Mohammad Al-Ubaydli’s blog

Reasons why I love physicists: #23

Posted in Books, Society by Dr Mohammad Al-Ubaydli on October 22, 2009

Crime of reason

The crime of reason: And the closing of the scientific mind is a book that has gripped me since I heard the author discuss it in a podcast with the lovely Dr Moira Gunn. It central message is a sad one for me as the book describes, in detail, why modern society is dismantling the freedom of scientific inquiry. Worse still, the book also describes why such dismantling is necessary.

I must quote this story from the book though which gave me such warm feelings about physicists, bless them:

In March 1986, Las Vegas newspapers buzzed with rumors that the MGM Grand Hotel and Casino had suffered its worst weekly take in history – including the week of its terrible fire. MGM had made the mistake of hosting a big physics conference. The scientists, it turned out, didn’t care for neon cowboys, tiger shows, topless barmaids and other distractions. In fact, they complained after returning home that these things had interfered with their concentration at seminars. Vegas cabbies got real mileage from this story and presumably generous tips too. No Las Vegas hotel has ever invited the physicists back.

Genomic electronic health records: opportunities and challenges

Posted in Articles, Medicine, My publications, Society, Technology by Dr Mohammad Al-Ubaydli on July 22, 2009

This article was originally published in Genome Medicine on 23rd July 2009 at

Mohammad Al-Ubaydli1 email and Rob Navarro2

1UCL Centre for Health Informatics and Multiprofessional Education, Archway Campus, Highgate Hill, London N19 5LW, UK

2Sapior, 16 Byron Avenue, London E18 2HQ, UK

author email corresponding author email

Genome Med 2009, 1:73doi:10.1186/gm73

The electronic version of this article is the complete one and can be found online at:

Published: 22  July  2009

© 2009 BioMed Central Ltd


There is value to patients, clinicians and researchers from having a single electronic health record data standard that allows an integrated view, including genotype and phenotype data. However, it is important that this integrated view of the data is not created through a single database because privacy breaches increase with the number of users, and such breaches are more likely with a single data warehouse. Furthermore, a single user interface should be avoided because each end user requires a different user interface. Finally, data sharing must be controlled by the patient, not the other end users of the data. A preferable alternative is a federated architecture, which allows data to be stored in multiple institutions and shared on a need-to-know basis. The data sharing raises questions of ownership and stewardship that require social and political answers, as well as consideration of the clinical and scientific benefits.

In the May issue of Genome Medicine, Belmont and McGuire [1] make the case for a ‘uniform electronic health record’ (EHR) that includes both genotype and phenotype information. By uniform they mean a single data standard across different EHR databases and user interfaces, rather than a single database or a single user interface (this has been confirmed by personal communication with the authors).

It is certainly true that a clearer picture of a patient’s health is possible when their genotype data are combined with phenotype data. The quantity and quality of these data are improving, along with the analytical tools that allow us to interpret them. Patients, clinicians and researchers can all benefit from a better understanding of these data, and Belmont and McGuire’s article [1] describes efforts in Europe and the USA to unify the datasets.

However, other parties that would benefit from better understanding include public health officials, government bureaucrats, insurance companies and employers. And in some cases, there are conflicts of interest; for example, an insurance company could use genetic information to raise premiums or deny cover, whereas a patient might use the same information to seek increased cover when they learn of the risk for future diseases.

There are ways to solve the conflicts of interest that can arise from the use and availability of patient data. First, as Belmont and McGuire [1] describe, efforts such as the Personal Genome Project [2] allow patients to opt in to fully disclose their genetic information for the benefit of researchers. [3] has an openness policy alongside their privacy policy so that participants can agree to share all their data, and tens of thousands of people from around the world have already agreed to do so. The value to researchers is currently limited because the data are self-submitted rather than independently verified, but the proof that patients are willing to share their personal information is there.

The principle must still stand, however, that data sharing begins with and is controlled by the patient. This favors a single personal health record (PHR) as a database rather than a single electronic health record. PHRs are records owned and controlled by the patient [4] , as opposed to EHRs, which are owned and controlled by health care practitioners.

