Thursday, 31 May 2007

Raymond Tallis and the patients who know too much

There are things that make you despise humanity – going shopping at IKEA on Saturday afternoons, or attending one of the European parliament’s stagiaire-feeding Tuesday evening buffets, come to mind.

Talking to Professor Raymond Tallis, a geriatric specialist at Manchester University, makes you despise patients.

It is the view from the other side, as it were. I am not saying the highly intelligent, thoughtful prof Tallis, named by Prospect magazine one of Britain’s top 100 thinkers, perhaps the UK’s top medical philosopher, is a misanthropist but, reading between the lines, sand removing his caveats, one gets the sense of frustration put on consultants feel about the behaviour of patients to a greater or lesser extent – even, perhaps, you.

Complaints against doctors about the poor communication skills are on the rise, Tallis notes in Hippocratic Oaths, his recent memoir of life in the medical profession. He tries to explain how this has come about, through explaining the constraints of the profession and the inevitable differences in the patient/doctor perspective..

The conflicts begin when, having worked on his internal narrative as to what is wrong with him, the patient encounters the doctor for the first time. The doctor is, as it were, a late entrant into the conversation between the patient and his inner self, between patient and relatives and friends. The doctor will discard some of the things the patient says – even though they will be of great personal importance to the patient. – as extraneous, and upgrade other things that patient may regard as minor.

Tension will arise. A medical retelling of the story, designed as a basis for appropriate action, might be seen as a “defoliation” of the personal tale the patient has nurtured. The passage of history taking from open to closed questions presage a physical examination where the patient ceases to become a speaking subject and becomes a proffered body-as-object.

Doubtless journalists and writers who have been giving the medical profession such a hard time over the years would see this process as a power struggle between God like consultant and powerless patient, where the patient is doomed to lose his “humanity”. But in fact, what the consultant is supposed to bring to meeting is not personal knowledge of the patient’s travails but impersonal expertise which allows the problem the patient has brought to the clinic to be solved. It is this objectivity that enables him to do his job,

If eliciting information about the patient leads to tensions enough, deciding what to tell the patient about his conditions leads to even greater difficulties. How much should the patient be told? How much technical information would he or she comprehend? How much can they cope with? How much do they want to be told?

Many patients’ interests groups, claiming to speak on behalf of patients, would say: everything. But some patients want to be kept in the dark. With other patients there is no set limit to how much they want to know – the name and the star rating of the surgeon, even though the surgeon might not be selected until a very late stage. Patients who want to know it all might have entirely appropriate demands, but this pays no heed to the unbearable time pressures consultants often suffer; there are other patients, in the waiting room, also wanting their share of attention.

Communication with the patient is often limited by his ability or knowledge to comprehend the vast new areas of biological information now relevant to him; the diagnosis is the beginning of a journey of learning – and yet it is often felt the consultant is incumbent on effecting complete understanding in the patient, in one session.

As diagnosis comes to medical action, one problem is that of consent, required for any procedure that carries significant risk. But what is significant risk? British doctors have a rule of thumb that anything with a 1/200 chance of happening, and anything with a much lower chance of happening if that side effect could cause death or serious injury. Since there are so many things that could go theoretically speaking wrong that the patient’s life – as Tallis demonstrates in an example involving his mother – is sometimes in danger as a long list these days has to be checked off before the operation can go ahead. Nevertheless, there will be operations carried out, for which there is an infinitesmally small chance which the patient isn’t told about, which then happens, and leads to a disappointed and angry patient saying they would not have had the operation had they known of this risk. One example is that of Jo Knowlesly, who ha ppened to be a Mail on Sunday journalist, and who wrote about her ordeal in her paper.

She was admitted to hospital for laparoscopy, a common procedure in which, though a small incision and through using a cleverly designed scope, the doctor is able to examine the abdominal cavity for diagnostic purposes. It is an essentially safe procedure, and a vast improvement on earlier diagnostic methods. In Knowlesly’s case there was a perforation of the abdomen, which only happens once in 2,000 cases. A larger incision had to be made to stitch up the perforation; as a result Knowlesly spent three days longer in hospital. When she woke up, despite being apologised profusely to, she was very angry because she hadn’t been told of this risk, and that she would not have consented to it – even if the probability was much lower than the 1.200 chance. Even though she fully recovered she wrote a four page article about her ill treatment by the NHS and sued the hospital.

