt says that, "It's a fantastic step forward, the Liverpool Care Pathway, and we need to be unabashed about that," and that it shouldn't be discredited if something went wrong in "one or two cases."  And, "Lots of people...want to die in a dignified way."

So far, euthanasia is illegal in the United States, but physician assisted suicide is legal in Washington, Oregon, and Montana.  Other states are looking at adopting it.  Yet I am unable to find anywhere in the Bible a passage on death with dignity.  It is a concept of modern society, and in my new book, Surviving the Suffering, I discuss this at more length in the chapter, "Suffering at the End."  It is interesting that often the same people that advocate death with dignity are also the ones who are in favor of abortion.  I can't think of a less dignifed way to die than to be scraped and torn apart while in the womb. 

1. http://www.ncsl.org/issues-research/health/fetal-homicide-state-laws.aspx
2. http://www.huffingtonpost.com/2013/01/14/marc-eddy-verbessem-belgium-euthanasia_n_2472320.html
3. http://www.dailymail.co.uk/news/article-2255054/60-000-patients-death-pathway-told-minister-says-controversial-end-life-plan-fantastic.html



Sunday, January 13, 2013

A Leavened Society

(Today's discussion will get rather technical; I will try and simplify things as much as possible, and I apologize for its length.)

 Our body is made of many different kinds of cells, all interconnected with each other and grouped into structures like bone, skin, and organs.  Our cells grow and divide, and eventually age, die and must be replaced.  To survive, our cells must receive nourishment and oxygen, which they do from our circulating blood.  If you remove cells from the body, they die.

Likewise, we age and die as well.  However, in certain circumstances, cells can be grown in a culture, like bacteria.  There is no circulating blood with oxygen, but the cells are supplied oxygen and nutrition in their culture media.  In fact, with a little genetic rearranging, you can keep cells alive forever.  The scientists call this "immortalizing."

The scientists do all kinds of tests on these cells, running all manner of experiments.  They can test drugs and vaccines, and they can even transform these cells by infecting them with viruses, a process called transfection.  Then these immortal cell lines, artificially kept alive as cultures, can then begin producing all sorts of new proteins.  The possibilities are endless, and some of these new proteins can then also be used to do experiments.  These cell lines have names, and some of these names are just letters and numbers.  One of the most common cell lines in use is named HEK-293.  This cell line comes from kidney cells obtained by a Dr. Alex van der Eb in 1972, and it was transformed by infecting it with an adenovirus by Dr. Frank L. Graham in his 293rd experiment.  This cell line has proven to be durable and easy to manage; you can buy a batch for less than $500.00 on-line.

When those of us in the medical profession wish to look up journal articles, we commonly use PubMed.   A search of PubMed shows about 5,000 articles describing experiments using HEK 293 cells.  I imagine that there is not a single medical school that isn't using them for medical research.  HEK 293 and other cell lines are routinely used to test and develop vaccines.  Now, industry has begun using them in product development research.  They are everywhere.  Of course, the original HEK 293 cells died decades ago; these are their descendants.  Like Abraham's descendants promised to him in Genesis 22:17, "as the stars of the heaven and as the sand which is on the seashore."

The "K" in HEK, of course, stands for "kidney."  The "H" stands for "human" and the "E" stands for "embryonic."  You see, the original cells for this immortal cell line came from an abortion performed in Holland in 1972.

In the Old Testament, yeast or leaven was often symbolic for sin.  And in Galatians 5:6, Paul asks, "Do you not know that a little leaven leavens the whole lump?"   A small amount of sin can diffuse and permeate throughout a church or a society.  That sin of abortion forty years ago has now resulted in cells that are used throughout our research facilities here and around the world.  Currently, there are outcries against Pepsi and calls for boycotts, because they have contracted with a company (Senomyx) that uses the HEK cell line to manufacture a taste receptor protein that can be used to test flavor additives.  When you drink a Pepsi, you are not drinking any proteins that were made by those cells, but perhaps some of the flavor ingredients were tested against proteins made by those cells. 

I guess a boycott of Pepsi could in theory serve a couple of purposes.  One logical chain would go something like this:  If you boycotted Pepsi, then they would stop doing business with Senomyx, who then would stop using HEK 293 cells, and somehow this would discourage everybody from using them, and then there would be no demand for HEK cells so perhaps that would pressure researchers into not obtaining cells from aborted fetuses and that would decrease abortions.  Although I am opposed to embryonic stem cell research (these come from embryos that were created for in vitro fertiliztion and then destroyed), it seems to me there are too many links in that chain between Pepsi and the pregnant woman who decides to abort her baby for a boycott to have much effect.  It may be, however, that a person who does decide to boycott Pepsi may simply be making a statement of conscience: "I don't want to use a product that has been tested on cells that came from an abortion."
But the leaven has leavened the whole lump.

So far, we have just been talking about one cell line, HEK 293.  But there are many more in use.  If you have been vaccinated for measles/mumps/rubella, chickenpox, hepatitis A, smallpox, or the shingles, your vaccine used a cell line from an aborted fetus in its development.  Likewise for any of your children who have yet to be vaccinated.  Millions are likely alive today because of research done using cells from babies that were killed in the womb. 