Useful data standards for PHR and EHR communication should be expanded to fit the genomic vision that Belmont and McGuire [1] outline. In particular, the Continuity of Care Record (CCR) data format is the digital equivalent of a referral letter from one clinician to another about a patient [5] . It is supported by PHR providers such as Google Health and Microsoft HealthVault; pharmacies such as Walgreens and CVS; and providers such as MinuteClinic [6] . The Department of Health and Human Services at the National Cancer Institute unveiled a standard earlier this year for family history [7] . However, a single genomic data standard is not yet available or widely adopted.

Second, de-identification algorithms that work for genotype data are needed. De-identification is a better term than anonymization because the latter implies a binary process, which is misleading, while the former accurately conveys a spectrum. We know that de-identification algorithms are already in use when the public interest demands phenotype sharing but patient consent is not possible or practicable. Examples include notifiable disease surveillance, public health planning and large-scale research. In these cases, looking after the patient’s privacy requires measures that ensure they cannot be identified through illicit use of those data. But de-identification algorithms for genotype data are not mature enough.

Re-identification becomes more likely as the number of users increases. Illicit patient re-identification has three sources of risk: the research team, all other people who have access to these data and finally the inherent readability of the data itself [8] . Building a single system to be accessed by hundreds or thousands of researchers across tens or hundreds of projects is simply inconsistent with minimizing these three sources of risk. Such systems can therefore never be adequately private.

What might work, when public interest demands but consent is not possible, are schemes that separately copy just the minimum of phenotype and genotype data from various health management systems for a specific group of vetted researchers working within a highly protective legal context. Any change in project purpose would necessitate a re-assessment of the prevailing risks. A system in which highly vetted organizations were permitted to collect and link minimal data from all its various sources would be ideal.

In addition, the architecture for a single EHR or PHR is not a simple one. It is desirable and correct to view all the relevant data at the time of making a clinical decision or coming to a research conclusion. However, that does not mean all the data should be viewable.

For the person viewing the data, their storage in a single place does mean faster access and allows data normalization. But for the people whose data are viewed, such a data warehouse is ripe for abuse. Citizens have expressed their distrust of such systems on many occasions [9] , and security experts have repeatedly pointed out the risks of data warehouses [10] . Federated architectures, where data are spread across multiple sites and queried as needed, have been deployed [11] and are made easier by new approaches, such as service-oriented architecture. And knowing how much protection to put in place is made easier by couching privacy concerns in terms of the risk of illicit patient re-identification.


All of the above discussion is not to say that a single EHR is a bad idea. Belmont and McGuire [1] make a good case for the need to unify data in the service of laudable aims, including providing good patient care and advancing medical research. However, just because something can be done does not mean that it should be done, and in health care it is patients who should decide what should be done. They will be the most affected by privacy breaches, so they must be the ones who decide which of the benefits to take advantage of. The danger is when professionals confuse their convenience with the benefit of patients. The good news is that mature technologies exist that do put patients in control. As professionals we need to earn their trust by using these technologies when we ask for data sharing that makes our jobs easier.


EHR: electronic health record; PHR: personal health record.

Competing interests

MA is the CEO of Patients Know Best, a company that makes and sells personal health record software. RN is the CEO of Sapior, a company that makes and sells de-identification software for the private sharing of health data.

Authors’ contributions

MA wrote the sections on personal health records and RN wrote those on de-identification.


  1. Belmont J, McGuire A The futility of genomic counseling: essential role of electronic health records.

    Genome Med 2009, 1:48. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text OpenURL

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  2. Personal Genome Project []


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  3. PatientsLikeMe []


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  4. Markle Foundation: Connecting for Health []


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  5. Continuity of Care Record Standard []


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  6. Medpedia: Continuity of Care Record (CCR) Standard [ Standard]


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  7. Cancer Biomedical Informatics Grid []


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  8. Navarro R An ethical framework for sharing patient data without consent.

