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Message Number 261197
Re: Kooky Left and the Wacky Right? View Thread
Posted by AllenF on 10/09/09 at 19:59

Marie,

This linear model of left and right is outdated and does not represent the diversity of political opinions in the world. Take this very short quiz and it will show you roughly where you are on a Nolan Chart which I believe is much more accurate than a left/right linear model:

http://www.theadvocates.org/quizp/index.html

In my opinion the middle does not rule they simply flap in the breeze.

Result number: 1

Message Number 261107

Re: Barefoot Running View Thread
Posted by Jav on 10/06/09 at 14:04

Thanks for the POSE method reference Dr. I found it (and the related 'Chi' running styles) rather baffling yet interesting. I never thought much about trying to adjust the body's alignment and foot strike positioning to such a degree (thinking that the body must naturally find the most efficient mode to move itself), but there is quite a bit of food for thought here, especially considering the number of injuries that runners sustain after years of hitting the pavement.

I would guess that younger runners might realize more benefits from starting out 'programming' all the muscles and tendons in a more 'proper' alignment, but I bet vets like myself would incur a whole raft of niggling ailments learning to re-train the musculature in such a radically different style. Then again, it might do wonders to older backs and knees to slowly adapt and introduce some of these methods in hopes of curing some classic running injuries (IO band, runners knee, PF etc).

That said, this running barefoot movement seems incredibly risky to me. Maybe if I wasn't a PF sufferer I'd be less wary, but as you point out, the minority of practitioners with perfect form will perhaps become raving advocates, while the majority of participants with even slight alignment issues likely would eventually fall foul of all sorts of 'issues'.

I'll monitor from the sidelines in my trusty, dusty Saucony Hurricanes for now :)

Result number: 2
Searching file 25

Message Number 258892

Re: The politics of being rich. View Thread
Posted by marie:) on 7/16/09 at 08:12

I must have misinterpreted your commentary on the 40%....but it came across to me that this group was being supported or financed by the top 1% or so.....through labor etc. And while some of that may be true the wealthy business owners haven't exactly been loyal advocates of the American worker. They have moved their operations off soil, used fake offshore addresses to duck paying taxes and hire talented tax accountants/lawyers to find as many loop holes as possible.

As far as the wealthy moving out of the USA, that's not an argument that holds up. Not so much for business as we've seen them move business or manufacturing to 3rd world nations....but they don't move there. If they are worried about individual income taxes let them move it'll be a real eye opener for them. There is a reason why 2 of the Beatles moved here, taxes. Europe is totally out of the question as their taxes make our taxes look like nothing.....Eastern Europe isn't bad but the trade off is security. There are many 3rd world nations that have lower taxes but again the trade off is security. So the threat of leaving doesn't hold.

The fact of the matter is simple....the middle class is the majority of the population but our government has spent to many years catering to the top 1-5%. Americans have had enough. It's payback time. Votes work. We saw that in 08. Americans found a way to connect and unite to get the job done. It's a new world of communication and our political leaders had best get on board.

Result number: 3

Message Number 257754

An explanation View Thread
Posted by wendyn on 5/26/09 at 22:24

I will try and do a better job of explaining my rant the other day.

People disagree and hold opposing views on abortion because it is an extremely complex and difficult issue. It is possible for folks on either side of the spectrum to have perfectly rational, well-reasoned, and morally justifiable reasons for whatever position that they hold. That is not to say that all people do have perfectly rational, well-reasoned, and morally justifiable reasons for their positions – but it is possible and some do.

On the pro-life side of things – there is a wide spectrum of positions. Some people believe that life begins at the moment of conception and that abortion (even when the mother’s life is endangered) is always morally unacceptable. A few of those people might even go so far as to say that birth control is also unacceptable since it prevents children from being conceived and being born. Those extreme positions would represent the very far right of the spectrum and are usually based on strong religious convictions.

Moving towards the middle, there are a larger number of people who find abortion morally reprehensible under certain circumstances but perhaps not others. They may think that it’s okay if an abortion is performed at less than 3 months gestation, or perhaps less than 6 months gestation, or perhaps only if the mother’s life is in danger. Some might think abortion remains unacceptable when the foetus has a known physical abnormality and some will think that known abnormalities can most certainly justify abortion.

To say one is “pro-life” does not mean that one is usually referring to an all or nothing opinion. Often, there is a whole spectrum of positions.

On the pro-choice side of things – there is also a wide spectrum of views. Some people believe that regardless of the circumstances, abortion is always a woman’s choice and no one should interfere. A few of those people might even go so far as to say that a nine month foetus in the birth canal can still be aborted since it is not yet born. That position would represent the very far left of the spectrum and is usually based on a very strong conviction regarding a woman’s right to non-interference from others.

Moving towards the middle, you find the blending and overlapping of pro-life and pro-choice opinions depending on the circumstances. Some people who are “pro-choice” find abortion morally reprehensible under certain circumstances but not in others. So again, to say that one is “pro-choice” does not always mean that one is referring to an all or nothing opinion.

Regardless of where someone’s opinion lands on the spectrum of far right to far left with abortion, I think the important matter is that it’s a well-reasoned, well-thought out opinion.

Now – to my rant.

Sometimes people who self-identify as “pro-life” espouse reasoning like: “Every life is precious. Every person or potential person has a right to life. Abortion is murder. Abortion is killing babies. A society is judged on how it protects its weakest members.” I don’t take particular exception with people who strongly feel this way (I understand the basis for the statement). My mom is one of the people who hold this opinion.

What I do take strong exception with, is when people claim to have these intense sentiments about a foetus, but then seem to have no interest in a child once it’s born. It’s as if those people perceive that every life is precious from the moment of conception......until birth.

My aunt is one of those people. She believes that abortion is always morally unacceptable and that it should be illegal in all circumstances. She professes to believe that life is precious and that society has an obligation to protect the life of the unborn. She believes that Obama is evil incarnate since he advocates a pro-choice opinion.

At the same time, she holds a number of social views that do not reconcile (from what I can see) with her claim to value life and the protection of the weak. She does not believe in state-supported pre-natal care for the mothers of those foetuses. She does not believe that the foetuses of poor mothers have the right to the same medical care as the foetuses of mothers who have private health insurance. She feels the same way about their future education.

In my opinion, her moral position on this particular subject can only be described as hypocrisy in its purest form.

Her stance provides her with a way of appearing to care about something when really, she does not. Think about it – by saying that all foetuses should be born, it requires no sacrifice on the part of anyone but the child’s mother. My aunt can sit in her kitchen and if abortion became illegal tomorrow then it wouldn’t affect her life one bit. It is very easy for her to claim that something is precious and worth tremendous sacrifice when it will never mean any sacrifice on her part.

But, when it comes to the matter of taking care of future people – the babies that those foetuses become - , when their care would have some effect on her life (through taxes to pay for social support) she washes her hands of any moral obligation.

For a woman who is carrying a child with a known severe physical abnormality – she would say that the woman must have her baby. However, she would not support social programs to provide that child with expensive life-time medical care. For a young pregnant teenager – she would say that the girl must have her baby. However, she would not support pre-natal care for her or funding for education so that she could remain in school and raise her child. The list goes on.

To me, this position exhibits a morally reprehensible stance on abortion. Not because of where her opinion falls on the spectrum of pro-life to pro-choice, but because of the indefensible reasoning behind her position.

I realize that I ranted at you and not my aunt, but knowing what I know about your opinion on social issues – I sensed some similar reasoning (albeit perhaps incorrectly). And I reacted to that.

Now, if you or anyone else can share with me (honestly and rationally) how one can defensibly claim the value of holding human life in such high esteem that it must be protected from the point of conception, but then believe that society is not responsible for the well-being of a child once it is born, I would be truly interested in trying to understand.

At this point in my own reasoning and thoughts I cannot reconcile those two positions in my mind.

I hope that makes sense...

Result number: 4

Message Number 255059

senators working on national medical records database portion of stimulus bill also taking millions from big pharma View Thread
Posted by Susan on 2/13/09 at 16:09

In the House, the pharmacists found a receptive ear in former House minority whip Roy Blunt (R-Mo.), who sponsored an amendment last month in the Energy and Commerce Committee ensuring that 'nothing' in the legislation would 'prevent a pharmacist from collecting and sharing information with patients.'

But when Democrats on the House Ways and Means Committee saw the language, they became concerned it would maintain a loophole that allows drug companies to pay pharmacists to send letters -- at up to $4.50 per letter -- pitching more expensive alternative drugs to their customers. They revised the language to close the loophole. Blunt tried once more to amend the bill to the pharmacists' liking but failed.

Blunt has taken $417,000 from the pharmaceutical industry and $718,000 from health professionals since 2000, according to OpenSecrets.org, but his spokesman, Nick Simpson, said the donations in no way influenced the congressman's position on the bill. Blunt wants pharmacists to be able to alert patients to less expensive, but equally effective generic drugs, Simpson said.

The Senate added an amendment to its bill by Sen. Tom Harkin (D-Iowa) that would allow pharmacists to send letters to patients as long as they are for a health-care item or service that has previously been prescribed.The pharmaceutical industry has given Harkin $1 million in donations since 2000, while health professionals provided $1.8 million over the same time, according to OpenSecrets.org.

Both bills still include some measures that industry opposes, such as one allowing state attorneys general to enforce federal privacy rules. 'We have no problem with enforcement of regulation,' said Karen M. Ignani, president of America's Health Insurance Plans, who sent a letter outlining the industry's concerns to House Speaker Nancy Pelosi (D-Calif.). 'The question is, 'Do you enforce it in 50 different ways?' '

But consumer advocates say that without strong privacy safeguards, the electronic medical records effort will fail. 'The only activities hindered . . . in the House bill are the data thefts and sales by the health data mining industries,' said Deborah Peel, founder of Patient Privacy Rights, a grass-roots coalition. 'The protections do not hamper legitimate uses of personal health data.'

A Senate vote is scheduled for today.

http://www.washingtonpost.com/wp-dyn/content/article/2009/02/09/AR2009020903263_2.html?hpid=moreheadlines

Result number: 5

Message Number 251793

Re: foot pain after suryery View Thread
Posted by Kelly on 11/04/08 at 00:22

ouch...cortisone shots?? read up on actipatch and then ask your doctor about it and see if maybe it will help you. I think it will. Dr. Tim Tesi is a well known doc in my area and he advocates for it.

Result number: 6

Message Number 251758

I Finished My List of 30 Reasons View Thread
Posted by cwk on 11/02/08 at 14:13

http://acivilizationworthyofthename.blogspot.com/

1. Barak Obama is-reflective- He embraces country’s virtues and is not afraid to address problems.

2. Barak Obama is a gentleman- He treats others with respect.

3. Obama’s tax plan is a first step toward a responsible budget. The Congressional Budget Office projects that McCain's plan will lead to the biggest growth of the deficit.

4. Obama’s health care plan begins to address serious problems.

5. Obama’s call on the Iraq war was correct and courageous.

6. Obama balances faith and politics. He is a man of faith who respects other spiritual journies.

7. Obama has a history of unifying leadership. He can be a political unifier.

8. Barak Obama has temperament to be president. He has superior intellect and calmness.

9. Obama’s tax plan is a step toward necessary tax reform.

10. Obama has managed a well run campaign.

11. Obama advocates personal and public fiscal responsibility.

12. The vile racism of the Republican party must not win. Our children are watching?

13. Obama understands complexity of foreign policy issues and is realistic about what must be done.

14. Obama is respected around the world and and will represent us well.

15. His position on the difficult subject of abortion is fair and balanced.

16. Sarah Palin is not ready to be president and John McCain is 72.

17. John McCain’s lack of focus on what concerns people most and emphasis on the trival proves he is not capable of managing priorities as President.

18. I do not want more conservative appointments to the Supreme Court. Read Gary Wills and Cass Sunstein.

19. Obama’s Presidency will help bridge the racial and cultural divide.

20. The principles of capitalism support progressive tax. Obama is not a socialist indeed according to the principles of Adam Smith he is a good capitalist.

21. She Blinded Me With Science- Palin attacks necessary research that would help her own cause and rejects research based science.

22. I’m Sick of Divisive, Dishonest Destructive Manipulation by the Media. Let’s show the media that we will not be bamboozled by innuendo, guilt by association, trivia and lies

23. Americans Are Fair and Balanced- we are not ‘afraid’ of a Black man.

24. Democrat presidents have been good for the economy

25. Obama and his family is an authentic example of solid family values I want my children to admire and emulate

26. We are not as divided as our politics suggest; Obama is attracting leading conservative thinkers and leaders who are disgusted with the result of the past eight years and saddened by the McCain campaign

27. Obama understands the importance of net neutrality that will assure innovation, wealth creation and social change will thrive on the net; we need a responsible climate policy governed by science

28. We must defend the Constitution from distortion which allows sweeping executive powers.

29. Because it’s a damn good list.

30. Because it is time--hell it is past time.

Result number: 7
Searching file 24

Message Number 248561

I agree with Al Gore! View Thread
Posted by john h on 7/18/08 at 10:03

I actually agree with Al Gore on his plan for energy. For a different reason however. Mr. Gore wants to get out of oil and coal within 10 years. His reasoning is for the environment. My reason is so we will not become a second class nation due to the economy heading south. Makes no difference as we both, in the end, want much of the same thing. He said he was not against nuclear energy but is not very enthusiastic about it. He advocates wind, solar, etc. He estimates, as do some experts, that the cost to convert from oil to other sources to cost over ($30 Trillion Dollars?) over the next 2-3 decades.

What no one is offering up is a plan to get through the next decade where there is no escaping our need for oil. We have perhaps 300 million cars, trucks, buses, and trains that run on oil based energy. Our airline industry is totally dependent on oil as is our military. It is not possible to convert all these trillions of dollars of capital investment in one decade. We will have to continue to pay the price of oil on the open market (70% of our oil is purchased from foreign resources). The public seems to be making an effort to cut back and has reduced use of fuel by 3% since last year at this time and it looks like that effort could pick up steam. Smaller fuel efficient cars have a waiting list. Motor cycle and moped sales are enormous. Public transportation has shown a large increase in traffic. However, those who have no problem with $4 gas continue there use of fuel. Food prices are increasing each day and food will likely have increased by 50% in the not to distant future. This is not just an American problem as across the world fuel is costing users anywhere from $8-$10 per gallon at the pump. Our ;public has not yet got over $4 a gallon.

