Research proving cannabis kills cancer cells safely has been suppressed since 1974


Watch: Incredible Microscopic Footage Of Cannabis Oil Eliminating Cancer Cells

 Remember the hassles Rick Simpson went through in his Canadian Nova Scotia town trying to bring the cannabis oil cures he and others used to cure themselves of various cancers? Rick assumed the world was ready for him to share the good news from his and his townspeople’s experiences.

After several attempts to get cannabis oil allowed through the court system with many testimonials from those who had been helped, Rick realized this important harsh reality: The cancer industry does not want a cure for cancer.

cancerpot

He was growing the hemp on his land, making the cannabis oil, and sharing it without cost to those who had needed it after curing his skin cancer and a fiercely intense neurological post concussion disorder from a head injury that pharmaceuticals only exacerbated. The townspeople were cured of several disorders, including lung cancer. All of them had been failed by mainstream medicine.

Rick removed himself from Canada and exiled himself to Amsterdam, Netherlands, at first. Now he tours the world spreading the wonders of cannabis healing to whomever is willing to listen.

You can view his full length documentary. URL:https://youtu.be/YuQVeeZki_E

 The Constantly Disappearing Cannabis Research from 1974

In 1974, the NIH (National Institutes of Health) funded the Medical College of Virginia to prove that cannabis hampers the immune system and destroys brain cells. This was research ammunition that the DEA (Drug Enforcement Agency), initiated under the Nixon administration to further justify throwing pot smokers into prison.

Unfortunately for the DEA and the war on drugs, the researchers came upon some interesting results with their lab rats. They discovered that cancer cells were getting destroyed, not healthy cells. The immune systems were enhanced, not impeded. Well, that was the end of that research.

Their funding was canceled at the behest of the DEA, and the research documents were destroyed. In 1976, president Gerald Ford halted all research on cannabis except for Big Pharma’s attempts at creating synthetic THC. In 1983, other college research centers who were privy to copies of the Virginia research documents were urged by the Reagan administration to destroy them. The memory hole mission for cannabis curing cancer was complete, almost.

The Virginia medical college applied for research grants for further inquiry into cannabis’ healing potentials in 1996 and 2006, both denied. Their 1974 studies were ignored by the  mainstream media except for one short mention of it in the Local Section of the Washington Post.

The documents went into such a memory hole that researchers in Madrid, Spain’s 2000 huge breakthrough study of cannabis TCH cannabinoid effects on cancer couldn’t get them for their paper. Madrid’s lead researcher, Dr. Manual Guzman commented: “I am aware of the existence of that research. In fact I have attempted many times to obtain the journal article on the original investigation by these people, but it has proven impossible.”

 This statement was made when an independent investigative journalist got document copies from a California university and faxed them over. By then, the Madrid study was completed.

But even the Madrid breakthrough research on rats was ignored by virtually all of our mainstream media. Not only did this study prove efficacy on reducing brain cancer tumors in rats, they also tested healthy rats with THC to see if there were any harmful effects. They found no harmful effects on normal brain tissues.

Currently, two large hospitals in Israel, Sheba and Abarbanel, are doing successful clinical studies and treatments on humans with cannabis for several maladies, funded by the Israeli government. But our mainstream media can’t touch that.

Rick Simpson got more favorably objective TV media coverage in Canada when he was trying to bring cannabis curing cancer to the attention of everyone in circa 1999. By the way, he wasn’t trying to “cash in” with any patents.

Anecdotal Testimonies and Independent Studies Confirm Cannabis Cancer Efficacy and Safety

Anyone who views alternative health information on the internet isn’t blocked by mainstream media’s lack of exposure. There have been many anecdotal recoveries from terminal cancer recorded by people as old as 80. Kudos to Dr. Sanjay Gupta of CNN for doing a public 180 reversal on his previous anti-cannabis stance while covering cannabis healing among extremely epileptic children.

Obviously, cannabis is both effective and safe. It induces apoptosis on tumor cancer cells. Apoptosis is cellular programmed cell death (PCD) that’s part of normal cells die-off and replacement from new cells. But cancer tumor cells don’t do apoptosis. They just keep on going and expanding. Cannabinoids also curb angiogenis, which tumors use to develop blood vessels that supply glucose for their metabolism.

So cannabis induces apoptosis to kill cancer cells and inhibits angiogenis to cut off their food supplies.And as the Madrid study proved and anyone who has used or uses cannabis can testify, healthy cells are not harmed. That’s what standard oncology’s treatments do.

It’s easily arguable that many of the cancer deaths reported are actually from the chemo and radiation treatments. But the Medical Mafia family doesn’t say that. They say death from cancer. Meanwhile fund raisers keep duping suckers into contributing money, time, and energy to find that cure for cancer.

Cannabis caveats: Smoking is the least effective for curing. Using a vaporizer or “vaping” is better. Ingesting cannabis oils or pastes is the best approach. But – ignoring lifestyle and diet habit changes can reverse what’s gained from any alternative cancer treatments.

 Here’s an example of a baby who was cured of brain cancer without being subjected to the cruelties of surgery, radiation, or brain cancer. Instead, he was given cannabis oil via his pacifier. The baby was completely cured within eight months. After two months of observed progress, the pediatric oncologist who had given the diagnosis called off any future treatments that would cause more damage, calling him a miracle baby.
Source:healthy-holistic-living.com
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Germany converting a huge coal mine into giant renewable battery


A German coal mine will be converted into giant “battery station” to store enough renewable energy to power some 400,000 homes.

The Prosper-Haniel pit in the state of North Rhine Westphalia near the Dutch border, has produced the fossil fuel for almost half a century.

But now it will find a new purpose as a 200 megawatt pumped-storage hydroelectric reservoir.

Researchers from a number of German universities are working alongside private engineering companies and the government on the project.

They believe the elevation provided by the pit will provide an opportunity for hydroelectric storage.

It is thought that water will be able flow downwards, powering turbines and generating electricity, with water pumped back up again during periods of low demand.

“In regions such as the Rhineland or the Ruhr area, the lack of relief in the landscape does not provide the necessary height differences [for hydroelectric power],” the project’s website says.

Work will begin when the mine closes in 2018.

Source: independent.co.uk

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative 


Abstract

Objectives To evaluate the impact of total knee replacement on quality of life in people with knee osteoarthritis and to estimate associated differences in lifetime costs and quality adjusted life years (QALYs) according to use by level of symptoms.

Design Marginal structural modeling and cost effectiveness analysis based on lifetime predictions for total knee replacement and death from population based cohort data.

Setting Data from two studies—Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST)—within the US health system.

Participants 4498 participants with or at high risk for knee osteoarthritis aged 45-79 from the OAI with no previous knee replacement (confirmed by baseline radiography) followed up for nine years. Validation cohort comprised 2907 patients from MOST with two year follow-up.

Intervention Scenarios ranging from current practice, defined as total knee replacement practice as performed in the OAI (with procedural rates estimated by a prediction model), to practice limited to patients with severe symptoms to no surgery.

Main outcome measures Generic (SF-12) and osteoarthritis specific quality of life measured over 96 months, model based QALYs, costs, and incremental cost effectiveness ratios over a lifetime horizon.

Results In the OAI, total knee replacement showed improvements in quality of life with small absolute changes when averaged across levels of confounding variables: 1.70 (95% uncertainty interval 0.26 to 3.57) for SF-12 physical component summary (PCS); −10.69 (−13.39 to −8.01) for Western Ontario and McMaster Universities arthritis index (WOMAC); and 9.16 (6.35 to 12.49) for knee injury and osteoarthritis outcome score (KOOS) quality of life subscale. These improvements became larger with decreasing functional status at baseline. Provision of total knee replacement to patients with SF-12 PCS scores <35 was the optimal scenario given a cost effectiveness threshold of $200 000/QALY, with cost savings of $6974 ($5789 to $8269) and a minimal loss of 0.008 (−0.056 to 0.043) QALYs compared with current practice. These findings were reproduced among patients with knee osteoarthritis from the MOST cohort and were robust against various scenarios including increased rates of total knee replacement and mortality and inclusion of non-healthcare costs but were sensitive to increased deterioration in quality of life without surgery. In a threshold analysis, total knee replacement would become cost effective in patients with SF-12 PCS scores ≤40 if the associated hospital admission costs fell below $14 000 given a cost effectiveness threshold of $200 000/QALY.

Conclusion Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life and QALYs at the group level. If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use.

 

Abstract

Objectives To evaluate the impact of total knee replacement on quality of life in people with knee osteoarthritis and to estimate associated differences in lifetime costs and quality adjusted life years (QALYs) according to use by level of symptoms.

Design Marginal structural modeling and cost effectiveness analysis based on lifetime predictions for total knee replacement and death from population based cohort data.

Setting Data from two studies—Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST)—within the US health system.

Participants 4498 participants with or at high risk for knee osteoarthritis aged 45-79 from the OAI with no previous knee replacement (confirmed by baseline radiography) followed up for nine years. Validation cohort comprised 2907 patients from MOST with two year follow-up.

Intervention Scenarios ranging from current practice, defined as total knee replacement practice as performed in the OAI (with procedural rates estimated by a prediction model), to practice limited to patients with severe symptoms to no surgery.

Main outcome measures Generic (SF-12) and osteoarthritis specific quality of life measured over 96 months, model based QALYs, costs, and incremental cost effectiveness ratios over a lifetime horizon.

Results In the OAI, total knee replacement showed improvements in quality of life with small absolute changes when averaged across levels of confounding variables: 1.70 (95% uncertainty interval 0.26 to 3.57) for SF-12 physical component summary (PCS); −10.69 (−13.39 to −8.01) for Western Ontario and McMaster Universities arthritis index (WOMAC); and 9.16 (6.35 to 12.49) for knee injury and osteoarthritis outcome score (KOOS) quality of life subscale. These improvements became larger with decreasing functional status at baseline. Provision of total knee replacement to patients with SF-12 PCS scores <35 was the optimal scenario given a cost effectiveness threshold of $200 000/QALY, with cost savings of $6974 ($5789 to $8269) and a minimal loss of 0.008 (−0.056 to 0.043) QALYs compared with current practice. These findings were reproduced among patients with knee osteoarthritis from the MOST cohort and were robust against various scenarios including increased rates of total knee replacement and mortality and inclusion of non-healthcare costs but were sensitive to increased deterioration in quality of life without surgery. In a threshold analysis, total knee replacement would become cost effective in patients with SF-12 PCS scores ≤40 if the associated hospital admission costs fell below $14 000 given a cost effectiveness threshold of $200 000/QALY.

Conclusion Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life and QALYs at the group level. If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use.

