Ketamine is a popular recreational drug in many countries; its popularity stemming in part from its low cost, and in part from its reputation for having a low addicition risk and few side-effects (and because of its interesting psychadelic effects, of course). However, it is becoming increasingly clear that at least the latter of these suppositions is not entirely accurate.
Some years ago, doctors in several countries started to notice that otherwise healthy people were presenting with damaged bladders and urinary tracts. Such urinary system damage has now been described over a hundred times in the literature [1]. In some cases the damage has been so severe that it has necessitated the complete removal of the damaged organs.
Within the ketamine-using community in the UK, the cause of such ‘ketamine bladder’ is often attributed to the drug crystallising in the bladder and causing damage. This explanation is understandable in the context of kidney stones – a condition that most people are aware of – but is not correct.
When a sufferer’s bladder is investigated, its wall is generally seen to have become thicker, markedly reducing the capacity of the bladder. This leads to some of the symptoms of ‘ketamine bladder’, such as the need to urinate often and pain when the bladder fills. Indeed, due to this pain some patients are not able to fill their bladder sufficiently for some relevant medical tests to be carried out. In addition to this change in the bladder wall, the mucosal layer of the bladder is enlarged, an indicator of long-term inflammatory change [2].
Indicators of inflammation have also been observed in mice that have been exposed to ketamine for several months. In such mice, special cells known as monocytes can be found within the kidney and in the wall of the bladder [3]. The role of these cells in the body is to move to areas of infection and inflammation, where they will then form part of the body’s immune response.
What, though, is prompting this immune response? It is extremely unlikely that the response is to ketamine itself, and so we must look a little deeper in order to find a cause.
In addition to its effects in the brain, ketamine has peripheral effects on particular neurotransmitters that are found in smooth muscle, called adrenoceptors [4]. As the bladder and urethra are formed in a large part by smooth muscle, this effect is likely to be highly relevant in these regions; a supposition potentially borne out by the observation that ketamine reduces the amount that rat bladder smooth muscle contracts [5], and the observation that mice exposed to ketamine have alterations to the innervations of the muscle in their bladders [3].
With these changes to the functioning of the muscles in the urinary system, it is possible that the muscle cells themselves are becoming damaged over time. Such damage may release cell components into the tissues, in turn prompting the body to mount an inflammatory response. It may be this inflammatory response in conjunction with the changes in muscle function that are causing ‘ketamine bladder’, although this remains a personal speculation at present.
Unfortunately there is no single treatment for the condition at present. The most important factor is a cessation of ketamine use, which can then be coupled with a variety of management strategies on a case-by-case basis.
References
1. Middela S, & Pearce I (2011). Ketamine-induced vesicopathy: a literature review. International journal of clinical practice, 65 (1), 27-30 PMID: 21155941
2. Mason K, Cottrell AM, Corrigan AG, Gillatt DA, & Mitchelmore AE (2010). Ketamine-associated lower urinary tract destruction: a new radiological challenge. Clinical radiology, 65 (10), 795-800 PMID: 20797465
3. Yeung, L., Rudd, J., Lam, W., Mak, Y., & Yew, D. (2009). Mice are prone to kidney pathology after prolonged ketamine addiction Toxicology Letters, 191 (2-3), 275-278 DOI: 10.1016/j.toxlet.2009.09.006
4. Bevan RK, Rose MA, & Duggan KA (1997). Evidence for direct interaction of ketamine with alpha 1- and beta 2-adrenoceptors. Clinical and experimental pharmacology & physiology, 24 (12), 923-6 PMID: 9406657
5. Ceran C, Pampal A, Goktas O, Pampal HK, & Olmez E (2010). Commonly used intravenous anesthetics decrease bladder contractility: An in vitro study of the effects of propofol, ketamine, and midazolam on the rat bladder. Indian journal of urology : IJU : journal of the Urological Society of India, 26 (3), 364-8 PMID: 21116355
Sunday, May 8, 2011
Sunday, May 1, 2011
An extremely amateur take on the arrest of Prof. Chris Knight
Should a person be arrested for planning a politically motivated public performance that includes the mock beheading of a living individual (with specific reference to the arrest of Prof. Chris Knight on the 29th of April)?
To answer this question we must establish two things: 1) whether the planning of the specific act is in itself a crime, and 2) whether, independent of this, the political nature of the act would make it one that should not be prevented by the state.
Let us first apprise ourselves of the available facts:
People
Professor Chris Knight is an anthropologist and a Marxist campaigner. He has been involved in the anti-capitalist movement for many years, participating in street theatre groups and protests at events such as the G20 summit in London in 2009. The suggestion that he might quite like attention would probably not be unfair. His partner and friend were also arrested.
