On Trial

As many readers of this blog will know, I have cancer. I’ve had many operations over the last fifteen years, but a few years ago we decided that the spread was now wide enough that further surgery was not very pointful; we should instead wait for particular lesions to start causing problems, and only then treat them. (I have metastases in my lungs, liver, remaining kidney, leg, pleura and other places.)

Historically, chemotherapy hasn’t been an option for me. Broad spectrum chemotherapies work by killing anything growing fast; but my rather unusual cancer doesn’t grow fast (which is why I’ve lived as long as I have so far) and so they would kill me as quickly as they would kill it. And there are no targetted drugs for Adenoid Cystic Carcinoma, the rare salivary gland cancer I have.

However, recently my oncologist referred me to The Christie hospital in Manchester, which is doing some interesting research on cancer genetics. With them, I’m trying a few things, but the most immediate is that yesterday I entered a Phase 1 trial called AToM, which is trialling a couple of drugs in combination which may be able to help me.

The two drugs are an existing drug called olaparib, and a new one known only as AZD0156. Each of these drugs inhibits a different one of the seven or so mechanisms cells use to repair DNA after it’s been damaged. (Olaparib inhibits the PARP pathway; AZD0156 the ATM pathway.) Cells which realise they can’t repair themselves commit “cell suicide” (apoptosis). The theory is that these repair mechanisms are shakier in cancer cells than normal cells, and so cancer cells should be disproportionately affected (and so commit suicide more) if the mechanisms are inhibited.

As this is a Phase 1 trial, the goal is more about making sure the drug doesn’t kill people than about whether it works well, although the doses now being used are in the clinical range, and another patient with my cancer has seen some improvement. The trial document listed all sorts of possible side-effects, but the doctors say other patients are tolerating the combination well. Only experience will tell how it affects me. I’ll be on the drugs as long as I am seeing benefit (defined as “my cancer is not growing”). And, of course, hopefully there will be benefit to people in the future when and if this drug is approved for use.

In practical terms, the first three weeks of the trial are quite intensive in terms of the amount of hospital visits required (and I live 2 hours drive from Manchester), and the following six weeks moderately intensive, so I may be less responsive to email than normal. I also won’t be doing any international travel.

Samuel David Markham

I am overjoyed to announce the birth of our third son, Samuel David Markham, at 9.01am on the morning of 28th January 2015, weighing 8lb 0oz. Mother, father, baby and older brothers are all well :-)

He is called Samuel after:

  • The prophet and leader Samuel, who was called into God’s service at an early age, as recorded in the book of 1 Samuel;
  • Samuel Rutherford (1600 – 1661), a Scottish minister and representative at the Westminster Assembly, whose book Lex, Rex contains arguments foundational to a Christian understanding of good government;
  • Samuel Davies (1723 – 1761), American non-conformist preacher, evangelist and hymn writer, who showed we are all equal in God’s sight by welcoming black and white, slave and free to the same Communion table;
  • Samuel Crowther (1809 – 1891), the first black Anglican bishop in Africa, who persevered against unjust opposition and translated the Bible into Yoruba.

He is called David primarily after the King David in the Bible, who was “a man after God’s own heart” (a fact recorded in the book of 1 Samuel, 13:14).

The Oatmeal and Religion

I’m a fan of The Oatmeal, with the odd reservation. But one cartoon in particular gets pointed out to me a lot – “How to suck at your religion“.

The trouble with arguing with him is that he’s a popular cartoonist, and I’m not. Cartoons suffer from the Twitter/Facebook effect – a humourous pithy short attack or condemnation of something is far more interesting and retweetable than any nuanced response to it. And then, of course, you get accused of having no sense of humour. And if he ever reads this post and takes offence, there’ll be cartoons lampooning me. Still, Jesus had to endure being mocked, so that’s an OK risk to take.

So, then, a few thoughts in response:

So is judging people wrong, then? Because there seems to be plenty of judgement in this comic. If it is wrong, then who says so, and who died and made them king? It’s easy to mock the moral stance of others, but rather difficult (if your understanding of the world doesn’t include an omnipotent moral lawgiver) to figure out why the morality you are in favour of should apply to other people. Should I not judge because a “silly web cartoonist” (his words) tells me not to? Morality can’t be hung from skyhooks.

This is before we even talk about what Jesus actually meant, in context, by “Do not judge, or you too will be judged”.

The Galileo affair was not the best moment in the life of the church. But the second comic makes the error that so many bits of reporting on stem cells make that one would almost think people are trying to hide the truth. There are two main types of stem cells – adult, and embryonic. Adult stem cells come from, well, adults, and I’ve never heard of anyone who has any theological problem with them. Embryonic stem cells are harvested from embroyos, tiny people who are killed by the process. And that is a problem.