Introduction

Osteoarthritis is a leading cause of disability worldwide,1 resulting in pain, structural changes in the bone and joint space, and limitation of motion. Disease onset is gradual and usually begins after the age of 40. Osteoarthritis of the knee has a variable prognosis. Once present, improvement of joint structure is rare when assessed by radiography, but abatement of joint pain and disability occurs frequently.2 About 12% of adults in the US are affected.3 The annual rate of total knee replacement in the US has doubled since 2000, especially in those aged 45-64.45 This disproportionate increase in this practice has been attributed to expansion of eligibility to people with less severe symptoms.6 The total number of procedures performed each year now exceeds 640 000, at a total annual cost of about $10.2bn (£8.3bn, €9.6bn).5

The potential benefit of total knee replacement in patients with knee osteoarthritis should outweigh the associated costs. A recent randomized controlled trial looked at replacement compared with non-surgical management alone in 95 patients and showed large improvements in pain and physical limitations and significant increases in quality of life at 12 months.7 The trial population predominantly included patients with severe preoperative symptoms, as shown by low mean quality of life utility values at baseline.7 Many previously published uncontrolled before-after studies showed similarly large effects.89 In particular, the systematic review by Shan and colleagues described 19 studies that showed substantial improvements from baseline status, both in the intermediate and long term, for disease specific and generic health related quality of life across a broad range of domains.9 It is estimated, however, that up to a third of recipients of total knee replacement experience chronic pain postoperatively,1011 and the health benefits of the procedure are assumed to be higher in those with poor physical functioning before surgery.121314 This would imply that patients undergoing the procedure because of the recently expanded practice in the US might show less significant improvement in symptoms. Yet, the effectiveness of total knee replacement has been understudied in patients who are representative for the current practice population.1011

We used data from the Osteoarthritis Initiative (OAI) to estimate the effect of total knee replacement according to patients’ functional status by looking at longitudinal health outcomes of patients with knee osteoarthritis with heterogeneous symptoms who underwent the procedure compared with those who did not.15 We subsequently performed a decision modeling study to evaluate the impact of the procedure on lifetime costs and quality adjusted life years (QALYs) while varying its use by level of symptoms.

Methods

Study populations

We obtained the data for our analysis from the Osteoarthritis Initiative (OAI) database, which is available for public access at http://www.oai.ucsf.edu/. The OAI is a multi-center cohort study of 4796 individuals with knee osteoarthritis or at risk for knee osteoarthritis who were recruited from the general population in 2005-06 across four US centers. Study participants were aged 45-79 at enrolment and were tracked with repeated follow-up evaluations for nine years. These evaluations included physical examinations, radiographs of both knees, and questionnaires on risk factors, symptoms, medical history, and quality of life. Knee osteoarthritis was defined as the patient having pain, aching, or stiffness in or around the knee on most days for at least one month during the past 12 months, and radiographically confirmed tibiofemoral osteophytes of grades 1-3 according to the Osteoarthritis Research Society International (OARSI) atlas.1617 Patients eligible for the current analysis were those included in the outcomes dataset released 11 October 2015 (n=4796). To develop a decision model for estimating lifetime outcomes, we excluded participants who had already undergone TKR at baseline, confirmed by radiography (n=62) and participants from the low osteoarthritis risk, “non-exposed” control group (n=122) who had no established risk factors, symptoms or radiographic findings of knee osteoarthritis.18 This resulted in a development sample of 4498 (table 1). OAI participants classified as having knee osteoarthritis at baseline (n=1327), as opposed to participants who were at high risk for knee osteoarthritis,were defined as the study population for estimation of the effect of total knee replacement on quality of life and use ofnon-surgical treatment for osteoarthritis pain, and for the base case cost effectiveness analysis. To validate the effect estimates, we repeated similar analyses with 30 months’ follow-up data on 965 participants with knee osteoarthritis at baseline of the Multicenter Osteoarthritis Study (MOST).23 To show generalizability of the base case cost effectiveness analysis, we performed a scenario analysis using the 965 MOST patients.

Modeling effect of total knee replacement on quality of life and use of non-surgical treatment

Outcomes were defined as the SF-12 physical component summary (PCS) score, the SF-12 mental component summary (MCS) score, the SF-6D utility index, the Western Ontario and McMaster Universities arthritis index (WOMAC), the quality of life subscale on the knee injury and osteoarthritis outcome score (KOOS), and self reported use of pain medication for osteoarthritis, all measured at 12, 24, 36, 48, 72, and 96 months. We evaluated the effect of total knee replacement on use of non-pharmacological treatments with measurements at 24, 48, and 96 months, as questions on these treatments were not included at the other study visits. The SF-12 instrument is a single page questionnaire measuring generic quality of life.24 To estimate this, we calculated the SF-6D utility index, which can be directly derived from SF-12 by using a previously published algorithm.25 The KOOS and WOMAC instruments are validated questionnaires measuring quality of life, pain, stiffness, and functionality specific for osteoarthritis.242627 We chose to use only the KOOS quality of life subscale, which measures knee related quality of life and mental and social aspects such as awareness and lifestyle changes. These items are not well captured by the WOMAC total score, which focuses on knee symptoms and functioning. The Pearson product moment correlation coefficient for the two scores in the 1327 OAI participants with knee osteoarthritis was −0.67. Osteoarthritis pain medication included acetaminophen (paracetamol), non-steroidal anti-inflammatory drugs (NSAIDs), and cyclo-oxygenase-2 (COX-2) inhibitors. Non-pharmacological treatments included massage, chiropractic, acupuncture treatments, and other less commonly used complementary treatment options such as acupressure, chelation therapy, folk medicine, and homeopathic treatment.

To estimate the effect of total knee replacement on these longitudinally measured outcomes compared with no/delayed procedure, we used marginal structural models for repeated measures defined as weighted generalized estimating equations (GEEs) with each outcome as the dependent variable.28 Marginal structural models are warranted when outcome values can vary over time and can predict future treatment assignment along with other time varying confounders. For example, an increase in use of osteoarthritis pain medication could be associated with a higher likelihood of receiving total knee replacement. Each GEE included a treatment variable for the procedure, which was set to one after performance, a study visit indicator, the outcome’s baseline value, and other baseline variables including age, sex, race, income, education, knee injury in medical history, knee surgery in medical history, body mass index (BMI), Charlson comorbidity score,29 use of osteoarthritis pain medication, doctor’s diagnosis of knee osteoarthritis, Kellgren-Lawrence radiographic grade, SF-12 scores, WOMAC total score, and KOOS quality of life. To evaluate the effectiveness of total knee replacement according to preoperative physical functioning, we included an interaction term for the procedure with baseline SF-12 PCS.3031 Within these GEEs, we included weights for treatment propensity (that is, the likelihood of having received total knee replacement) for each study visit. Weights were estimated by logistic regression models pooled for study visits with the above mentioned baseline variables, study visit, longitudinally measured BMI, Charlson comorbidity score, doctor’s diagnosis of knee osteoarthritis, Kellgren-Lawrence radiographic grade, and all outcome variables. The main treatment effect estimate obtained from the marginal structural modeling should be interpreted as a “time averaged” causal effect.28

Missing values were imputed 20 times with a flexible additive model including status variables and the Nelson-Aalen estimator of the cumulative hazard for total knee replacement and death. To estimate parameter uncertainty, we re-fitted imputation, pooled logistic regression, and GEE models in 500 bootstrap datasets. We used the 2.5th and 97.5th centiles of bootstrap effect estimates for uncertainty interval limits. To validate the effect estimates from models developed with OAI patients, we performed multivariable adjusted analyses for SF-12 scores, SF-6D utility index, WOMAC, and use of osteoarthritis pain medication using 30 months’ follow-up data on 965 MOST participants with knee osteoarthritis at baseline. All statistical analyses were performed with R version 3.2.0 (2015, R Foundation for Statistical Computing). For more information on these statistical analyses see appendix 1.

Modeling of lifetime outcomes and cost effectiveness of total knee replacement

We developed the KOSMOS (Knee OSteoarthritis MicrOSimulation) model to simulate the virtual life course of 1327 OAI patients by modeling the occurrence of primary total knee replacement, revision procedure, and death up to age 100. Rates of primary total knee replacement and death were modeled by cause specific multivariable Cox regression with chronological age as time scale. Revision rates were based on the literature19 using the log cumulative hazard of revision procedure as reported for different age groups, which was modeled as a linear function of log time since the primary procedure. Health related SF-6D utility scores, use of osteoarthritis pain medication, and use of non-pharmacological treatment were based on the patients’ baseline and predicted 96 month values taken from the output of the GEEs with and without total knee replacement. We used linear interpolation to calculate patients’ values through eight years. We estimated SF-12 PCS, SF-12 MCS, and SF-6D scores for patients alive longer than eight years by linear extrapolation, based on the observed steady changes over time (figs A-C in appendix 3). Use of osteoarthritis pain medication and non-pharmacological treatments was assumed to remain stable after eight years (figs F and G in appendix 3), and the predicted 96 month probability of use was carried forward.

For simulated patients who survived each cycle of the model, we calculated an undiscounted QALY as the predicted SF-6D score multiplied by one year, thus resulting in a different QALY outcome for patients receiving total knee replacement in that cycle. Patients could accrue QALYs in the model until death or age 100. We calculated effect modification of procedure by SF-12 PCS scores using the latest predicted score, which was updated every eighth year until total knee replacement. We assumed that with revision procedure a beneficial effect on SF-12 PCS, use of osteoarthritis pain medication, and non-pharmacological treatment would be cancelled out by deterioration and improvement before and after the revision.3233

Costs associated with care of knee osteoarthritis and total knee replacement procedures were estimated from a US health system perspective (table 2) and were either applied for each model cycle (annual costs associated with pharmacological and non-pharmacological treatment, physician office visits, and imaging) or as a one off cost penalty (costs associated with primary and revision procedures and rehabilitation including physiotherapy). All costs were expressed in 2013 $, with inflation rates reported in the US healthcare consumer price index.34 We recalibrated the average life expectancy predicted by the KOSMOS model for the modeled patient cohort to reflect the average life expectancy as predicted by age and sex specific US 2011 life tables and validated the KOSMOS model’s predictive performance in OAI and MOST data. More details on the development and validity of the KOSMOS model are provided in appendix 1.

For the base case analysis, we modeled 10 scenarios, ranging from current practice with rates as observed in the OAI, to lower rates of practice in which the procedure was performed only in individuals with lower SF-12 PCS levels (from <55-<20), to a scenario without total knee replacement. In the restricted scenarios, the underlying annual rate was kept the same as modeled for the current practice scenario, but no effects on quality of life, use of non-surgical treatment, and costs, and no procedural mortality rates were incorporated if the preceding SF-12 PCS level was greater than or equal to the threshold value.