Poor communications are just one source of dissatisfaction with the modern doctor; I will spare you for the moment the others,. Summarising his chapter, Tallis writes that the “causes range from the incommensurability of personal experience of illness with the scientific understanding of it, to the impossibility of finding the limits of what should be should be communicated.”

Saturday, 19 May 2007

Shokai




Tabita Shokai is the NHS nurse who became a rebel
activist, then health minister - a black woman, a Christian - in
Sudan's predominantly Muslim Arab government.
The Sudan government is accused of killing 200,000 people in Darfur,
western Sudan. The government is said to be a UN pariah and is under
US sanctions. Discussions about whether actually to let in a UN force to
stop the killing have stalled. Meanwhile, Sudan, which has just
discovered oil, has to grapple with the worst health indicators in
Africa, where a woman is more likely to die of childbirth than complete primary school. I talked to Shokai and found her remarkably optimistic....


The government is fighting "rebels" in Darfur. You are also a rebel butpart of the government. I think people are a little bit confused......

My movement, the SPLM, is based in the Christian, black south and
fought the government until 2005. Then we made a peace agreement. The
rebellion in Darfur, western Sudan, inhabited by black muslims, is
different.

What do you do all day?

I attend the weekly cabinet meetings, I chair one of the sectors - in
charge of education and health, the first Sudanese woman to do so. I
travel around Sudan a lot. The rest of the government has many grand
schemes, but I am constantly lobbying for a bigger budget on health.
It's an investment, not an expenditure.

Aids is your special priority?

Aids has grown. We now have the highest rate in the middle east and
north Africa. The borders with Kenya and Uganda are now wide open,
the
peace agreement means people move around more. Soldiers are coming
home. Still, we have a public education campaign. People are more
honest about reporting Aids. though it is difficult to change people's
culture.

Aids is not our only problem: Malaria is big. In the past people
refused to use malaria nets although they got them free - people
didn’t seem to want that. But now they are very grateful. Malaria kills
millions per year. However avian flu gets much more attention; it's a
press disease.

What about female genital mutilation, or female circumcision; Sudan is
one of the leading countries to practise it?


It is illegal, all official bodies in Sudan have pronounced it bad, but
again it is difficult to change cultural habits. Male circumcision
could help reduce Aids, though.

Are the large number of rapes in Darfur contributing to the rise in
Aids?


Well, a lot of those rapes are exaggerated. It is the concern of the
justice ministry.

There is a lost generation, is there not? People who now would have
been in their thirties or forties, are dead. Who will take your place?
Does it mean you in power will have to rule forever?


It’s a problem. We have a programme for Aids orphans.

Isn't the Aids in soldiers a cause of the violence of soldiers - they
have nothing else to live for?


In Rwanda, where the Aids rate is 3 percent, former soldiers travel the
country as Aids counsellors, which is something we are trying to
arrange here.

I met someone who met a delegation of women coming off a plane and
realised "That's the 12 educated women in Sudan and I know all of
them".


Yes, the problem in south is very bad. But in the north, despite being
Muslim, there are still a lot of educated women who work as doctors,
judges.

So how do you reach out to uneducated women. Isn’t that part of the
health problem too?


We run illiteracy classes....it is an enormous challenge. Everything is
so difficult. But
we hope it will get better and better.

Is it true that you have secretly been phoning pharmacies in Khartoum
to tell them to stock condoms?


No, I would not do something like that secretly. In fact after a debate
about AIDS i stood in front of parliament advocating condoms. Someone
asked me if I was shy. I am not shy.

Why did you join the Sudanese people's rebel movement?

I joined it because the principal vision of our party was
non-discrimination and the the promise of equality. It wants to end
discrimination against women in public services. I also admired the
party's leader, John Garang, who was killed in a helicopter accident
last year shortly after we joined the national government. He was a
great man, much loved, and knew a lot.
After the peace agreement was signed in 2005, I became an MP in
Khartoum and was asked to be one the SPLM's three ministers in the new
coalition government. The government had set up a male candidate but I
won out. I know Khartoum well, having done my schooling here.


What is it like to be a African woman in an Arab Muslim-government,
which in the eighties was close ally to Al Qaeda and which introduced
tough sharia laws in the 80s?


Well, you know in the Nuba mountains where I come from the women are
quite free. Leni Riefenstahl, who made films about Hitler and was a
very strong woman herself, came to the mountains in the 1980s and made
films and wrote books about us. Khartoum is still male dominated, but
one of the SPLM's goals is to have 25% women in public life. Women in
Khartoum are, how to say, more laid back.