    Inform Prim Care 2008, 16:257-262. PubMed Abstract | Publisher Full Text OpenURL

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  9. McKie Robin Icelandic DNA project hit by privacy storm. [,6903,1217842,00.html]

    The Observer 2004. OpenURL

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  10. Anderson R, Brown I, Dowty T, Inglesant P, Heath W, Sasse A: []

    Database State.York: Joseph Rowntree Reform Trust; 2009. OpenURL

    // Return to text

  11. Gruman G Massachusetts takes a spoonful of SOA. []

    InfoWorld 2005. OpenURL

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A short history of short messages: What technology means for Iran

Posted in Arabs and Arabic, Politics, Society, Technology by Dr Mohammad Al-Ubaydli on June 16, 2009

The Iranian revolution of 2009 is being co-ordinated through an American company called Twitter. Their web site,, allows people to send short messages, each no longer than 140 characters. These messages are shared with everyone in the world, available for anyone to read.

At the moment, a lot of people are interested in whether or not the Iranian elections were rigged, and what to do about it. And a lot of these people agreed, through short messages on Twitter, that someone did cheat and that everyone should gather in Tehran to protest.

This is not the first time that short messages had big consequences. In 2001 many Filipino citizens were angry over the corruption allegations about President Joseph Estrada. When the impeachment trial’s Senators refused to look at crucial evidence, the voters got angry. A simple mobile phone SMS message was sent and forwarded from one citizen to another: “Go 2EDSA. Wear black”. In four days, one million people gathered in the EDSA square. President Joseph Estrada resigned.

Twitter allows even more efficient co-ordination through short messages and police in the Middle East understand this. Egypt’s Alaa Abd El Fattah, an Egyptian programmer, democracy activist and blogger, knew that the police were following his profile on Twitter when they came to arrest him. As one police officer approached, Abd El Fattah sent out a message about the approach but also saying that he had many friends close by and that they would protect him. This was not true, but the police responded as he thought they would: they sent so many police cars for the arrest that they blockaded the first police car. And by that point a large crowd of citizens gathered. He did have friends after all.

Myanmar and China heeded the risks. In 2007 Myanmar’s government shut down all access to the Internet and all mobile phone networks. Photographs and reports gradually leaked out about the regime’s crimes, but the ability of the protesters to co-ordinate their efforts was hampered. Last week, on the 20th anniversary of the Tienanmen Square massacre, the Chinese government temporarily switched off access to sites like Twitter.

But herein lies the dictator’s dilemma. “Switching off the Internet is a double-edged sword,” said Bahraini Professor Omar Al-Ubaydli*, an economist specializing in political economy. In today’s world switching off access also means switching off the economy. Countries like Myanmar can tolerate this as their economy is so primitive, but China’s cannot do so indefinitely. And for any government in the Middle East that is pretending to be democratic, switching off access uncovers their pretenses.

Which brings us to the short messages of Twitter. Stop pretending. Step aside. Power to the people.

* Yes, that’s my brother. Isn’t he cool!

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The five ‘Why’s

Posted in Books, Entrepreneurship, Patients Know Best, Society by Dr Mohammad Al-Ubaydli on May 25, 2009

Eric Ries’s description of the five ‘why’s has been playing on my mind recently as I figure out how to apply it in my company. Briefly, mistakes happen to everyone all the time, but the difference is how you respond to them. In particular, if you ask Why five times you have a much better chance at understanding the true cause of a problem and thus solving it.

The press do this too little and as citizens we suffer from this lack of questioning. Take the tragic story from May 12th of a roof collapsing on students while they were doing an exam. The link is to Google’s indexing of coverage for the story. Sadly, most of the articles focus on showing the “devastation inside exam horror hall”.

It is only on the excellent Teachers TV that I saw a follow-up to the story. As a side note, this is a wonderful channel that I am becoming hooked on. The technical director for the founding team is Dawson King, who is now our chief technology offier.

The channel gets much further than the newspapers did on the day just by asking Why once. In the seventh minute of this video they mention that an inquiry had found that the heating duct “fell because the wires attaching it to the roof broke”. This is not really informative. Just to translate, something (the duct) fell because what used to stop it from falling (the wires) stopped stopping it. In general, it is reasonable to assume the same to be true for any story of part of a building falling.