Prince Andrew, Duke of York, is fourth in line to the throne and currently serves as an international trade envoy for the United Kingdom. He has close links to Jeffrey Epstein (billionaire and convicted child abuser), Timur Kulibayev (billionaire under investigation for money laundering, and son and probable successor of Nursultan Nazarbayev, president of Kazakhstan and torturer) and the Saudi regime (billionaire supporters of international terrorism and enemies of wrist-watch salesmen everywhere). He is not known to have marched to the top of any hills, but does enjoy golf and selling weapons to despots.
The act
Prof. Knight had planned to carry out a mock execution using a theatrical guillotine and an effigy of Prince Andrew. This performance was to be part of a wider set of broadly republican or otherwise “alternative” political events that were to take place in Soho square, central London, on the day of the marriage of Prince William and Kate Middleton. The parties were arrested on the day prior to the wedding and prior to them travelling to central London (although in the midst of preparing to transport themselves and their props to the City).
The planned act would not seem to constitute a particularly clever piece of theatre, and indeed would seem to be rather tacky. The artistic (and political) merit of the act is, however, fundamentally irrelevant to the question of its legality, and even more irrelevant to the second question of whether it should have been allowed or not, independent of its legality. The office of Examiner of Plays was abolished for a reason.
The law
Prof. Knight and his associates were, according to media reports (with a television crew by chance having been present at the arrest), arrested for conspiracy to cause a public nuisance and breach of the peace. The offence of causing a public nuisance covers cases where the community as a whole suffers injury, loss or damage. Breach of the peace is an offence that covers the disturbance of public space through actions such as the making of loud noise, or by the use of offensive words that are likely to incite violence. Conspiracy in English law is an agreement between persons to commit an offence at some point in the future.
Was it a crime?
Let us now ask whether the act that was planned would constitute an instance of either of the offences for which the individuals were arrested for. If it does do so then the conspiracy charge follows without too many prima facie objections.
In the case of committing a public nuisance offence, it could be argued that by seeking to enact the mock execution of a member of the royal family on a day when many people were coming together to celebrate the wedding of another member of the family, the arrested parties were seeking to cause an injury to the community. This line of argument would hold that the planned act would be so unreasonably offensive that it would constitute a harm to the other people gathered in London for the wedding. Thus, the act would be acceptable on any other day; it would just be the particular circumstances of the day in question that would elevate it to the status of being harmful. However, this line of argument must be unsuccessful due to the fact that the act was planned as part of a wider street party in the centre of London that was specifically aimed at those who sought to distance themselves from the monarchist sentiments of other street parties going on throughout Britain. The act would thus be in keeping with the mood of the majority of those who would witness it, and so could not reasonably be described as injurious to them.
An alternative argument for the act constituting an injury to the community would be to say that the expression of the republican views it sought to represent would be unacceptable – that the undermining of the monarchy that might result would be dangerous to the fabric of the community itself. This argument is not sound on two levels. Firstly, it is unreasonable to suggest that a fairly unimaginative piece of street theatre could represent a threat to the well-being of the community as a whole. Secondly, contained within the argument is the premise that it is unacceptable, and indeed dangerous, for an individual to express opposition to the system of government in place in the society in which they lived. This premise should obviously be resisted in the strongest manner possible.
It is thus not clear in what way the planned act could constitute a public nuisance.
Turning to breach of the peace, there can be no argument that the act per se would constitute a breach of the peace from a noise or nuisance point of view – it seems to have been planned to be a fairly self contained piece of theatre and would have taken placed amongst the extensive street parties already happening in London that day.
There may be an argument that the planned act involved the mock execution of an identifiable living person and so would potentially constitute a breach of the peace through being an incitement to violence. This argument fails, however, on the nature of incitement in law. The violence in question would assumedly be any assault against Prince Andrew, but in order for incitement to have taken place it is necessary for the accused to intend that other parties carry out the relevant act of violence. Prof. Knight explicitly stated in the days before his arrest that the mock execution should not be construed as a desire for actual executions, and there can be no wider suggestion that he (as with other republicans) actually wishes the death of members of the royal family. Thus, with no mens rea there is no crime. It should also be noted that Prof. Knight was not arrested for something like conspiracy to incite murder, suggesting that the police did not believe that this was an offence that he would be committing.
On the above analysis we can conclude that the planned act did not constitute an instance of either breach of the peace or public nuisance. The accusation of conspiracy to commit either of these offences is thus most likely to be spurious.
Was it justified?