For each scenario, we performed microsimulation of 1327 individuals for each set of 500 bootstrap equations and calculated the accrued QALYs and costs using the recommended 3% discount rate.35 We calculated 95% uncertainty intervals by using the 2.5th and 97.5th centiles of 500 modeled outcomes, each averaged across 1327 individuals. We calculated incremental cost effectiveness ratios (ICERs), defined as the difference in average costs divided by the difference in average QALYs, after ranking scenarios according to increasing costs and exclusion of dominated scenarios. Dominated scenarios were defined as programs less effective and more costly than the previous program (absolutely dominated) and programs with a larger incremental cost effectiveness ratio than the next not dominated program (extendedly dominated). We considered cost effectiveness thresholds of $50 000, $100 000, and $200 000 per QALY for decision making.36

Sensitivity analyses

In threshold analyses, we varied the hospital admission costs of primary and revision total knee replacement and used various percentages up to 100% for a further decline in quality of life (SF-12 PCS, SF-12 MCS, and SF-6D) in patients who were simulated to receive the procedure in the current practice scenario but were modeled to not receive the procedure in the other scenarios. For modeling the additional decline, we multiplied the main effect of follow-up time by values from 1 to 2. We used a time lag of four years after total knee replacement (equal to the difference in last follow-up measurement and median time to the procedure), so that the further decrease would reflect a long term effect of total knee replacement that we could have missed using OAI data.

We performed a scenario analysis using the 965 MOST patients after recalibration of hazard rates for total knee replacement and an analysis using EuroQol (EQ)-5d utility values as a substitute for SF-6D values by conversion of SF-12 MCS and PCS scores by a published equation.373839 In additional analyses, we modeled an increased rate of primary total knee replacement up to 30% to investigate the impact of a further increase in procedure rates as observed in the US after 2006.5 We also increased the background mortality rate based on findings that patients with osteoarthritis might have an excess all cause mortality compared with the general population by multiplying mortality rates by standardized mortality ratios sampled from a lognormal distribution (mean 1.55, 95% confidence interval 1.41 to 1.70).40 Finally, we performed an analysis exploring the potential influence of non-healthcare costs and loss of productivity not captured by a decrease in health utility,41 through inclusion of costs due to work time lost by patients and cost of informal caregiving. More details on these sensitivity analyses are provided in appendix 1.

Patient involvement

No patients were involved in developing plans for recruitment, design, or implementation of the studies, nor were they involved in developing the research questions and outcome measures. No patients were asked to advice on interpretation or writing up of results. Plans are in place for dissemination of the results of the research to the patient community. These plans include providing manuscript summaries to media sources, osteoarthritis charities, provider bodies, and patient organizations, in addition to social media announcements and institutional provision of pamphlets in health system waiting areas.

Results

Study populations

The 1327 OAI participants with knee osteoarthritis at baseline had worse SF-12 PCS, SF-6D, and osteoarthritis specific quality of life scores than the 3171 at high risk for knee osteoarthritis (P<0.001, table 1). There were 382 total knee replacements, of which 319 were done before the 96 month visit, and 255 were in the 1327 with knee osteoarthritis at baseline. In the MOST cohort (table A, appendix 2), 135 total knee replacements were performed in 965 participants with knee osteoarthritis at baseline, and 16 were performed in 1719 individuals at high risk of knee osteoarthritis, all before the 30 month visit.

Effect of total knee replacement on quality of life and use of non-surgical treatment

Figures A-G in appendix 3 show time trends of SF-12 PCS, SF-12 MCS, SF-6D, WOMAC, KOOS quality of life, use of osteoarthritis pain medication, and non-pharmacological treatments, specified for those who did and did not undergo total knee replacement. After adjustment for baseline and time varying confounders, the main effects of total knee replacement (that is, treatment effects averaged across confounding variable levels and follow-up time) comprised an absolute improvement of 1.70 points (95% uncertainty interval 0.26 to 3.57) on SF-12 PCS, and changes in SF-12 MCS of −0.22 (−1.49 to 1.31) and SF-6D of 0.008 (−0.008 to 0.028) point. For each unit decrease in baseline SF-12 PCS, the effect on SF-6D increased and could be calculated as 0.098−0.002×(SF-12 PCS), suggesting that total knee replacement would become more effective if it was restricted to patients with SF-12 PCS scores <50. For osteoarthritis specific measures of quality of life, the procedure’s main effects included improvement of the WOMAC score by 10.69 (8.01 to 13.39) and KOOS quality of life of 9.16 (6.35 to 12.49) points. Total knee replacement reduced the odds of use of medication for osteoarthritis pain, but this effect was uncertain, with an odds ratio of 0.81 (0.55 to 1.12). Use of non-pharmacological treatment did not significantly seem to change with total knee replacement (0.91, 0.55 to 1.77). These effects were generally consistent with those obtained from multivariable adjusted analyses of MOST data, although in MOST the effect on SF-12 MCS was positive in contrast with the effect in OAI (table 3).

Table 3

Changes in quality of life measures and use of non-surgical treatment after total knee replacement (TKR) in four models*. Figures are effect estimates with 95% uncertainty intervals based on refitting all modeling steps in 500 bootstrap datasets given for 1327 Osteoarthritis Initiative (OAI) participants with knee osteoarthritis at baseline who were repeatedly followed up until 96 months v 965 Multicenter Osteoarthritis Study (MOST) participants with knee osteoarthritis at baseline who were followed up until 30 months

 Lifetime outcomes and cost effectiveness of total knee replacement practice

In the current practice scenario, the lifetime likelihood of undergoing total knee replacement, as predicted for OAI, was 39.9% (95% uncertainty interval 34.5 to 45.3), and the average undiscounted life expectancy was 22.39 years (21.13 to 23.85 years). Modeled quality of life values and proportions of use of non-surgical treatments over time were generally most favorable in the current practice scenario, except for SF-12 MCS scores (figs I-M, appendix 3). The mean discounted QALYs in the current practice scenario were 11.18 (10.66 to 11.70) and costs were $17 168 ($15 307 to $19 124).

In the base case cost effectiveness analysis, only the ICER of total knee replacement for those with SF-12 PCS <20 fell below $100 000/QALY. The optimal scenario given a cost effectiveness threshold of $200 000/QALY was surgery for those with SF-12 PCS scores <35; surgery for those with SF-12 PCS <40 was borderline cost effective. Compared with current practice, restriction of surgery to those with SF-12 PCS <35 would decrease the lifetime likelihood of total knee replacement to 10.2% (95% uncertainty 8.1 to 12.4), and would save $6974 ($5789 to $8269) per patient, whereas the effectiveness would be only slightly lower at −0.008 (−0.056 to 0.043) QALYs. The ICER of this strategy compared with the previous best scenario was $160 974/QALY (table 4 and fig 1). The current practice scenario was less effective and more expensive than the more restrictive scenarios with SF-12 PCS threshold values of 40-55 and therefore dominated. None of the ICERs fell below the $50 000/QALY threshold. The likelihood that the current practice scenario would be considered to be cost effective was low for cost effectiveness thresholds below $200 000/QALY (fig N, appendix 3).

Table 4

Lifetime cost effectiveness outcomes for different scenarios for determining which patients are eligible for undergoing total knee replacement (TKR) with 95% uncertainty intervals based on 500 bootstrap datasets for simulations of 1327 participants from the Osteoarthritis Initiative (OAI) with knee osteoarthritis at baseline

 

Fig 1 Base case analysis cost effectiveness at different levels of SF-12 PCS (physical component summary). Costs ($) and QALYs are means in OAI study population. Incremental cost effectiveness ratios (ICERs) not shown for dominated scenarios

“>Figure1

Fig 1 Base case analysis cost effectiveness at different levels of SF-12 PCS (physical component summary). Costs ($) and QALYs are means in OAI study population. Incremental cost effectiveness ratios (ICERs) not shown for dominated scenarios

 Sensitivity analyses

With a cost effectiveness threshold of $200 000/QALY, restriction of surgery to those withSF-12 PCS <40 became attractive if the hospital admission costs of primary total knee replacement fell below $14 000. If the admission costs of primary total knee replacement fell below $8000, restriction of surgery to those withSF-12 PCS <30 would become economically attractive given a cost effectiveness threshold of $100 000/QALY. Cost effectiveness outcomes were not sensitive to the admission costs of revision procedures.

Simulation of the MOST population with knee osteoarthritis provided much higher lifetime likelihoods of total knee replacement, but similar ICERs, although restriction of surgery to those withSF-12 PCS <40 now became the optimal scenario at a cost effectiveness threshold of $200 000/QALY (table E in appendix 2). Use of EQ-5D utility values improved ICERs, with the ICER of restriction of surgery to those withSF-12 PCS <40 now amply falling below $200 000/QALY (table F in appendix 2). Increasing rates of primary total knee replacement or background mortality only minimally affected incremental cost effectiveness outcomes, and restriction of surgery to those withSF-12 PCS <35 remained the optimal scenario at a cost effectiveness threshold of $200 000/QALY (tables G and H in appendix 2).

Inclusion of costs associated with work days lost (see table D in appendix 2) and informal caregiving did not have a major impact on the cost effectiveness results: again restriction of surgery to those withSF-12 PCS <35 was the optimal scenario at a cost effectiveness threshold of $200 000/QALY (table I in appendix 2). If patients who would receive total knee replacement in current practice, but not in the more restrictive scenarios, experienced an additional decline of 50% in quality of life over the long term, all scenarios of performing total knee replacement including current practice became economically attractive given a cost effectiveness threshold of $200 000/QALY and with an additional decline of 80% given a cost effectiveness threshold of $100 000/QALY.

Discussion

Principal findings

We evaluated the effectiveness of total knee replacement on quality of life and use of non-surgical treatment in a recent US cohort of patients with knee osteoarthritis. Compared with patients who did not undergo total knee replacement, generic quality of life scores (on SF-12 physical) and those related to osteoarthritis improved with performance of the procedure, with larger improvements generally in those with a lower SF-12 physical score at baseline. Changes in use of osteoarthritis pain medication and SF-12 mental scores were small and heterogeneous across the two cohorts. In a cost effectiveness analysis modeling the life courses of OAI patients with knee osteoarthritis with inclusion of utility values derived from the SF-12, current practice was more expensive and in some cases even less effective compared with scenarios in which total knee replacement was performed only in patients with lower physical functioning. At the group level, the economically most attractive strategy was performing the procedure in those with a SF-12 PCS <35, assuming a cost effectiveness threshold of $200 000 per QALY. These findings were reproduced among knee osteoarthritis patients from the MOST cohort. Extension of the use of total knee replacement to those with a SF-12 physical score of ≤40 would become financially attractive if the hospital admission costs fell below $14 000.

