Off Trial

Six weeks ago, I posted “On Trial”, which explained that I was taking part in a medical trial in Manchester. In the trial, I was trying out some interesting new DNA repair pathway inhibitors which, it was hoped, might have a beneficial effect on my cancer. However, as of ten days ago, my participation has ended. The trial parameters say that participants can continue as long as their cancer shrinks or stays the same. Scans are done every six weeks to determine what change, if any, there has been. As mine had been stable for the five months before starting participation, I was surprised to discover that after six weeks of treatment my liver metastasis had grown by 7%. This level of growth was outside the trial parameters, so they concluded (probably correctly!) the treatment was not helping me and that was that.

The Lord has all of this in his hands, and I am confident of his good purposes for me :-)

Is Plagiarism A Sin?

In the last year or so there have been several occasions where it has been discovered that some words in books written by Christian authors were not their own words, but yet were not footnoted as being written by someone else. This occurrence is usually referred to as “plagiarism”. The publishers of the books in question have reacted by halting sales of the affected books, sometimes forever, or sometimes until this can be corrected. This both harms the public, who are deprived of the wisdom such books contain, and harms the reputation of the author, who is labelled a plagiarist. Therefore, it is important to be certain that the act the author has committed is, in fact, sinful. If it is, fair enough. But if it is not, both the removal from sale of the book and the loss of reputation are unwarranted and harmful.

Contemporary academic standards certainly see plagiarism as a serious misdemeanour. In a context where work has to be marked for credit, it’s clearly important that the marker knows which of the work is the student’s own, and which is taken from others. In this case, the act is clearly wrong – but one could argue either that it is wrong per se, or that it’s wrong because the student is breaking a promise they made to attribute all their quotations correctly – when the sin would be “not keeping one’s word”, rather than plagiarism.

Don Carson also writes that giving another’s sermon is also a sin. I would not agree with all his reasons but certainly would agree with reason number 3 – “you are not devoting yourself to the study of the Bible to the end that God’s truth captures you, molds you, makes you a man of God and equips you to speak for him”. Preachers should not use the words of others as a way of avoiding engaging in their God-given and weighty task.

However, I think plagiarism is not a sin in itself, and I base my argument on the construction of Scripture. Scripture contains many examples of what today would be called plagiarism – unattributed use of the words of another. Many of these are where words are taken from other places in Scripture, but there are also some where words are taken from outside Scripture. Not all such quotations are unattributed, but many are. Large examples include:

* The dependence of Kings on other books (e.g. (e.g. 2 Kings 18-20 is basically the same as Isaiah 36-39; 2 Kings 25 is nearly identical to Jeremiah 52)
* The dependence of Chronicles on Kings
* The dependence of Matthew on Mark (e.g. Mark 2:1-12 has strong similarities with Matthew 9:1-8)
* The dependence of Luke on Mark
* The dependence of 2 Peter on Jude (or the other way around, if you prefer)

And that’s before you consider Q (a proposed document also used by Luke and Matthew, so unattributed that scholars argue about its very existence), and all the times the New Testament quotes or alludes to the Old (most of which are unattributed). Paul quotes 3 Greek philosophers in various places; none of the quotes are attributed by name, even though Paul must have known the names. They are in quotation marks in our modern Bibles, but Greek does not have quotation marks. One could go on. Any one of these examples would prove my point.

If it is a sin in all circumstances to take the words of others and pass them off as your own, then the very construction of Scripture as we have it involved its authors doing this sinful act many times. While Scripture describes sins, and was written down by sinners, I don’t believe that God would have used sinful methods in the process of assembling his good and perfect word – because if the existence of something necessarily depends on sin, how can it be described as good and perfect? If God thinks that unattributed quotation is a sin, why would he not have caused the authors to attribute all their quotations, thereby setting us all a good example? If plagiarism is a sin, lack of attribution of quotations is a flaw in Scripture itself.