Thing is, which type of cells have been producing all the amazing treatments and treatment possibilities? Adult stem cells. A guy recently became able to walk again after they injected stem cells from his nose into his spine. That’s so awesome. By contrast, despite lots of positive talk, they can’t figure out how to stop the embryonic ones giving you cancer. And yet, every time there’s a “stem cell success” story, the church is castigated for “its opposition to stem cell research”, and people vow to continue the murder of microscopic human beings.

In the last panel, is he really asserting that anyone can make any old thing up, and the universe will bend to accommodate the wishes of the person concerned? Or just that it’s cool and righteous to affirm people in whatever rubbish they make up in their own minds? Also, no matter how politely phrased, “No-one really knows for sure” is dogma, plain and simple. All education is indoctrination – the question is simply “whose doctrine?”. What he is really saying is “don’t use your doctrine, use mine”.

I wonder if the Oatmeal had a kid, who was told “no-one really knows”, and who replied “well, I think God then decides who goes to heaven and who goes to hell, and I’m worried about your eternal soul”, he’d say “sure, sweetie”, or “NO. NO-ONE REALLY KNOWS FOR SURE AND THAT’S FINAL.” Given the rest of the comic’s antipathy towards Christianity…

My religion gives me no anxieties about my sexuality at all. However, what the Oatmeal is really saying is “any parameters religion puts around the correct use of sex are evil”. So is he in favour of no parameters at all (permitting every vile act one could imagine – you know I could list all the usual things which every country makes illegal) or does he just want to impose different parameters to the ones Christianity does? And if so, apart from the detail of what’s in and what’s out (ahem), how is his principle of imposing laws regarding the expression of sexuality any different from the principle that he mocks?

Christians who try and convince others that what they believe is true are not trying to “validate their beliefs”. There are no points from God for making more Christians. In fact, Christians can’t make more Christians – only God can do that. We don’t get any credit when it happens. Also, Christians are (or should be) specifically encouraged to avoid groupthink – the idea that if lots of people believe something, it must be true. (Incidentally, if you think Buddhists all leave people alone, read this and this.)

Fortunately, the real and true “awesome shit” is available to everyone. Including the Oatmeal.

Calling something ‘crazy’ is not an argument. It’s hard to refute a sneer. And, of course, his summary of what Christians believe is wrong in several places. If it’s such crazy nonsense, why not illustrate using the version Christianity teaches, rather than a straw man? Or is the real view not so crazy after all?

Amen to the general point here. Although the idea (which, I agree, is not his main point) that one should vote based on which policies are better for you personally is a sad, divisive and dangerous one. One should vote based on which policies are best for society as a whole. (For me, those are generally policies which make the law conform more closely to God’s law. YMMV.)

Yes, indeed. Je suis….

Yes, I would die for Jesus. Adam4d puts it well:

No, I would not kill for Jesus. However, the point of Christianity is not to “inspire people to help people” (although it does) or to make you happier (although it might) or to help you cope with the atheistic feeling of cosmic helplessness (although it does deal with it very effectively). Christianity is not utilitarian. The point is to have a real relationship with your Creator – to know Christ. Which is the most awesome thing in the world. Having experienced it, who would ever want to keep it to themselves?

Je Suis…

When Muhammad is mocked, Islamic extremism kills and says:

We have avenged the Prophet Muhammad!

When Jesus is mocked, Christianity hopes and says:

And so Jesus also suffered outside the city gate to make the people holy through his own blood. Let us, then, go to him outside the camp, bearing the disgrace he bore. For here we do not have an enduring city, but we are looking for the city that is to come.

We are called not to avenge him, but to identify with him and accept the same disgrace.

Je Suis Charlie. Et Je Suis Jésus.


I will be away and without email from Thu 14th August to Friday 22nd August, and then mostly away from email for the following week as well (until Friday 29th August).


Dear world,

This week, I ordered Haribo Jelly Rings on eBay and had them posted to me. My son brought them from the front door to my office and I am now eating them.

That is all.

PDX Biopsy

(Those who faint when reading about blood may want to skip this one.)

On Tuesday, I went down to London to have the biopsy for the PDX trial in which I’m taking part. The biopsy happened at the Royal Marsden hospital in Chelsea on Wednesday morning. It was a CT-guided needle biopsy, which means that they use a CT scanner in near-real-time to guide a hollow needle towards the lump to be sampled, and the sample extraction needle is then passed down that needle to take multiple samples.

