Haider Javed Warraich writes: Physicians are thought to be the harbingers of bad tidings, the people who use cold words like “prognosis.” But studies show that they are just as capable of emotions as their patients are. According to a study published in 2000 in the British medical journal BMJ, about two-thirds of doctors overestimate the survival of terminally ill patients.
A study of cancer patients and their doctors in the Annals of Internal Medicine a year later found that many doctors didn’t quite tell patients the truth about their prognosis. Doctors were up front about their patients’ estimated survival 37 percent of the time; refused to give any estimate 23 percent of the time; and told patients something else 40 percent of the time. Around 70 percent of the discrepant estimates were overly optimistic.
This optimism is far from harmless. It drives doctors to endorse treatments that most likely won’t save patients’ lives, but may cause them unnecessary suffering and inch their families toward medical bankruptcy.
One source of this optimism is pop culture, which frequently depicts heroic recoveries from seemingly life-threatening situations. Another is the medical school experience. What motivates weary medical students is the hope that one day interventions they perform will save lives, heal families and enact cosmic good.
Later, our judgment becomes clouded as we build relationships with patients, share their fears and anxieties, cherish their small victories and celebrations and hope that there may still be a way, however unlikely, they can make it to their grandson’s bar mitzvah.
And yet studies have shown that patients almost universally prefer to be told the truth. If physicians cannot deliver the hard facts, not only do they deprive their patients of crucial information, but they also delay the conversation about introducing palliative care.
Modern palliative care originated in response to the proliferation of new treatments and resuscitation technologies. Keeping a patient “alive” became easier. And yet the definition of “alive” suffered — with quality of life frequently being usurped by length of life. [Continue reading…]
Guantanamo detainee says prison ‘shakedown’ sparked hunger strike
The Los Angeles Times reports: Obaidullah, an Afghan villager captured with diagrams of improvised bombs, has marked nearly 11 years as a detainee at the U.S. naval base on Guantanamo Bay, Cuba.
Three months ago, outraged by what he called another prison “shakedown,” he joined a hunger strike there, and now is locked in solitary confinement with at least 100 fellow detainees.
“I have seen men who are on the verge of death being taken away to be force-fed,” Obaidullah said in a federal court affidavit declassified Friday. “I have also seen some men coughing up blood, being hospitalized, losing consciousness, becoming weak and fatigued.”
His observations are the most extensive yet by a detainee about conditions at the military prison and what prompted the hunger strike. He and others tell of a Feb. 6 search when guards confiscated toiletries, family pictures and copies of the Koran. For the detainees, the trigger was “U.S. soldiers rifling through the pages of many Korans and handling them roughly.”
Military officials said about four dozen doctors and nurses had been deployed to Guantanamo Bay to help the detainees stay alive and maybe start eating again. And Col. John Bogdan, who runs the prison, recently told reporters that the raid, which he defended, unearthed contraband including crudely fashioned weapons made out of mop handles. [Continue reading…]
Obama on airstrikes: Israel has to guard against Hezbollah
Reuters reports: U.S. President Barack Obama said on Saturday that Israel has the right to guard against the transfer of advanced weapons to Hezbollah a day after Israel attacked a Hezbollah-bound missile shipment in Syria.
Israel has long made clear it is prepared to resort to force to prevent advanced Syrian weapons from reaching Hezbollah or jihadi rebels. Israeli warplanes went after the shipment inside Syria, where a two-year civil war is raging.
Obama, in an interview with the Spanish-language network Telemundo as part of a three-day Latin America tour that ended in Costa Rica, would not comment on whether the airstrikes had in fact taken place.
“I’ll let the Israeli government confirm or deny whatever strikes that they’ve taken,” he said.
But Obama, who visited Israel in March, made clear such strikes would be justified.
“What I have said in the past and I continue to believe is that the Israelis justifiably have to guard against the transfer of advanced weaponry to terrorist organizations like Hezbollah. We coordinate closely with the Israelis recognizing they are very close to Syria, they are very close to Lebanon,” he said.