Comparison with other studies

Scenarios of total knee replacement restricted to those with lower SF-12 PCS scores provided higher QALYs in our cost effectiveness analysis because small improvements in quality of life after the procedure became more prominent in people with lower baseline scores. A recently published randomized controlled trial showed larger effects of total knee replacement on quality of life measures than we found. 7 The OAI patient population undergoing total knee replacement, however, had on average less severe symptoms before surgery compared with the population from that randomized controlled trial, and the mean follow-up duration was longer in the OAI. Moreover, measures of quality of life were assessed independently of care providers in the OAI, contributing to a more limited potential for reporting desirable answers on quality of life scores before and after surgery.4243 Recent uncontrolled before-after studies have also shown larger effects of total knee replacement, generally including improvements in SF-12 PCS scores of 5-15 points.3244454647484950515253 In these studies, changes in SF-12 MCS were heterogeneous and varied from no improvement to 5 points.4749 Similar to SF-12 PCS, larger effects have been shown in before-after studies for quality of life measures specific to osteoarthritis.1332445455 As with the study population in the randomized controlled trial, however, the preoperative quality of life scores for these studies were on average worse than those of our study population and the duration of follow-up was generally shorter, possibly explaining the larger effects.

In addition to our analysis, three observational studies have compared quality of life outcomes in patients who did and did not undergo total knee replacement.125657 Two of these studies were not designed to prospectively collect data on generic and osteoarthritis related quality of life measures in people who did not and did undergo the procedure.1256 In a single hospital prospective cohort study (n=174) including 30 patients who received total knee replacement, there were large improvements in SF-12 PCS (9.6 points) and total WOMAC (24.2 points) scores at 12 months after joint replacement. The effect estimation, however, included effects of hip replacements (n=21), which generally have much larger effects than knee replacements.4749 Modeling studies that investigated the cost effectiveness of total knee replacement all used effects from before-after studies with larger marginal effects on quality of life, contributing to much lower estimated ICERs than we found.135859

Strengths and limitations of study

We estimated the effectiveness of total knee replacement versus no or delayed surgery in a large population based sample, the OAI cohort study, adjusting for baseline and time varying variables using marginal structural models. Marginal structural modeling has been shown to produce unbiased estimates of causal treatment effects.28 The larger number of procedures in our analysis enabled us to evaluate effect modification by baseline symptoms. Effect estimates and modification by baseline physical functional scores obtained in OAI were generally consistent with those found in the MOST population. Nevertheless, our findings should be interpreted in light of several limitations. First, the knee osteoarthritis populations of the OAI and MOST might not be representative of the current total population of patients with knee osteoarthritis in the US, limiting the generalizability of our findings. For example, younger patients might have been under-represented, contributing to fewer lower quality of life values from symptoms affecting work and other regular activities. Yet, both studies recruited participants from the general population across different regions in the US and obtained detailed information on risk factors, total knee replacements, and outcome measures independently from the hospital in which procedures were performed. Furthermore, our conclusions were unaffected by an increase in the rate of total knee replacement, resembling the most recent increase in use on a national level. Second, the study visits performed within OAI and MOST did not allow for measurement of outcomes immediately before procedures, and ignoring worsening symptoms just before could cause an underestimation of the true effect. We, however, adjusted for differences in 12 month changes in use of osteoarthritis pain medication, Kellgren-Lawrence radiographic grade, and quality of life scores assessed at the visit preceding total knee replacement. In addition, no changes in quality of life are observed at 12 months before procedures versus at one month before,50 and an immediate worsening of symptoms as a reason for undergoing total knee replacement is not likely as patients generally defer surgery for years before finally proceeding.606162 Third, as our study was based on analyses of non-randomized data without an intention to treat principle, residual confounding by indication and selection bias could be possible. Fourth, the self reported outcomes available in the retrospective data, such as use of osteoarthritis pain medication and loss of productivity, could potentially have influenced outcomes because of reporting bias or non-differential overestimation and underestimation. Finally, we made several assumptions in our cost effectiveness analysis. In any modeling study, a trade-off must be made between comprehensively including consequences of each strategy and their relevance to the decision problem at hand. We developed our decision model using individual level data on quality of life, treatment use, and survival, which allowed us to incorporate correlation between the model parameters while assessing uncertainty. Unfortunately, the OAI and MOST studies did not include collection of cost data. We therefore had to estimate costs using the best available external data sources, which might not have been representative for our patient cohort.

Conclusions and policy implications

Improvements in quality of life with total knee replacement were on average smaller than previously shown. Given its limited effectiveness in individuals with less severely affected physical function, performance of total knee replacement in these patients seems to be economically unjustifiable. Considerable cost savings could be made by limiting eligibility to patients with more symptomatic knee osteoarthritis. Only one randomized controlled trial has so far been published evaluating total knee replacement as an adjunct treatment to optimized non-surgical treatment, but it did not include results according to symptom status.7 Our findings emphasize the need for more research comparing total knee replacement with less expensive, more conservative interventions, particularly in patients with less severe symptoms, and research aiming to develop individualized prediction models for a better selection of patients with a predicted large net benefit from the procedure. These interventions can then be compared within cost effectiveness analyses, for which non-US data sources should be considered as well. In conclusion, the practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life. If the procedure were restricted to patients with more severe functional status, however, its effectiveness would rise, with practice becoming economically more attractive.

What is already known on this topic

  • Rates of total knee replacement in the US have more than doubled since 2000, primarily because of expanding eligibility to patients with less symptomatic knee osteoarthritis

  • Up to a third of recipients of total knee replacement experience chronic pain postoperatively, and health benefits are assumed to be higher in those with poor preoperative physical functioning

What this study adds

  • Quality of life outcomes generally improve after total knee replacement, with small effects becoming larger with decreasing preoperative functional status

  • The practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on QALYs at the group level and was found to be economically unattractive

  • Total knee replacement practice, however, could be considered cost effective if the procedure were restricted to patients with more severely affected functional status.

Soure: BMJ

Kazuo Ishiguro: Soon, We Will Be Able to Create Humans Who Are Superior to Other Humans


IN BRIEF
  • Author Kazuo Ishiguro believes we are unwittingly walking into a dystopian future because the world has yet to give science and technology more than just peripheral interest.
  • He believes that we have yet to engage in meaningful conversations about where scientific advancements will take us, and the kind of impact they will have on our lives.

DYSTOPIAN FUTURE

According to Kazuo Ishiguro, there are three areas of science that are set to transform how we live and interact with others over the next few decades: gene editing, robotics, and artificial intelligence (AI).

Ishiguro, granted, is best known as one of the most celebrated fiction writers today. He is behind the novel Never Let Me Go, the story of a dystopian future where humans are cloned to be organ donors. But the possibility of a future so fundamentally changed by scientific advancements could be more than the fruit of the author’s creativity and imagination.

Ishiguro

He cites CRISPR as a primary example. The discovery of this gene editing tool gives scientists the option to modify pieces of the genome, paving the way for unprecedented applications in medicine. Right now, we can replace faulty genes with working ones, which is a great accomplishment unto itself. But moving forward, as we learn more about this new technology, the option to enhance functional genes to create intellectually and physically superior humans becomes a real possibility.

Think of it as like a real world Gattaca, where society is divided into two classes. Half will be populated with humans with genetically engineered genes that makes them healthier, smarter, stronger—designer babies, essentially. And the other half, with humans whose genetic sequence has been left to chance, untouched, leaving them biologically inferior.

A NEW FOCUS ON SCIENCE

Ishiguro believes we are unwittingly walking into this dystopian future because the world has yet to give science and technology more than just peripheral interest. Sure, we celebrate the headlines and acknowledge the accomplishments, but we have yet to engage in meaningful conversations about where these advancements will take us, and the kind of impact they will have on our lives.

Developments in AI and robotics for instance, mean a major part of intellectual capital will shift to what he refers to as “the Silicon Valley masters of the universe”—it will no longer be under universities or government funded labs. The lack of regulation regarding these rapid developments is also cause for concern. And of course, there is the ongoing debate about the ethics behind advancements in genetic sciences, like CRISPR.

The relevance of Ishiguro’s musings about the future comes in time for the opening of a new permanent mathematics gallery at the Science Museum in London. Included in the exhibit is the author’s father, oceanographer Shizuo Ishiguro, who created a machine that can predict coastal storm surges.

The author however, hopes that exhibits such as this will prompt more discussion about the trajectory of science and spur deeper interest. These breakthroughs have real implications that deserve to be discussed.

Source:futurism.com

Audiences are lining up to watch this guy play video games badly


Michael Jones from Rooster Teeth.

Michael Jones from Rooster Teeth.

When Michael Jones takes the stage, he doesn’t hold a mic or a musical instrument. His main tools to entertain are his video game controller and the words that come out of his mouth.

“I certainly didn’t think I’d find myself in this situation,” said Jones, 29.

After graduating high school, Jones apprenticed as an electrician. He bought a camera to film family moments, and decided to film himself playing video games for fun.

 In July 2010, he posted an expletive-laden video of him chasing of one of the impossible-to-catch orbs in “Crackdown 2.” It went viral and suddenly people noticed.

“I realized, ‘Oh, people like it when I’m pissed?'” Jones said. “I’m from New Jersey. I do that all the time.”

Six months later, production company Rooster Teeth asked him to join its team, and in January 2011 he launched his online show “Rage Quit,”a series featuring him playing difficult levels or challenges in video games. Spoiler alert: It usually ends in him quitting with an epic tantrum. It’s gotten more than 350 million views to date on YouTube.

“Anybody can play a video game,” said Jones. “You don’t have to be good. I consider myself okay. I’m better than the average person, but compared to people on the Internet I’m horrible.”

The youngest of three brothers, Jones grew up in Woodbridge, NJ, playing video games. He fondly remembers his brothers saving money to buy him a Nintendo 64 for his tenth birthday…then his middle brother claimed he didn’t mean to give it as a gift and took it for himself.

“There was not a lot of controller sharing going on in the household,” he said.

Jones is now about to embark on the four-city “Let’s Play Live” tour with the other stars of production company Rooster Teeth’s “Achievement Hunter” channel, where they will perform for his online — and now offline — fans. First up will be a stop on April 24 in Jones’ home state of New Jersey at the 2,900-seat New Jersey Performance Arts Center in Newark.

“Now my Mom is asking for tickets for my Aunt and Uncle, my cousin — so many tickets,” he said joking. “Mom, leave some for the audience.”

Then, they’ll pack up the tour bus and head to Baltimore, MD, Orlando, FL, and Tampa, FL. Previously, Jones and the rest of the “Achievement Hunter” crew sold out venues in New York, Los Angeles, Chicago and Austin, bringing their brand of rowdy commentary and hijinks to a live audience.