Asking Why four more times would get you much further. Why did the wire break? Because it was frayed, the answer might come back – I am guessing here and do not know any more facts than the ones I saw in the news story. Why was it frayed? Because it was old. Why was it old? Because the school’s maintenance budget has been underfunded for the last five years. Why was it underfunded? The answer to this will be an interesting one.

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O’Cracy: D.E.M., died 26/06/1976

Posted in Books, History, Society by Dr Mohammad Al-Ubaydli on April 10, 2009

Here is another story from Indira Gandhi’s emergency rule in India. It is only in the last couple of months that I have been learning about this period in India’s history and this quotation is also from Rafiq Dossani’s India Arriving.

The Emergency marked both the low point of press freedom and a turning point. With the exception of the Statesman and the Indian Express, the English-language press scraped and groveled to accommodate the state during the Emergency. Even the former had to be very careful to escape the censor’s eye. In what are now iconic tales of defiance, the Indian Express got away with the following message in its obituary section in 1976: “O’Cracy: D.E.M. O’Cracy, beloved husband of T. Ruth, Father of L. I. Berty, father of Faith, Hope and Justice, on June 26.”[1] And a library in Calcutta issued a notice in the Statesman in December 1975, stating: “On and from 1st January 1976, newspapers will be found in the fiction section.”[2]

1. Indian Express, Mumbai edition, June 27, 1976
2. Statesman, Calcutta edition, December 31, 1975.

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Annals of globalization and Google

Posted in People / organisations, Politics, Society by Dr Mohammad Al-Ubaydli on February 8, 2009

Here is the latest gem of an advert to reach me on GMail’s advertising:


The translation is “Read now what happened in Iraq between Bush and the reporter Muntathir Al-Zaidi”. I have no idea why they advertised this to me (or this, or this), but I was so fascinated by who “they” were today: Russia Today’s Arabic edition. It seems RT has an entire web page devoted to the shoe incident, with news stories from all over the Arab world.


This morning I was considering paying for Relenta (started by another Russian) as a serious producitivity improvement, but honestly the thought of losing out on the entertainment of GMail adverts saddens me.

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Saudi Arabia’s free speech violations #78: you cannot even discuss football

Posted in Arabs and Arabic, People / organisations, Society by Dr Mohammad Al-Ubaydli on February 6, 2009

Here is a wonderful video featuring Prince Sultan bin Fahad, سلطان بن فهد, the first person in a long time to get me interested in football:

A little background for those who cannot understand Arabic. Saudi Arabia’s football team lost against Oman’s in the Gulf Cup. Not every team is as great as Bahrain’s.

The video shows some post-match commentary on Saudi Arabian television. Now, personally, I think that watching a football match is a waste of my time, but watching commentary about a football match is a far worse use of my time. Most commentary is low quality, and when you consider the topic of football…

Still, in a country like Saudi Arabia, football is one of the few outlets of free debate. In this case, the commentartors began critiquing the strategy, or lack thereof, of the football team. Then they opened up the phone lines for viewers. One of the viewers was Prince Sultan bin Fahad, president of the kingdom’s Youth and Sports department, i.e. the sports minister.

You do not need to understand Arabic to understand the thoughts of the commentators by watching their facial expressions or hearing the Prince’s shouting. He ended by saying: “If you’re not well-mannered enough, then let me educate you myself”.

Professionalism when you have no privacy: advice for medical students

Posted in Society by Dr Mohammad Al-Ubaydli on February 4, 2009

This post is the result of a conversation I had with David Doherty (3G Doctor), Dawson Costello (Medical Student Blog) and Rob Navarro (Sapior) on my birthday. I know I should have been discussing more entertaining topics but when faced by three incredibly bright and interesting people I cannot help but try and learn from them. They certainly got me thinking and any errors below are due to my thinking.

The other day I saw a Facebook status update for a medical student saying that he was “Hating patients”. When someone tried to teach the student that this was a foolish sentence to write the student said he thought no one would find his writing interesting. This is a serious error of judgement.

