Sunday, September 27, 2009

My Eureka! Moment

It was a eureka moment eighteen years in the making. Two years ago, a wealthy man made me a proposal I could not refuse. A family member with an inherited neurological condition was my patient. She suffered from a disease that I had been researching for a number of years. He wanted to help move the research forward and asked me to give him a far-reaching, long-term research plan and he would fund it. I came up with a seven year plan to create a "center without walls" with the aim of bringing together researchers with complementary expertise to work collaboratively on this project. He agreed to the plan and committed several million dollars to the project. It was an unusual proposal. Most scientists would have opted for a project that would keep all of the money at their institution. That was never a consideration for me as I thought that the quickest and most efficient way to move the science forward was to tap into already existing expertise elsewhere rather that try to recreate it locally.

Scientific research is a cutthroat business full of back-stabbing, petty jealousies and over-inflated egos. It is these attributes that often get in the way of scientific advancement and make successful collaborative research a rarity. The medical sciences are no exception. Therefore I had to choose my partners carefully. In addition to being good scientists, they must be willing to leave their egos at the door. I partnered with a Dutch scientist whom I had known for some time. He not only had the scientific talent, but he also had the temperament that I was looking for in a collaborator. A year into the project, we extended the collaboration to include a scientist in Seattle.
Last week, we gathered to go over the data generated in the first two years of the project. I knew this would be a good meeting. When careful scientists not usually given to hyperbole and exaggeration tell you that they are "very, very, excited...", you cannot help but get giddy. When all the data was presented, the members of the scientific advisory board overseeing the project were stunned. Several independent lines of evidence all pointed to one mechanism for this disease. For eighteen years since the initial discovery of the genetic defect, there were several competing theories about what was happening at the cellular level to cause this disease. With the data presented last week, all but one remains, and that last one is now backed by solid evidence.

Of course it is not the end of the road. It will be years before we have an effective treatment, but we finally have a target to go after and the technology to eventually reverse the effects of this sometimes devastating neurologic condition. For me, as a clinician, I can now for the first time offer my patients hope and truthfully tell them that we understand their disease and that we are working on a treatment.

My next eureka moment will come when I can look my patients in the eye and tell them that we finally have a treatment.

Sunday, September 13, 2009

Blogging Against Fossilized Thinking التدوين ضد التفكير المتحجر

Fossilized thinking inflicts people who rigidly adhere to an ideology, be it religious, political or philosophical. Lest anyone misrepresent my post, let me say up front that when it comes to religious fossilized thinking, no religion is immune to fossilized thinking. Fossilized religious thinkers:
  • Consider everyone who does not think like they do an enemy and legitimate target for conquest or elimination.
  • Deform the faith they seek to defend because they are more concerned with process and ritual than with the true content of their faith.
  • Take the spirit out of spirituality.
  • Are happiest when everyone looks dresses and acts exactly like they do; like identical preprogrammed, unthinking automatons.
  • Stifle creativity, ingenuity and critical thought.
  • Foster intolerance and conflict.
  • Will create an intolerably boring world, should they gain the upper hand

Several years ago I told a wise friend that I was considering sending my daughter to the local mosque for weekly religious lessons but was concerned that she will taught by and old shaikh with fossilized ideas. On the contrary, he said, the older shaikhs tend to be more moderate and reasonable, it is the young ones who think they have all the answers that I should be concerned about. And therein lies the problem; it is the large number of young people who seem to be going from green to fossilized that is a source of concern for the future.

Tuesday, September 08, 2009

Along the Karakoram Highway

Pakistan today occupies the front and center the global media's attention. Pakistan is also on my mind. You see, for the past several months, my younger brother has been in Islamabad working for an international organization. I worry about him, but not excessively; we've lived through more dangerous times in Beirut of the early eighties. In one of those ironic twists of fate, twenty years ago, it was my father who was posted in Islamabad and worked in the same office complex where my brother now works.

During my father's tenure there, I visited several times and came know and like this complicated and troubled country. During one visit, I went on road trip in the company of an Argentinian photographer and Mustafa, an Argentine Sufi convert. We drove West to Peshawar, then teeming with Afghan refugees as well as plotters and schemers of all stripes. We continued to the North West Frontier province and the lovely Swat valley, now ground zero for the Taliban insurgency. It is in the Northern reaches of the Swat valley that you realize how complex this country is. All you have to do is look at the people passing you by to realize the multiplicity of distinctive features and distinctive clothes that mark the various ethnicities, tribes and sects that share this land at the crossroads of China, the Indian subcontinent, and central Asia.