Things that are likely to happen: (1) As fuel prices continue to rise, and they will, the consumption will drop as people make adjustments. That is just plain economics. (2) Our economy will continue to suffer as we pay high prices for oil and every thing connected to it. There 'IS NO SHORT TERM SOLUTION' regardless of what politicians say. You cannot legislate the supply or cost of fuel. (3) Our exports will continue to increase due to the cheap dollar which is a good thing. (4) Americans, except for the very wealthy will finally move into and accept smaller fuel efficient vehicles. (5) As oil prices rise the public will finally put enough pressure on Congress that we will open up drilling for oil in many areas. With our technology we can now bring oil on line in 5 years or even less. (6) Our stock market has really never faced a long term problem like we have now. It will stagger along for some years to come. Some stocks will do well especially ones that are associated with new energy, new more fuel efficient vehicles. Actually Detroit may get a boost as we suddenly have a new market with most people wanting smaller fuel efficient vehicles. There will be pain along the way but Detroit will and already is making some giant changes. (7) In the near term we will continue to lose jobs. (8) The housing market should come out of its problems as inventory shrinks but we still have a couple of years of pain ahead of us. (9) To bring new sources of energy on to our National Grid will take a lot of man power and will be expensive so do not expect energy prices to drop for many years. This will create a lot of new jobs once we have a plan in place and actually start to move on it. (10) For many years we in America have had the highest standard of living in the world. It certainly appears to me that we are in for an economic shock over the next 5 years and it will be the Oil Countries that will live like Kings. I personally recall The Great Depression and I do not see anything like that in store for us but we will not live as well as we have in the past. We all got along just fine in WWII when we had gas rationing and only were allowed about 25 gallons of fuel a month for a family. In the end we will do what we have to.

As to our President and Congress. They really cannot do much of anything about the supply of oil which is the root cause of our problems. We can only hope they do not make things worse which they often do. The most important thing they can do is formulate an Energy Plan immediately and put it into action. This should be a bipartisan no brainer. Currently inflation looks to be more likely a problem than deflation. It is rising fast. No one is sure just where this is headed. I very much remember the inflation under the Carter administration when U.S.30 year Treasury Bonds yielded an amazing 16%. Today such a bond yields around 4.5%. This was a disaster for people on fixed incomes.

Boone Pickens is making an effort to inform Americans of what is ahead and the magnitude of the problem but for the most part Americans only care about the cost of gas for their car. Congress and the President need to get out front on this and tell America and present to them an energy plan for the future. I am starting to hear a few Congressmen speaking out. The President proposed opening up drilling for oil and some like Boone Pickens are spending millions to bring information to America. We are a long way from being informed as a nation of the hardships ahead. There is an old saying in the military that has stood for longer than I can remember and it is to 'Keep the troops informed'. They will usually follow you to the gates of hell but must know why and how.

Result number: 8

Message Number 248457

Fannie Mae and Freddie Mac View Thread
Posted by SteveG on 7/14/08 at 11:55

From a blog post this morning -

Normally, financial crises happen because really, really rich people screw up, because they're the ones who have most of the money. Yet, the mortgage meltdown is much more egalitarian in origins than the typical collapse. For instance, until a few months ago, mortgages backed by the now tottering Fannie Mae and Freddie Mac were capped at $417,000. Certainly not all, but some of the blame should rest on the bipartisan consensus to social engineer the home ownership rate above the 64 percent level, where it had been stuck since the 1960s.
Here are some excerpts from my June 22 article in Taki's Magazine on 'The Diversity Recession:'

In 1992, Congress passed the Government Sponsored Enterprises bill, which set “targets” (i.e., quotas) for Fannie Mae and Freddie Mac, which are quasi-governmental publicly-traded for-profit thing-a-ma-bobs, to encourage “affordable” and “underserved” (more or less minority) home loans.

Both the Clinton and Bush departments of Housing and Urban Development raised the quotas repeatedly. For example, initially, the Clinton Administration required 21% of these quasi-governmental mortgages must go to ”underserved areas” (which are officially defined as “low-income census tracts or in low- or middle-income census tracts with high minority populations'), but the quota for 2008 established by the Bush Administration is 39 percent.

Reuters reported October 13, 1999:
'The mortgage industry intends to pursue minorities with greater intensity as federal regulators turn up the heat to increase home ownership in underserved groups. ‘We need to push into these underserved markets as much as we can,’ said David Glenn, president and chief operating officer of Freddie Mac. …
'In September, Freddie Mac launched a new lending program, based on research done in collaboration with five black colleges, to bring more African-Americans into the market.

'The federal government in the meantime has increased pressure on lenders to seek out minorities, as well as low-income groups and borrowers with poor credit histories.
'Fannie Mae recently reached an agreement with the U.S. Department of Housing and Urban Development to commit half its business to low-and moderate-income borrowers. That means half the mortgages bought by Fannie Mae would be from those income brackets.'

Now, even the head of Freddie Mac has protested that the quotas have become “perverse.” On March 12, 2008, Bloomberg News reported:
'Freddie Mac Chief Executive Officer Richard Syron said he’s urging changes in federal rules that enabled too many low- and moderate-income Americans to buy houses they can’t afford. It’s ‘perverse’ that Freddie Mac and Fannie Mae, the two biggest providers of money for U.S. home loans, have been encouraged ‘to put people into homes that they end up losing,’ Syron said at a meeting with analysts and investors in New York.'

Ironically, Syron helped get us into this mess when he was head of the Boston Fed. His Freddie Mac biography boasts, “Syron also was sponsor of a landmark study on racial discrimination in mortgage lending …”

… Straightforward tax-and-spend programs were out of favor in the 1990s, but lean-on-lenders for the benefit of your political constituents is always in season.

For instance, an article entitled “Fannie Mae Bending Financial System to Create Homeowners, Says Raines” reported in 2000:
'Yet home ownership is unevenly distributed in society, [Fannie Mae head Franklin] Raines said. He quoted the famous pronouncement by W.E.B. Du Bois, in The Souls of Black Folk in 1903, that the problem of the 20th century is the problem of the color line. Du Bois also observed that the size and arrangement of people’s homes is an index of their condition…

'In the early days of the movement, he said, there was a significant commitment of government funds. … Now, said Raines, more money is being invested in community development through private mechanisms, including Fannie Mae, which works through mainstream lenders to reach out to underserved communities.

'During the 1990s, Fannie Mae pledged $1 trillion in capital over seven years to boost home ownership among underserved populations. Last spring, said Raines, the commitment was completed ahead of schedule, and Fannie Mae pledged a further $2 trillion to assist 18 million families during the next decade.' [More]
A trillion here, a trillion there, pretty soon you are talking about real money.

Bill Burnham explains how Fannie Mae and its supposed competitor Freddie Mac work here. Essentially, they figured out in the 1980s that they had a license to print money, as long as Congress didn't take it away:

Fannie Mae’s only significant problem thus became that the supply of mortgage securities would prove insufficient to fund its projected earnings growth (which was well above the projected growth in mortgage debt). As a result Fannie began a series of largely successful political campaigns to increase the volume of mortgage securities available to fund their habit. Theoretically, the easiest way to increase the supply of mortgage securities was to get the federal government to increase the size limit of mortgages that Fannie could buy and guarantee, but this was a very difficult political fight for Fannie to win because commercial and investment banks dominated the so-called “jumbo” mortgage market and, already smarting from Fannie’s dominance of the so-called “conforming” market, they had drawn a line in the sand in the jumbo market and committed most their lobbying resources to keeping Fannie’s size limit as low as possible.

Moral Hazard vs. Mo’ Money

While Fannie still fought to increase its size limits, it quickly found another, much more politically palatable, way to increase the pool of mortgages it could buy: it dropped underwriting standards under the guise of increasing “home ownership” and “affordability”.

Traditionally, Fannie had required the mortgages it purchased to be so-called 80/20 mortgages wherein the borrower puts at least a 20% down payment on the mortgage. This was a requirement because residential mortgages in the US are a “no-recourse” loan in which the borrow can generally “walk away” from the loan with no recourse to the lender other than seizing the house and reporting the default to a credit agency. A 20% down payment was generally thought to be enough to dramatically limit the moral hazard of borrowers “walking away” because housing values would have to decline 20%+ for the borrower to be underwater and even then the borrower would still face the prospect of losing their own sunk capital which makes walking away even more difficult from a psychological perspective
The problem with a 20% down payment is for many people it was very hard to come up with that big a down payment and thus it limited the total size of the mortgage market which in turn limited the volume of mortgage securities that Fannie Mae could purchase for its golden goose. While the obvious solution to this problem is just to lower the down payment requirement, Fannie couldn’t do this unilaterally because the government unit that regulated it would see such cuts as needlessly raising Fannie Mae’s risk profile. Far more politically astute that that, Fannie Mae began a campaign to increase “home ownership” and “affordability”. It created a home ownership “foundation” which opened offices in almost every congressional district and promptly set about mobilizing all the local advocates for “affordable” housing to put pressure on their elected representatives to let Fannie Mae offer “affordable housing programs”. Of course, “affordable housing problems” was just a euphemism for allowing Fannie Mae to lower its underwriting standards so that more mortgages could be created and the golden goose could thus kick out more golden eggs.

This proved to be a highly effective political coalition for Fannie Mae. Not only did they build a huge network of grass roots political supporters through their “foundation”, but politicians saw political advantages in supporting the programs because it cast them in the role of trying to help families buy a new home (as opposed to lowering underwriting standards to help a giant corporation keep up its earnings growth by taking a free ride on the US government’s guarantee). Even commercial banks and investment banks signed on to the program because it at least resulted in higher origination fees and an expanded credit market, even if most of the assets ultimately went to Fannie Mae and Freddie Mac.

Fannie Mae's 'grassroots' allies are all over the political spectrum, including the far left. Barack Obama's friends at ACORN are in deep with Fannie Mae.

Paul Jackson at Housing Wire writes:
It wasn’t that long ago, after all, that nearly everyone was swept up in “the Ownership Society” — with the White House issuing press release after press release challenging lenders to loosen their credit standards and make riskier loans to minorities in the name of “expanding homeownership.” Consumer groups often even partnered with lenders to make riskier loans to the very minority groups they’re now indignantly suing lenders for lending to.
Let’s take a trip down memory lane, shall we? Consider this press release from Citigroup in September of 2004, which finds ACORN and Citi happily holding hands and pushing “the goals of both organizations to promote homeownership in low- and moderate-income neighborhoods, especially in immigrant communities.”
From the press statement:
“With this agreement, ACORN will be able to expand our mission of strengthening communities by helping low- and moderate-income families, including new immigrants to this country, become homeowners,” said Maude Hurd, National President of ACORN.
It’s not as if Citi and ACORN were the only ones jumping deep into subprime lending together, either. Economic policy research at the time centered on how lenders were denying loans to those with poor credit, often minorities; consider the following conclusion from a September 1999 study:
The Urban Institute report issued today says that “not all Americans enjoy equal access to the benefits of homeownership, in part because of unequal access to capital.”

“Fair lending” essentially became synonymous with a universal lowering of credit standards — and as lenders loosened credit standards, community groups cheered, and the White House lauded the commitment to “expanding homeownership.”
Legislatively, President Bush went so far as to propose eliminating down payment requirements altogether. In a September 2004 press statement, administration officials touted a so-called “Zero-Downpayment Initiative” that would eliminate the statutory requirement of a minimum three percent down payment for FHA-insured single-family mortgages for first-time homebuyers.
Even when we had clear data suggesting that lending to people who couldn’t afford their loans would likely end up badly, we ignored it. Consider this story from April 2004, which noted a Fannie Mae study that found that 49 percent of English-language Hispanics, 46 percent of Spanish-language Hispanics, and 42 percent of African Americans cited “credit concerns” as the primary reason they had not yet bought a home.

Instead of realizing that borrowers’ concerns over their credit and finances might actually be valid, we — and that means everyone, from lenders to legislators, to community and consumer groups — decided to convince them otherwise, out of the belief that being part of the “Ownership Society” trumped small-minded credit concerns. There was a bigger experiment in social progress at stake, after all.

We unfortunately now know all too well how well pursuing “greater access to credit and capital” turned out, not only for ACORN and Citi, but for nearly every lender and consumer group out there that bought into the strange and wonderful ethic of “the Ownership Society.” None more than Countrywide Financial.

Result number: 9

Message Number 245703

Re: Executive Pay View Thread
Posted by cwk on 4/11/08 at 10:37

Shareholders are owners. It is a non-sequitur to posit that strengthening the voice of the shareholder (owner) in determining management compensation could lead to Congress setting limits on the earning power of athletes. (or artists, rock stars or plumbers for that matter). Corporate ownership and governance is not analogous to Congress. Congress does not own the Yankees, the PGA or any of the entities that pay Tiger Woods and Michael Jordan to endorse products.

Your statement that Obama favors a law that will allow shareholders to set the management salary is incorrect. Senator Obama favors legislation that would, 'require corporations to offer a nonbinding shareholder vote on executive compensation'. (Nick Timiraos WSJ, April 11, 2008). The key word here is non-binding.

The Shareholder Vote on Executive Compensation Act would allow shareholders to 'signal their displeasure' (Timiraos, WSJ) but does not give them veto power over elected corporate boards. The legislation would NOT give shareholders the right to set salaries.

John McCain has recently decried executive pay. '
“It’s outrageous that someone who is the head of Bear Stearns cashes in millions and millions of dollars in stocks,” McCain said last weekend. “And I think it’s unconscionable when the guy who apparently is the head of Countrywide and his co-conspirators make huge amounts of money while Americans are facing the threat of losing their own homes.” (WSJ, April 11, 2008) but does not favor the proposed legislation. 'Investor advocates, union pension funds and shareholder groups have supported the legislation. ' (CNN.money.com, April 11, 2008)

Corporate governance, the evolution of corporate capital, the nature of investment bankers and venture capitalists who use OPM (Other's People's Money) to reward themselves lavishly regardless of the quality of their performance are all related to the current precarious imbalance in our economic system. Certainly a long discussion is required to authentically examine these issues but in short capitalism can work quite well but it can also be dangerous. Of course capitalism relies on self interest but unbridled self interest (greed) can destroy the foundation of our society.

Result number: 10

Message Number 244539

Re: Obama - a message of hope View Thread
Posted by Kat on 3/14/08 at 09:31

Project Islamic H.O.P.E. is a national civil rights organization that advocates for the human rights of oppressed People regardless of race, gender or religion.

Obama's father is of the Islamic religion isn't he? I am sure his fathers family is also. That doesn't make them terrorist or bad people in anyway. One of my doctors was born into that faith and she and her husband are two of the kindest people you'll ever meet. Please do not judge Obama if he has family and friends who practice the Islamic faith.

Result number: 11

Message Number 244538

Re: Obama - a message of hope View Thread
Posted by Kat on 3/14/08 at 09:29

Project Islamic H.O.P.E. is a national civil rights organization that advocates for the human rights of oppressed People regardless of race, gender or religion.

Obama's father is of the Islamic religion isn't he? I am sure his fathers family is also. That doesn't make them terrorist or bad people in anyway. One of my doctors was born into that faith and she and her husband are two of the kindest people you'll ever meet. Please do not judge Obama if he has family and friends who practice the Islamic faith.

Result number: 12

Message Number 244522

Re: footmaxx orthotics View Thread
Posted by Dr. Wedemeyer on 3/13/08 at 21:05

They purchased Foot Levelers I understand TBDCH. Does this sound like a lab intent on providing quality custom products?

BTW if you like the FootMaxx scanner you should look into the tekscan. The FM scanner is similar to the Quasar software and they do not compare.

I invite you to publish your name and credentials since this is your first post and it advocates a specific product.