I am not a fan of Facebook’s founder, and one of the things that trouble me the most about the site is that it encourages a mental model of privacy but has a business model of publicity. In other words, people are comfortable sharing information because they have the impression of private conversations with friends, but fundamentally Facebook benefits from spreading your messages as far and wide as possible. This is why they ban applications that reduce the number of “friends” you have.

The comfort you should feel in Facebook is the same you should feel about picking your nose while in your car: it feels private, but everyone can see you. And with video phones, if you are famous enough, someone will record you.

In the long run, this will not be a problem for most people. First, as everyone gets caught doing something stupid in a social network website, legislation will arise to minimize the fallout, just as politicians step in when everyone makes financial mistakes by borrowing too much or saving too little. Second, and more significantly, people will be more forigiving as they see that everyone is falliable. In 2005 there was a witch hunt over a South Korean woman caught on video phone failing to clean up after her dog in a railway carriage appeared on the internet. In 2015 there will be no such recriminations, in South Korea at least, as such an incident will no longer be news.

But there will never be such clemency for doctors. For example, the public reaction to an NHS manager getting in touch with her friends on Friends Reunited has been severe:

Eastern and Coastal Kent PCT assistant director of strategic partnerships Caroline Davis wrote on Friends Reunited: “I now live in Dover, where I work for the NHS, bullshitting for a living, no change there then.”

I found out recently about discplinary action the trust was compelled to take. The reaction towards doctors will be even more severe. Partly this is because there are so few of us, but mainly because we have a duty to society. We receive heavily subsidized training, the public trust us with their lives, and accords us the respect of professionals.

My advice to medical students is simple: assume everything you write today will be read in 20 years’s time. John Steinbeck has a good line on this:

It seems to me that if you or I must choose between two courses of thought or action, we should remember our dying and try so to live that our death brings no pleasure on the world

What you write will definitely be availabe in that time because Google, and its more powerful successors, index and archive everything. And because storing old data costs less than the revenue from putting advertisments around those data, no matter how trivial the data seems to be. And people will definitely read what you wrote because in 20 years you will be a doctor with status in your community. Members of your community – including patients, journalists and lawyers – will regularly study your older writings to look for patterns of behaviour. Do not give them a reason to think badly of you.

If that means not using Facebook, then stop using Facebook. The privilege of being a doctor is far more significant than anything a free website can offer you.

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Bahrain Medical Bulletin is Bahrain’s first open access journal

Posted in Arabs and Arabic, Medicine, Society by Dr Mohammad Al-Ubaydli on December 23, 2008

Here is a press release we sent out recently to journalists in Bahrain. I hope to announce more good news soon.

Issued: 23 December 2008

For Immediate Release
With support from Ministry of Health and Kuwait Finance House.

TITLE Bahrain Medical Bulletin is Bahrain’s first open access journal

Today, the Bahrain Medical Bulletin (BMB became an open access journal. What this means is that the journal is now free to read online, and is published under a progressive copyright that allows readers to reuse the articles provided they cite them correctly.

Dr. Jaffar Al-Bareeq, Chief Editor of the BMB, said “This change is part of BMB‘s belief that medical research is an international public resource and should be provided with a copyright license that supports sharing of scientific knowledge.” Dr. Al-Bareeq founded the journal in 1979 to provide a forum for medical research in the region.

Starting with the December 2008 issue, all BMB articles are freely available online and deposited in a public archive immediately upon publication. Anyone is free to copy, distribute, and reuse BMB content as long as he or she credits the original author and source.

Dr. Mohammad Al-Ubaydli, a Senior Editor at the BMB, said “Open access publishing brings the same revolution to the publishing of scientific information that open source software brought to the creation of software”. Dr. Al-Ubaydli led the conversion of BMB to an open access journal. He is author of the book Free Software for Busy People ( which discusses the use of open source software in health care.