The black Christian south, where you came from, and the Muslim Arab
north have been fighting since Sudan's independence in 1956. Why?

It is a myth to say that northerners are Arabs. The Arabs came from
Egypt and mixed with the local African population; so we are all black,
one shade or another. You go to Lebanon and Syria, real Arabs, and you
can see the difference. Sudanese "Arabs" who go abroad come back and
say: "I am Sudanese!" Some of their treatment of "Africans", comes
because they hate themselves. With religion, in the Nuba mountains, it
is 50% muslim, 50% christian, but we all sing, dance, make clothes and
drink beer together.
The war was really about resources, not religion or skin colour.

About wanting a proper share of Sudan's oil?

Oil was discovered in southern and western Sudan. But it is not our
only resource. We have agriculture too

The US has declared what is going on in Sudan a genocide. Why did the
fighting start there? Is it because in spite of the generous peace deal
the government gave you and the SPLM, the rebels in Darfur wanted their
share of the oil you had?


Something like that. But it could be different. I met Minni Minawi, who
was one of the rebel groups' leaders. Two groups refused to sign an
agreement and are still fighting the government but Minni Minawi joined
the government. I See him at every cabinet meeting; he shakes
everyone's hand.

Why does your president Omar al Bashir not want UN forces to come and
make peace in Darfur. Is it because he fears the Americans will come
in, seize the oil and turn it into another Iraq?


Well, we already have UN troops in southern Sudan and they have done a
good job. It is a very political matter, for the National Congress
Party. They are very political about it.

The US does not allow its companies to do business in Sudan because it
accuses the country of supporting terror. Do you have problems with the
international health community as a result?

Not at all. A few weeks ago I had dinner at the British Ambassador's
with Hilary Benn, the UK development secretary. NGOs are very good,
very supportive. The Sudanese people just want peace in Darfur.

What is your relationship with the UK? Tony Blair has talked of
sanctions against Sudan.


My relationship with the UK is very good. I went there as a refugee,
worked in the NHS and was given a British passport, which I still
possess. There was respect. My late father was archbishop of Sudan and
the archbishop of Canterbury was present at his enthronement.

You are a woman in President Omar al-Bashir's cabinet. Bashir is one of
the most hated leaders in the world, accused of carrying out a genocide
in Darfur. What is he like as a man?


He likes children, he has a great sense of humour. He has been very
supportive. When the bird flu vaccine was discussed, he was there
straight away with $7m.

Do you miss the UK, where you worked as a nurse from 1988 - 2005 and
took a PHD in nursing?

Very much. But this is my country.

Friday, 18 May 2007

"If doctors are unhappy, let's do something"


Labour MEP Stephen Hughes, 54, talks about
working in Brussels, the controversial European
working time directive, how it might be amended, and
how to operate in the Brussels legislative scene....


You are the British MEP most heavily involved with the European
working time directive in the European parliament.
Apparently it is now subject to possible revision.
What’s happening with it?


The EWTD stipulates a maximum average 48-hour working
week for health and safety reasons.
It also stipulates a minimum 11 hours per day rest
period.
When it was signed, in 1993, the Conservative
government in the UK secured the right of companies
across Europe to get an opt-out. In most areas of
work, employees could - only if they wanted to -
sign an agreement with their employers permitting them
to work more than that. Although the stated reason
was to give businesses flexibility and boost British
economic growth, there were several reasons why this
was unacceptable - one being the matter of whether it
was truly voluntary, since many workers were asked to
sign the opt-out at the same time as they signed their
contracts. There might be an element of invisible
coercion involved. The opt-out has been extensively
used by UK firms, less often by German, Luxembourg and
Spanish companies.
Several governments have come around to the view that
the opt-out is unacceptable
and are negotiating for it to be abolished.
There was for long a complete deadlock among the EU’s
employment ministers about this: Sweden, France,
Italy, Spain and others want the opt-out to go. The UK,
Ireland, Germany and Poland wanted to keep it.
But now things are changing; Poland has signalled it
will be changing sides, because it wants to see introduced some of
the uncontroversial provisions in the amended directive, so in the
next year I expect, with the UK and others losing their blocking
minority, the opt-out will be abolished in return for which there
will be greater flexibility in the reference period
over which the 48-hour week is calculated, from four
months to a year, a concession to economic
flexibility.

How does all this relate to doctors?

Doctors in training were brought into the provisions of the EWTD in
2004, with a phasing in period. Today they work 58 hours a week, from
2009 it will be 48 hours a week.
But doctors could still opt out on an individual basis. That loophole
will now close.