Result number: 13

Message Number 243661

Re: ESWT Success Story View Thread
Posted by Dr. Ed on 2/24/08 at 18:40

Kathy:

I have worked with 3 machines: Dornier EPOS, Ossatron and the Siemen's Sonocur. I feel that both high energy and low energy ESWT are equally effective for PF. According to Dr. Jan Rompe, (see www.ismst.com) it is the amount of energy applied to the tissue that counts, not how quickly it is applied. In other words, the fact that high energy machines are utilized to provide the therapeutic level of shockwave energy with fewer high energy shocks vs. low energy machines that do it with a higher number of low energy shocks, the total amount of energy applied to the target tissue is the same.

Application of shockwaves does provide a form of analgesia to tissue and I have heard some advocates of high energy ESWT claim that that analgesia is the sole mechanism of action with low energy. I do not beleive that to be the case. Another claim is that in order for ESWT to work there must be a cavitation phenomenon in tissue and that that can only be seen with high energy. Again, that has been shown with low energy too. I met a physician-researcher from Germany a couple of years ago at the national ACFAS Meeting (American College of Foot and Ankle Surgeons). He was acting as a rep for the Swiss Dolorclast which is a form of low energy ESWT used in the US only in the veterinary community but in Europe for people. They were in the process of expanding FDA approval of the machine to humans at the time. He showed me photographic evidence that the Dolorclast produced cavitation.

That machine performs something called RSWT or radial shockwave therapy...
1) There is a claim that RSWT is not true ESWT. I am not sure if I can accept that claim because it depends on the definition of ESWT.
Extracorporeal= originating from outside the body; shockwave= shockwave. Nothing in that nomenclature defines the shape or nature of the schockwave.
2) There is the claim that RSWT uses only post-stimulation hypoanalagesia as its mechanism and that cavitation is necessary for the primary effect of ESWT. Again, I saw the photos of cavitation (assuming that the doctor was honest) with the Dolorclast. Additionally, the real bottom line is the thinning of the fascia as viewed sonographically (diagnostic ultrasound) -- that occurs with both low and high energy units.

Dr. Ed

Result number: 14

Message Number 242175

Re: "All my ex's live in Texas...thats why I hang my hat in Tennessee" -George Strait View Thread
Posted by Kathy H. on 1/19/08 at 14:16

Dr. Ed, Yes, I know that George Strait song. I believe I have fasciosis now, not fasciitis after 1.7 years. I am having graston technique done in Dallas. It is not available in the state of Tennessee. I have had it done for 2 months and will probaly give it another month or so. I have had some improvement, but don't know if it is possible to see complete healing with graston or not. Does anybody know if complete healing of
fasciosis has occurred with graston?

If graston doesn't totally work, I am thinking about either an autologous blood platelet injection( APC) or ESWT with the Dornier Epos Ultra. After reading messages on this board, I believe this is the machine I want.

I posted once on this board asking the doctors if anyone knew of the results of APC injections and no one answered so I don't know if they know that much about it. There is a long article about it on the podiatry today.com website.

Through the Dornier website, I contacted them and asked them if they knew anyone in Nashville who used the Dornier Epos Ultra and they gave me the phone no. of the technician who actually does it. I talked briefly with him yesterday and he gave me the name of a podiatrist in the Nashville area who let him use his office to do it in.

I would love to know the questions to ask this gentleman( that's the Southern in me). Should I ask him how many he has performed? What questions should I ask the podiatrist himself? At this time I am trying to have my MRI read by a musculoskeletal radiologist to confirm fasciosis. If I do ESWT, I want this to be as successful as possible, so insight on what to ask would be so... helpful.

Also, this may be a crazy question...but since the board advocates heat after ESWT, would it be wiser it have it performed when it is a little warmer, say April or May, because it is cold..in Tennessee right now.

Result number: 15
Searching file 23

Message Number 238120

World's Smallest Political Quiz View Thread
Posted by marie on 10/20/07 at 14:22

http://www.theadvocates.org/quiz.html

My test results..........

CENTRISTS espouse a 'middle ground' regarding government

control of the economy and personal behavior. Depending on

the issue, they sometimes favor government intervention

and sometimes support individual freedom of choice.

Centrists pride themselves on keeping an open mind,

tend to oppose 'political extremes,' and emphasize what

they describe as 'practical' solutions to problems.

Result number: 16

Message Number 237489

Re: Jena March View Thread
Posted by john h on 10/10/07 at 15:46

How does this mesh with the truck driver that got his head beat in during the Rodney King case. That driver was just driving down the street and because he was white was dragged out of his truck and nearly beat to death with a brick or something over and over while the TV camera in the helicopter filmed him and the assailant stood over him in triumph. Why did not some of the thousands of on lookers come to his aid. No heroes in that crowd or mob. I am not even sure the guy who beat him nearly to death was ever even put on trial. I sure do not recall any of the civil rights people coming to LA to march in defense of him or to prosecute the assailant. Where was Jesse and Al while this was going on. Some people are professional civil rights advocates but only when the civil rights of there on people have been violated. I know little of the Jenna, La case and perhaps this kid was given a heavy sentence. There are legal remedies without marching and causing more civil unrest. Guys like Sharpton and Jackson create more problems than they help. Do either of them have a job? Where do they get there money. I guess Sharpton made a bundle defending Tawana Brawley some years ago when she later admitted she was lying about a group of white men attacking her. If we are ever to move forward in race relations the majority of good African Americans need to speak out against the Sharptons and Jackson.

Result number: 17

Message Number 237171

Hillary Care View Thread
Posted by john h on 10/04/07 at 19:38


Socialism at it's best.


Subject: Health Care IMPORTANT READ

>>> This was sent from Canada to a friend in the States.
>>>
>>>
>>>
>>> I saw on the news up here in Canada where Hillary
>>> Clinton introduced her new health care plan. Something similar to what
>>> we have in Canada. I also heard that Michael Moore was raving about the
>>> health care up here in Canada in his latest movie. As your friend and
>>> someone who lives with the Canada health care plan I thought I would give
>>> you some facts about this great medical plan that we have in Canada.
>>>
>>> First of all:
>>>
>>> 1) The health care plan in Canada is not free. We pay
>>> a premium every month of $96. for Shirley and I to be covered. Sounds
>>> great eh. What they don't tell you is how much we pay in taxes to keep
>>> the health care system afloat. I am personally in the 55% tax bracket.
>>> Yes 55% of my earnings go to taxes. A large portion of that and I am not
>>> sure of the exact amount goes directly to health care our #1 expense.
>>>
>>> 2) I would not classify what we have as health care
>>> plan, it is more like a health diagnosis system. You can get into to
>>> see a doctor quick enough so he can tell you 'yes indeed you are sick or
>>> you need an operation' but now the challenge becomes getting treated or
>>> operated on. We have waiting lists out the ying yang some as much as 2
>>> years down the road.
>>>
>>> 3) Rather than fix what is wrong with you the usual
>>> tactic in Canada is to prescribe drugs. Have a pain here is a drug to
>>> take- not what is causing the pain and why. No time for checking you out
>>> because it is more important to move as many patients thru as possible
>>> each hour for Government re-imbursement
>>>
>>> 4) Many Canadians do not have a family Doctor.
>>>
>>> 5) Don't require emergency treatment as you may wait
>>> for hours in the emergency room waiting for treatment.
>>>
>>> 6) Shirley's dad cut his hand on a power saw a few
>>> weeks back and it required that his hand be put in a splint - to our
>>> surprise we had to pay $125. for a splint because it is not covered under
>>> health care plus we have to pay $60. for each visit for him to check it
>>> out each week.
>>>
>>> 7) Shirley's cousin was diagnosed with a heart
>>> blockage. Put on a waiting list . Died before he could get treatment.
>>>
>>> 8) Government allots so many operations per year. When
>>> that is done no more operations, unless you go to your local newspaper
>>> and plead your case and embarrass the government then money suddenly
>>> appears.
>>>
>>> 9)The Government takes great pride in telling us how
>>> much more they are increasing the funding for health care but waiting
>>> lists never get shorter. Government just keeps throwing money at the
>>> problem but it never goes away. But they are good at finding new ways to
>>> tax us, but they don't call it a tax anymore it is now a user fee.
>>>
>>> 10) A friend needs an operation for a blockage in her
>>> leg but because she is a smoker they will not do it. Despite paying
>>> into the health care system all these years. My friend is 65 years old.
>>> Now there is talk that maybe we should not treat fat and obese people
>>> either because they are a drain on the health care system. Let me see
>>> now, what we want in Canada is a health care system for healthy people
>>> only. That should reduce our health care costs.
>>>
>>> 11) Forget getting a second opinion, what you see is
>>> what you get.
>>>
>>> 12) I can spend what money I have left after taxes on
>>> booze, cigarettes, junk food and anything else that could kill me but I
>>> am not allowed by law to spend my money on getting an operation I need
>>> because that would be jumping the queue. I must wait my turn except if I
>>> am a hockey player or athlete then I can get looked at right away. Go
>>> figger. Where else in the world can you spend money to kill yourself but
>>> not allowed to spend money to get healthy.
>>>
>>> 13) Oh did I mention that immigrants are covered
>>> automatically at tax payer expense having never contributed a dollar to
>>> the system and pay no premiums.
>>>
>>> 14) Oh yeh we now give free needles to drug users to
>>> try and keep them healthy. Wouldn't want a sickly druggie breaking into
>>> your house and stealing your things. But people with diabetes who pay
>>> into the health care system have to pay for their needles because it is
>>> not covered but the health care system.
>>>
>>> I send this out not looking for sympathy but as the
>>> election looms in the states you will be hearing more and more about
>>> universal health care down there and the advocates will be pointing to
>>> Canada. I just want to make sure that you hear the truth about health
>>> care up here and have some food for thought and informed questions to ask
>>> when broached with this subject.
>>>
>>> Step wisely and don't make the same mistakes we have.
>>>

Result number: 18

Message Number 235035

Re: Morton Neuroma View Thread
Posted by Dr. DSW on 8/28/07 at 07:28

Excision from a plantar approach allows excellent visualization of the 'neuroma' with less resultant scar tissue forming in the dead space created from a dorsal approach. However, my main concern is that after failing cortisone injections, cryosurgery and alcohol injections, is your doctor confident that a 'neuroma' truly exists?

Has an ultrasound been performed or an MRI with contrast to make sure that following the punture wound there isn't a foreign body still in your foot or some form of inclusion cyst, small abscess, etc.?

Following a puncture wound there can be a tract of scar tissue or other complication other than a 'neuroma'. Although many doctors on this site are advocates of ultrasound due to it's low cost and ease of use, I was just at a seminar that compared ultrasound vs. MRI and now it's got me re-thinking the comparison, since a LOT of pathology was missed on the ultrasound but did show up on the MRI.

Anyway, if your doctor has not performed either one of these studies, I would hold off on the surgery until at least one of these studies was performed. If at least one of these studies was performed, and your doctor is confident that a 'neuroma' does exist, a plantar approach is certainly reasonable and this case probably the best choice.

Result number: 19

Message Number 233482

Goodell tells Vick to stay home! View Thread
Posted by marie on 7/24/07 at 16:04

Good news from the dogfighting front. I firmly believe a suspension from playing until after the trial is more then fair. Whether it's 4 games or ten. What went on at Bad News Kennel was not small or hidden on Vick's property. If Vick didn't know about then he is just plain stupid..........how can one miss the buildings, b*tch stand and blood stained arena. Dogfighters are cowards and if Vick is one then he is also a coward. Just so some of you politically partisan advocates know..........Vick is a Democrat. I will nail a Democrat ten times harder then a Republican any day of the week for breaking the law. Was he a politician? No. But he did attend several Democratic fundraisers. Lock the door and keep him the H*ll out of our Party. After the news conferenace with the Atlanta Falcons owner, manager and coac I highly doubt we will see Vick in a Falcons uniform again.

http://news.yahoo.com/s/ap/20070724/ap_on_sp_fo_ne/fbn_falcons_vick_leave_16
'While it is for the criminal justice system to determine your guilt or innocence, it is my responsibility as commissioner of the National Football League to determine whether your conduct, even if not criminal, nonetheless violated league policies, including the personal conduct policy,' Goodell said.

http://www.atlantafalcons.com/News/Articles/2007/07/Goodell_asks_Vick_not_to_report.aspx

Result number: 20
Searching file 22

Message Number 229110

Re: Jobless rate rises View Thread
Posted by marie on 5/04/07 at 11:34

Yes Toyota is doing very well. Toyota USA is the sales division of Toyota and is an American owned company. Toyota is building plants in the US and employing thousands but what you are failing to grasp is the far reaching scope of the auto industry problem. It's not just about the big 3.......During the Reagan years the big 3 came up with creative ways to downsize and reduce costs. One of which was and is outsourcing. Entire divisions of the auto industry where shut down and outside firms and manufacturers where contracted to provide services and manufactured parts for their vehicles. Hundreds of smaller manufacturers began to produce everything from wheel frames to radiator hoses without the pressure of the UAW labor contracts. On the business end of things accounting firms and financial services where also outsourced. What has happened now is that all of these businesses are failing and shutting the doors due to the big 3's inability to fairly compete under current uninforced trade laws. Those people are out of work and as this study demonstrates are having difficulty finding employment of any kind.

I have to say that the ONLY Republican who addressed the unfair and uninforced trade laws was last night and then again this morning was Sen. Duncan Hunter. They may all support enforcing current trade laws but I personally have yet to see that. The 2008 election will be determined by the Midwest and the voters in the Midwest are out of work in part because the current administration refuses to enforce trade laws. Duncan Hunter felt the discrepensies are so out of wack that he advocates allowing the auto industry and several others to pay NO TAXES for a number of years to get caught up. I don't know if thats feasable but I can tell you the Midwest is watching every candidate very closely on this issue and agree or disagree it's the Midwest who will determine who wins 08.

btw: My family has 85 years combined working in the auto industry...........both in factories and in business end of things.

Another indicator of economic turbulence is housing, furniture and vacation industries.

Result number: 21

Message Number 228585

Re: NRA Backs McCarthy / Dingell Bill View Thread
Posted by Rick R on 4/26/07 at 11:27

One of my arguements has a fundamental flaw as well. I will argue that the 2nd ammendment pertains to both an individual right as well as a collective right. The gun control advocates will argue that it is a collective right only. It is in the collective right that I see greater infringement. That collective right is a safeguard against government getting outside of constitutional limits. This is why it is not about who 'needs' a semi-automatic. If that collective right is to matter, then how can we allow ourselves to be outgunned by our own government. However; I will not argue that I should have RPG's in the basement, or a suitcase nuke in the closet, hense the flaw. A tank would come in handy from time to time.

I cannot assemble a local militia in my town without violating the law. In case we haven't noticed, the collective right is long gone. What had been the local miltia of the past has been replaced by the 'National' Guard, and 'para-military' organizations, along the lines of the 18th century local militia, are illegal. Look at what happened in New Orleans. The authorities swooped in to confiscate weapons to leave the law abiding folk defenseless.

The need for a check and balance is not obsolete. I can't say I'm a big fan of armed green, blue, what ever colour supremacists running around. Yet how far would they get if the majority of good decent citizens were capable of handling matters in a well organized and regulated manner of days past.

I don't even like to think along these lines. I suspect many refuse to. I'd love to believe that the rise of the common man against tyrany was a done deal that distant past anscestors paid for and all I need to do is have respect.