At least, that’s what happens when it all goes well. :-)

The target, I found out on the day, was an isolated tumour in the top corner of my left lung. As they were biopsying my lungs, which are not a stable target, I had to both stay very still, and achieve a consistent size of “held breath”, so that when they moved the needle or did a scan, everything was in pretty much the same place. I was placed on the CT scanner table, and they used a lead-or-similar grid placed on my chest to find the optimum point of entry. They then injected generous quantities of local anaesthetic (a process which itself stings) and started inserting the needle. After each movement, they stopped, slid me into the scanner, told me to take a standard breath, and used the scan to see where the needle was and whether the track needed correction.

All went fairly smoothly until the needle passed through the outer wall of the lung itself. At this point, I started bleeding into my lung, which (although I tried to suppress it) led to significant amounts of convulsive coughing. They had to use suction to remove the liquid from my mouth. One nurse said afterwards that she thought they might well have abandoned the procedure at this point. In someone as young as me, this complication at this point is fairly rare. Of course, coughing so much, I was not able to hold still or take the standard breath, and it was dangerous to move the needle any further.

After a couple of minutes, I managed to get the coughing under control, although later I opened my eyes for a short time and saw blood spatters all over the inside of the CT machine! Once I was stable again, they were able to continue inserting the needle and were able to get 8 good “cores” of sample for use in the PDX trial.

However, a final whole-chest scan revealed that all that jerking about had given me a small pneumothorax, which is where air gets into the pleural space, between the lung and the chest wall. So I had to stay there for longer while they inserted a second needle into a different part of me and attempted to suck out the introduced air. This took less long, and was mostly successful. Any remaining air should, God willing, be reabsorbed in the next week or so.

Towards the end, I asked what my heart rate was; they said “66”. That’s the peace of God in action, I thought. The nurses joked that we should measure the heart rate of the surgeon! :-)

I was sent to the recovery room and then to the Clinical Assessment Unit. After 3 hours, they did a chest X-ray, then after another 2 hours another one, to check that I was stable and the remaining tiny pneumothorax was not growing. It wasn’t, so they let me go home. But I have another X-ray in a week, here in Sheffield, to make sure everything is OK and I’m fine to fly to the USA the following Monday :-)

Cancer Update

Last November, and again this month, I had CT scans, and it turns out my cancer (Adenoid Cystic Carcinoma) has been growing. (If you haven’t known me for long and didn’t know I have cancer, the timeline and in particular the video might be a useful introduction.) I now have lumps of significant size – 2cm or larger – in both of my lungs and in my liver. It has also spread to the space between the lung and the chest wall. It normally doesn’t cause much bother there, but it can bind the lung to the wall and cause breathing pain.

For the last 14 years, we have been following primarily a surgical management strategy. To this end, I have had approximately 5 neck operations, 2 mouth operations, 2 lung operations, and had half my liver, my gall bladder and my left kidney removed. Documentation about many of these events is available on this blog, linked from the timeline. Given that I’m still here and still pretty much symptom-free, I feel this strategy has served me rather well. God is good.

However, it’s now time for a change of tack. The main lump in my left lung surrounds the pulmonary artery, and the one in my liver is close to the hepatic portal vein. Surgery on these might be risky. So instead, the plan is to wait until one of them starts causing actual symptoms, and to apply targetted radiotherapy to shrink it. Because my cancer is “indolent” (a.k.a. “lazy”), it can have periods of activity and periods of inactivity. While it seems more active at the moment, that could stop at any time, or it could progress differently in different places.

There is no general chemotherapy for ACC. However, at my last consultation I was asked to take part in a clinical trial of a new and interesting therapeutic technique, of which more very soon.

A friend texted me a word of encouragement this morning, and said he and his family had been reading Psalm 103. It’s a timely reminder of the true nature of things:

The life of mortals is like grass,
    they flourish like a flower of the field;
the wind blows over it and it is gone,
    and its place remembers it no more.
But from everlasting to everlasting
    the Lord’s love is with those who fear him,
    and his righteousness with their children’s children –
with those who keep his covenant
    and remember to obey his precepts.

Psalm 103:15-18

21st Century Nesting

Our neighbours have acquired a 21st century bird’s nest:

Not only is it behind a satellite dish but, if you look closely, large parts of it are constructed from the wire ties that the builders (who are still working on our estate) use for tying layers of bricks together. We believe it belongs to a couple of magpies, and it contains six (low-tech) eggs.

I have no idea what effect this has on their reception…

Merry Christmas!

Merry Christmas to everyone :-)

And here, for your delight, is what happens when you let a 2-year-old decorate your Christmas cake. It’s “Attack of the Killer Father Christmas”…

Guilt and Shame

Do you live in a guilt-based or a shame-based society?