What do you say to the controversial allegations being levelled at the EWTD: that the rest requirements
of 11 hours a night impose a straight shift system
where doctors work 13 hours a day, often 7 days in a
row, with no rest in those 13 hours. That less time
spent in hospitals means they have less training under
their belt when qualifying. That a shift system means
no continuity of care, and so on....


I have talked to consultants about this. One, a few
weeks ago, said that whereas when he qualified as a
consultant it took him about two years to find his
feet, it now takes a consultant five years because he will have had
less time training in hospital up to qualification. I am
sympathetic to this argument and am happy to receive
petitions.

Are British doctors good at lobbying Brussels?

The BMA junior doctors’ committee and the Royal
College of Nursing have done some lobbying. But
generally they are not as effective as they might be.
My advice is to get into the process early, and
upstream. Find out what is going on - the commission
is now discussing proposals that haven’t seen the
light of day yet but could become law in a decade. And
that will affect doctors.

Who should they lobby?

The commission; MEPs, especially on the employment and public health
committees; doctors’ organisations in Europe,
such as the CPME. Incidentally, if you are a qualified doctor and
want to work in medical politics and in Brussels, the
CPME is a good place to start looking for a job

So when you as an MEP have been “lobbied” , what do
you do.


It is not like national politics. There is a lot of opportunity for
lobbyists to change legislation at the parliamentary level. Unlike
British backbenchers, perhaps, MEPs have great freedom in shape
legislation, able to suggest amendments that are completely at odds
with a commission’s original proposal. When we have inserted
an amendment, you have to get support from it, first
in the relevant committee and then in parliament as a
whole. You have to build cross party alliances with individuals who
support your ideas in other parties, and hope they can
deliver block votes from their side. Brussels is all about building
alliances, coalitions.

Do you get lobbied by the pharmaceutical corporations?

All the time. They have big resources, instrumental in their success
in getting their views taken into account in the recent patent
extension legislation; they overwhelm us with information; and our
own research facilities are under-resourced by comparison. We have
access to fewer researchers than the Houses of Congress. Hopefully
this will change soon.

Why should health and safety at work issues be a
European competence?


Because of the European single market: there has to be a level
playing field. It is unfair if some countries have a competitive
advantage by having their workers subjected to worse health and
safety regulations.

Isn’t there too much legislation coming from Europe?

A lot of problems come from “gold-plating” - the
adding of clauses by national civil servants when
EU directives are transposed into national law.
Britain has the second biggest health and occupational
safety manual in Europe after Germany. It is also true
that Britain is more zealous than other countries at
implementing laws - including the EWTD.

What other health and safety at work legislation is going through at the moment?

Legislation on repetitive strain injury. A ban on unsafe needles in
Hospitals. Experiments in Manchester have shown that safe needles
reduce needlestick injuries by 95 percent. Since safe needles cost
the same these days, and each needlestick injury costs health systems
thousands of pounds in compensation and time off work, it is a good
idea to introduce safe needles across Europe.

Do you enjoy Brussels, having been an MEP here for 22 years?

There is a lot of travel, but the place has a great buzz.
Even though not nearly enough people know what we do.

Minstry of charlatanry

Faith healers, shamans, have, by invoking gods or spirits, for thousands of years been mankind’s defence against sickness, a fact often forgotten in the era of modern western medicine.

Now faith healing appears to be on the rise again.

It’s faith healing with a difference. The modern shaman uses the techniques of modern technology – to reach millions through syndicated TV programmes; hundreds of thousands through large stadium events where the healers, like rock stars, prance about, sing and, climactically, invite the chosen sick to roll up in their wheelchairs or limp up on their crutches to be “touched”, and cured.

Benny Hinn, perhaps the world’s best known faith healer, will be appearing this summer at London’s main conference centre, the Excel, on 27 and 28 July, to perform before thousands of Britons – and will proclaim, on past form, to have healed hundreds.


Statistics on the rise of the global phenomenon are hard to come by, but Hinn’s income is estimated to have doubled to US$200m in the last two years, quadrupled since 1997.

And there is such fertile ground: a poll of 1,000 US adults by USA Today suggests that 79 percent of the population believes prayer could help them to better health.

But faith healing is not just about rich gurus healing the masses. In a growing number of churches and healing centres across the States, small groups of lay healers and priests are getting together in churches and healing centres to pray for and heal neighbours, friends and local people.