This conversion is funded by grants from the Kuwait Finance House and the Ministry of Health. H.E. Dr. Faisal Al Hamar, Minister of Health, said “We supported this work because of its importance to medical research in the region”. Mr A. Al Khayat, from Kuwait Finance House, said “As an Islamic Bank we are delighted to provide funding for work that will ultimately improve patient care”.

Although some journals in the region already allow readers free access to their journal website, BMB is the first to allow readers to reuse the content in other ways through the open access license.

Such reuse has many powerful applications.  For example, anyone will be free to distribute any article in BMB, make translations, put the articles into course packs in universities, and make derivative educational works.  If a minister of health reads an important study in BMB, they are now free to send a copy to every health professional in the country.

This commitment to access to knowledge by a Bahraini journal complements Bahrain’s existing medical infrastructure. For example, the only Cochrane Center in the Middle East is in Bahrain. Cochrane is the international collaboration between medical scientists around the world to evaluate and identify clinical treatments for patient care.

بيان إخباري، 23 ديسمبر 2008

[بدعم وزارة الصحة والتمويل الكويتي]

مجلة البحرين الطبية: أول مجلة علمية مفتوحة في البحرين
أصبحت مجلة البحرين الطبية ومنذ اليوم (Bahrain Medical Bulletin (BMB), أول دورية علمية مفتوحة، وبهذا باتت متاحة للقراءة على الإنترنت بلا كلفة، وتنشر حسب شروط حقوق نشر متقدمة بحيث أصبح ممكنا للقراء إعادة استعمال المقالات بشرط الإشارة الصحيحة للمصدر والكاتب.

ويقول الدكتور جعفر الإبريق رئيس تحرير المجلة: “ينطلق هذا التغيير من الاقتناع بأن البحث الطبي هو مصدر عالمي عام ويجب أن تترافق طبيعته مع الترخيص باستخدام حقوق النشر الداعمة للتشارك في المعرفة العلمية.” وكان الدكتور الإبريق قد أسس المجلة عام 1979 لإيجاد ملتقى للبحث العلمي بالمنطقة.

وبدءاً من عدد ديسمبر 2008، فإن كل مقالات مجلة البحرين الطبية ستكون منشورة للاستخدام المجاني عبر الإنترنت وستُخزّن فوراً في أرشيف عام وقت النشر. وسيحق لأي مستخدم أن ينقل أو يوزع أو يعيد استخدام محتويات المجلة طالما قام الشخص بالتوثيق للمؤلف الأساس وللمصدر.

وقال الدكتور محمد العبيدلي أحد كبار المحررين بمجلة البحرين الطبية إن “النشر المفتوح يحقق بعالم نشر المعلومات العلمية نفس الثورة التي أدخلها برامج المصدر المفتوح لعالم إبداع برامج الحاسوب.” وكان الدكتور العبيدلي قد قاد عملية تحويل المجلة إلى نشرة مفتوحة. وهو مؤلف لكتاب “البرامج المجانية للأناس المشغولين” ( والذي يناقش استخدام برامج المصدر المفتوح في العناية الطبية.

ولقد موّلت عملية التحويل بمنح قدمها بيت التمويل الكويتي ووزارة الصحة. وقال الدكتور فيصل الحمر، وزير الصحة: “موّلنا هذا البحث لأهميته للبحث الطبي في المنطقة.” وقال السيد عبدالحكيم الخياط من بنك التمويل الكويتي بأنه وبالنظر: “لكون البنك مصرفاً إسلامياً فإننا سعداء لتوفير تمويل لعمل سيحسن بالنهاية العناية بالمريض.”

وعلى رغم من أن بعض المجلات الطبية بالمنطقة قد بدأت بالسماح للقراء بالاطلاع الحر على مواقعها، فإن مجلة البحرين الطبية هي الأولى في منح حق استخدام المحتويات وبأية طرائق أخرى عبر منح ترخيص الاستخدام المفتوح.