He’s also done other projects with Rooster Teeth, including starring in “Lazer Team,” one of the top fundraised Indiegogo film campaigns of all time. He also is a voice actor in the company’s anime series “RWBY,” in which his wife Lindsay Jones voices the main role.

People may not see the appeal of watching someone else play a video game, but it’s the same as watching someone else play basketball on TV which is why it easily translates live, Jones points out. On top of that, the guys on the “Let’s Play Live” tour chat about things you talk about with your friends, turning it from a voyeur sport to a comedy show, he said.

“Video games give us this amazing platform,” said Jones. “We could walk into the office and go into a room, and we would have this exact same conversation.”

He admits audience members who expect to see well-executed gameplay will be disappointed, but that’s not stopping him.

“I wouldn’t put us on the same level as musicians or superstars,” Jones said. “For some reason we fooled them (our fans), and they just want to consume our content in any possible way.”

Watch the video doctumentary. URL:

Source:http://www.cnbc.com

You Can’t Understand ISIS If You Don’t Know the History of Wahhabism in Saudi Arabia.


It appears — even now — that Saudi Arabia’s ruling elite is divided. Some applaud that ISIS is fighting Iranian Shiite “fire” with Sunni “fire”; that a new Sunni state is taking shape at the very heart of what they regard as a historical Sunni patrimony; and they are drawn by Da’ish’s strict Salafist ideology.

Other Saudis are more fearful, and recall the history of the revolt against Abd-al Aziz by the Wahhabist Ikhwan (Disclaimer: this Ikhwan has nothing to do with the Muslim Brotherhood Ikhwan — please note, all further references hereafter are to the Wahhabist Ikhwan, and not to the Muslim Brotherhood Ikhwan), but which nearly imploded Wahhabism and the al-Saud in the late 1920s.

Many Saudis are deeply disturbed by the radical doctrines of Da’ish (ISIS) — and are beginning to question some aspects of Saudi Arabia’s direction and discourse.

THE SAUDI DUALITY

Saudi Arabia’s internal discord and tensions over ISIS can only be understood by grasping the inherent (and persisting) duality that lies at the core of the Kingdom’s doctrinal makeup and its historical origins.

One dominant strand to the Saudi identity pertains directly to Muhammad ibn ʿAbd al-Wahhab (the founder of Wahhabism), and the use to which his radical, exclusionist puritanism was put by Ibn Saud. (The latter was then no more than a minor leader — amongst many — of continually sparring and raiding Bedouin tribes in the baking and desperately poor deserts of the Nejd.)

The second strand to this perplexing duality, relates precisely to King Abd-al Aziz’s subsequent shift towards statehood in the 1920s: his curbing of Ikhwani violence (in order to have diplomatic standing as a nation-state with Britain and America); his institutionalization of the original Wahhabist impulse — and the subsequent seizing of the opportunely surging petrodollar spigot in the 1970s, to channel the volatile Ikhwani current away from home towards export — by diffusing a cultural revolution, rather than violent revolution throughout the Muslim world.

But this “cultural revolution” was no docile reformism. It was a revolution based on Abd al-Wahhab’s Jacobin-like hatred for the putrescence and deviationism that he perceived all about him — hence his call to purge Islam of all its heresies and idolatries.

MUSLIM IMPOSTORS

The American author and journalist, Steven Coll, has written how this austere and censorious disciple of the 14th century scholar Ibn Taymiyyah, Abd al-Wahhab, despised “the decorous, arty, tobacco smoking, hashish imbibing, drum pounding Egyptian and Ottoman nobility who travelled across Arabia to pray at Mecca.”

In Abd al-Wahhab’s view, these were not Muslims; they were imposters masquerading as Muslims. Nor, indeed, did he find the behavior of local Bedouin Arabs much better. They aggravated Abd al-Wahhab by their honoring of saints, by their erecting of tombstones, and their “superstition” (e.g. revering graves or places that were deemed particularly imbued with the divine).

All this behavior, Abd al-Wahhab denounced as bida — forbidden by God.

Like Taymiyyah before him, Abd al-Wahhab believed that the period of the Prophet Muhammad’s stay in Medina was the ideal of Muslim society (the “best of times”), to which all Muslims should aspire to emulate (this, essentially, is Salafism).

Taymiyyah had declared war on Shi’ism, Sufism and Greek philosophy. He spoke out, too against visiting the grave of the prophet and the celebration of his birthday, declaring that all such behavior represented mere imitation of the Christian worship of Jesus as God (i.e. idolatry). Abd al-Wahhab assimilated all this earlier teaching, stating that “any doubt or hesitation” on the part of a believer in respect to his or her acknowledging this particular interpretation of Islam should “deprive a man of immunity of his property and his life.”

One of the main tenets of Abd al-Wahhab’s doctrine has become the key idea of takfir.Under the takfiri doctrine, Abd al-Wahhab and his followers could deem fellow Muslims infidels should they engage in activities that in any way could be said to encroach on the sovereignty of the absolute Authority (that is, the King). Abd al-Wahhab denounced all Muslims who honored the dead, saints, or angels. He held that such sentiments detracted from the complete subservience one must feel towards God, and only God. Wahhabi Islam thus bans any prayer to saints and dead loved ones, pilgrimages to tombs and special mosques, religious festivals celebrating saints, the honoring of the Muslim Prophet Muhammad’s birthday, and even prohibits the use of gravestones when burying the dead.

Those who would not conform to this view should be killed, their wives and daughters violated, and their possessions confiscated, he wrote.

Abd al-Wahhab demanded conformity — a conformity that was to be demonstrated in physical and tangible ways. He argued that all Muslims must individually pledge their allegiance to a single Muslim leader (a Caliph, if there were one). Those who would not conform to this view should be killed, their wives and daughters violated, and their possessions confiscated, he wrote. The list of apostates meriting death included the Shiite, Sufis and other Muslim denominations, whom Abd al-Wahhab did not consider to be Muslim at all.

There is nothing here that separates Wahhabism from ISIS. The rift would emerge only later: from the subsequent institutionalization of Muhammad ibn ʿAbd al-Wahhab’s doctrine of “One Ruler, One Authority, One Mosque” — these three pillars being taken respectively to refer to the Saudi king, the absolute authority of official Wahhabism, and its control of “the word” (i.e. the mosque).

It is this rift — the ISIS denial of these three pillars on which the whole of Sunni authority presently rests — makes ISIS, which in all other respects conforms to Wahhabism, a deep threat to Saudi Arabia.

BRIEF HISTORY 1741- 1818

Abd al-Wahhab’s advocacy of these ultra radical views inevitably led to his expulsion from his own town — and in 1741, after some wanderings, he found refuge under the protection of Ibn Saud and his tribe. What Ibn Saud perceived in Abd al-Wahhab’s novel teaching was the means to overturn Arab tradition and convention. It was a path to seizing power.

Their strategy — like that of ISIS today — was to bring the peoples whom they conquered into submission. They aimed to instill fear.

Ibn Saud’s clan, seizing on Abd al-Wahhab’s doctrine, now could do what they always did, which was raiding neighboring villages and robbing them of their possessions. Only now they were doing it not within the ambit of Arab tradition, but rather under the banner ofjihad. Ibn Saud and Abd al-Wahhab also reintroduced the idea of martyrdom in the name of jihad, as it granted those martyred immediate entry into paradise.

In the beginning, they conquered a few local communities and imposed their rule over them. (The conquered inhabitants were given a limited choice: conversion to Wahhabism or death.) By 1790, the Alliance controlled most of the Arabian Peninsula and repeatedly raided Medina, Syria and Iraq.

Their strategy — like that of ISIS today — was to bring the peoples whom they conquered into submission. They aimed to instill fear. In 1801, the Allies attacked the Holy City of Karbala in Iraq. They massacred thousands of Shiites, including women and children. Many Shiite shrines were destroyed, including the shrine of Imam Hussein, the murdered grandson of Prophet Muhammad.

A British official, Lieutenant Francis Warden, observing the situation at the time, wrote: “They pillaged the whole of it [Karbala], and plundered the Tomb of Hussein… slaying in the course of the day, with circumstances of peculiar cruelty, above five thousand of the inhabitants …”

Osman Ibn Bishr Najdi, the historian of the first Saudi state, wrote that Ibn Saud committed a massacre in Karbala in 1801. He proudly documented that massacre saying, “we took Karbala and slaughtered and took its people (as slaves), then praise be to Allah, Lord of the Worlds, and we do not apologize for that and say: ‘And to the unbelievers: the same treatment.’”

In 1803, Abdul Aziz then entered the Holy City of Mecca, which surrendered under the impact of terror and panic (the same fate was to befall Medina, too). Abd al-Wahhab’s followers demolished historical monuments and all the tombs and shrines in their midst. By the end, they had destroyed centuries of Islamic architecture near the Grand Mosque.

But in November of 1803, a Shiite assassin killed King Abdul Aziz (taking revenge for the massacre at Karbala). His son, Saud bin Abd al Aziz, succeeded him and continued the conquest of Arabia. Ottoman rulers, however, could no longer just sit back and watch as their empire was devoured piece by piece. In 1812, the Ottoman army, composed of Egyptians, pushed the Alliance out from Medina, Jeddah and Mecca. In 1814, Saud bin Abd al Aziz died of fever. His unfortunate son Abdullah bin Saud, however, was taken by the Ottomans to Istanbul, where he was gruesomely executed (a visitor to Istanbul reported seeing him having been humiliated in the streets of Istanbul for three days, then hanged and beheaded, his severed head fired from a canon, and his heart cut out and impaled on his body).

In 1815, Wahhabi forces were crushed by the Egyptians (acting on the Ottoman’s behalf) in a decisive battle. In 1818, the Ottomans captured and destroyed the Wahhabi capital of Dariyah. The first Saudi state was no more. The few remaining Wahhabis withdrew into the desert to regroup, and there they remained, quiescent for most of the 19th century.

HISTORY RETURNS WITH ISIS

It is not hard to understand how the founding of the Islamic State by ISIS in contemporary Iraq might resonate amongst those who recall this history. Indeed, the ethos of 18th century Wahhabism did not just wither in Nejd, but it roared back into life when the Ottoman Empire collapsed amongst the chaos of World War I.

The Al Saud — in this 20th century renaissance — were led by the laconic and politically astute Abd-al Aziz, who, on uniting the fractious Bedouin tribes, launched the Saudi “Ikhwan” in the spirit of Abd-al Wahhab’s and Ibn Saud’s earlier fighting proselytisers.