Israeli airstrike in Syria targeted missiles from Iran, U.S. officials say
The New York Times reports: The airstrike that Israeli warplanes carried out in Syria was directed at a shipment of advanced surface-to-surface missiles from Iran that Israel believed was intended for Hezbollah, the militant Lebanese organization, American officials said Saturday.
It was the second time in four months that Israel had carried out an attack in foreign territory intended to disrupt the pipeline of weapons from Iran to Hezbollah, and the raid was a vivid example of how regional adversaries are looking after their own interests as Syria becomes more chaotic.
Iran and Hezbollah have both backed President Bashar al-Assad in the Syrian civil war, now in its third year. But as fighting in Syria escalates, they also have a powerful stake in expediting the delivery of advanced weapons to Hezbollah in case Mr. Assad loses his grip on power.
Israel, for its part, has repeatedly cautioned that it will not allow Hezbollah to receive “game changing” weapons that could threaten the Israeli heartland after a post-Assad government took power.
Israel, for its part, has repeatedly cautioned that it will not allow Hezbollah to receive “game changing” weapons that could threaten the Israeli heartland after a post-Assad government took power.
And as Washington considers how to handle evidence of chemical weapons use by the Syrian government, a development it has described as a “red line,” Israel is clearly showing that it will stand behind the red lines it sets.
“The Israelis are saying, ‘O.K., whichever way the civil war is going, we are going to keep our red lines, which are different from Obama’s,’ ” said Ehud Yaari, an Israel-based fellow of the Washington Institute for Near East Policy. [Continue reading…]
Syrians flee ‘massacres’ in Baniyas and al-Bayda
BBC News reports: Hundreds of Syrians have fled coastal areas where activists accuse government forces of carrying out massacres in a campaign of sectarian cleansing.
Footage of mutilated and burned bodies, allegedly from the town of Baniyas, have been posted online.
Activists said at least 77 people – 20 from the same family – were killed, a day after 72 died in nearby al-Bayda.
The government said it had fought back “terrorist groups” and restored peace and security to the area.
All telephone calls recorded and accessible to the U.S. government
Glenn Greenwald writes: The real capabilities and behavior of the US surveillance state are almost entirely unknown to the American public because, like most things of significance done by the US government, it operates behind an impenetrable wall of secrecy. But a seemingly spontaneous admission this week by a former FBI counterterrorism agent provides a rather startling acknowledgment of just how vast and invasive these surveillance activities are.
Over the past couple days, cable news tabloid shows such as CNN’s Out Front with Erin Burnett have been excitingly focused on the possible involvement in the Boston Marathon attack of Katherine Russell, the 24-year-old American widow of the deceased suspect, Tamerlan Tsarnaev. As part of their relentless stream of leaks uncritically disseminated by our Adversarial Press Corps, anonymous government officials are claiming that they are now focused on telephone calls between Russell and Tsarnaev that took place both before and after the attack to determine if she had prior knowledge of the plot or participated in any way.
On Wednesday night, Burnett interviewed Tim Clemente, a former FBI counterterrorism agent, about whether the FBI would be able to discover the contents of past telephone conversations between the two. He quite clearly insisted that they could: [Continue reading…]
The human cost of climate change
Overheated: The Human Cost of Climate Change — a review: The dedication of Andrew Guzman’s book makes obvious what he hopes to convey in the couple of hundred pages to follow. “To Nicholas and Daniel,” he writes, referring to his sons, “Whose Generation Will Face The Consequences.”
Many authors have written about how global warming will damage some of the world’s most treasured landscapes and beloved species. This book aims to lay out exactly how bad it will be for human beings. Guzman, a law professor and associate dean at the University of California at Berkeley, is neither a scientist nor a trained environmental activist; he is an academic well-versed in international treaties and legal niceties. This background gives him an interesting perspective on the shifts that are sure to come as climate change rearranges the world’s traditional social and economic order and as different factions jockey for advantage.