Having established that the act itself would be unlikely to constitute a crime we can switch to our second question – irrespective of the legality of the act, should it have been allowed as a political statement?
There can be no argument that political protest should be limited by the state. This principal can even extend to (some) acts of protest that are illegal; as maintained, for example, in the ruling of Judge Caddick in the Kingsnorth power station case. Thus the argument that the act planned by Prof. Knight should not have been allowed relies on it being shown that it was not in fact a suitably political protest to justify the content that the proponent of this view would presumably object to.
The first line of argument that could be made is that a mock execution is not an acceptable form of political protest (glossing over the issues inherent in the judgement of ‘acceptability’). The response to this arguably lies in the method of execution being represented. Britain was a republic for a time in the 17th century, this status being brought about through the beheading of Charles I. That other great symbol of republicanism and the power of the people, the French revolution, also involved a transition from monarchy to republic that necessitated the beheading of a king. The beheading of a monarch, and in particular the guillotine, is thus a potent and extremely recognisable symbol of the possibility of change being brought about by the people. Of course, this symbolism does not lead one to the conclusion that the monarch should actually be beheaded, and it would be nonsensical to suggest that a person employing it would desire such a thing.
As such, the act planned by Prof. Knight would seem to be an explicitly political one, using a symbol of the potential for the people to overcome a royalist political system in order to protest against this status quo.
One could next question the need to use a recognisable member of the royal family in the act, rather than a generic figure in a crown; a potential argument being that doing so switches the act from being an acceptable political comment to being an unacceptable personal attack. The answer to this is twofold.
Firstly we must briefly consider the nature of the British monarchy. Since the demise of the divine rights theorist, James VI & I’s son, the constitutional power of the British monarchy is justified, one could argue, on tradition (the rights and wrongs of this are irrelevant to the current argument – that it is tradition rather than divine right makes the argument a little simpler as it takes the deity out of the equation). The monarchy is the Sovereign described in the theories of thinkers such as Hobbes and Rousseau, and forms the theoretical fulcrum of the constitutional setup of the nation (the Sovereign being a concept that can be instantiated in a variety of guises, from despots to democracies). As such, the members of the monarchy have a dual existence – in one sense they are people; but in the other, more important, sense they are the physical embodiment of the Sovereign. The particular individuals who temporarily instantiate this role are essentially irrelevant to it, as the role itself is timeless whilst the people are mortal. Thus, whilst royal families have come and gone, the Sovereign has persisted unaltered (this being fundamental to many of the grounds of justification for the system). It could thus be argued that the Prince Andrew effigy represented him not in his role as a person, but instead in his role as a physical embodiment of the Sovereign. In this way the act would not be one that attacked a person (which would be of dubious merit), but rather one that attacked a political system, with his visage as a mere symbol of it and so individually irrelevant.
The second line of argument lies with the particular member that was chosen, namely Prince Andrew. A part of the argument that republicans in Britain make is that the monarchy is a bed of corruption and unfettered privilege, as well as it being an embarrassment to the country. Here the individual involved does become relevant, as it is not necessarily the corrupt nature of the institution itself that is being bemoaned, it instead being the corruption of the individuals and the role that their status as royalty plays in allowing this corruption. As detailed above, Prince Andrew is linked in many ways to corrupt individuals and corrupt practices. He is thus perhaps the most appropriate member of the royal family to be personally protested against in this context. Similarly, on the charge of the monarchy being an embarrassment, the boorish (cf. Wikileaks) and allegedly corrupt Prince Andrew is a prime example of this. It is hard to argue that protest about either of these issues would not be political in nature.
Conclusion
To conclude, we have established that the act planned by Prof. Knight and his associates was unlikely to represent an instance of either of the offences that he was accused of conspiring to commit. We have also established that the performance that he was planning was of a political nature and so any suppression of it by the state represents an extremely worrying occurrence.
It is made all the more worrying in the context of the other arrests that were made before and on the day of the wedding of Prince William and Kate Middleton. These arrests included those of an activist who planned to make some republican and anti-capitalist statements through a loudhailer, some people a mile and half away from Westminster who were dressed as zombies, and a man getting off a train in London who had a banner that read “Democracy not monarchy”. It will be interesting to see if any of those arrested will ever be charged with anything.
All of those arrested were quite likely rather irritating individuals with less than sensible political positions. That is irrelevant however – we are all irritating to someone at some time and all have some less than sensible positions. Allowing the state to act against these traits is thus ultimately a threat to us all.
To answer this question we must establish two things: 1) whether the planning of the specific act is in itself a crime, and 2) whether, independent of this, the political nature of the act would make it one that should not be prevented by the state.