Rick

Result number: 22

Message Number 228527

NRA Backs McCarthy / Dingell Bill View Thread
Posted by marie on 4/25/07 at 19:59

Wow! I suspect even the NRA knows when something is wrong with the system and sides with gun control advocates. Unfortunately it should not have cost the lives of 33 young people at VT before they got their head out of the sand. What they didn't want their members to know was that the NRA silently supported McCarthy's bill and requested she keep it quiet......that was before the killings.

It took Cho 9 minutes to shoot off 170 rounds killing our nation's most valuable treasure......our youth. No one needs to posses a weapon that can do that much damage in 9 minutes. I strongly believe in the right to own guns, where I put my foot down is with high powered semi-automatic weapons and innefficiant background checks. It doesn't take 170 rounds to kill a deer or an intruder for that matter. And I don't buy into the idea of arming students and teachers with guns. Why would anyone think that our of 26,000 students that there isn't one hot head, one mentally ill, one victim? Ok now all you gun fanatics can pummel me all you want but it won't change my mind.

http://www.msnbc.msn.com/id/18298126/site/newsweek/?from=rss
In his first public comments since last week’s massacre, the National Rifle Association’s top lobbyist said today that the group backs proposed new legislation designed to ensure that mentally unstable killers like Cho Seung-Hui do not gain access to firearms.

.....he proposed bill sponsored by Dingell and Rep. Carolyn McCarthy, Democrat of New York. The measure would provide $1.1 billion in funding to the states and local courts systems over the next three years to computerize records of mental-health orders and commitments so they can be entered into the FBI’s National Instant Criminal Background Check System, a database that is used for background checks of prospective gun buyers.

Result number: 23
Searching file 21

Message Number 218021

Shhhhh don't tell the spirit of President Reagan what Ed said.... View Thread
Posted by marie on 12/27/06 at 18:13

"Enough time to develop a few nukes and annihilate the Middle East?"

Any nation in particular or all of the Middle East?

Israel has nukes and the means to launch from submarines should they be hit first. So you must be talking about the rest of the Middle Eastern Countries right?

The Federation of American Scientitst's has this to say about Israel's nuclear program.

http://www.fas.org/nuke/guide/israel/nuke/
Based on plausible upper and lower bounds of the operating practices at the reactor, Israel could have thus produced enough plutonium for at least 100 nuclear weapons, but probably not significantly more than 200 weapons.

I also agree iran should not have nuclear weapons and because we are bogged down in iraq there is little we can do about it......except negotiate, talk and impose sanctions.

"So what, it is not a democracy. A lot of nations have elections including the former Soviet Union but they really were not meaningful."

Have you forgotten the Soviet Union doesn't excist anymore. Can you say Lech Wałęsa? Wałęsa organized and led the Citizenship Committee of the Chairman of Solidarity Trade Union......they won all of the parlament seats in 1989. So he for sure had nothing to do with the demise of the USSR....it was just another meaningless election. did it happen overnight? No.

In the 60's these long haired musicians from Liverpool slowly seeped into the Soviet Union. Through their music they shared the message of freedom. That's why Paul McCartney did a gig in the Red Square 2 years ago.......because for those people the Beatles meant freedom. Never underestimate the power of music.

"Yes, and we tried to handle Germany diplomatically in 1940."

We never stopped talking to the Soviet Union after the war was over. Those diplomatic talks prevented from WWIII. As i recall Reagan's effort and discussions with the USSR may possibly have ended the COLD WAR. I believe Reagan was very successful at Arms Reduction treaties.


"What? The far right neocon wing of the Republican Party???? The term "neocon" means new conservative. Many neocons were former moderates, and occasionally liberals who adopted certain aspects of conservatism. Most neocons are not social conservatives. The neocons by any reasonable description are not even on the right in the Republican Party let alone the far right."
http://www.sourcewatch.org/index.php?title=Neocon

The Webster definition:

Main Entry: neo·con·ser·va·tive
Pronunciation: "nE-O-k&n-'s&r-v&-tiv
Function: noun
1 : a former liberal espousing political conservatism
2 : a conservative who advocates the assertive promotion of democracy and U.S. national interest in international affairs including through military means
- neo·con·ser·va·tism /-v&-"ti-z&m/ noun
- neoconservative adjective

best wishes marie

Result number: 24

Message Number 217613

World's smallest political quiz... View Thread
Posted by Dr. Ed on 12/21/06 at 09:14

http://www.theadvocates.org/quiz.html

There are limitations tothe above but it remains a good discussion piece.

Result number: 25

Message Number 217517

Re: To Dr. Wander "pain" View Thread
Posted by Dr. David S. Wander on 12/19/06 at 16:15

First of all Ralph, I take offense to "what's up with pods?" I really don't think it's unique to podiatrists, and if you've read any of my posts, and I know you have, you know that I really hate generalizations. There are asshole doctors in ALL specialties.

I'm not sure I agree with your tactic of making a potential scene in a waiting room, although as a last resort that is certainly an option. I do believe that patients need to be much more firm with their dealings with doctors and office staff and must assert their rights more forcefully, without being obnoxious.

When a patient tells me the doctor rushed out the door, or tells me that they can't get be seen for at least 2-3 weeks DESPITE the fact that they are having considerable post operative pain, it tells me that the patient may NOT have gotten his/her message across strongly enough.

I believe patients are much too passive in this regard. I'm confident that if this patient was to call the office again, and speak with the office manager and FIRMLY but NICELY state the facts and tell the office manager that surgery was performed and now there is considerable post operative pain that does not seem normal and she does not want to wait until January 5th for an appointment, I have a feeling that a sooner appointment will be offered. At the very least, she should ask to speak with the doctor or have him/her return the call ASAP. If that doesn't work, and it almost ALWAYS will, then I would tell the office manager you may walk into the office to create a scene. Warning her ahead of time will prompt her to give an appointment.

But the bottom line is that it's NOT all doctors and I believe that a patient CAN get a feel for the doctor's that are going to be a problem by the way the patient is treated pre operatively. Did the doctor spend adequate time with the patient explaining the procedure(s) or did the doctor simply have the patient sign the consent form? Did the doctor take the time to give a thorough explanation AND discuss what to expect post operatively? Did the doctor talk to the patient following the surgery or run out of the hospital/surgery center?

Patients MUST be their own advocates and stick up for their own rights and stop being passive regarding their own care. If there is a problem, they must INSIST on seeing the doctor in what is a reasonable time and must INSIST on having questions answered. If not, they can only blame themselves.

Result number: 26

Message Number 213788

Re: More GOP Investigated View Thread
Posted by kconnell on 10/20/06 at 01:07

John,
I am sorry for hitting so hard about the school issue, I come from a military and education family background. I just get very upset when people support a stupid,( yes I said it,"stupid,") policy. If we are looking at equalizing the education system than educators should write the bills. Not administrators but people like my mother, and many of her friends. They work with these "special children," daily for years. Even after retirement they still volunteer at the schools to help the children. They also volunteer as court appointed special advocates for children in foster care.
Anyway I am running on and on, my point is that any laws affecting education should be run by some type of "educators," review panel. The second point that I am making is that if a law is passed that affects our children in a positive manner it needs to have adequate funding. No laws can be affective without the tools needed to implement it.kconnell

Result number: 27
Searching file 20

Message Number 209364

AOL Sells Clients Search History View Thread
Posted by marie on 9/05/06 at 16:22

UH-OH! AOL just sold your so-called private search records and those records may become VERY PUBLIC.

http://www.dmnews.com/cms/dm-news/search-marketing/38133.html

more than 20 million queries run by more than 650,000 AOL users - that AOL released to the research community earlier this month. Unfortunately for AOL, the research site wasn't protected, and the data quickly made its way out onto the Web.

AOL's extraordinary gaffe has a lot of people buzzing, including lawyers, privacy advocates and government regulators, and it's a troubling incident for everyone in online marketing. AOL has apologized and fired several people associated with the breach, but the damage may be longstanding. Trust is what holds the whole online advertising game together, and this trust has been badly breached.

Result number: 28

Message Number 204908

Re: Back from Yuma-travel not to bad-surgery denied View Thread
Posted by kelly l on 7/21/06 at 09:29

Does your insurance company actually know what TTS is? You may want to check on that. I called my ins.co. looking for another Dr. to visit, I was trying to find one very knowledgeable on TTS( not that my own Dr. isn't), but more just for a fresh approach. Thay never heard of TTS!! It kind of shocked me since they had been paying my medical bills for this, as well as 3 surgeries. I have also applied for SSDI and they call it and I quote "painful feet". Good luck to you and remember.. we have to be our strongest advocates.

Result number: 29

Message Number 203115

Re: Not Ready To Make Nice View Thread
Posted by know them on 7/06/06 at 06:07

Are you suggesting that terrorism was and continues not to be threat to this country? Have you looked at a picture of the NYC skyline after 9/11? Do you want this country to have riots like France did when the govt tried to give private business' the right to employ people at their will? The relative lack of happiness, if it does exist in this country, you speak about is probably due in great part to traitors like you attempting to destroy this country.

HAPPY BIRTHDAY PRES. BUSH. I AM PROUND OF YOUR PERSERVERANCE IN SPITE OF THE VERBAL ASSASINATION ATTEMPTS BY SNIVERLING TRAITORS LIKE scott
WHO'S AMBITION IS TO DESTROY THIS COUNTRY.
GOD BLESS THE USA AND GOD-DAMN scott and his advocates

Prediction- At the next election we will have Democratic administration. The economy will soften considerabley about 2 years later.Unemployment will reach about 7-8%, prime rate will go to 10%+, and the average private home price will tumble about 15-20% The blame will be placed on the previous administration.

Result number: 30

Message Number 203092

Re: Dr. Goldstein, Should I get cryo? View Thread
Posted by Dr. Goldstein on 7/05/06 at 20:00

Chris : I read your postings and answers by Dr. Zuckerman and Ralph. If you pain is only a 3 out of 10 I do not think that is bad enough to jump to cryosurgery now. Most patients 85% or more respond to conservative treatments and never need any surgery. I would go for the PT in addition to pre fab orthotics, ice, stretching etc.
Many advocates state that one should to 6 months of conservative treatments before thinking about any surgery no matter how minor it may seem.

As far as the temperature issue of the treatment that is totally irrelevant and maybe dependant upon the type of equipment used but no one can measure that so it is of no importance.

Honestly, I WOULD NOT do cryosurgery with a VAS score of 3 out of 10 I do not think it warrants surgery atb this point in time.

Also try oral anti-inflammatories and you may want to purchase night splints also.
Hope this is of benefit to you.
Dr. Goldstein call me in my office at 973-992-9214 and I will be happy to discuss this further at no charge to you.
Dr. goldstein

Result number: 31

Message Number 201745

MUST READ-ORTHOTICS-NEW YORK TIMES View Thread
Posted by judy on 6/22/06 at 07:13

not that we did not know this ... about profit margins and orthotics and how they are overprescribed...

*******
June 22, 2006
Do You Really Need an $800 Custom Insole?
By SARAH TUFF
FOR runners, walkers and many other exercisers, a satisfying workout often involves no small amount of abuse to an intricate piece of sports equipment — each foot and its 100-plus parts. So when your heel hurts or your ankle throbs, investing up to $800 in a pair of prescription orthotics, customized insoles designed to slip into a sneaker or shoe, often seems worthwhile.

"A custom orthotic puts your foot in an ideal position at every stage of walking, running and pivoting," said David A. Schofield, the president of the American Podiatric Medical Association, which represents more than 12,000 podiatrists. "You'll be at your most strong and at your maximum efficiency."

Dr. Schofield said he recommends custom orthotics to 90 percent of his patients. And he is not alone.
Prescriptions for custom orthotics are becoming almost commonplace. And podiatrists recommend them far more often than medical doctors, according to Sue Lorenzo, the marketing director for Langer, a leading custom orthotics maker. Ms. Lorenzo said that 85 to 90 percent of Langer's orders come from podiatrists.

Industrywide sales of specially made orthotic devices have risen at a rate of 12 percent annually in the last five years, a higher growth rate than a decade ago, said Mary Thorson, the general manager of Burns Laboratory, one of the oldest makers of prescription foot orthotics in the United States. W. Gray Hudkins, the chief executive of Langer, estimated that overall sales of prescription insoles are now $180 million, compared with $130 million in 2000.

Advocates say that the surge in custom orthotics has to do with their effectiveness and with growing demand. Baby boomers who participate in more strenuous sports than their forebears did in middle age don't want to be sidelined by foot pain.

But while there is certainly a place for them in many shoes, some foot specialists and athletes say that custom orthotics are overprescribed. Some research indicates that in many cases less expensive prefabricated inserts may work just as well.

And critics warn that alternative low-cost remedies — like icing, rest and stretching — are being overlooked by practitioners who profit from the specially made insoles they recommend. Because the price of a tailor-made product is often marked up by the podiatrist or medical doctor who prescribes it, the consumer pays anywhere from $200 to $800 a pair, even though the manufacturing cost is typically under $100.

"If your main business is feet, and part of your income is prescribing orthotics, then you might prescribe them 90, 100 percent of the time," said Dr. William O. Roberts, a sports medicine doctor in St. Paul, Minn. "It's a financial issue, and I don't think there's a huge need for custom orthotics."

Dr. John G. Kennedy, an orthopedic surgeon at the Hospital for Special Surgery in Manhattan, shares this opinion. "There is a big problem with orthotics out there and people are not aware of it," he said. "The number of orthotics that I see prescribed in this city is far greater than is warranted by the number of pathological reasons."

If podiatrists and medical doctors differ on the issue of orthotics, it may stem in part from a difference in training. Podiatrists specialize in the foot and ankle, and have four years of training in podiatric medicine and at least one year of residency, as opposed to medical doctors, who attend four years of more generalized school before a minimum three-year residency.

"Podiatrists are obviously very knowledgeable about the foot and its structure," said Dr. Paul Stricker, a medical doctor in La Jolla, Calif., specializing in athletic injuries. "But when you look at the overall picture and the other biomechanical needs of the athlete, there are many other factors to take into account."

Podiatrists argue that their specialization allows them to deduce how the foot and ankle affect other body parts.
No one disputes that custom orthotics are a blessing for diabetics and people with abnormalities like a leg length discrepancy. But critics question why they are often the first suggestion for relieving run-of-the-mill problems, rather than a last resort.

Take plantar fasciitis, an inflammation of foot tissue that is felt as heel pain. Specially made orthotics are often prescribed to prevent the foot from rocking inward.

But Dr. Charles Saltzman, a foot-and-ankle surgeon in Salt Lake City, said that a shoe with adequate support is generally all that sufferers of plantar fasciitis require. Most people don't need an orthotic to control their motion, he said. "Shoes have elements built in to do that."

Research also has stoked the debate. A 2004 study by the American Orthopaedic Foot and Ankle Society that tested the effectiveness of various inserts in preventing injury in active, healthy people found no statistically significant difference between prefabricated inserts and custom orthotics in the incidence of stress fractures, ankle sprains and foot problems.