The idea that copying the work of others, either at all or without attribution, is unreasonable is a relatively recent one in history. Copyright has only been around since the Statute of Anne in 1707, and that was a measure designed at controlling publishers rather than restricting people’s ability to quote. More recently in history, such things have been thought about under the banner of “intellectual property”, a name which rather begs the question, as it’s not clear at all that such things should be treated in the same manner as physical property. This concept of a particular person “owning” a set of words or ideas was unknown until relatively recently. The fact that these ideas are innovative should certainly give us caution in suggesting that they are reflections of the moral will of God which humans had been unaware of until 300 years ago. Christians have always built on the wisdom God has given those before them, and we should be wary of any man-made laws which restrict that free flow of ideas forward in time.

Nevertheless, the law is the law – is plagiarism wrong because it’s a breach of copyright law as it stands today, and Christians are called to obey the law (Romans 13)? The answer is that it depends on the context and the level of copying. Copyright law has exceptions to try and balance its view that the author should have control of their work with what it sees as the legitimate rights and desires of the public. But the way copyright law works in the UK is that the law doesn’t provide actual affirmation that certain exempt acts are OK, it instead provides for defences in court. This means that the only way to know for certain whether a particular use is an infringement or not is to ask a judge. This is relevant because of the legal doctrine of de minimis – below a certain level, a court would undoubtedly refuse to waste its time with a copyright infringement.

Nevertheless, it is reasonable to ask if this behaviour seems to be covered by an exception. Exceptions unfortunately vary from country to country; in the UK, there is an exception for “criticism, review, quotation and news reporting“, which is certainly designed to permit quotation of one book in another. It does require “sufficient acknowledgement (unless this would be impossible for reasons of practicality or otherwise)” (section 30). It could certainly be argued that if you took notes 20 years ago and neglected to record the source, it is now practically impossible to acknowledge it. One might consider prosecution if attribution were intentionally left off; would a prosecutor really do so if it were done unintentionally?

Earlier, I noted that in some contexts, plagiarism can be sinful because it involves breaking a promise. Can that be the case in commercial publishing? There are two possible promises to consider – that of the author to his publisher, and that of the author (and publisher) to the readership.

Let us consider the author/publisher relationship first. Having not yet authored my first best-seller I am not familiar with the contracts that authors draw up with publishers. These may well contain a clause saying the author will attribute all quotations, or perhaps make a good faith effort to do so. However, someone’s culpability for breaking a promise depends significantly on intent and circumstances. If I promise my wife to be home by a certain time and my train is late (and I write this while waiting for a train after missing a connection due to a late incoming train), I would suggest only an unreasonable wife would take me to task for this. If an author deliberately plagiarises others when having promised not to do so, that is a clear case of a broken promise. If they do so accidentally, is pulping all copies of their book a proportionate response?

The second situation to consider is the possibility that an author makes an implicit promise to his readership. I think this argument is stronger in an academic work where the footnotes average a third of each page, than in a non-academic work which has 20 endnotes in total. There are different reader expectations in each case. But how normative are reader expectations? I expect books I buy to be written in good English, theologically sound, thought-provoking and enlightening. These expectations are, sadly, often not met, but I don’t expect the publisher to pulp the book in response to my complaint! To add to that, one is on shaky ground construing promises where no explicit promise has been made. Lastly, the point about what one does if a promise is broken accidentally (as opposed to wilfully) still stands.

Plagiarism may be problematic and unwise in certain circumstances. For example, it makes it harder to trace the history of an idea back to its source, which is often important in avoiding groupthink and validating “what everyone knows”. But we must avoid the genetic fallacy – the worthiness of an idea or thought is not connected to whose idea or thought it was. If a book explains the Trinity well, it does not suddenly do so less well if it’s discovered that some of the words were not written by the author named on the cover.

So I would suggest that the idea that plagiarism is always and everywhere wrong is a recent innovation and not a reflection of the moral will of God. Intentionally breaking one’s explicit promises is sinful; plagiarism itself alone is not.

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).