Let us first apprise ourselves of the available facts:
People
Professor Chris Knight is an anthropologist and a Marxist campaigner. He has been involved in the anti-capitalist movement for many years, participating in street theatre groups and protests at events such as the G20 summit in London in 2009. The suggestion that he might quite like attention would probably not be unfair. His partner and friend were also arrested.
Prince Andrew, Duke of York, is fourth in line to the throne and currently serves as an international trade envoy for the United Kingdom. He has close links to Jeffrey Epstein (billionaire and convicted child abuser), Timur Kulibayev (billionaire under investigation for money laundering, and son and probable successor of Nursultan Nazarbayev, president of Kazakhstan and torturer) and the Saudi regime (billionaire supporters of international terrorism and enemies of wrist-watch salesmen everywhere). He is not known to have marched to the top of any hills, but does enjoy golf and selling weapons to despots.
The act
Prof. Knight had planned to carry out a mock execution using a theatrical guillotine and an effigy of Prince Andrew. This performance was to be part of a wider set of broadly republican or otherwise “alternative” political events that were to take place in Soho square, central London, on the day of the marriage of Prince William and Kate Middleton. The parties were arrested on the day prior to the wedding and prior to them travelling to central London (although in the midst of preparing to transport themselves and their props to the City).
The planned act would not seem to constitute a particularly clever piece of theatre, and indeed would seem to be rather tacky. The artistic (and political) merit of the act is, however, fundamentally irrelevant to the question of its legality, and even more irrelevant to the second question of whether it should have been allowed or not, independent of its legality. The office of Examiner of Plays was abolished for a reason.
The law
Prof. Knight and his associates were, according to media reports (with a television crew by chance having been present at the arrest), arrested for conspiracy to cause a public nuisance and breach of the peace. The offence of causing a public nuisance covers cases where the community as a whole suffers injury, loss or damage. Breach of the peace is an offence that covers the disturbance of public space through actions such as the making of loud noise, or by the use of offensive words that are likely to incite violence. Conspiracy in English law is an agreement between persons to commit an offence at some point in the future.
Was it a crime?
Let us now ask whether the act that was planned would constitute an instance of either of the offences for which the individuals were arrested for. If it does do so then the conspiracy charge follows without too many prima facie objections.
In the case of committing a public nuisance offence, it could be argued that by seeking to enact the mock execution of a member of the royal family on a day when many people were coming together to celebrate the wedding of another member of the family, the arrested parties were seeking to cause an injury to the community. This line of argument would hold that the planned act would be so unreasonably offensive that it would constitute a harm to the other people gathered in London for the wedding. Thus, the act would be acceptable on any other day; it would just be the particular circumstances of the day in question that would elevate it to the status of being harmful. However, this line of argument must be unsuccessful due to the fact that the act was planned as part of a wider street party in the centre of London that was specifically aimed at those who sought to distance themselves from the monarchist sentiments of other street parties going on throughout Britain. The act would thus be in keeping with the mood of the majority of those who would witness it, and so could not reasonably be described as injurious to them.
An alternative argument for the act constituting an injury to the community would be to say that the expression of the republican views it sought to represent would be unacceptable – that the undermining of the monarchy that might result would be dangerous to the fabric of the community itself. This argument is not sound on two levels. Firstly, it is unreasonable to suggest that a fairly unimaginative piece of street theatre could represent a threat to the well-being of the community as a whole. Secondly, contained within the argument is the premise that it is unacceptable, and indeed dangerous, for an individual to express opposition to the system of government in place in the society in which they lived. This premise should obviously be resisted in the strongest manner possible.
It is thus not clear in what way the planned act could constitute a public nuisance.
Turning to breach of the peace, there can be no argument that the act per se would constitute a breach of the peace from a noise or nuisance point of view – it seems to have been planned to be a fairly self contained piece of theatre and would have taken placed amongst the extensive street parties already happening in London that day.
There may be an argument that the planned act involved the mock execution of an identifiable living person and so would potentially constitute a breach of the peace through being an incitement to violence. This argument fails, however, on the nature of incitement in law. The violence in question would assumedly be any assault against Prince Andrew, but in order for incitement to have taken place it is necessary for the accused to intend that other parties carry out the relevant act of violence. Prof. Knight explicitly stated in the days before his arrest that the mock execution should not be construed as a desire for actual executions, and there can be no wider suggestion that he (as with other republicans) actually wishes the death of members of the royal family. Thus, with no mens rea there is no crime. It should also be noted that Prof. Knight was not arrested for something like conspiracy to incite murder, suggesting that the police did not believe that this was an offence that he would be committing.