The wisest choice Guzman has made in outlining this scenario concerns the warming estimate on which he bases his projections: an increase of 2 degrees Celsius, or 3.6 degrees Fahrenheit, above pre-industrial levels by 2100. This is the threshold political leaders have pledged to keep within to have a chance of averting dangerous consequences, but every indication is that the world will warm much more by the end of the century. By adopting what Guzman himself calls “a conservative prediction,” he bolsters his case for action. After all, if things fall apart under a 2-degree scenario, how much worse would it be if the rise reached 4 degrees, which is what might very well happen given the current rate of global carbon emissions?
His answer is harsh: Plenty of disasters will unfold. The book ticks off the obvious losers in a world of rising seas, hotter temperatures and less predictable precipitation patterns: tiny Pacific island nations such as the Maldives, but also larger jurisdictions, including Bangladesh and, closer to home, California, where more than half of the state’s water supply could be disrupted if the levees in its delta region fail as a result of such effects as rising sea levels and more intense storms. Water scarcity in many regions, including the Middle East and Africa, could not only harm individuals but destabilize nations. [Continue reading…]
Future drones: Micro Air Vehicles — unobtrusive, pervasive, and lethal
When graduate student Pakpong Chirarattananon at the Harvard robotics laboratory successfully launched RoboBee on its first flight, the project might have looked like an innocuous and ingenious exercise in miniaturized robotics. But the Pentagon has had its eyes on such technology for several years, with “Micro Air Vehicles” which could be launched in swarms and used for surveillance and even killing.
M.A.V. – Micro Air Vehicles — U.S. Air Force Research Laboratory:
Guantanamo burns through $900,000 a year per inmate
Reuters reports: It’s been dubbed the most expensive prison on Earth and President Barack Obama cited the cost this week as one of many reasons to shut down the detention centre at Guantanamo Bay, which burns through some $900,000 (£577,886) per prisoner annually.
The Pentagon estimates it spends about $150 million each year to operate the prison and military court system at the U.S. Naval Base in Cuba, which was set up 11 years ago to house foreign terrorism suspects. With 166 inmates currently in custody, that amounts to an annual cost of $903,614 per prisoner.
By comparison, super-maximum security prisons in the United States spend about $60,000 to $70,000 at most to house their inmates, analysts say. And the average cost across all federal prisons is about $30,000, they say.
Sidelining Palestinians in Israel will doom prospects for peace
Ben White writes: In mid-April, the United States state department published its annual human rights review – and the country report for Israel makes for interesting reading. An ally praised in public as the embodiment of liberal democratic values in a “tough neighbourhood” is described as practising “institutional discrimination” against its own Palestinian citizens (the so-called Israeli Arabs).
Even in a far-from-comprehensive summary of Israel’s systematic racism, the report notes discrimination in the education system, the land regime and housing, and the legal restrictions on a Palestinian from the West Bank or Gaza living with his or her spouse in Israel.
These were not unprecedented observations – previous state department reports have said similar things – but the study provides an opportune moment to think through some important, neglected questions.
Palestinians in Israel continue to get far less attention from the international community than those in the West Bank and the Gaza Strip, even though this omission makes for bad history, poor analysis and even worse long-term peacemaking.
By coincidence, at the same time the US government published its report, Amnesty International called on the Israeli government to “scrap plans to forcibly evict Bedouin” in the Negev. The so-called Prawer Plan would involve Israel expelling tens of thousands from communities that it refuses to recognise and moving them into approved shanty towns.
Amnesty says that the plan for “house demolitions and forced evictions” is one that “blatantly violates international law”. It is criticism echoed by other human rights groups and not least by the Bedouin community itself.
But it is not just discrimination and segregation that raise concerns. There are those in Israel who would like to be rid of Palestinian citizens altogether – and see an opportunity to do so in the context of the “peace process”. [Continue reading…]
As Israel bombs Syria the U.S. weighs its own pptions
Following reports of the latest Israeli air strike on Syria, the New York Times says: The Israeli attack came as the Obama administration — as part of its examination of possible responses to obtaining conclusive proof that Mr. Assad has used chemical weapons — is considering military options with allies. Those options include attacking Syria’s antiaircraft systems, military aircraft and some of its missile fleet, according to senior officials from several countries.