But Irene Davis, a researcher at the University of Delaware, cautioned: "We're still scratching the surface as far as predicting who's going to do well in each device." She is part of a team studying the effectiveness of custom orthotics for different foot types.

The market for all athletic insoles, custom and prefabricated, has grown dramatically. The number of inserts sold in stores has doubled in the last six years to about 800 products, according to the National Shoe Retailers Association. In 2005, Superfeet, a leading over-the-counter maker, sold more than a million insoles, up from 450,000 in 2000.

With so many insoles, it's becoming more difficult for athletes to decide among them. So if a foot specialist recommends a custom orthotic, patients often try it.

Patricia Cliff, 62, of Manhattan, who developed plantar fasciitis while hiking in New Zealand, tried four custom insoles, to no avail. "I've gone to foot doctors who charged me for these enormously expensive orthotics that may have $10 of material," Ms. Cliff said. "They're very hard, and they pained the arches of my feet."

Ms. Cliff said that she spent "a lot of money" with Rock G. , a podiatrist at the Hospital for Special Surgery. Dr. was surprised to learn of her dissatisfaction. "We have an extremely high success rate in this office," he said, explaining that the rare exceptions are patients who wear the wrong shoes with a custom orthotic or who fail to break in the device.

Athletes are partly responsible for the boom in custom orthotics. Used to spending to fuel their active lifestyle, they find it hard to believe that off-the-shelf orthotics may measure up to the expensive ones.

"Are orthotics overprescribed?" said Robert Eckles, a podiatrist and a professor at the New York College of Podiatric Medicine. "I would probably say yes. But look at guys in their 40's and 50's, overweight and riding a $5,000 bicycle though Central Park. Do they need that? Of course not."

The average cost of making a custom orthotic is $78, said Ms. Thorson of Burns Laboratory. Customers often pay two and even eight times the cost of production. "It's doctors' business to mark up accordingly," said Frank Mancuso, a spokesman at Solo, another maker of prescription orthotics.

Some practitioners say that the bills are justified by the X-rays, casts and analyses that come with individualized orthotics. "It's hard to see the value in the plastic," said Dr. Eckles, the Manhattan podiatrist. But, he argued, "you're paying for a comprehensive diagnosis of present and future problems," not the device alone.

Still, not every podiatrist is convinced that prescription orthotics outperform store-bought ones. David M. Davidson, a podiatrist in Buffalo, N.Y., who focuses on sports injuries, said he solves 99 percent of his patients' problems without a custom orthotic. Stretching, anti-inflammatories and off-the-shelf insoles are treatments he suggests.

And a recent survey of 500 podiatrists conducted by Podiatry Management Magazine found that they were not prescribing custom orthotics more now than in the past decade. Those surveyed, in fact, were recommending low-cost prefabricated models at a slightly higher rate than custom ones.

Depending on the foot problem, the most effective remedy may be right at home. Ms. Cliff found relief for her plantar fasciitis in a bag of frozen peas. And after spending $1,745 on six pairs of custom orthotics, David Kessler, 42, a runner from Denver, Colo., discovered through trial and error that his ailing ankles were a result of tight quadriceps and hamstrings. The solution? Stretching, at a cost of absolutely nothing.

Result number: 32
Searching file 19

Message Number 199753

Re: Ethical ESWT Company? View Thread
Posted by Advocates for ESWT on 5/24/06 at 11:04

Unfortunate but true. Yes there are companies out there that are billing through an ASC but the treatments are being performed in another office sometimes way at the other end of the state. As we both know, facility charges to insurance companies can be quite lucrative for ESWT. It is in the best interest of ESWT companies to prevent this practice from entering their state.

Result number: 33

Message Number 199741

Re: The end of ESWT View Thread
Posted by Advocates for ESWT on 5/24/06 at 09:14

In order to maintain the credibility of the ESWT treatments,it is up to the podiatric profession not to allow the insurance carriers to dictate what is and will not be paid for. As for United...they are still currently paying for ESWT but because of some unethical billing practices from ESWT companies and Doctors they are requesting clinicals before paying. ESWT can be compared to lasik if it explained to the patient as a last step before conventional surgury. Patients will pay a resonable amount for the proceedure if explained properly. We all need to agree on the amount of the fee for the service! Any ideas???

Result number: 34

Message Number 199740

Ethical ESWT Company? View Thread
Posted by Advocates for ESWT on 5/24/06 at 08:52

I heard recently that a shockwave company from upstate NY is entering into other states by establishing a billing site in surgical centers. By establishing this central site they are billing patients treated elsewhere in the state through the surgical center.How can this and is it ethical? I dont think so.How can these centers secure themselves from being audited? They can't. If this is not ethical, Once again an ESWT company reduces the credibility of the treatment and the Podiatric profession. The Doctors associated with the surgical centers may also open themselves up for posible insurance audits.

Result number: 35

Message Number 199239

Re: Depression View Thread
Posted by F. S. on 5/16/06 at 23:44

Monica:
I totally understand what you are feeling and you probably are feeling a combination of anxiety and depression. The concern of the pain and what you should expect and the demands on your body and mind are not to be diminished.

I would stress to your dr. what you are feeling. I did not do that when I had TTS release. No one really told me what to expect nor did I ask. This was many years ago and I just figured it is JUST A FOOT!!!! How bad could that be. I was not expecting the recovery time or the nagging pain weeks afterwards. I struggled with it. Of couse, this too shall pass and of course you will recover, but with all the great new drugs approved now you should not be suffering in the least.

Lexapro really worked for me. I hesitate to say that because we are all different and I am not a doctor. It had few side effects for me and helped my mood and anxiety alot. This greatly helps you thru this process. I am still on it and it has really changed my life. I never realized how much anxiety I really had!!!!

All you need to do is ask and if it does nothing after a month you can stop but do give it time. I hope your dr. is aware of the value anti-depressants are for pain issues. We really all have to do alot of work ourselves these days and be total self advocates. It is just the reality of the medical world now. Do your own research, and let your needs be KNOWN. Take care and do not forget to breath!!!!! I understand what you are feeling xoxooxxo

Result number: 36

Message Number 197906

Re: prolotherapy View Thread
Posted by Dr Ben Pearl on 4/23/06 at 11:14

Sometimes advocates will pick their best outcomes in case study examples
I think the jury is still out on this

Result number: 37

Message Number 191684

Re: Poor Clinical Outcomes View Thread
Posted by Dr. David S. Wander on 1/18/06 at 15:44

Wow, you've certainly been through a lot. I'm a little surprised to hear that you went to a Dellon trained podiatrist and he sent you for an EMG/NCV. My understanding was that Dellon did not have a lot of confidence in EMG/NCV and he invented his own device for sensory testing that was more accurate and that was used by doctors that were utilizing his techniques. This is something that you should DEFINITELY address with your surgeon. At this point, since there has been improvement in your EMG/NCV, and the varicosity was addressed during your surgery, it must be determined whether your pain is coming from the tarsal tunnel or from your back. This may be difficult to determine, but it may be beneficial if you can arrange for a "roundtable" discussion with all your treating doctors in an attempt to organize a game plan. Has your doctor attempted to simply block the nerve in the ankle to see if the pain disappears temporarily? Did you receive any transient relieve with the epidurals? Once again, I would address the issue of why if he is a Dellon trained surgeon, he didn't use the pressure sensory device that Dellon advocates (unless he did) and instead used an EMG/NCV and I would also ask if it would be possible to arrange some form of meeting with all the treating doctors to allow everyone to put their heads together in an attempt to find a solution to your problem. I don't know where you live, but I would also consider making a trip to Baltimore to visit Dr. Dellon himself.

Result number: 38
Searching file 18

Message Number 186583

Re: How long should we hold the postion in Foot Yoga exercises View Thread
Posted by Jan P on 11/02/05 at 15:49

Amber, I don't have the answer either, but I use the idea that goes with another type of stretching that I do. Their theory is that the body tries to combat a stretch after two seconds, and stretches should be combined with series of 2 second stretches along with 2 second rests.

I have actually gotten more help from AIS than I do from Foot Yoga, although I do it too. Visit this site:

http://www.hartmann-international.com/001articles/stretching.htm

I do mostly 8, 9, and 10. I used to do some of the others. They're all beneficial, but I pulled a muscle in my back doing some of the leg raises, so I'm more cautious now.

P.S. For some reason, I think that Yoga actually advocates holding stretches for a long time.

Result number: 39

Message Number 182443

Re: Chevy to the Levee once again View Thread
Posted by liboralis on 9/09/05 at 06:42

No John that cant be true. Bush was supposed to inspect those levees himself 2x per year and he didnt.

I watched the senator from LA last night speak from the floor. She praised "HER" Lt governor, governot, mayor etc. but kept getting digs in at Bush or the administration. I think when everything comes out we will see the real issues such as the article you posted. I thought senators were supposed to be advocates for their state? I know that entertainment and casinos sure were funded.

Result number: 40
Searching file 17

Message Number 179912

Re: eswt for achilles? View Thread
Posted by dr ben pearl on 8/03/05 at 19:06

Dr. Kim E. advocates higher energy with achilles tendonosis versus plantar fasciitis followed by casting. What have you been doing?

Result number: 41

Message Number 178924

Re: cosmetology surgery on foot View Thread
Posted by Elyse B on 7/23/05 at 13:54

How come you never believe anything Dr. Z? It is not an urban myth and I remember exactly reading it the NYC newspapers and seeing that podiatrist on the morning shows:

"More than half of the 175 members of the American Orthopaedic Foot & Ankle Society who responded to a recent survey by the group said that they had treated patients with problems resulting from cosmetic foot surgery. The society will soon issue a statement condemning the procedures, said Rich Cantrall, its executive director.

The American Podiatric Medical Association is also likely to formally discourage medically unnecessary foot operations, said Dr. Glenn Gastwirth, executive director of the group.
" I think it's reprehensible for a physician to correct someone's feet so they can get into Jimmy Choo shoes," said Dr. Sharon Dreeben, an orthopedic surgeon in La Jolla, Calif., who is chairwoman of the foot and ankle society's public education committee.

But advocates for the procedures say that critics simply do not understand the importance of high heels. "Some of these women invest more in their shoes than they do in the stock market," said Dr. Suzanne M. Levine, an Upper East Side podiatrist who is widely quoted in women's magazines and has appeared on network television promoting the procedures.

"Take your average woman and give her heels instead of flats, and she'll suddenly get whistles on the street," Dr. Levine said. "I do everything I can to get them back into their shoes.

Result number: 42

Message Number 177370

ESWT on the rise View Thread
Posted by Ed Davis, DPM on 6/27/05 at 14:24

biomech
June 2005Positive plantar fasciitis findings help ESWT regain its momentumBy: Jordana Bieze Foster
The tide seems to have turned for advocates of extracorporeal shock wave therapy, less than three years after a provocative study set the trend back on its proverbial heels. In the March-April issue of the Journal of Foot and Ankle Surgery, researchers from Columbus, OH, reported significant improvements in plantar fasciitis pain about four months after a single high-energy ESWT treatment given to 37 patients. Also in March, researchers from Atlanta reported

in Foot & Ankle International that 312 patients with a history of cortisone injection were no more or less likely to benefit from high-energy ESWT than 243 patients who had never received cortisone.

These were only the most recent of six studies on ESWT for plantar fasciitis published since the much-discussed September 2002 study in the Journal of the American Medical Association that found no difference in pain relief between patients treated with ESWT and those treated with a sham therapy (see "ESWT manufacturers respond to shock of negative JAMA study," December 2002, page 62).

Three also involved sham therapy control groups. One, published in the September 2003 issue of the Journal of Orthopedic Research, found no treatment effect for low-energy ESWT, but-like the JAMA study-has been criticized for using protocols that diverged from the manufacturer's recommendations. Another, published in Foot & Ankle International in May 2004, reported more success at three months in patients treated with high-energy ESWT than in controls. The third, published in the March-April 2003 issue of the American Journal of Sports Medicine, detailed positive effects in runners first reported earlier that year at the annual meeting of the American Academy of Orthopedic Surgeons (see "Runners in study return to form after ESWT for plantar fasciitis," April 2003, page 11).



Copyright: 2005 CMP Media, LLC

Result number: 43

Message Number 177325

momentum View Thread
Posted by Ed Davis, dPM on 6/26/05 at 01:20



biomech
June 2005
Positive plantar fasciitis findings help ESWT regain its momentum
By: Jordana Bieze Foster


The tide seems to have turned for advocates of extracorporeal shock wave therapy, less than three years after a provocative study set the trend back on its proverbial heels.
In the March-April issue of the Journal of Foot and Ankle Surgery, researchers from Columbus, OH, reported significant improvements in plantar fasciitis pain about four months after a single high-energy ESWT treatment given to 37 patients. Also in March, researchers from Atlanta reported

in Foot & Ankle International that 312 patients with a history of cortisone injection were no more or less likely to benefit from high-energy ESWT than 243 patients who had never received cortisone.

These were only the most recent of six studies on ESWT for plantar fasciitis published since the much-discussed September 2002 study in the Journal of the American Medical Association that found no difference in pain relief between patients treated with ESWT and those treated with a sham therapy (see "ESWT manufacturers respond to shock of negative JAMA study," December 2002, page 62).

Three also involved sham therapy control groups. One, published in the September 2003 issue of the Journal of Orthopedic Research, found no treatment effect for low-energy ESWT, but-like the JAMA study-has been criticized for using protocols that diverged from the manufacturer's recommendations. Another, published in Foot & Ankle International in May 2004, reported more success at three months in patients treated with high-energy ESWT than in controls. The third, published in the March-April 2003 issue of the American Journal of Sports Medicine, detailed positive effects in runners first reported earlier that year at the annual meeting of the American Academy of Orthopedic Surgeons (see "Runners in study return to form after ESWT for plantar fasciitis," April 2003, page 11).




Copyright: 2005 CMP Media, LLC

Result number: 44

Message Number 176443

Re: Stretching - How do you know? View Thread
Posted by Kathy G on 6/10/05 at 08:28


I believe Dr. Z advocates heat vs. icing. As far as I can see, the consensus on the Boards has been to use whatever seems to work. I found more comfort in heat than I did in icing.

Result number: 45

Message Number 173759

Re: Plantar Fasciitis View Thread
Posted by Julie on 4/26/05 at 10:15


I think the point is that someone who is marketing something should identify him or herself as such, and not purport to be a heel pain sufferer "sharing" knowledge about what has been helpful.

I could be wrong, but I suspect that the "heelbilly" advocates have been marketeers, not fellow sufferers.
.

Result number: 46

Message Number 172727

Re: Some interesting number crunching..... View Thread
Posted by Ed Davis, DPM on 4/06/05 at 19:43

john:

I understand your point but keep in mind that the ACFAS is the American College of Foot and Ankle Surgery, the group that SUPPORTS surgery. That being said, many have maintained that it takes a good surgeon to understand when not to do surgery. The prior editor of the ACFAS journal would not even allow a great piece of ESWT research by Norris (VP of United Shockwave), et. al. to be publsihed in the journal becasue it did not involve surgery. Obviously, there is some internal dissention going on so I don't see ACFAS coming to a concensus on this area any time soon.