But regular doctors shouldn’t have to hang up their stethoscopes just yet.

Several organisations have campaigned against faith healing, arguing that the hopes healers instil prevent people from seeking proper medical treatment. The Dallas-based Trinity Foundation – which is Christian, but which feels stadium faith healing besmirches Christianity’s name – says the big faith healers make fortunes from donations collected at meetings. Benny Hinn lives in $5,000-a-night hotel suites; his tax-free “parsonage” is a multimillion dollar mansion in an exclusive estate overlooking the Pacific. Meanwhile the people they “heal” actually get worse because they then reject proper treatment. Trinity says the mass healings - kinetic performances that involve invocations of God and symbolic laying of hands on the sick onstage - don't actually work.

Investigations into Hinn’s case history have revealed the story of one ten-year-old Indian boy with two brain tumours attending Hinn's rally. Despite the healing pronounced a success and a pledge by his impoverished parents to give thousands of dollars to Hinn’s ministry, the child died seven weeks later.

For all the numerous calls to show evidence for the success of his miracles, dispensed at his Prayer Meetings around the world, Hinn has failed to so convincingly, say researchers – even when presenting evidence on his own terms.

At one typical stadium prayer meeting, in Oregon, where the usual three score miracles were proclaimed, Hinn's habitually secretive ministry, when asked to provide verifiable evidence for these miracles, first stalled for months, then eventually provided only five names. When these cases were checked out, one woman “cured” of lung cancer had died nine months later, an old woman’s broken vertebrae hadn’t healed after all, a man with a logging injury deteriorated because he refused medication and a needed operation, a woman claimed to have been healed of deafness had never been deaf (according to her husband), and a woman complaining of "breathlessness" had stopped going to the doctor on instructions of her mother.

British readers would surely like to know all this before they book their rendez-vous with God in Docklands this summer.

The grotesque Chinese take away




15 minutes with…the Canadian foreign minister turned campaigner against illegal organ transplants

“Warning to all transplant patients”

Need a transplant? Order the organ by phone, the donor will be killed, and the part will be brought to you. If the stories are true, it would be the ultimate, grotesque Chinese take-away:
Human rights groups have long alleged that China harvests the organs from executed criminals to use in patients elsewhere, without their or their families’ consent.
But recent allegations go a step further. Campaigners are saying that large number of members of harmless spirituality movement Falun Gong – banned in China – who have been hauled off the street or parks for practising their belief system and are being hoarded in labour camps indefinitely for no other purposes than as live sources for organs. When their organs are needed – by a rich foreigner or Chinese – they are taken into hospital, killed and have their organs harvested.

All the useful internal organs - kidneys, livers, hearts, corneas – are
allegedly removed in sequence by a team of doctors. The bodies are thrown into large incinerators to obliterate all traces of them. Their families do not know where they are, since they were taken off the street without warning.
The organs are then transplanted into rich Chinese and overseas patients, who have communicated their need for a transplant via Chinese websites offering organs. A kidney can costs 60,000 dollars. A large number of rich
foreigners, including British people, are said to travel to China every year for transplant operations.

The stories have circulated since April, when the Falun Gong practitioners in the west started to raise the alarm. There was considerable scepticism in the western media, but the dapper, patrician David Kilgour, 65, a former Canadian MP and deputy foreign minister with responsibility for Asia, decided to investigate further, accepting an offer to do so from a Washington NGO specialising in human rights abuses in China.
Along with another Canadian lawyer, respected human rights specialist David Matas, co-director of the Canadian Helsiinki Watch human rights monitoring organisation, they conducted their investigation independently from Falun Gong – neither is an adherent - and have travelled around world capitals in the last few weeks to present their findings. We caught up with him after speaking to MPs and peers in the House of Lords, where Lord Thurlow, a former British high commissioner to New Zealand and Nigeria, a diplomat with 40 years’ experience, introduced the former cabinet minister as a “man of rare integrity”.

What evidence is there that this is happening?

It is in the nature of the allegations that they are difficult to prove or disprove. The best evidence is eyewitness testimony, yet for this alleged crime there are unlikely to be any eyewitnesses. The victims do not survive, and the perpetrators are unlikely to confess! Those reporting on human rights in China are thrown into jail, and the Red Cross is not allowed to visit prisoners.
Proof can either be inductive or deductive. Criminal investigation usually works deductively, connecting bits of evidence to form a coherent whole. We did have some deductive evidence – from investigative phone calls to Chinese hospitals, but there was a whole, bigger picture.