The Ikhwan was a reincarnation of the early, fierce, semi-independent vanguard movement of committed armed Wahhabist “moralists” who almost had succeeded in seizing Arabia by the early 1800s. In the same manner as earlier, the Ikhwan again succeeded in capturing Mecca, Medina and Jeddah between 1914 and 1926. Abd-al Aziz, however, began to feel his wider interests to be threatened by the revolutionary “Jacobinism” exhibited by the Ikhwan. The Ikhwan revolted — leading to a civil war that lasted until the 1930s, when the King had them put down: he machine-gunned them.

For this king, (Abd-al Aziz), the simple verities of previous decades were eroding. Oil was being discovered in the peninsular. Britain and America were courting Abd-al Aziz, but still were inclined to support Sharif Husain as the only legitimate ruler of Arabia. The Saudis needed to develop a more sophisticated diplomatic posture.

So Wahhabism was forcefully changed from a movement of revolutionary jihad and theological takfiri purification, to a movement of conservative social, political, theological, and religious da’wa (Islamic call) and to justifying the institution that upholds loyalty to the royal Saudi family and the King’s absolute power.

OIL WEALTH SPREAD WAHHABISM

With the advent of the oil bonanza — as the French scholar, Giles Kepel writes, Saudi goals were to “reach out and spread Wahhabism across the Muslim world … to “Wahhabise” Islam, thereby reducing the “multitude of voices within the religion” to a “single creed” — a movement which would transcend national divisions. Billions of dollars were — and continue to be — invested in this manifestation of soft power.

It was this heady mix of billion dollar soft power projection — and the Saudi willingness to manage Sunni Islam both to further America’s interests, as it concomitantly embedded Wahhabism educationally, socially and culturally throughout the lands of Islam — that brought into being a western policy dependency on Saudi Arabia, a dependency that has endured since Abd-al Aziz’s meeting with Roosevelt on a U.S. warship (returning the president from the Yalta Conference) until today.

Westerners looked at the Kingdom and their gaze was taken by the wealth; by the apparent modernization; by the professed leadership of the Islamic world. They chose to presume that the Kingdom was bending to the imperatives of modern life — and that the management of Sunni Islam would bend the Kingdom, too, to modern life.

On the one hand, ISIS is deeply Wahhabist. On the other hand, it is ultra radical in a different way. It could be seen essentially as a corrective movement to contemporary Wahhabism.

But the Saudi Ikhwan approach to Islam did not die in the 1930s. It retreated, but it maintained its hold over parts of the system — hence the duality that we observe today in the Saudi attitude towards ISIS.

On the one hand, ISIS is deeply Wahhabist. On the other hand, it is ultra radical in a different way. It could be seen essentially as a corrective movement to contemporary Wahhabism.

ISIS is a “post-Medina” movement: it looks to the actions of the first two Caliphs, rather than the Prophet Muhammad himself, as a source of emulation, and it forcefully denies the Saudis’ claim of authority to rule.

As the Saudi monarchy blossomed in the oil age into an ever more inflated institution, the appeal of the Ikhwan message gained ground (despite King Faisal’s modernization campaign). The “Ikhwan approach” enjoyed — and still enjoys — the support of many prominent men and women and sheikhs. In a sense, Osama bin Laden was precisely the representative of a late flowering of this Ikhwani approach.

Today, ISIS’ undermining of the legitimacy of the King’s legitimacy is not seen to be problematic, but rather a return to the true origins of the Saudi-Wahhab project.

In the collaborative management of the region by the Saudis and the West in pursuit of the many western projects (countering socialism, Ba’athism, Nasserism, Soviet and Iranian influence), western politicians have highlighted their chosen reading of Saudi Arabia (wealth, modernization and influence), but they chose to ignore the Wahhabist impulse.

After all, the more radical Islamist movements were perceived by Western intelligence services as being more effective in toppling the USSR in Afghanistan — and in combatting out-of-favor Middle Eastern leaders and states.

Why should we be surprised then, that from Prince Bandar’s Saudi-Western mandate to manage the insurgency in Syria against President Assad should have emerged a neo-Ikhwan type of violent, fear-inducing vanguard movement: ISIS? And why should we be surprised — knowing a little about Wahhabism — that “moderate” insurgents in Syria would become rarer than a mythical unicorn? Why should we have imagined that radical Wahhabism would create moderates? Or why could we imagine that a doctrine of “One leader, One authority, One mosque: submit to it, or be killed” could ever ultimately lead to moderation or tolerance?

Or, perhaps, we never imagined.

ISIS is indeed a veritable time bomb inserted into the heart of the Middle East. But its destructive power is not as commonly understood. It is not with the “March of the Beheaders”; it is not with the killings; the seizure of towns and villages; the harshest of “justice” — terrible though they are — that its true explosive power lies. It is yet more potent than its exponential pull on young Muslims, its huge arsenal of weapons and its hundreds of millions of dollars.

“We should understand that there is really almost nothing that the West can now do about it but sit and watch.”

Its real potential for destruction lies elsewhere — in the implosion of Saudi Arabia as a foundation stone of the modern Middle East. We should understand that there is really almost nothing that the West can now do about it but sit and watch.

The clue to its truly explosive potential, as Saudi scholar Fouad Ibrahim has pointed out (but which has passed, almost wholly overlooked, or its significance has gone unnoticed), is ISIS’ deliberate and intentional use in its doctrine — of the language of Abd-al Wahhab, the 18th century founder, together with Ibn Saud, of Wahhabism and the Saudi project:

Abu Omar al-Baghdadi, the first “prince of the faithful” in the Islamic State of Iraq, in 2006 formulated, for instance, the principles of his prospective state … Among its goals is disseminating monotheism “which is the purpose [for which humans were created] and [for which purpose they must be called] to Islam…” This language replicates exactly Abd-al Wahhab’s formulation. And, not surprisingly, the latter’s writings and Wahhabi commentaries on his works are widely distributed in the areas under ISIS’ control and are made the subject of study sessions. Baghdadi subsequently was to note approvingly, “a generation of young men [have been] trained based on the forgotten doctrine of loyalty and disavowal.”

And what is this “forgotten” tradition of “loyalty and disavowal?” It is Abd al-Wahhab’s doctrine that belief in a sole (for him an anthropomorphic) God — who was alone worthy of worship — was in itself insufficient to render man or woman a Muslim?

He or she could be no true believer, unless additionally, he or she actively denied (and destroyed) any other subject of worship. The list of such potential subjects of idolatrous worship, which al-Wahhab condemned as idolatry, was so extensive that almost all Muslims were at risk of falling under his definition of “unbelievers.” They therefore faced a choice: Either they convert to al-Wahhab’s vision of Islam — or be killed, and their wives, their children and physical property taken as the spoils of jihad. Even to express doubts about this doctrine, al-Wahhab said, should occasion execution.

“Through its intentional adoption of this Wahhabist language, ISIS is knowingly lighting the fuse to a bigger regional explosion — one that has a very real possibility of being ignited, and if it should succeed, will change the Middle East decisively.”

The point Fuad Ibrahim is making, I believe, is not merely to reemphasize the extreme reductionism of al-Wahhab’s vision, but to hint at something entirely different: That through its intentional adoption of this Wahhabist language, ISIS is knowingly lighting the fuse to a bigger regional explosion — one that has a very real possibility of being ignited, and if it should succeed, will change the Middle East decisively.

For it was precisely this idealistic, puritan, proselytizing formulation by al-Wahhab that was “father” to the entire Saudi “project” (one that was violently suppressed by the Ottomans in 1818, but spectacularly resurrected in the 1920s, to become the Saudi Kingdom that we know today). But since its renaissance in the 1920s, the Saudi project has always carried within it, the “gene” of its own self-destruction.

THE SAUDI TAIL HAS WAGGED BRITAIN AND U.S. IN THE MIDDLE EAST

Paradoxically, it was a maverick British official, who helped embed the gene into the new state. The British official attached to Aziz, was one Harry St. John Philby (the father of the MI6 officer who spied for the Soviet KGB, Kim Philby). He was to become King Abd al-Aziz’s close adviser, having resigned as a British official, and was until his death, a key member of the Ruler’s Court. He, like Lawrence of Arabia, was an Arabist. He was also a convert to Wahhabi Islam and known as Sheikh Abdullah.

St. John Philby was a man on the make: he had determined to make his friend, Abd al-Aziz, the ruler of Arabia. Indeed, it is clear that in furthering this ambition he was not acting on official instructions. When, for example, he encouraged King Aziz to expand in northern Nejd, he was ordered to desist. But (as American author, Stephen Schwartz notes), Aziz was well aware that Britain had pledged repeatedly that the defeat of the Ottomans would produce an Arab state, and this no doubt, encouraged Philby and Aziz to aspire to the latter becoming its new ruler.

It is not clear exactly what passed between Philby and the Ruler (the details seem somehow to have been suppressed), but it would appear that Philby’s vision was not confined to state-building in the conventional way, but rather was one of transforming the wider Islamic ummah (or community of believers) into a Wahhabist instrument that would entrench the al-Saud as Arabia’s leaders. And for this to happen, Aziz needed to win British acquiescence (and much later, American endorsement). “This was the gambit that Abd al-Aziz made his own, with advice from Philby,” notes Schwartz.

BRITISH GODFATHER OF SAUDI ARABIA

In a sense, Philby may be said to be “godfather” to this momentous pact by which the Saudi leadership would use its clout to “manage” Sunni Islam on behalf of western objectives (containing socialism, Ba’athism, Nasserism, Soviet influence, Iran, etc.) — and in return, the West would acquiesce to Saudi Arabia’s soft-power Wahhabisation of the Islamic ummah (with its concomitant destruction of Islam’s intellectual traditions and diversity and its sowing of deep divisions within the Muslim world).

“In political and financial terms, the Saud-Philby strategy has been an astonishing success. But it was always rooted in British and American intellectual obtuseness: the refusal to see the dangerous ‘gene’ within the Wahhabist project, its latent potential to mutate, at any time, back into its original a bloody, puritan strain. In any event, this has just happened: ISIS is it.”

As a result — from then until now — British and American policy has been bound to Saudi aims (as tightly as to their own ones), and has been heavily dependent on Saudi Arabia for direction in pursuing its course in the Middle East.

In political and financial terms, the Saud-Philby strategy has been an astonishing success (if taken on its own, cynical, self-serving terms). But it was always rooted in British and American intellectual obtuseness: the refusal to see the dangerous “gene” within the Wahhabist project, its latent potential to mutate, at any time, back into its original a bloody, puritan strain. In any event, this has just happened: ISIS is it.

Winning western endorsement (and continued western endorsement), however, required a change of mode: the “project” had to change from being an armed, proselytizing Islamic vanguard movement into something resembling statecraft. This was never going to be easy because of the inherent contradictions involved (puritan morality versus realpolitikand money) — and as time has progressed, the problems of accommodating the “modernity” that statehood requires, has caused “the gene” to become more active, rather than become more inert.