The other affiliate organizations don't carry the "weight" that ACFAS does.

Just as there is an ISMST, it certainly is time to form an ASMST or American Society for Musculoskeletal Shockwave Therapy or even a North American Society for Musculoskeletal Shockwave Therapy. Smaller Europeran countries have their own societies so you would expect one here - why not? My guess is that it has been the infighting between advocates of differnt techniques and machines that has prevented formation of such a group. Read my many, many posts in which I plead to stop the infighting and get together on this. I think that we have the "mass" to form a society with enough clout to really influence standards of care.
Ed

Result number: 47

Message Number 172406

Re: To Elliott Re: cryosurgery revisited View Thread
Posted by Ed Davis, DPM on 4/01/05 at 22:13

Elliott:
Understandable. But practitioners are waiting to hear sufficient quantities of positive experiential data from credible practitioners. So far, there is not much out there. Practitioners certainly take into account the financial relationship of practitioner advocates to a company when evlauating such experiential data. You may be surprised to find out that docs are a lot more scrutinizing lot than you may suspect.
Ed

Result number: 48

Message Number 170165

PF View Thread
Posted by Darlene on 2/28/05 at 16:24

I found some interesting information on the www.myfootshop.com website. This is something I haven't heard of before.

I will paste below:

On The Horizon....

Drs. Barrett and Erredge in Texas have taken a novel approach to treating plantar fasciitis. They have put forth a hypothesis that plantar fasciitis is not the result of repetitive loading and inflammation but rather the result of degenerative change in the fascia unrelated to mechanical load. Their study, published in the November 2004 edition of Podiatry Today advocates the use of autologous platelet concentrate (APC+) injected directly into the portion of the fascia that is painful. This technique stimulates healing.

Autologous (meaning derived from the patient) platelets are obtained by drawing the patients blood and processing it to obtain a concentrated mix of platelets. Platelets are known to have 4-6 times the normal level of human growth factor. Introduction of growth factor into a wound stimulates the influx of fibrocytes and new vascular ingrowth. This technique has been used for some time in the treatment of chronic wounds but is a new way of addressing chronic inflammatory problems such as fasciitis and tendonitis.

We applaud these doctors for their innovative thinking and look forward to more studies using this technique.

Result number: 49

Message Number 170037

Re: Ed and Elliott/Helping HIlda View Thread
Posted by JudyS on 2/27/05 at 12:06

I've been looking at a very good book about family members being hospitalized-patient advocates. It's called Helping Hilda. It's written by a trio of San Diego sisters so I don't know if it was only published locally.........

Well, having said that I paused writing here to see if it was on Amazon and it is.

Anyway, these sisters had enough experience with their hospitalized mother, and enough varying professional experience, to have decided to write this book. I wish I'd had it when my Dad, then my Mother-in-law were hospitalized - eventually passing away.

I also wish I'd had it during a harrowing experience that had my husband in Emergency a few years ago. It's all about understanding hospital processes, what to be aware of, when to be assertively vocal, etc. I was thinking that, because many of us here are Baby Boomers with elderly parents, it seems like an informative resource.

Result number: 50
Searching file 16

Message Number 169575

does standing stretching stand or is standing stretching a stretch? View Thread
Posted by elliott on 2/21/05 at 12:40


There's been some debate on these boards about stretching, with some advocating only seated PF stretches for everyone, and others claiming the standing stretches can also be valuable. Maybe we need to take a closer look. Well, there's plenty of literature out there. Here's some I picked up (I strongly urge you to click on every link):

Evidence that non-weightbearing stretches alone are better than weightbearing stretches alone (at 8 weeks):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12851352

Night splint beats out standing stretching:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12194511

Night splint makes no difference in stretching group:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10613168

Splint alone is better:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9462907

Stretching should be first before splint:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7653427

Claims stretching highly effective for PF, and includes standing stretches:

http://healthlink.mcw.edu/article/987116429.html

Great photos on stretching, apparently for when already healing:

http://www.nismat.org/ptcor/plantar/

Recommends stretches including standing:

http://familydoctor.org/140.xml

Advocates standing stretches among other treatments, citing references that have been quoted frequently above:

http://www.aafp.org/afp/20010201/467.html

Advocates standing stretching:

http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=144&topcategory=Foot

Here's what I make of this: First of all, it seems to be standard practice, among orthopedists at least, to include standing stretching. So if one has fault with it, take on the orthopedists. I am guessing some of the prominence given stretching may have a lot to do with the same few articles that keep getting quoted, which included prominent orthopedists such as Conti. I'd prefer there was a consensus. Also very clear from a few of those links, and something we all already know, is that some things work for some and not others, and it is not always clear why. Nor is it often clear, even with many studies, exactly what treatment, or even subtreatment, to try first.

So I see it as being there is no one answer or universal rule here. It should be clear that the pro-standing stretch crowd is not advocating stretching a cold muscle hard with reckless abandon and likely injuring it. They also are not avoiding the seated stretches either.

My own view is, if one is not better with whatever he or she is trying, try the other conservative measures. If standing stretches, use some common sense in how you do them, and if it seems things are getting worse, back off. As long as one avoids permanent damage, no harm done, and they might just reap the benefits.

One thing for is sure: that's a great post title, if I may say so myself.:-)

elliott

{}

Result number: 51

Message Number 169061

Re: 2 days post op View Thread
Posted by Dorothy on 2/14/05 at 19:08

Mike C -

I like your posts. They are reassuring in their clarity, factual simplicity and apparent authority. They make sense to me. If I recall correctly, you are the same poster who advocates weight-bearing calf stretching as a - or perhaps as THE - key treatment for plantar fasciitis. If so, this position is in contradiction to what some other, also knowledgable, people here recommend. I may be misinterpreting these positions, but I don't think so. In any case, I would like to request a civil discussion of these two points of view: yes - weight-bearing stretching vs. no - weight-bearing stretching. If you are the person who recommended a particular calf stretch a few weeks ago, I have been doing that stretch (with others)occasionally and seem to be having no adverse reaction so far. But each time I do it, I am SURE I am hearing the sound of an Achilles tendon rupturing or the plantar fascia becoming more damaged.....It seems to me that any stretching regimen should be more comprehensive than just one stretch because I think of our bodies as integrated units, made up of connected parts and interconnected actions and reactions and compensations.

I am not asking this so people of opposing viewpoints begin arguing but only for a civil discussion and perhaps enlightenment on this controversial subject. Thank you.

Result number: 52

Message Number 165449

Re: The exercises, stretches View Thread
Posted by Robert J on 12/10/04 at 13:39


Actually, I don't think describing my exercises will be difficult because most of them have been described here many times. Trust me, my regime was garden variety. The trick--for me--was doing them with great consistency and working up to more reps over time so that real strengthening was taking place. As Julie suggested, most of the exercises were geared to the intrinsic foot muscles along the bottom of the foot. Each morning's session also started with a stretching session. Anyway, here goes:

--Stretching: I did only non-weight bearing stretches that were taken from the Mattes method. I bought one of Mattes' books, "Specific Stretches for Everyone," and it served well. For those not familiar with Mattes, he advocates short stretches of 2-second duration with many reps. My stretches include those for hamstrings, quads, calf, and bottom of the foot. For the calf I used an elastic band while sitting on the floor. For the foot, I simply bent the toes back according to Mattes' book. I did 15 reps for each exercise (15 per side, or a total 30 calf stretches, etc)

--Strengthening:

+Windshield washers. Sit in chair, press feet to floor, make windshielf washer motion with feet. 2 sets of 20 reps.

+Heel lifts. Nothing extreme here. Eventually I did lifts with balls of feet resting on a dictionary. 2 sets of 20 reps.

+Toe curling. Sit in chair, put one foot on the other knee. Curl toes, then use hand to uncurl toes while the toes resist. Repeat with other foot. This is called eccentric exercise, I think, and stretches muscles and tendons while strengthening rather than shortening. 2 sets of 20 reps for each foot.

+Chair pull. Sit in office chair (with wheels) on hardwood floor. Pull yourself forward across room using your toes on the floor. 4 trips across 20' room.

+Calf flex pull. Sit on floor with back against wall. Put elastic band under ball of one foot. Pull bank tight then press ball of foot forward against band pressure. Repeat with other foot. 2 sets of 15 reps.

+Calf extensor pull. Same position as above. Point toes of one foot away from you. Place resisting device (like a Foot Trainer but other devices will also work) against tops of toes. Pull toes toward you against resistance. 2 sets of 15 reps.

As for the walking, I started with short, timed walks, beginning at 6 minutes. I increased intervals by 3-4 minutes every third walk. After a while I gave up the timing and just walked.

One other thing that was important, for me at least. I tossed out every device that was designed to take stress off my feet: orthotics, tape, etc. I tossed them because the whole idea of my experiment was to increase stress on my feet in a gradual way rather than protect them from stress. I also started walking barefoot simply because it seemed to feel good.

I want to repeat my caveat about all this. I have believed for a long time that atypical PF people have a significantly different injury from those with classic PF. Mine is atypical. I suspect that this regime would be much more likely to help other atypicals rather than classics.

Hope this helps.



+

Result number: 53
Searching file 15

Message Number 157219

Re: Survey View Thread
Posted by Kara S. on 8/08/04 at 19:04

Thanks, Jason, for responding. I certainly understand your anger. We're used to being in control of our lives and all of a sudden we get side-swiped with this! We can take back control of our lives tho, by doing our own research into possible causes and solutions and then following each lead as far as we can. Thankfully the internet provides excellent, up-to-date information to get us started and these message boards provide a lot of trial and error suggestions. We have to be our own advocates and do our own detective work. Your children will understand if you can't run with them right now, just don't shut them out of your heart by being angry. They still need a daddy. Best to you.

Result number: 54

Message Number 154127

Re: Medical Devices and the FDA View Thread
Posted by Ed Davis, DPM on 6/28/04 at 22:26

Bill:
I understand your point. There are quite a few manufacturers in Europe who would love to get their machines into the US, only 3 have spent the money to get their machines into the US. The hurdles and cost for a class 3 device are significantly greater than for a class 2 device.
Less choice of machines = less availability. Greater availability means more citizens will obtain ESWT which in turn would place more pressure on insurance companies. We can spend much time discussing this but the best advocates for ESWT are the patients who are delighted that they were cured without painful surgery.
Ed

Result number: 55

Message Number 153723

Re: long history of pf, new diagnosis of TTS View Thread
Posted by Ed Davis, DPM on 6/22/04 at 20:07

Dorothy:

Most docs who are concientious are not happy with this situation. My immediate area lost 4 middle aged family docs to early retirement this year. Unfortunately, they were very dedicated types who just got burned out by the current situation. You have probably heard about the recent supreme court decision insulating HMO's from malpractice. Some of the HMOs are supporting certain family practice residencies where they can "indoctrinate" young practitioners with their way of doing things. I share your anger and, beleive me, many good docs do so too. I blame the AMA for wasting their energies on inane turf battles while watching the Hippocratic oath get swept away.

Unfortunately, things may have to get worse before they get better.
http://www.gppf.org/article.asp?RT=&p=pub/HealthCare/consumerism_2.htm
I placed this just minutes ago in the ESWT section. The patient must become the consumer as that is the only way to regain control of the system. One of the main reasons I stick around here is that I feel very strongly that patients must do everything possible to educate themselves about their condition. Doctors should be patient advocates and only patient advocates but that is not mandated in any means - either legally, by peer review or otherwise. The attorney-client relationship is well defined but not the physician-patient relationship. It must be defined both legally and ethically. In the interim, patients must become their own advocates as NO ONE ELSE is charged with that responsibility. That means, patients must self-educate and evaluate medical decisions. This site is a good tool to do so as are similar sites dealing with other conditions on the web. We must demand that, via legislation, the physician-patient relationship be restored and that the physician ALWAYS be the patient advocate.
Ed

Result number: 56

Message Number 151203

Latest information, from the AP View Thread
Posted by BrianG on 5/25/04 at 12:41

This article is only one day old, and appears to be relevant to this thread............BrianG

Cut & Pasted:

Woman has led fight for medical marijuana to a new high
- MARTHA MENDOZA, AP National Writer
Monday, May 24, 2004
(05-24) 00:16 PDT SANTA CRUZ, Calif. (AP) --

What do you do when you sue U.S. Attorney General John Ashcroft and win? Fifty-one-year-old Valerie Corral, a sinewy 5-foot tall great-granddaughter of Italian immigrants, throws back her head laughing, her hands reaching to the clouds, hips wiggling, feet stomping.
"It's my happy dance!" she says, throwing her arms around her husband Mike.
She has also planted an acre of marijuana.
The decision that lets the crop remain is just one round in a long legal battle.

Last month, a federal judge in San Jose issued a preliminary injunction banning the Justice Department, including the Drug Enforcement Administration, from interfering with the Corrals' pot garden, set above an ocean bluff near Davenport, about an hour south of San Francisco. The injunction gives the judge time to reconsider his earlier decision to allow the garden to be uprooted.
Still, the Corrals call the injunction a victory.
They share their harvest through the first legally recognized, nonprofit medical marijuana club in America, which they founded in 1993. The club has about 250 seriously ill members who have prescriptions from their doctors to use marijuana to alleviate their suffering, increase their appetites and control their seizures. The marijuana is free.

The San Jose ruling is one of a number challenging federal restrictions on medical marijuana, which has consistently won support in national opinion polls since 1995 but has had a mixed record in state ballot measures.
This summer, the U.S. Supreme Court is expected to decide whether to hear another case that could undo or affirm the Corrals' right to grow pot -- granted by state and local regulations, but denied by federal law. A second case in federal court in San Francisco -- in which other medicinal-use growers seek to reclaim seized marijuana -- could also affect the couple.
The Justice Department refused comment.
For now, the Corrals are the only people in the United States growing marijuana in their backyard backed by state law, a local ordinance and a federal judge's injunction. And Valerie Corral has become a heroine to proponents of medical marijuana.

"This could be the moment of the beginning of the end of this insane war against the sick," said Bruce Mirken of the Washington D.C.-based advocacy group Marijuana Policy Project. "And while the DEA and the Justice Department characterize Valerie as a common drug dealer, all you have to do is spend two minutes with her to know that's a lie."
During the past three decades, while sharing marijuana with sick people, Corral has watched -- and in many cases held -- 140 friends, ranging in age from 7 to 96, as they died of cancer, AIDS and other illnesses.
"It is the greatest honor to be asked by a person who is dying to sit with them," she said.
Reflection on those deaths has given her strength, she said -- while battling the government, when federal agents pointed a rifle at her head, and when her motives have been called into question.
"John Ashcroft is not someone I would have chosen to tangle with,but I think of him, and George Bush, as lost souls," she said. "When I look at them, I think about how they are just people, ... and that makes them less fearsome. Ultimately we all make the same journey, and ultimately I hope they make theirs in peace."