ويمكن لهذا الحق أن يمكّن من تطبيقات قوية متعددة. مثلاً، يمكن لأي شخص أن يوزع  أي مقال بالدورية أو يقوم بترجمته، أو يضمن مقالة ما بأي مقررات للتدريس بالجامعات، وأن يحقق أية أعمال مشتقة من تلك المقالات. ويحق بذلك لأي وزير صحة اليوم وحينما يقرأ دراسة مهمة بالمجلة أن يرسل نسخة منها لأي محترف للعناية الصحية بالبلد.

ويكمل الالتزام بحق استخدام المعرفة الذي تمنحه مجلة بحرينية، البنية التحتية الطبية البحرينية القائمة. وعلى سبيل المثال فإن فالبحرين تضم مركز كوكرين الوحيد بالشرق الأوسط. وكوكرين هو تعاون دولي بين العلماء الطبيين حول العالم لتقييم وتحديد العلاجات السريرية للعناية بالمريض.

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Now that you can believe in change, what are you going to do?

Posted in Politics, Society by Dr Mohammad Al-Ubaydli on November 6, 2008

I witnessed a wonderful thing on Tuesday with the election of Obama. America’s brilliance is not presidency, but process. It is America’s ability to change. No other nation does this so well and for that it can justly be proud.

Jesse Jackson crying

Read this passage[1] below from the diary of Henry Seward as he journeyed with his wife through Virginia in 1835 and saw ten black children:

Ten naked little boys, between six and twelve years old, tied together, two and two, by their wrists, were all fastened to a long rope, and followed by a tall man, gaunt white man, who, with his long lash, whipped up the sad and weary little procession, drove it to the horse-trough to drink, and thence to a shed, where they lay down on the ground and sobbed and moaned themselves to sleep.

On November 5th 2008, Virginia was one of the states that voted for Obama as president. America was one of the worst countries in the world when it came to treating with dignity those of African descent. It still has a long way to go. We all do. But on Tuesday its citizens took leadership by giving leadership to an African American.

The USA has an extraordinary infrastructure for change. It is well worth listening to Gavin Newsom discuss how he changed San Francisco law to allow gay marriage. America was one of the least progressive in the West for the rights of homosexuals, but individual states are beginning the change. Hearing Robert Klein talk about how Californians voted to provide $3 billion worth of funding for stem cell research taught me about so many initiatives that were not discussed in the press. America had one of the worst policies for stem cell research, but California’s initiative alone meant the USA had world leadership in government funding.

But it is not just that California made progressive choices that I liked. After all, they elected Schwarzenegger, who I hate. Rather, listen to the speakers discuss the opposition they received – strong, vociferous, and passionate – and how they overcame it – with more passion from more people.

Obama captures that passion. “Change we can believe in”, he said, and “Yes we can”, he chanted. And along with millions of Americans he achieved what millions of non-Americans thought was impossible.

So. What are we non-Americans going to do? Will a European country give her highest office to a citizen of color? Perhaps the UK, as a Bahraini doctor and I were discussing on Tuesday, will elect and British Asian. And will Bahrain do something similar? Or more relevantly, will Arab voters be able to vote outside of their tribe or sect? Will we able to vote for the common good and the higher cause?

More immediately, what can we do today? In the UK, there is a crisis of politics as the rich are too scared to give any money to parties, the middle classes refuse to pay, and the working classes occasionally funnel money through the few remaining unions. The major parties are running on deficits and teetering on bankruptcy. And in Bahrain, most of the non-religious candidates have been overwhelmed and over-run. The results in the UK and Bahrain are not the moral majority at work but the apathetic majority failing to work.

Obama has shown that citizens paying $5 can make a $500 million difference. No matter how bad you think your local party or representative is, look at your options, pick the best, and pay them money so they can work better. Turn up to their meetings. Explain to them what you want and help them explain to others what needs to be done.  Yes. We. Can.

[1] I read this quote in the book Team of Rivals: The political genius of Abraham Lincoln. The book describes how, Lincoln, another unlikely lawyer from Illinois became president, running on an anti-slavery platform. It also describes how this brilliant man was so brilliant that he felt confident enough to hire all three of his election rivals (including Henry Seward) into his new cabinet and to use them to steer the nation through difficult times. I wonder who Obama hires.