Even Abd al-Aziz himself faced an allergic reaction: in the form of a serious rebellion from his own Wahhabi militia, the Saudi Ikhwan. When the expansion of control by the Ikhwanreached the border of territories controlled by Britain, Abd al-Aziz tried to restrain his militia (Philby was urging him to seek British patronage), but the Ikwhan, already critical of his use of modern technology (the telephone, telegraph and the machine gun), “were outraged by the abandonment of jihad for reasons of worldly realpolitik … They refused to lay down their weapons; and instead rebelled against their king … After a series of bloody clashes, they were crushed in 1929. Ikhwan members who had remained loyal, were later absorbed into the [Saudi] National Guard.”

King Aziz’s son and heir, Saud, faced a different form of reaction (less bloody, but more effective). Aziz’s son was deposed from the throne by the religious establishment — in favor of his brother Faisal — because of his ostentatious and extravagant conduct. His lavish, ostentatious style, offended the religious establishment who expected the “Imam of Muslims,” to pursue a pious, proselytizing lifestyle.

King Faisal, Saud’s successor, in his turn, was shot by his nephew in 1975, who had appeared at Court ostensibly to make his oath of allegiance, but who instead, pulled out a pistol and shot the king in his head. The nephew had been perturbed by the encroachment of western beliefs and innovation into Wahhabi society, to the detriment of the original ideals of the Wahhabist project.

SEIZING THE GRAND MOSQUE IN 1979

Far more serious, however, was the revived Ikhwan of Juhayman al-Otaybi, which culminated in the seizure of the Grand Mosque by some 400-500 armed men and women in 1979. Juhayman was from the influential Otaybi tribe from the Nejd, which had led and been a principal element in the original Ikhwan of the 1920s.

Juhayman and his followers, many of whom came from the Medina seminary, had the tacit support, amongst other clerics, of Sheikh Abdel-Aziz Bin Baz, the former Mufti of Saudi Arabia. Juhayman stated that Sheikh Bin Baz never objected to his Ikhwan teachings (which were also critical of ulema laxity towards “disbelief”), but that bin Baz had blamed him mostly for harking on that “the ruling al-Saud dynasty had lost its legitimacy because it was corrupt, ostentatious and had destroyed Saudi culture by an aggressive policy of westernisation.”

Significantly, Juhayman’s followers preached their Ikhwani message in a number of mosques in Saudi Arabia initially without being arrested, but when Juhayman and a number of the Ikhwan finally were held for questioning in 1978. Members of the ulema (including bin Baz) cross-examined them for heresy, but then ordered their release because they saw them as being no more than traditionalists harkening back to the Ikhwan— like Juhayman grandfather — and therefore not a threat.

Even when the mosque seizure was defeated and over, a certain level of forbearance by the ulema for the rebels remained. When the government asked for a fatwa allowing for armed force to be used in the mosque, the language of bin Baz and other senior ulema was curiously restrained. The scholars did not declare Juhayman and his followers non-Muslims, despite their violation of the sanctity of the Grand Mosque, but only termed them al-jamaah al-musallahah (the armed group).

The group that Juhayman led was far from marginalized from important sources of power and wealth. In a sense, it swam in friendly, receptive waters. Juhayman’s grandfather had been one of the leaders of the the original Ikhwan, and after the rebellion against Abdel Aziz, many of his grandfather’s comrades in arms were absorbed into the National Guard — indeed Juhayman himself had served within the Guard — thus Juhayman was able to obtain weapons and military expertise from sympathizers in the National Guard, and the necessary arms and food to sustain the siege were pre-positioned, and hidden, within the Grand Mosque. Juhayman was also able to call on wealthy individuals to fund the enterprise.

ISIS VS. WESTERNIZED SAUDIS

The point of rehearsing this history is to underline how uneasy the Saudi leadership must be at the rise of ISIS in Iraq and Syria. Previous Ikhwani manifestations were suppressed — but these all occurred inside the kingdom.

ISIS however, is a neo-Ikhwani rejectionist protest that is taking place outside the kingdom — and which, moreover, follows the Juhayman dissidence in its trenchant criticism of the al-Saud ruling family.

This is the deep schism we see today in Saudi Arabia, between the modernizing current of which King Abdullah is a part, and the “Juhayman” orientation of which bin Laden, and the Saudi supporters of ISIS and the Saudi religious establishment are a part. It is also a schism that exists within the Saudi royal family itself.

According to the Saudi-owned Al-Hayat newspaper, in July 2014 “an opinion poll of Saudis [was] released on social networking sites, claiming that 92 percent of the target group believes that ‘IS conforms to the values of Islam and Islamic law.’” The leading Saudi commentator, Jamal Khashoggi, recently warned of ISIS’ Saudi supporters who “watch from the shadows.”

There are angry youths with a skewed mentality and understanding of life and sharia, and they are canceling a heritage of centuries and the supposed gains of a modernization that hasn’t been completed. They turned into rebels, emirs and a caliph invading a vast area of our land. They are hijacking our children’s minds and canceling borders. They reject all rules and legislations, throwing it [a]way … for their vision of politics, governance, life, society and economy. [For] the citizens of the self-declared “commander of the faithful,” or Caliph, you have no other choice … They don’t care if you stand out among your people and if you are an educated man, or a lecturer, or a tribe leader, or a religious leader, or an active politician or even a judge … You must obey the commander of the faithful and pledge the oath of allegiance to him. When their policies are questioned, Abu Obedia al-Jazrawi yells, saying: “Shut up. Our reference is the book and the Sunnah and that’s it.”

“What did we do wrong?” Khashoggi asks. With 3,000-4,000 Saudi fighters in the Islamic State today, he advises of the need to “look inward to explain ISIS’ rise”. Maybe it is time, he says, to admit “our political mistakes,” to “correct the mistakes of our predecessors.”

MODERNIZING KING THE MOST VULNERABLE

The present Saudi king, Abdullah, paradoxically is all the more vulnerable precisely because he has been a modernizer. The King has curbed the influence of the religious institutions and the religious police — and importantly has permitted the four Sunni schools of jurisprudence to be used, by those who adhere to them (al-Wahhab, by contrast, objected to all other schools of jurisprudence other than his own).

“The key political question is whether the simple fact of ISIS’ successes, and the full manifestation (flowering) of all the original pieties and vanguardism of the archetypal impulse, will stimulate and activate the dissenter ‘gene’ — within the Saudi kingdom. If it does, and Saudi Arabia is engulfed by the ISIS fervor, the Gulf will never be the same again. Saudi Arabia will deconstruct and the Middle East will be unrecognizable.”

It is even possible too for Shiite residents of eastern Saudi Arabia to invoke Ja’afri jurisprudence and to turn to Ja’afari Shiite clerics for rulings. (In clear contrast, al-Wahhab held a particular animosity towards the Shiite and held them to be apostates. As recentlyas the 1990s, clerics such as bin Baz — the former Mufti — and Abdullah Jibrin reiterated the customary view that the Shiite were infidels).

Some contemporary Saudi ulema would regard such reforms as constituting almost a provocation against Wahhabist doctrines, or at the very least, another example of westernization. ISIS, for example, regards any who seek jurisdiction other than that offered by the Islamic State itself to be guilty of disbelief — since all such “other” jurisdictions embody innovation or “borrowings” from other cultures in its view.

The key political question is whether the simple fact of ISIS’ successes, and the full manifestation (flowering) of all the original pieties and vanguardism of the archetypal impulse, will stimulate and activate the dissenter ‘gene’ — within the Saudi kingdom.

If it does, and Saudi Arabia is engulfed by the ISIS fervor, the Gulf will never be the same again. Saudi Arabia will deconstruct and the Middle East will be unrecognizable.

“They hold up a mirror to Saudi society that seems to reflect back to them an image of ‘purity’ lost”

In short, this is the nature of the time bomb tossed into the Middle East. The ISIS allusions to Abd al-Wahhab and Juhayman (whose dissident writings are circulated within ISIS) present a powerful provocation: they hold up a mirror to Saudi society that seems to reflect back to them an image of “purity” lost and early beliefs and certainties displaced by shows of wealth and indulgence.

This is the ISIS “bomb” hurled into Saudi society. King Abdullah — and his reforms — are popular, and perhaps he can contain a new outbreak of Ikwhani dissidence. But will that option remain a possibility after his death?

And here is the difficulty with evolving U.S. policy, which seems to be one of “leading from behind” again — and looking to Sunni states and communities to coalesce in the fight against ISIS (as in Iraq with the Awakening Councils).

It is a strategy that seems highly implausible. Who would want to insert themselves into this sensitive intra-Saudi rift? And would concerted Sunni attacks on ISIS make King Abdullah’s situation better, or might it inflame and anger domestic Saudi dissidence even further? So whom precisely does ISIS threaten? It could not be clearer. It does not directly threaten the West (though westerners should remain wary, and not tread on this particular scorpion).

The Saudi Ikhwani history is plain: As Ibn Saud and Abd al-Wahhab made it such in the 18th century; and as the Saudi Ikhwan made it such in the 20th century. ISIS’ real target must be the Hijaz — the seizure of Mecca and Medina — and the legitimacy that this will confer on ISIS as the new Emirs of Arabia.

Written by Alastair Crooke Fmr. MI-6 agent; Author, ‘Resistance: The Essence of Islamic Revolution’

Detection of Atherosclerotic Inflammation by 68Ga-DOTATATE PET Compared to [18F]FDG PET imaging.


Abstract

Background Inflammation drives atherosclerotic plaque rupture. Although inflammation can be measured using fluorine-18-labeled fluorodeoxyglucose positron emission tomography ([18F]FDG PET), [18F]FDG lacks cell specificity, and coronary imaging is unreliable because of myocardial spillover.

Objectives This study tested the efficacy of gallium-68-labeled DOTATATE (68Ga-DOTATATE), a somatostatin receptor subtype-2 (SST2)-binding PET tracer, for imaging atherosclerotic inflammation.

Methods We confirmed 68Ga-DOTATATE binding in macrophages and excised carotid plaques. 68Ga-DOTATATE PET imaging was compared to [18F]FDG PET imaging in 42 patients with atherosclerosis.