Those officials say that attacking the chemical stockpiles directly has been all but ruled out. “You could cause exactly the disaster you are trying to prevent,” a senior Israeli military official said in an interview last week in Tel Aviv.
But attacking Mr. Assad’s main delivery systems, the officials say, would curtail his ability to transport those weapons any significant distance. “This wouldn’t stop him from using it on a village, or just releasing it on the ground, or handing something to Hezbollah,” said one European official who has been involved in the conversations. “But it would limit the damage greatly.”
The topic was alluded to on Thursday, when Secretary of Defense Chuck Hagel met with his British counterpart and talked about “the need for new options” if Mr. Assad used his chemical arsenal, the officials said. But while the military has been developing and refining options for the White House for months, the discussion appears to have taken a new turn, officials say, in the struggle to determine whether the suspected use of sarin gas near Aleppo and Damascus last month was a prelude to greater use of such weapons.
“There are a lot of options on the table, and they’re generally carrying equal weight at the moment,” a senior administration official said Friday. He declined to discuss the others, though Mr. Hagel talked on Thursday about arming rebel groups
So far, President Obama has been reluctant to get involved in the Syrian conflict. He has ruled out placing American forces on the ground, a stance he reiterated on Friday at a new conference in San José, Costa Rica, where he was meeting with Latin American leaders.
Mr. Obama told reporters he did not foresee a situation in which “American boots on the ground in Syria would not only be good for America but also would be good for Syria,” adding that he had consulted with leaders in the Mideast who agree.
When asked in recent days whether recent evidence of chemical weapons use in Syria crossed the “red line” he set in August, Mr. Obama described questions he would need to have answered — including when and how chemical weapons were used — before he would take action. Even then, he made clear, he may choose something well short of military action.
By Israeli estimates, Syria has 15 to 20 major chemical weapons sites, many near airfields that would make transport by plane relatively easy. Military planners say they would want to avoid hitting the chemicals for fear of creating toxic sites that could injure or kill civilians.
Ideally, one American commander said, the stockpiles would be surrounded, protected and then incinerated, much as the United States has done with its chemical arsenal. But that takes years, and as one official said, “We don’t have years, and we can’t keep troops there.”
That is why attacking the delivery systems seems like the next best option to many in the administration. Israel was believed to be behind an attack on some Syrian missiles in February as they were about to be transported, presumably to Hezbollah. On Wednesday, Prime Minister Benjamin Netanyahu told Israeli lawmakers that a Hezbollah missile attack, using chemical weapons, was one of his chief concerns. [Continue reading…]
Israel confirms airstrike inside Syria
Al Jazeera reports: Israeli officials have confirmed that the country’s air force carried out a strike against Syria and say it targeted a shipment of advanced missiles.
The officials said on Saturday the shipment was not of chemical arms, but of “game changing” weapons bound for the Lebanese Hezbollah group.
They claimed, speaking on condition of anonymity, that the airstrike was early on Friday, but no mention was made of where it took place.
Following the strike, Defence Ministry strategist, Amos Gilad, said that Syrian President Bashar al-Assad retains control of Syria’s reputed chemical weapons and they are not sought by his Hezbollah allies in Lebanon.
“Syria has large amounts of chemical weaponry and missiles. Everything there is under (Assad government) control,” Gilad said in a speech.
“Hezbollah does not have chemical weaponry. We have ways of knowing. They are not keen to take weaponry like this, preferring systems that can cover all of the country (Israel),” he said.
Hezbollah leader defends involvement in Syria
Following a speech by Hezbollah’s leader Hassan Nasrallah this week, Jean Aziz writes: Beirut circles familiar with Hezbollah’s thinking said that Nasrallah addressed his supporters to assert that the war he is waging — in Sayyeda Zeinab’s shrine, Qusayr, and of course in south Lebanon — is legitimate. That legitimacy rests on three grounds:
First, that the war on Syria aims to liquidate the Palestinian cause and thus the war falls within Hezbollah’s doctrine of fighting Israel.