Like what?

There has been an official policy of prosecution, harassment, arrest and detention of Falun Gong members since 1999.
Falun Gong was founded in China in 1992; it is a peaceful spirituality and exercise movement, often called Chinese yoga, which grew quickly in popularity. Before the movement was banned in 1999, its millions of adherents gathered regularly in parks and streets to do their exercises. Then, in 1999, president Jiang Zemin banned the movement. Though avowedly non political, the movement was seen as a threat to the Communist party’s control over Chinese hearts and minds. The head of the so-called 6-10 office set up to deal with the movement told 3,000 officials in the Great Hall of the People that the new policy on Falun Gong would be to “defame their reputations, bankrupt them financially, destroy them physically”.
According to the US state department China report of 2005, the police run hundreds of detention centres, with 340 re-education through labour camps alone having a holding capacity of 300,000 persons. The report also estimated that the number of Falun Gong practitioners who have died in custody is at least several hundred but could be as many as several thousand. Local government everywhere was given the authority to implement Beijing’s orders to demonstrate to the Chinese population that practitioners committed suicide, killed family members and refused medical treatment. There have been reports on practitioners were shocked into standing for hours on end with electric truncheons and forced to undergo re-education classes for 16 hours a day for weeks in order to renounce the movement.

What other inductive evidence do you have?


In recent years, China has been carrying out many more transplants than identifiable sources. There are very few voluntary donations in China; because of the culture surrounding death. Assuming that every executed official death row prisoner has organs removed - with or without consent being given – that still leaves a shortfall of 41,000 transplants in the last six years. You have to combine this with the fact that Falun Gong prisoners are officially blood tested, unlike other prisoners – this is a prerequisite for transplants. They are not told why. There is also the fact that Chinese organ transplant websites advertise to customers that suitable organs can be had within weeks. Because compatibility rates are so low, the waiting time in Canada for an organ is months or even years, suggesting that, in China, there is a large available pool of live donors.

The following websites in China are among those offering organs to international customers. www.ootc.net; http://en.zoukiishoku.com. Here is an excerpt from the latter website: “It may take only one month to receive a liver transplantation , the maximum waiting time being two months. As for the kidney transplantation , it may take one week to find a suitable donor,the maximum time being one month. Although the procedure to select a donor is very strict,, the transplant operation will be terminated if the doctor discovers that there is something wrong with the donor's organ . If this happens, the patient will have the option to be offered another organ donor and have the operation again in one week.”
One week. Compare that to – again – the 32 month wait in Canada,

Do you have any testimonial evidence?

We interviewed one highly credible witness, a woman who worked as an administrator in a hospital in north-eastern China. She has now fled to the West. She says her surgeon husband had told her he personally removed the corneas from over 2,000 anaesthetised prisoners between 2001 and 2003. None of the donors survived since their other vital organs were removed at the same time. Although this is a second hand testimony, I talked to the woman at length and the detail and depth of her descriptions of her husband’s activities leave me in no doubt that she is telling the truth.

What about the telephone calls to Chinese hospitals that you detail in your report?

One Mandarin-speaking researcher called a number of hospitals to ask whether they had Falun Gong patients . One Dr Zhou of the Guangzhou military region hospital told her that he had some type B kidneys from Falun Gong, but would have several batches before May 1 and no more until May 20 or later. Chief Physician Song at the Oriental Organ Transplant centre said his hospitals had more than ten beating hearts. The caller asked if he meant live bodies and Song replied “This is so.” Our report has transcripts of a number of calls to different hospitals across China saying similar things.

Do you have any recommendations what to do?

Countries need to pass laws that require doctors to report patients who obtain trafficked organs. We have some support here from the British Transplantation Society. The chair of its ethics committee, Stephen Wigmore, who thinks the use of executed prisoners’ organs probably happens and condemns it.
Chinese transplant surgeons should be banned from attending international conferences. Human rights organizations should be allowed to inspect re-education camps and interview prisoners.

And what if China doesn’t comply with inspections?

The point of leverage will be the Olympics, to be held in Beijing in 2008. Should we boycott the games? Do Olympians really want to be visiting a country where these barbaric operations go on? We are convinced that thousands of innocent individuals belonging to a peaceful organisation have been in effect executed by medical practitioners for their organs, with the profits going to doctors and the local gangs whop run transplant hospitals, but ultimately sanctioned by the Chinese government which wants to exterminate Falun Gong. It is organised murder.