In fact, Corral's compassion is grudgingly respected at the DEA's San Francisco office.
"I'm personally impressed with her desire to help deathly ill people," said spokesman Richard Meyer. "It's just that she makes it look like the way to help sick and dying people is to give them marijuana. And that's not the case.
"There's hundreds of ways to help these people. The DEA has a lot of compassion for those people who are sick and dying, but I think there are many, many ways to help them without giving them marijuana."
At DEA headquarters, authorities said the issue has nothing to do with Valerie Corral or compassion.
"This may be personal to her, but it's not personal to the DEA," said the agency's Will Glaspy in Washington, D.C. "The DEA's job is to enforce the Controlled Substance Act. Congress passed the laws and charged us with enforcing them. She is attempting to use the court system to get what she wants."

Valerie Corral's path to becoming a medical marijuana advocate began 31 years ago, the day a small airplane swooped low and buzzed a Volkswagen she was riding in through the Nevada desert. The car went out of control and was sent skidding, rolling and bouncing 365 feet through the dust, brush and rocks.
Corral's slight body was flung against the roof and doors, causing brain damage, epilepsy, and a lifetime of staggering migraines. She took prescription drugs but still suffered convulsions, shaking and grand mal seizures.
Then one day, Mike handed her a medical journal article that showed marijuana controlled seizures in mice. Since then, for 30 years, Valerie Corral says she has maintained a steady level of marijuana in her system.

Her legal challenges began in 1992, when the local sheriff arrested her for growing five marijuana plants. With Mike, she challenged the law, using the defense of necessity.
Prosecutors dismissed the case, saying they didn't think they could win before a sympathetic jury in liberal Santa Cruz. When the sheriff arrested the Corrals again in 1993, the district attorney said he had no intention of ever prosecuting them and told police to leave them alone.
A few years later, the Corrals helped draft California's landmark Compassionate Use Act, approved by voters in 1996, that allows patients with a doctor's recommendation to use marijuana. Similar laws in Alaska, Arizona, Colorado, Hawaii, Maine, Nevada, Oregon and Washington allow the infirm to receive, possess, grow or smoke marijuana for medical purposes without fear of state prosecution.
But the law did not provide complete protection from arrest.

While local authorities worked with the Corrals to protect them against theft and coordinate distribution, federal agents continued to assert that growing, using and distributing marijuana was illegal. To provide legal protection, the city of Santa Cruz deputized the Corrals in 2000 to function as medical marijuana providers.
But in September 2002, federal agents raided the Corrals' farm -- just weeks before their annual harvest -- taking the couple to jail and pulling up more than 150 plants.
The Corrals were never charged, but the raid prompted them to begin a legal challenge to the federal ban, aided by a team of attorneys including University of Santa Clara law professor Gerald Uelmen and advocates at the Drug Policy Alliance, a non-profit Washington D.C.-based organization.
This is the case in which the San Jose judge recently ruled in their favor.

"Representing Valerie Corral, for me, is like representing Mother Teresa," said Uelmen, a constitutional law expert, calling her "one of the most compassionate people I've ever met."
And one who has led a movement to a new high.
URL: http://sfgate.com/cgi-bin/article.cgi?file=/news/archive/2004/05/24/state0316EDT0006.DTL

Result number: 57
Searching file 14

Message Number 149886

Re: Shock Wave Versus Rolfing View Thread
Posted by Ed Davis, DPM on 5/01/04 at 21:26

Collene:
So many of the "unique" massage technique advocates imply that there is something very unique about their specific technique that defies explanation. If one goes on the ART websites, the "originator" offers practitioners a "self-replicating" marketing based site that extols the virtues of the system but is very short on specifics. Lets be totally open and honest about what those systems of massage are, how they work and what makes them unique. I am very interested in alternative techniques but feel that they, too, should be willing to stand up to the scrutiny of intelligent discussion and scientific inquiry.
Ed

Result number: 58

Message Number 149885

Re: ART View Thread
Posted by Ed Davis, DPM on 5/01/04 at 21:19

Pamela:
I am sure that you can find some people that it has helped as I can go through the long list of massage techniques and find their advocates and practitioners who in turn will find a few "beleivers." There is definitely something to the various techniques but am not convinced that they are very unique, "patentable." I have emailed the originator of ART oln several occasions asking him here, respond to my queries or even allow me to take his "course" -- no response. Why will he not speak?
Ed

Result number: 59

Message Number 143159

New method of pain control View Thread
Posted by BrianG on 1/29/04 at 08:01

I thought I'd pass this on, as this new type of pain control can be used after foot, and ankle surgery. Like I've mentioned in the past, I'm always happy to see new methods of pain control.

Regards,
BrianG

Cut & Pasted from the Net:

Killing Pain One Drip at a Time

New technique leaves patients less distressed after surgeries, researchers say.

By Linda Searing
HealthDay Reporter FRIDAY, Jan. 23 (HealthDayNews) -- In a growing number of operating rooms across the United States, surgeries are ending with a slightly different twist.
Rather than stitching up a patient and then prescribing various narcotics to control the pain that's bound to follow, doctors are leaving a tiny catheter-like device in the area of the incision. For the next few days, a local anesthetic drips automatically into the wound.
This not only stops the pain, say those who've used the technique, but it does so without the side effects of so many pain-killing drugs. That speeds recovery, advocates say, letting patients get up and around -- and out of the hospital -- much more quickly.

"The main point is that long-lasting local anesthesia reduces the need for narcotics, and that facilitates recovery," says Dr. Paul F. White, professor and former chairman of the department of anesthesiology and pain management at the University of Texas Southwestern Medical Center.

Two just-published studies by White confirm that people whose pain relief came via a catheter-drip reported less pain and needed 60 percent less narcotics than those not given the local anesthetic.

In one study, which involved 36 people who had open-heart surgery, everyone who had received a painkiller through a catheter-drip sat up in a chair and moved around on the first day after surgery. They also left the hospital sooner than those who did not get the drip.
In the second study, involving 24 people who had foot and ankle surgery, 40 percent of those who had the catheter-drip were discharged from the hospital on the day of their surgery. None of the others were discharged that day.

Results of the foot and ankle surgery appear in the November issue of Anesthesia and Analgesia; the study on the heart surgery patients appears in the October issue of Anesthesiology.

"A lot of factors influence the effectiveness [of the technique]," White says, including concentration and volume of the painkiller used. But, he says, it "works best when you can block a nerve or put [the catheter] near a nerve."
That was the case with the foot surgeries, he says, when the catheter-drip "blocked a particular nerve that innervates most of the foot." With the heart surgeries, it "blocked the pain fibers at the site of the chest incision." The drip also seems to require "less drug, or a lower concentration of the drug, if you're near a major nerve," White says.

But the technique has not produced good results with hip- and knee-replacement surgeries or with hysterectomies. And a study nearing completion at the University of Wisconsin is examining whether the catheter-drip will work with hernia surgery. Another research project, under way at The Johns Hopkins University School of Medicine in Baltimore, is testing the technique with radical prostate surgery.
Dr. Christopher Wu, an associate professor in the department of anesthesiology and critical care medicine at Hopkins, says that "preliminary data suggests [the catheter-drip system] does improve pain control, but how that is going to play out in comparison to other forms of pain control…is not clear at this point."

"In some cases you might still need narcotics," Wu says, mentioning abdominal surgery that involves a lot of deep wounds as an example. But even using the technique in conjunction with more traditional pain-killing medication would "decrease the number of opiates you use after surgery, and decrease the side effects," Wu says.
Narcotic painkillers commonly cause nausea, constipation and grogginess -- problems that can interfere with quick recovery and speedy discharge from the hospital.
Doctors using the technique lay a small catheter in the wound before it's closed, explains Wu. "It infuses some type of local anesthetic, just like you'd get when you go to the dentist, to numb up the wound area."
The catheter is "very tiny," White says. "It's non-electronic. There are no gizmos and gadgets to adjust. It's very, very simple."

The idea, apparently, isn't entirely new. Years ago, White says, such a procedure was mentioned in surgical literature but wasn't followed up because the appropriate equipment had not yet been developed. Now, though, several manufacturers have filled that void. White's two studies both used the ON-Q Post-Operative Pain Relief System, made by the I-Flow Corp. of Lake Forest, Calif.
Patients seem to like the technique, too. People who've participated in studies on the pain control method report less pain, and greater satisfaction with the management of their post-operative pain, than do people not treated with the system, both White and Wu report.
"Narcotics themselves don't modify pain signals," Wu says, "but local anesthetic at the site [of the wound] can decrease the amount of pain signals."

More information
To learn more about traditional options for managing pain after surgery, check out information from the American Academy of Family Physicians. For more on controlling post-operative pain in children, visit Yale-New Haven Hospital.

SOURCES: Paul F. White, M.D., Ph.D., professor, department of anesthesiology and pain management, University of Texas Southwestern Medical Center, Dallas; Christopher Wu, M.D., associate professor, department of anesthesiology and critical care medicine, The Johns Hopkins University School of Medicine, Baltimore; October 2003 Anesthesiology; November 2003 Anesthesia and Analgesia

Result number: 60
Searching file 13

Message Number 139517

Feet View Thread
Posted by Dorothy on 12/07/03 at 03:43

There have been several posts here about cosmetic changes to the feet. This article from the New York Times relates:

December 7, 2003
If Shoe Won't Fit, Fix the Foot? Popular Surgery Raises Concern
By GARDINER HARRIS

Days after her daughter's engagement a year ago, Sheree Reese went to her doctor and said that she would do almost anything to wear stilettos again.

"I was not going to walk down the aisle in sneakers," said Dr. Reese, a 60-year-old professor of speech pathology at Kean University in Union, N.J. She had been forced to give up wearing her collection of high-end, high-heeled shoes because they caused searing pain.

So Dr. Reese, like a growing number of American women, put her foot under the knife. The objective was to remove a bunion, a swelling of the big-toe joint, but the results were disastrous. "The pain spread to my other toes and never went away," she said. "Suddenly, I couldn't walk in anything. My foot, metaphorically, died."

With vanity always in fashion and shoes reaching iconic cultural status, women are having parts of their toes lopped off to fit into the latest Manolo Blahniks or Jimmy Choos. Cheerful how-to stories about these operations have appeared in women's magazines and major newspapers and on television news programs.

But the stories rarely note the perils of the procedures. For the sake of better "toe cleavage," as it is known to the fashion-conscious, women are risking permanent disability, according to many orthopedists and podiatrists.

"It's a scary trend," said Dr. Rock Positano, director of the nonoperative foot and ankle service at the Hospital for Special Surgery in Manhattan. Dr. Positano said that his waiting room is increasingly filled with women hobbled by failed cosmetic foot procedures, those done solely to improve the appearance of the foot or help patients fit into fashionable shoes.

More than half of the 175 members of the American Orthopaedic Foot & Ankle Society who responded to a recent survey by the group said that they had treated patients with problems resulting from cosmetic foot surgery. The society will soon issue a statement condemning the procedures, said Rich Cantrall, its executive director.

The American Podiatric Medical Association is also likely to formally discourage medically unnecessary foot operations, said Dr. Glenn Gastwirth, executive director of the group.

"I think it's reprehensible for a physician to correct someone's feet so they can get into Jimmy Choo shoes," said Dr. Sharon Dreeben, an orthopedic surgeon in La Jolla, Calif., who is chairwoman of the foot and ankle society's public education committee.

But advocates for the procedures say that critics simply do not understand the importance of high heels. "Some of these women invest more in their shoes than they do in the stock market," said Dr. Suzanne M. Levine, an Upper East Side podiatrist who is widely quoted in women's magazines and has appeared on network television promoting the procedures.

"Take your average woman and give her heels instead of flats, and she'll suddenly get whistles on the street," Dr. Levine said. "I do everything I can to get them back into their shoes."

Foot fashion and function have, of course, long been in conflict. Chinese girls' feet were bound to shorten them by bending the toes backward. High heels have been fashionable in the United States for decades, even though they can cause not only serious foot problems but knee, pelvic, back, shoulder and even jaw pain.

It is not just the height of shoes that can lead to damage. A 1991 study found that almost 90 percent of women routinely wear shoes that are one to two sizes too narrow. A 1993 study found that women have more than 80 percent of all foot surgeries, primarily because their shoes are too tight.

Narrow shoes can cause the big toe to bend outward, permanently changing the shape of the bone and causing a bunion, or swollen big-toe joint. Women have more than 94 percent of bunion surgeries, the 1993 study found. By scrunching up the smaller toes, fashionable shoes can also cause or worsen claw or hammer toes, a condition in which the smaller toes are permanently bent downward. Painful and unsightly corns or calluses often form on the tops of such toes.

Foot doctors disagree sharply over how to respond to such problems. Most advise patients to stop wearing the offending shoes. "It's far simpler to cut the shoe to fit the foot than to cut the foot to fit the shoe," said Dr. Pierce Scranton, a Seattle orthopedic surgeon who was an author of the 1993 study.

But an increasing number of doctors are performing delicate and expensive operations to allow women to continue to wear their favorite shoes.

Dr. Levine's Park Avenue office, called Institute Beauté, is decorated with cream and rose-colored wallpaper, pictures of Dr. Levine with celebrities like Oprah Winfrey, Katie Couric, Diane Sawyer and Joan Lunden, and framed copies of articles in which she is quoted. Dr. Levine has medium-length blond hair, a striking resemblance to the singer Deborah Harry, and often wears fashionable high heels. A public relations firm schedules her media appearances.

Sitting with a brown Yorkie in her lap, Dr. Levine explains that she is "simply fulfilling a need, a need to wear stylish shoes." Although she would not provide specific numbers, Dr. Levine said that this year she will undertake 40 percent more cosmetic foot surgeries than she did three years ago. Among the most common are operations to shorten toes, at a cost of $2,500 per toe, and collagen injections into the balls of the feet — to restore padding lost from years of wearing high heels — about $500 per injection, she said.

Her business is taking off, Dr. Levine explained, because shoes are an increasingly indispensable fashion accessory. "These women come in and say, `Listen, I just came from my other podiatrist who told me to stop wearing high heels, and I don't want to hear that,' " she said.

Many of her patients are youthful, beautiful women who want to look their best, she said. To prove her point, she walked into an examining room where Jennifer Cho, a 27-year-old Manhattan lawyer was waiting to have the stitches on her right toes examined.

Wearing high heels caused her discomfort, Ms. Cho said, and her toes had begun to curl downward and develop corns. She saw Dr. Levine on NBC's "Today" program and decided to have the problem fixed. On Monday, Dr. Levine shortened the toes on Ms. Cho's right foot, and she is scheduled to operate on the left toes on Friday.

"This will help me wear the shoes that I want to wear," Ms. Cho said happily.

Dr. Levine and her partner, Dr. Everett Lautin, said that critics do not understand that when doctors tell their patients not to wear high heels, patients do so anyway. "People say, `why do toe surgery if they work just fine?' " Dr. Lautin said. "Well, `why do a nose job when your nose is working just fine?' It's the same thing. People want to look their best."

The answer, Dr. Positano said, is that "you don't walk on your face." The foot is a complex network of 26 bones, 33 joints, 107 ligaments and 19 muscles that must support more than 100,000 pounds of pressure for every mile walked. Even small changes can unexpectedly undermine the foot's structural integrity and cause crippling pain, Dr. Positano and others said.