Second, that some Lebanese parties are directly involved in the Syrian conflict, as Nasrallah asserted. That involvement indicates that there has been a decision to use the Syrian arena to strike at Hezbollah. According to Nasrallah, that involvement preceded the Shiite involvement in Syria.
In effect, Nasrallah said to both his supporters and opponents that when former Lebanese Prime Minister Saad Hariri started arming the Syrian opposition, and when Hariri appointed one of his MPs to represent him with the jihadist and takfiri groups in Syria, and when Lebanese Shiites returning from a religious pilgrimage in Iran were kidnapped in Syria on the Turkish-Syrian border last year, and when the arms shipments to the Syrian opposition were coming through the Tripoli port, and when dozens of Lebanese Sunni fundamentalists were ambushed when infiltrating Syria from northern Lebanon to fight alongside Jabhat al-Nusra, Hezbollah was not yet involved in Syria, as it is today in a limited way. So Nasrallah was telling his supporters that he is in a position of self-defense and is defending his people, or at least was counterattacking a push to eliminate Hezbollah.
The third ground is purely religious: to defend Sayyeda Zeinab’s shrine. Zeinab was the daughter of Imam Ali, who is revered by Shiites, and Fatima, who was the daughter of Islam’s prophet, Muhammad. Zeinab also played a key role in the Battle of Karbala, which happened in 680 and is central to Shiite consciousness. It is that battle that split the Muslims into Sunnis and Shiites. [Continue reading…]
Jabhat al-Nusra’s ties to Syria seem stronger than its allegiance to Al Qaeda
Scott Lucas writes: You know that a media narrative has been established when Reuters puts it into its boilerplate text.
For example, the standard reference for the Islamist faction Jabhat al-Nusra is now “the Nusra Front, an al-Qaeda linked rebel group“.
Other news outlets have joined in — or go even farther. Associated Press also uses “Al-Qaeda-linked group“.
The New York Times chooses “aligned with Al Qaeda“. Then, after declaring, “Nowhere in rebel-controlled Syria is there a secular fighting force to speak of”, it asserts: “Among the most extreme groups is the notorious Al Nusra Front, the Qaeda-aligned force declared a terrorist organization by the United States.”
But what if that narrative is only part of the story, based on a repetition of a distorted interpretation of a Jabhat al-Nusra statement, which misses crucial points and nuances?
How does that affect our understanding of the Syrian conflict, and our responses to it?
While the US Government established the “extremist” label for Jabhat al-Nusra late last year when it designated the faction as a terrorist group, the “Al Qa’eda-linked” mantra was fostered last month after a statement by JAN head Abu Mohammad al-Golani.
Responding to an attempt by the Islamic State of Iraq to claim leadership of JAN, al-Golani emphasised the autonomy of the movement, stressing that it is a local faction that is working and fighting with other local groups.
However, that part of the message was lost — at least in the Western press, who rather than analyzing the nuances of al-Golani’s statement and placing those within a wider context, focussed entirely on a reference to Ayman al-Zawahiri, the head of Al Qa’eda after the death of Osama bin Laden.
However, the full text of al-Golani’s statement, translated by EA, is far different from the simplistic, reductionist “allegiance to Al Qa’eda” soundbite presented and re-presented in media outlets, few (if any) of which actually read al-Golani’s full statement in English, let alone Arabic. [Continue reading…]
Egyptian voices — conservative and progressive — clamour to be heard
The Guardian reports: Last weekend, the owners of the 4Win hotel in Hurghada uncorked the entire contents of their drinks cabinet, and poured it down their stairs. Attended by a Salafi sheikh, and by supporters chanting “Allah is great”, the event was a first for Hurghada. It marked the opening of the first hotel in the Red Sea resort – a westernised tourist town where much of the signage is in English and Russian – that promises to cater for religiously conservative guests.
“At the moment, many Middle Eastern men won’t come to Hurghada because they won’t get the privacy they require,” said 4Win’s manager and co-owner, Abdelbasset Omar. “We’re trying to fill that gap in the market.”