Guilt is assigned by law, quantifiably based on right and wrong, and it usually goes away after punishment. Shame, by contrast, is assigned by the community, it is much harder to quantify and only disappears when a person’s honour is restored. It can potentially destroy a person’s standing in the community permanently.

In a recent book by author Steve Bell on explaining the gospel to those from an Eastern context, one of the points he makes is that Western Christians often explain the gospel in terms of guilt: “I was guilty before God, and Christ took the punishment for my sins”. This is true, and gloriously so, but Eastern societies tend to be based on shame, and this does not resonate with people from them. There is, however, also a telling of the gospel based on the concept of shame: “My sin shames me, but Jesus has taken away my shame and given me honour”. In expounding this point, he writes (p.12):

The unfortunate thing is that the Western focus on ‘guilt’ has developed to the exclusion of the eastern focus on ‘shame’…

This got me thinking (as all good books do) about the relative places of guilt and shame in UK society today. As would be expected for a 21st century Western country, I think that we are almost entirely a guilt-based society. Politicians no longer resign if they are caught in moral turpitude. People argue that private lives should have no effect on public status. Few actions which used to lead to shame do any more – in fact, “shaming” someone is in some quarters considered to be a great evil.

What consequences does this have? If people only have the ability to understand the world in guilt-based categories, then I wonder if they will tend to take their ideas of what is right and wrong from what is legal and illegal. “This is legal, so it must be OK.” This then means that people attempting to make something socially acceptable campaign hard for its legalization, because they believe it will then lead to its social normalization and acceptability. And, in a society with little concept of shame, they may well be right.

Living with Cancer

I recently did an interview for my church, The Crowded House in Sheffield, on my experience living as a Christian with cancer. An edited video of the interview was used as the introduction to a talk called “An Imaginary God in a Suffering World?”, which covered the question of how both Christians and non-Christians try and make sense of the existence and meaning of suffering – because it’s a difficult question wherever you stand.

Gervase Markham’s Story from TCH Sheffield on Vimeo.

You can also hear the talk which followed the video (length: about 38 minutes including Scripture readings).


[This post was pre-recorded.]

Today, March 31st, is the logical anniversary of three significant beginnings, all of which are wonderful.

Firstly, it’s the logical anniversary of the start of Mozilla. There are several significant dates here – the organization itself was created on February 23rd – but historically we have always remembered the day at the end of Code Rush, the day when the source code became available to the public – March 31st 1998, 15 years ago today. Because that’s the primary way we do what we do – we make great open source software and give it to people. And while the software that was released that day may not have been great in many ways (we threw a lot of it out some time later), it had the seeds of greatness within it. We’ve come a long way from there to Firefox OS, and we should pause and recognise our achievement.

Secondly, it’s the logical anniversary of my engagement to Ruth – a seed which has flowered into a happy marriage and two lovely sons. We got engaged on Easter Sunday 2010 (which, that year, was 4th April) and so we like to celebrate at Easter each year.

And no post about today would be complete without recognising that Easter Day is, of course, the logical anniversary of the day Jesus rose from the dead. The Easter story is how he does what he does – he provides salvation, hope and joy for all who come to him, by dying in their place and rising from the dead, conquering death. In doing so he also planted a seed, which has now grown into a worldwide church, hundreds of millions strong.

So all in all, a great day, and hopefully one which will be marked by peace and harmony. Happy Easter!

John Phinehas Markham

I am pleased to announce the birth of John Phinehas Markham at 10.55pm on the evening of 10th March 2013, Mother’s Day, weighing 8lb 3.5oz. Mother, father, baby and older brother are all well :-)

He is called John after:

  • John the Apostle, who wrote the Gospel of John, the Epistles of John and the Book of Revelation, all of which provide invaluable divinely-inspired guidance to the church;
  • John Calvin, whose Biblical scholarship and preaching underpinned much of the Reformation, that glorious time when half the world rediscovered the truth of salvation by faith;
  • John Wycliffe, one of the forerunners of that Reformation, who created and directed the first translation of the Bible into vernacular English;
  • G. C. John Rotter, Ruth’s grandfather, a godly man who served as an engineer in World War II and brought Ruth’s father up in the faith;
  • Admiral John Markham, second son of Archbishop William Markham (after whom his brother is named), who served his country in the navy and then became MP for Portsmouth.

He is called Phinehas after the priest whose rather striking story (pun intended) is told in the Biblical book of Numbers, chapter 25. God’s and our approval of that Phinehas may surprise or shock some; I’ve written a little more elsewhere about why we think he is a wonderful person to be named after.

To my eyes, John looks nothing like his brother (and so not much like me either), so we’ll have to see if he is as different in personality also!