On the above analysis we can conclude that the planned act did not constitute an instance of either breach of the peace or public nuisance. The accusation of conspiracy to commit either of these offences is thus most likely to be spurious.
Was it justified?
Having established that the act itself would be unlikely to constitute a crime we can switch to our second question – irrespective of the legality of the act, should it have been allowed as a political statement?
There can be no argument that political protest should be limited by the state. This principal can even extend to (some) acts of protest that are illegal; as maintained, for example, in the ruling of Judge Caddick in the Kingsnorth power station case. Thus the argument that the act planned by Prof. Knight should not have been allowed relies on it being shown that it was not in fact a suitably political protest to justify the content that the proponent of this view would presumably object to.
The first line of argument that could be made is that a mock execution is not an acceptable form of political protest (glossing over the issues inherent in the judgement of ‘acceptability’). The response to this arguably lies in the method of execution being represented. Britain was a republic for a time in the 17th century, this status being brought about through the beheading of Charles I. That other great symbol of republicanism and the power of the people, the French revolution, also involved a transition from monarchy to republic that necessitated the beheading of a king. The beheading of a monarch, and in particular the guillotine, is thus a potent and extremely recognisable symbol of the possibility of change being brought about by the people. Of course, this symbolism does not lead one to the conclusion that the monarch should actually be beheaded, and it would be nonsensical to suggest that a person employing it would desire such a thing.
As such, the act planned by Prof. Knight would seem to be an explicitly political one, using a symbol of the potential for the people to overcome a royalist political system in order to protest against this status quo.
One could next question the need to use a recognisable member of the royal family in the act, rather than a generic figure in a crown; a potential argument being that doing so switches the act from being an acceptable political comment to being an unacceptable personal attack. The answer to this is twofold.
Firstly we must briefly consider the nature of the British monarchy. Since the demise of the divine rights theorist, James VI & I’s son, the constitutional power of the British monarchy is justified, one could argue, on tradition (the rights and wrongs of this are irrelevant to the current argument – that it is tradition rather than divine right makes the argument a little simpler as it takes the deity out of the equation). The monarchy is the Sovereign described in the theories of thinkers such as Hobbes and Rousseau, and forms the theoretical fulcrum of the constitutional setup of the nation (the Sovereign being a concept that can be instantiated in a variety of guises, from despots to democracies). As such, the members of the monarchy have a dual existence – in one sense they are people; but in the other, more important, sense they are the physical embodiment of the Sovereign. The particular individuals who temporarily instantiate this role are essentially irrelevant to it, as the role itself is timeless whilst the people are mortal. Thus, whilst royal families have come and gone, the Sovereign has persisted unaltered (this being fundamental to many of the grounds of justification for the system). It could thus be argued that the Prince Andrew effigy represented him not in his role as a person, but instead in his role as a physical embodiment of the Sovereign. In this way the act would not be one that attacked a person (which would be of dubious merit), but rather one that attacked a political system, with his visage as a mere symbol of it and so individually irrelevant.
The second line of argument lies with the particular member that was chosen, namely Prince Andrew. A part of the argument that republicans in Britain make is that the monarchy is a bed of corruption and unfettered privilege, as well as it being an embarrassment to the country. Here the individual involved does become relevant, as it is not necessarily the corrupt nature of the institution itself that is being bemoaned, it instead being the corruption of the individuals and the role that their status as royalty plays in allowing this corruption. As detailed above, Prince Andrew is linked in many ways to corrupt individuals and corrupt practices. He is thus perhaps the most appropriate member of the royal family to be personally protested against in this context. Similarly, on the charge of the monarchy being an embarrassment, the boorish (cf. Wikileaks) and allegedly corrupt Prince Andrew is a prime example of this. It is hard to argue that protest about either of these issues would not be political in nature.
Conclusion
To conclude, we have established that the act planned by Prof. Knight and his associates was unlikely to represent an instance of either of the offences that he was accused of conspiring to commit. We have also established that the performance that he was planning was of a political nature and so any suppression of it by the state represents an extremely worrying occurrence.
It is made all the more worrying in the context of the other arrests that were made before and on the day of the wedding of Prince William and Kate Middleton. These arrests included those of an activist who planned to make some republican and anti-capitalist statements through a loudhailer, some people a mile and half away from Westminster who were dressed as zombies, and a man getting off a train in London who had a banner that read “Democracy not monarchy”. It will be interesting to see if any of those arrested will ever be charged with anything.
All of those arrested were quite likely rather irritating individuals with less than sensible political positions. That is irrelevant however – we are all irritating to someone at some time and all have some less than sensible positions. Allowing the state to act against these traits is thus ultimately a threat to us all.
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