Omar said female guests will stay on a segregated, women-only floor guarded by female security personnel, and will also have the option of swimming in a segregated pool. The bar is alcohol-free, while images of musicians Elvis Presley and Shakira – the residue of the hotel’s previous life as a conventional establishment – have been removed from the walls. But the transformation is not entirely complete: paid-for pornography channels have not yet been removed from the hotel’s televisions.
“It gives me the chance to enjoy tourism in my own country in a way that does not contradict my beliefs,” said one of the hotel’s first guests, Abdel Rahman – an electronics engineer from Cairo. “Especially the privacy for women – they can enjoy swimming now with no problems.”
“I’m very glad that this hotel has been opened,” said Sheikh Khaled Saeed, who spoke at the hotel’s opening. “It helps better reflect a real image of Egyptian society.”
Western tourism in Egypt has fallen since the 2011 uprising – one local hotelier said his hotel’s occupancy was down by 50%, while nationwide numbers have fallen by over a fifth in the past two years. In this light, 4Win’s existence is partly seen as a clever attempt to make up for the shortfall with a different kind of tourist. “It’s a smart move,” said Adel Ibrahim, the owner of Canary Hotel, another Hurghada inn. “It’ll attract conservative guests – both from the Gulf countries and from Egypt.” [Continue reading…]
The death of Egypt Independent
Jenna Krajeski writes: In 2010, I moved to Cairo to try something new. I had taken a job with an education N.G.O., and saw the work—which I knew from friends to be frustrating but fulfilling — as a fresh start. Development, I thought, was useful; I wasn’t sure I could say that about journalism. It took about a week in Cairo for me to change my opinion. I quit the N.G.O.
For the next year, and through months of the revolution in Tahrir Square, I was on the staff of Al-Masry Al-Youm English Edition, the online-only version of a local Arabic-language newspaper. The papers shared a name and the same management, but they didn’t have a lot else in common. The staffers of the English edition were young — mostly under thirty — and around a quarter of them were foreign; their paper was both a platform for news and a protest against the journalistic old guard. They saw the established Egyptian media as rife with flaws—a rigid hierarchy, sexism, laziness, nepotism, and self-censorship among them — which impeded the free society they wanted to live in.
What the journalists at the English Edition lacked in mentors, they made up for with camaraderie, determination, and optimism. Earlier this month, when the management of Al-Masry Al-Youm announced that the English Edition (now called Egypt Independent, and weekly in print) was closing, they derided that optimism as naïveté.
Egypt Independent’s bosses cited a lack of resources—a believable claim, given the business situation for most newsrooms today. But there was more to it. A letter signed the “Al Masry Al Youm Institution” (the media company, Al-Masry Al-Youm, owns both the Arabic paper of the same name and Egypt Independent) and posted on Egypt Independent’s Web site reads “…the false hopes that the print version of ‘The Egypt Independent’ will create the desired impact on the Egyptian society were nothing but a huge waste of financial resources, labor, and time.”
For the young journalists, it was a blow. Since January, they had been learning to keep themselves afloat. They raised money, courted investors and advertisers, and canvassed for subscribers. The management “disregarded everything we’d done and completely killed the operation,” said the editor Lina Attalah, when I reached her on Monday via Skype. “The facade is financial, but there are politics in economic moves.” Attalah was tired; she had spent the day arguing for severance pay for the staff. (Al-Masry Al-Youm maintains that the decision is purely financial, and plans to publish English translations of their Arabic content online under the name Egypt Independent.)
Egypt Independent isn’t just a newspaper in English; it’s a crucial, local voice at a time when Egypt needs trustworthy representatives. An article intended for the last issue of Egypt Independent, by Dina K. Hussein and Dalia Rabie, explains the value of “allowing Egyptian journalists to tell Egypt’s story to the world, not as fixers who might or might not get their due credit, but as primary storytellers.” They speak the language and know the customs; they have sources. Perhaps most important, they truly — not just intellectually — care. When one of these news sources closes, it’s not only Egyptian society that rocks off balance. Independent, reliable news on Egypt will be harder for English-speakers in the rest of the world to find. [Continue reading…]