Figure1

Results Target SSTR2 gene expression occurred exclusively in “proinflammatory” M1 macrophages, specific 68Ga-DOTATATE ligand binding to SST2 receptors occurred in CD68-positive macrophage-rich carotid plaque regions, and carotid SSTR2 mRNA was highly correlated with in vivo 68Ga-DOTATATE PET signals (r = 0.89; 95% confidence interval [CI]: 0.28 to 0.99; p = 0.02). 68Ga-DOTATATE mean of maximum tissue-to-blood ratios (mTBRmax) correctly identified culprit versus nonculprit arteries in patients with acute coronary syndrome (median difference: 0.69; interquartile range [IQR]: 0.22 to 1.15; p = 0.008) and transient ischemic attack/stroke (median difference: 0.13; IQR: 0.07 to 0.32; p = 0.003). 68Ga-DOTATATE mTBRmax predicted high-risk coronary computed tomography features (receiver operating characteristics area under the curve [ROC AUC]: 0.86; 95% CI: 0.80 to 0.92; p < 0.0001), and correlated with Framingham risk score (r = 0.53; 95% CI: 0.32 to 0.69; p <0.0001) and [18F]FDG uptake (r = 0.73; 95% CI: 0.64 to 0.81; p < 0.0001). [18F]FDG mTBRmax differentiated culprit from nonculprit carotid lesions (median difference: 0.12; IQR: 0.0 to 0.23; p = 0.008) and high-risk from lower-risk coronary arteries (ROC AUC: 0.76; 95% CI: 0.62 to 0.91; p = 0.002); however, myocardial [18F]FDG spillover rendered coronary [18F]FDG scans uninterpretable in 27 patients (64%). Coronary 68Ga-DOTATATE PET scans were readable in all patients.

Conclusions We validated 68Ga-DOTATATE PET as a novel marker of atherosclerotic inflammation and confirmed that 68Ga-DOTATATE offers superior coronary imaging, excellent macrophage specificity, and better power to discriminate high-risk versus low-risk coronary lesions than [18F]FDG. (Vascular Inflammation Imaging Using Somatostatin Receptor Positron Emission Tomography)

Conclusions

We provide gene-, cell-, plaque-, and patient-level data demonstrating that SST2 PET imaging using 68Ga-DOTATATE provides a quantifiable, cell-specific marker of atherosclerotic inflammation that outperforms [18F]FDG in the coronary arteries. Further work is needed to confirm these findings in a larger patient population and to compare imaging with clinical outcomes. 68Ga-DOTATATE PET offers measurement of both generalized atherosclerotic disease activity and detailed information about local plaque functional phenotype to complement multimodal assessments of anatomic, morphologic, and hemodynamic disease severity. This approach, in selected patient populations, has the potential to improve CVD risk prediction, allowing personalized tailoring of therapies aimed to improve clinical outcomes.

source:onlinejacc.org

Donald Trump Warns Flu Shots Are The Greatest ‘Scam’ In Medical History


The flu shot is the greatest scam in medical history, created by Big Pharma to make money off vulnerable people and make them sick, warns President Donald Trump. In an interview with Opie and Anthony on Sirius XM, Trump slammed flu shots as “totally ineffective” and declared that he has never had one. “I’ve never had one. And thus far I’ve never had the flu. I don’t like the idea of injecting bad stuff into your body. And that’s basically what they do. And this one (latest flu vaccine) has not been very effective to start off with. I have friends that religiously get the flu shot and then they get the flu. You know, that helps my thinking. I’ve seen a lot of reports that the last flu shot is virtually totally ineffective.” Trump is right on this – flu shots are the greatest medical fraud in history. They are full of “bad stuff” including formaldehyde and mercury – two powerful neurotoxins – and the vaccine industry even admits that laboratory tests prove the popular jab does not work.

Donald Trump Warns Flu Shots Are The Greatest ‘Scam’ In Medical History

Why is a toxic, medical hoax, backed by nothing but voodoo faith-based dogma and clever marketing, pushed on the whole population every year? Vaccines are the one medicine where no scientific evidence of safety or efficacy is required by anyone: not the FDA, not the CDC and not the media. Congress even passed a law protecting the vaccine industry with absolute legal immunity, even when they manufacture and sell defective products that injure and kill people. And vaccine manufacturers have been lying to us for years about toxic levels of mercury in flu shots. Everybody knows mercury is toxic to inject into the human body. That’s not debated except by irrational anti-science denialists. So why won’t manufacturers remove the mercury? And why does Big Pharma continue to push a product that the vaccine industry admits does not even work?

Watch the video. URL:https://youtu.be/cDARZJxzeoY

Source:.whydontyoutrythis.com

Confirmed: Those mysterious radio bursts really are coming from outer space.


For almost a decade now, scientists have been trying to decode the origin of some of the most mysterious and explosive signals in the Universe – fast radio bursts (FRBs).

Lasting only milliseconds, these bursts of energy are about a billion times more luminous than anything we’ve ever seen in our own galaxy, and seem to be travelling across vast distances. But despite having detected more than 20 of them, scientists still aren’t sure where they’re coming from, or what causes them. Now researchers are one step closer by ruling out any source on Earth.

 

There are still several hypotheses out there that need to be ruled out before we can say for sure where FRBs do come from – perhaps the most bizarre one put forward by Harvard scientists last month is that the FRBs could actually be alien signals.

But the fact that we now know the answer lies in space is a big deal. It might sound obvious, but let’s not forget that back in 1998, researchers thought they had discovered a new type of radio signal coming from space, only to figure out 17 years later that it was coming from a microwave oven in their research facility.

The reason the origin of these radio signals is so hard to nail down is that we often find them using single-dish radio telescopes, which can ‘hear’ a lot without providing much perspective on where it’s coming from.

“Conventional single dish radio telescopes have difficulty establishing that transmissions originate beyond the Earth’s atmosphere,” said one of the researchers on the latest study, Chris Flynn from Swinburne University of Technology in Australia.

To overcome this problem and rule out terrestrial interference as the source of FRBs once and for all, the researchers used the Molonglo telescope in the Australian Capital Territory (ACT), which has a collecting area of around 18,000 square metres (194,000 square feet).

This huge collection area means the telescope is ideal for picking up FRBs, but back in 2013, the team also realised that because of its architecture, it’s not possible for it to detect any signals coming from within our atmosphere.

 So the team set about hunting through Molonglo’s data to see if they could find any traces of FRBs – seeing as the telescope produces more than 1,000 TB of data each day, that’s no easy feat. The idea was that if the telescope had detected the signals, then they must be coming from outer space.

Eventually, they uncovered three new FRB signals in the telescope’s data, which matched perfect with the signals we’ve picked up before – indicating that they couldn’t possibly be coming from Earth.

Their conclusions back up findings from earlier this year, when researchers were able to pinpoint the source of a FRB to a tiny dwarf galaxy more than 3 billion light-years from Earth.

But for now, the sources of the three newly detected FRBs remain relatively mysterious, except for the fact that they’re not of this world – the data suggest they’re coming from the direction of the constellations Puppis and Hydra (signified by the three red stars below):

Mongolo FRB LSJames 

The Molonglo telescope is now being updated with the hope that it might be able to provide some more insight in future – hopefully even going as far as pinpointing specific galactic origins.

“Figuring out where the bursts come from is the key to understanding what makes them. Only one burst has been linked to a specific galaxy,” said lead researcher Manisha Caleb.

“We expect Molonglo will do this for many more bursts.”

Source:sciencealert.com

Scientists have invented a graphene-based sieve that turns seawater into drinking water.


Researchers have achieved a major turning point in the quest for efficient desalination by announcing the invention of a graphene-oxide membrane that sieves salt right out of seawater.

At this stage, the technique is still limited to the lab, but it’s a demonstration of how we could one day quickly and easily turn one of our most abundant resources, seawater, into one of our most scarce – clean drinking water.

 

The team, led by Rahul Nair from the University of Manchester in the UK, has shown that the sieve can efficiently filter out salts, and now the next step is to test this against existing desalination membranes.

“Realisation of scalable membranes with uniform pore size down to atomic scale is a significant step forward and will open new possibilities for improving the efficiency of desalination technology,” says Nair.

“This is the first clear-cut experiment in this regime. We also demonstrate that there are realistic possibilities to scale up the described approach and mass produce graphene-based membranes with required sieve sizes.”

Graphene-oxide membranes have long been considered a promising candidate for filtration and desalination, but although many teams have developed membranes that could sieve large particles out of water, getting rid of salt requires even smaller sieves that scientists have struggled to create.

One big issue is that, when graphene-oxide membranes are immersed in water, they swell up, allowing salt particles to flow through the engorged pores.

The Manchester team overcame this by building walls of epoxy resin on either side of the graphene oxide membrane, stopping it from swelling up in water.

 This allowed them to precisely control the pore size in the membrane, creating holes tiny enough to filter out all common salts from seawater.

The key to this is the fact that when common salts are dissolved in water, they form a ‘shell’ of water molecules around themselves.

“Water molecules can go through individually, but sodium chloride cannot. It always needs the help of the water molecules,” Nair told Paul Rincon from the BBC.

“The size of the shell of water around the salt is larger than the channel size, so it cannot go through.”

Not only did this leave seawater fresh to drink, it also made the water molecules flow way faster through the membrane barrier, which is perfect for use in desalination.

“When the capillary size is around one nanometre, which is very close to the size of the water molecule, those molecules form a nice interconnected arrangement like a train,” Nair explained to Rincon.

“That makes the movement of water faster: if you push harder on one side, the molecules all move on the other side because of the hydrogen bonds between them. You can only get that situation if the channel size is very small.”

There are already several major desalination plants around the world using polymer-based membranes to filter out salt, but the process is still largely inefficient and expensive, so finding a way to make it quicker, cheaper, and easier is a huge goal for researchers.

Thanks to climate change, seawater is something we’re going to have plenty of in the future – Greenland’s coastal ice caps which have already passed the point of no return are predicted to increase sea levels by around 3.8 cm (1.5 inches) by 2100, and if the entire Greenland Ice Sheet melts, future generations will be facing oceans up to 7.3 metres (24 feet) higher.

But at the same time, clean drinking water is still incredibly hard to come by in many parts of the world – the UN predicts that by 2025, 14 percent of the world’s population will encounter water scarcity. And many of those countries won’t be able to afford large-scale desalination plants.

The researchers are now hoping that the graphene-based sieve might be as effective as large plants on the small scale, so it’s easier to roll out.

Graphene oxide is also a lot easier and cheaper to make in the lab than single-layers of graphene, which means the technology will be affordable and easy to produce.

“The selective separation of water molecules from ions by physical restriction of interlayer spacing opens the door to the synthesis of inexpensive membranes for desalination,” Ram Devanathan from the Pacific Northwest National Laboratory, who wasn’t involved in the research, wrote in an accompanyingNature News and Views article.

“The ultimate goal is to create a filtration device that will produce potable water from seawater or wastewater with minimal energy input.”

He added that the next step will be to test how durable the membranes are when used over long periods of time, and how often they need to be replaced.

Source: Nature Nanotechnology.