But perhaps the most memorable journey was flying up North to Gilgit, at foothills of the Himalayan chain at the juncture of the Hindu Kush mountains and the Karakoram chain, and then driving the incredible Karokaram highway all the way to the border of China. Recently married , the trip was a gift from my parents to me and my wife.

The first inkling that this was no ordinary place was the view from the window of the PIA turboprop flying us from Islamabad to Gilgit. At cruising altitude, we were flying below the peaks of the mountains that surrounded us from all sides. After a night in Gilgit, the birthplace of polo, we set out on the Karkoram highway. The highway itself was an engineering feat that took fifteen year to complete and the combined efforts of Pakistani and Chinese engineers. It runs 848 Km to the border of China at the Khunjerab pass, the world's highest paved mountain pass at 4703 m. We head North in a jeep with open sides, on narrow roads often hugging deep precipices, across raging rivers on hanging bridges and with baited breath across rock slide zones. The Karokaram highway is notorious for rock slides. Upon emerging unscathed from a rock slide zone, a sign exclaims "Alhamdulilah". All fears, however, are quickly forgotten as the most stunning scenery unfolds in front of our eyes. The sheer scale of the place is breathtaking and the views otherworldly. You are surrounded, in all directions by peaks that are six and seven thousand meters high. The landscape goes from stark moonscapes to , within minutes around a bend in the road, lush green valleys with terraced gardens and orchards pregnant with apples, peaches and apricots spread amid humble villages; it is as if you'd died and gone to heaven.

The Hunza valley is one such place. We stopped for the night in the town Karimabad nestled on a rocky ridge across the valley from the mighty Rakaposhi mountain with its peak, at 7788 m, showing just above the clouds. We are the only customers at the Karimabad resthouse that evening. The family that runs it goes into a frenzy of activity when they learn that we haven't eaten and within an hour two huge platters of rice pilaf with chicken and meat materialize, enough to feed a family of ten.

The people of Hunza valley are predominantly Ismailis and are known for their peaceful demeanor. The also benefit from the generosity of the Agha Khan Foundation. Each humble village has a decent looking school and a medical clinic courtesy of the Foundation. We continued along the Karakoram highway for the next day encountering equally majestic scenes, past the Batura glacier and shortly before arriving to the Khunjerab pass, to the east, we glimpsed the mighty K2 at a distance, the worlds second highest peak at 8611 m, straddling the border of China in Pakistan. At the Khunjerab pass car and buses stopped and passengers descended inhaling the thin air and taking measure of the place. The pass, after all, sits astride of the old silk trade route travelled by Marco Polo in the 13th century but before him by the Chinese Monk, Fa Hien in the 4th century and the Iranian historian and scientist, Al Biruni in the 11th century.

Twenty years on, no other place we have visited measures up to what we saw along the Karakoram highway. And on the evening news, when Pakistan is reduced to a one-dimensional cutout about terrorism and extremism, I remember a very different Pakistan.
Photos by AK:
1. View from flight to Gilgit
2. Rakaposhi peak and Hunza valley
3. Karimabad
4. Chatting with the elders of Karimabad (I am in the blue T shirt)
5. Mountains around Gilgit
6. K2 top left of photograph

Friday, September 04, 2009

Don't Touch This!

I had been working on a post expressing my disappointment with the content of much of the Syrian blogosphere when I saw this today: A campaign to combat masturbation! Need I say more? I almost fell off my chair!! Is this for real? I guess I was not aware of the masturbation "epidemic" that has hit Syria’s youth.

I am still trying to understand what the impetus was for this campaign. Are there no other more pressing righteous causes? How about poverty, gender discrimination, honor killings, the absence of civil liberties and the absence of freedom of expression among a long list of societal ills. Don’t these deserve more immediate attention than a practice that is the realm of the personal and affects no one else?
(Prophylactic T Shirt: works best with MC Hammer's "U Can't Touch This" playing in the background)