And aborted fetus cell lines are being used in the development of cosmetics, for things such as wrinkle creams and treatments for age spots.  It is going to be hard to find out in each and every food, medication, vaccine, or cosmetic if one of these cell lines was used at some point in its development.  Kraft and Nestle use Senomyx;  Campell's Soup used to, but quit.  So if you eat any of their soup, you can be comforted by knowing they don't work with Senomyx anymore, but the taste of your soup was developed using aborted fetal cell technology.  And many more products and medicines are in the works. 

I guess I am mostly off the hook.  I don't drink Pepsi, for I am a Diet Coke addict.  My vaccines were fifty years ago, before the HEK 293 baby was aborted.  And I don't wear make-up.  But the leaven has spread far and wide.

About five years ago, I developed an overwhelming infection due to pneumonia.  I was rushed to the hospital barely conscious and with no measurable blood pressure.  I was rescuscitated in the emergency room and sent to the ICU with three different medications to support my blood pressure.  I also received a fourth medication designed to fight the shock that comes from the toxins released by the bacteria that were causing the infection.  Within a few hours, my condition stabilized, and with those medicines and antibiotics, the pneumonia was controlled.  I remained on the fourth medication, drotrecogin, for four days, which continued to reverse the shock and circulatory collapse.  Without it, I would likely not have survived.  I would not have imagined leaven was involved.

Drotrecogin was made from HEK 293. 

Thursday, January 10, 2013

iSurvivingtheSuffering

We are pleased to announce that Surviving the Suffering has now been successfully released and is available as a download e-book in the Apple Bookstore for those of you who would like a version for your iPad or iPhone.  Of course, it is also available for the Kindle from Amazon or Nook from Barnes and Noble.  (These are not available for an author signature, however; only print books from the website can have an inscription made out to you.)

Monday, January 7, 2013

The Big Day

Tomorrow marks the offical release date for Surviving the Suffering.  The book will be available in print and e-Book versions on Amazon and Barnes and Noble.  The publisher will now begin the process of introducing it into stores.  Many thanks to all of you who have supported the book.

Sunday, January 6, 2013

The Christmas I Didn't Want

Many months ago I began planning a surprise Christmas for my wife.  The groundwork for this gift had actually taken several years to arrange, but only over the last half of the year could I see it coming to fruition.  I frequently lay awake at night, planning for Christmas Eve, and how I would present her the surprise, and imagined her stunned reaction.  I began looking for special gift boxes.  I planned an evening meal for after church.  This was going to be the best Christmas, ever.  One we would talk about for decades to come.

Without getting into great detail, events unforseen arose that forced my hand.  Circumstances in our life meant that I had to tell her about the gift several weeks before Chistmas.  Broken-hearted that I would have to reveal my surprise early, I reluctantly presented her present to her one weeknight.  She was indeed thrilled, but it certainly lacked the overwhelming punch it would have had on Christmas Eve.

Then she got a cold and was sick for a week.  Then she got well and I got sick with the same cold for a week.  Then she got the flu and was sick for two weeks.  Then I got the flu and was sick for two weeks.  Christmas came and went, celebrated with antihistamines, decongestants, and cough syrup.  New Year's passed, and we slowly began pulling out of the viral fog that had enveloped us.  Hopefully, we coughed our last coughs this weekend.  Although we survived the microbial suffering, it wasn't the Christmas that I wanted for us.

Somewere in all of this planning and rehearsing and scheming I had lost sight of what Christmas was supposed to be.  You would think that I would know better after fifty-three Christmases.  Yes, we worshipped our Saviour Christ Jesus, and acknowledged the anniversary of His birth, but I was so focused on what I wanted to do, what I wanted to accomplish, the experience I wanted to share that when things didn't work out the way I desired, I was disappointed. 

I don't imagine Joseph fantasized about dragging his very pregnant young wife from Nazareth to Jerusalem to deliver their first child, only to have to lay Him in a food trough somewhere because they couldn't get a room.  (A manger is actually an open feeder for livestock, not a stable.)  I am sure that as they planned early on in her pregnancy, he imagined that they would share in the birth of their child in Nazareth, surrounded by family and friends, in more comfortable surroundings.  Only later did Caesar decree that a census would be taken (Luke 2:1).  So the birth of Christ, the first Christmas, was not a propitious one.  And how many countless others have spent Christmases in unfortunate situations?

I would have been better served to have never lost sight of the eternal blessing we have received by the gift of Jesus to us by the Father that first Christmas.  There is nothing on this earth that I could possibly acquire,  no treasure I could amass, no gift I could give to my wife that could come close to the gift of Christ that we remember at Christmas.  Even if we spent one of our lifetimes to devise it, what could we possibly give to another that would last for eternity?  When we celebrate Christmas, the package that we open is our own soul, destined for heaven forever in peace with the Maker of all good and great things. 

And although I didn't get to pull off the "perfect" Christmas, my wife and I are blessed in so many ways that to feel disappointment is to be ungrateful for that perfect gift we have already received.  Nothing that I could give her did not first come from the graciousness and good will of the Father.  As James said in 1:17 of his epistle, "Every good gift and every perfect gift is from above, coming down from the Father of lights, with whom there is no variation or shadow due to change."  My Christmas gift to my wife was only possible because of the generosity of the Lord.

So we were still blessed at Christmas, and rejoice at a loving Father, the source of all perfect things, and the gift of His Son, the perfect gift.  Still could have done without those viruses, though.