Even collagen injections have risks. Simone Levitt's toes are numb because collagen injections into the pads of her feet damaged nerves. Ms. Levitt was persuaded to get them because she thought they would allow her to walk freely in high heels. "Like a dope, I let this happen," said Ms. Levitt, 74, who lives in the Upper East Side of Manhattan. Now Ms. Levitt said that she is unable to wear anything but sneakers and that her feet hurt constantly.

These risks explain why many foot doctors advise patients to try everything — including never wearing high heels again — before risking surgery. There are no solid figures for cosmetic foot procedures, so the American Orthopaedic Foot & Ankle Society is beginning a study to measure how common the operations have become.

Critics say that one factor compelling the increase they are seeing in such procedures is a push by doctors to expand their practices in areas not covered by managed care. "People are making a lot of money off of this, because patients pay in cash," said Dr. Dreeben, the California surgeon.

Dr. Levine said that insurers pay for many of her procedures, because patients are in pain. "I'm not looking to make a killing," she said. "I make a living."

Dr. Reese finally found 2-inch heels that she could briefly wear while walking down the aisle at her daughter's wedding in July. She quickly changed into a pair of ballet slippers that she had dyed black and fitted with special supports. She expects, however, that she will never again be able to walk barefoot or wear anything but specially designed shoes.

"I really regret being worried about looking good for my daughter's wedding," Dr. Reese said, "because I'll pay for it for the rest of my life."

Result number: 61

Message Number 138851

Re: rest for post tib tendonitis DR Z OR WANDER?? View Thread
Posted by Dr. David S. Wander on 11/27/03 at 20:02

I agree with Dr. Z that you should have an MRI. ONE of the symptoms of posterior tibial tendonitis is flattening of the arch, but it isn't always present. There will usually be discomfort or weakness when you are asked to raise up on the toes of the symptomatic foot.

I respectfully disagree with the use of heat. It is simple, Dr. Z advocates the use of heat and I'm opposed to the use of heat. Do what YOUR doctor recommends and what you find helps you the most.

Result number: 62

Message Number 136513

ESWT TODAY 11-5-03 View Thread
Posted by Molly H on 11/05/03 at 22:22

Hi all!
I had my 2nd ESWT today and it went very well! Last time I was their 1st patient with the Dornier Machine and it didn't seem like they had it all together. Even though the company was United Shockwave both times. This time they were GREAT! They were pinpointing the inflamation and measuring my PF for thickness. (All things they did NOT do last time). I have hope that this time I will be cured especially since there was a marked difference in how they handled the procedure this time.
One thing I found interesting is on the instruction sheet for after care was do NOT put your feet in a whirlpool!?????????????? I know everyone most of you who have had ESWT and the Dr.s are heat and moist heat advocates so, I wonder why they would recommend not doing that? I know it helped with my healing last time! Anyone have thoughts on this???

Thanks!

Molly

Result number: 63

Message Number 136307

Re: Advice re surgery & re Dr. Cooper View Thread
Posted by BrianG on 11/03/03 at 22:08

Hi Sherry,

I think you are very lucky to have found Dr. Paul S. Cooper, from Georgetown University. I'm not a big backer of surgery, but I really think that you have grabbed the Brass Ring, by hooking up with this doc. He is a true humanitarian, who also knows his stuff. I would visit him in a heart beat, and I am not usually pro-surgery.

Check out this article from the Washington Post, dated 2-20-01. The article does contain some dreaded politics, but I hope that everyone can let them be, as to delete them, would really take away from the story. Please, lets just stick to the medical aspects of this story, which I found on Google. Sorry, I couldn't link to it, so I'll have to cut and paste. It's long, but worth the read.

Good luck,
BrianG, Cut & pasted from the Net:

Cover Story
First Steps to Freedom
By Kate McKenna
Tuesday, February 20, 2001; Page HE10
It was March 1999 in Pristina, Kosovo's capital. Masked Serbian militia
marauded through the city, ordering all ethnic Albanians out of their
homes immediately. As frightened residents crowded into the streets, the
night sky glowed from the torching of distant houses. Shots rang out and
the entire Ademi family -- mother, father and four children aged 14 to
22 -- knew there was no time to lose.
But the Ademis' situation was unlike that of their fellow Kosovo
Albanians. Adding to their terror and vulnerability was the fact that
three of the four children were crippled by a mysterious condition that
impeded simple mobility -- much less a forced trek to the border at
gunpoint.
The oldest son, 22-year-old Artan, could no longer walk unassisted
on his twisted limbs; 14-year-old Valon would lose his balance and fall
every few steps. And Fllanza, 17, was bedridden, her ankles turned
sharply inward and frozen at unnatural angles. In valiant efforts to
stand, she had broken her feet and raised calluses on her ankles. She
was now reduced to crawling painfully on her hands and swollen knees.
Doctors in Kosovo had told the family that nothing could be done, that
Fllanza and her brothers must simply accept their fate, as this
unexplained malady slowly curled their limbs into bent and useless
things.
But now they had to move or die. "You could see the fire in the sky,
and hear the machine-gun shots," recalls the children's mother, Fehmije
Ademi. "All you could hear was screaming and shouting and shooting."
Her eyes darken and her face tightens as she remembers her
persecutors. "The soldiers didn't care if you were sick, if you could
walk or not," she says. "They were barbarians. They would grab you, and
push you and kick you. And the ones who couldn't move fast enough, they
would shoot.
"For everyone, it was terrible! Horrible. But for us, what could we
do? Where could we go with these kids who could not walk?"
Artan struggled to his feet. But, his mother recalls, "Fllanza was
on the floor, lying there, crying because she couldn't move. She kept
telling us that we must go, that she would stay there, because she had
no place to go. But her cousins were also crying that she couldn't stay
in the house because they would come and shoot her -- or worse."
Her parents lifted her into their arms and ran, with Artan and Valon
straggling behind, while soldiers killed a neighbor's son -- to make an
example of him and create a panic that would get the crowd moving. The
Ademis, bearing their children and struggling along as they could,
joined the refugee flood.
What happened to ethnic Albanians that spring in Kosovo has been
described by former secretary of state Madeleine Albright as a "horror
of biblical proportions." But what happened to this family in the
following months was little less than a miracle. The tragic
circumstances of their upheaval notwithstanding, this episode of
"ethnic cleansing" led them, oddly enough, to salvation.
At a resettlement camp, the unexpected intervention of a high-level
American delegation gave them a chance at a new life and medical
attention. From the burning ruins of their life in Pristina, they came
to a place where their condition was seen not as the unalterable hand of
fate but as a recognizable disease that could be treated, if not cured
-- a disease with a name, albeit an odd one: Charcot-Marie-Tooth.
A Stealthy Disease
In the United States, as many as one in 2,000 people has a form of
Charcot-Marie-Tooth disease, or CMT, named after the three doctors who
first described it in 1886: Jean-Martin Charcot and Pierre Marie, who
worked together in Paris, and Howard Tooth of London.
The inherited disorder leads to slow deterioration of the nerves
that control muscle function, causing some muscles to weaken and
throwing the body out of balance. Symptoms generally start in the
extremities -- foot, lower leg, hand and forearm -- and are often first
noticed in adolescence.
CMT can also cause loss of sensation in the limbs, fingers and toes.
In its most severe form, CMT can lead to curvature of the spine, rigid
bone growth and abnormalities. In some patients, it can affect
respiratory functions. The spectrum of symptoms is broad, ranging from
mild discomfort to obvious deformity.
Overall, it is said to affect about 150,000 people in the United
States -- a figure small enough for the ailment to count as rare but
large enough to make it the country's most common inherited neurological
disease. In fact, it may affect more people: CMT advocates claim the
malady is one of the most under-diagnosed diseases. CMT symptoms can
masquerade as anything from arthritis to aging. In extreme cases, like
that of the Ademis, lack of treatment can lead to devastating results.
Basic texts describing the disease often note that there is no cure
or single prescribed treatment. For the Ademis, it took a long journey
-- ending in Alexandria -- before they found a doctor who offered a
treatment, a therapy and the hope that they could walk independently
once again.
Artan Ademi was just past puberty when the disease became evident,
bending his feet inward at freakish angles and impeding his ability to
move. Medical experts call this symptom "marionette gait," because it
leaves the legs and hips unstable and makes walking an arduous affair.
But at least he was still able to put weight on his feet.
Fllanza was less fortunate. At about age 13, her feet contorted
inward, then froze in that position. Her parents, who had watched the
disease cripple their oldest son, were inconsolable. "We lived the
sadness twice," recalls Fehmije, speaking through an interpreter.
Fllanza tried to keep walking -- on the outer edges of her twisted
ankles -- but for most of her teenage years, crawling on her hands and
feet was her only means of locomotion. The family could not afford a
wheelchair.
Then the Ademis' youngest boy, Valon, developed symptoms. His
deformities worsened until he was able to walk only on his toes.
Only the siblings' 21-year-old brother, Mentor, was left unaffected.
Kosovo doctors offered no consolation, appearing mystified by the
family's misfortune. "They said it was God's will," says the children's
father, Nazmi Ademi, in a voice filled with sadness. "It's a disease,
and there's nothing we can do," they told him.
And then came the militia, the forced evacuation and the terrible
flight to the border.
Family members say their first miracle was finding each other again,
unharmed, at a Macedonian refugee camp after weeks of separation and
deprivation. The terror of the forced flight was still fresh. Recalls
Fehmije, "The soldiers were shooting in the air to make us move faster.
We were like lambs . . . they would throw us in one direction, then in
another."
Lost in the turmoil and forced to hide in the hills for weeks, Artan
and Fllanza were the last to reach the relative safety of the Stenkovec
camp in Macedonia, just over the Yugoslav border. While their frightened
parents listened to daily radio reports of Serbian atrocities against
ethnic Albanians -- rapes and shootings and the discovery of mass graves
-- the two siblings were still making their harrowing odyssey. Fellow
refugees slowed their own pace to hoist Artan upright; others dragged
Fllanza along for miles in a blanket.
Once reunited, the family drew notice from relief workers. "Their
condition was a big shock to everybody there," said Indrit Bregasi, the
family's interpreter. "It helped them get the attention they needed."
President and Mrs. Clinton made a visit to their camp, teeming with an
estimated 20,000 displaced people. A senator traveling with the White
House entourage (his identity still unknown to the refugees) noted the
Ademi family's plight. Even amid this crush of human calamity, their
case stood out.
Lutheran Social Services of the National Capital Area got a call
from abroad, asking if the agency was willing to take on a family with
so many needs. "Medical cases need a lot more time and attention than
the typical refugee/asylum case. And we had no idea what their condition
was," recalls Ruth Anne Dawson, director of the agency's Falls Church
office. "We only knew that they were in wheelchairs [that had been
provided by relief agencies]. We knew [the disease they shared] was
genetic. But we didn't know anything else about it." Possible diagnoses
ranged from advanced arthritis to muscular dystrophy to polio.
"You never know what can be done medically. Maybe nothing could be
done," says Dawson. "Our initial plan anticipated having to look into
in-home care, even nursing homes. We had no idea if doctors could do
something." Nonetheless, the agency took the chance.
In August 1999, the Ademi family was settled in a first-floor
apartment in Alexandria. Dawson assigned the case to Bregasi, a
soft-spoken but determined Albanian native and social worker from
Gaithersburg, who immediately set to work on the family's next miracle:
getting treatment.
In Search of a Miracle
Over the next six months, the Ademis went from doctor to doctor --
internists, neurologists and foot doctors. Says Bregasi, "It was very
difficult just getting the appointments, just getting on a waiting list.
Because you'd have to call and explain the whole long story, and some
doctors just didn't want to take such a serious case."
On top of that were the logistical challenges of getting to the
examinations. For each consultation, Bregasi would have to help Artan
and Valon walk and carry Fllanza from the apartment into a van,
wheelchair in tow.
But doctors repeatedly declined to take their case, dashing their
new hopes. Recalls Bregasi, "I'd be telling the family: We will change
this. Doctors can help you. And we'd be refused by doctors who said
there was nothing they could do. They just didn't want to take the
responsibility of such a serious case. It was very bad. Those kids
suffered a lot."
Richard Foa, then a neurologist at Georgetown University Hospital,
was the first to diagnose Charcot-Marie-Tooth that fall. Speaking from
Colorado, where he now lives, Foa recalls that the Ademis presented a
unique and extreme case. "It's highly unusual to see three out of four
siblings heavily affected and one spared totally. And for it to be so
forcefully manifested in the children but not in the parents, that also
is unusual." Also startling, "particularly to Western eyes," he says,
was to see a condition that had gone neglected so long. Foa suspected
that the Ademi family's status as ethnic Albanians had probably kept
them from reliable medical care, even in peacetime.
From a list of specialists provided by Foa, Bregasi came eventually
to Paul S. Cooper, director of the Foot and Ankle Center at Georgetown.
It was Cooper who literally put the Ademis back on their feet again.
Taking on their case pro bono, he made plans for immediate treatment,
including surgery.
Getting Limbs Into Line
Treating such extreme cases of the disease was a first for Cooper,
despite his years of experience working with CMT patients at Georgetown
and in Connecticut. He chose a series of surgeries, involving slicing
into bones and transplanting muscle from an unaffected part of the leg
to an impaired part. "Nothing we did was uniquely revolutionary
separately -- but the combination of all these treatments performed on
one patient is fairly unique," he said.
Cooper blocked out one day to operate on all three patients, one
after another, so the siblings could recover together and support one
another. Starting just after dawn on March 2, 2000, he and his
assistants started on Fllanza, the most complex case, followed by Artan
and, nearly eight hours later, Valon.
First, Cooper rebuilt Fllanza's foot by fusing three bones below the
ankle to provide greater strength and allow Fllanza maximum motion in
that joint. Called triple arthrodesis, the operation can also help
arthritis patients and people with flat feet or other major foot
deformities.
Next, he transfered tendons from the strong side of her foot to the
weak side, in a soft-tissue balance procedure often used for stroke and
polio patients. The goal was to correct the imbalance of foot muscle
strength that pulls the foot in unusual directions.
Those same two procedures would put Artan, the oldest son, on the
road to recovery. One similar, less radical, operation took care of
Valon's toe deformities and tendon problems. But Fllanza's condition was
so severe that it required another delicate procedure.
"Her foot was so contracted that if we had completely brought it
back into normal position, we could have stretched her nerves too far
and cut off circulation," says Cooper. So as not to risk further damage
to nerves and arteries, he installed an Ilizarov frame, consisting of
high-tension wires cutting through the skin to the bone. The device is
generally used to save limbs of diabetics and patients with infections
who might otherwise face amputation.
Through a system of color-coded struts, the device allowed Fllanza's
feet to be moved slowly back into position, millimeter by millimeter.
Her mother tightened the settings daily to keep the strings taut, like
those of a well-tuned piano.
The day Fllanza took her first halting steps -- four months after
the operation and nearly five years since she'd last walked normally --
her mother cried all day. "It was such a miracle," she says now. "I had
hopes, but never could have imagined how good it would be."
A New Life
Today, Fllanza wears a constant smile. "She was even happy to get into
the surgery room," says Bregasi. "Now she's so happy, she smiles all the
time!" Even the aftermath of surgery, the discomfort of the Ilizarov
frame, the wires through her skin and painful physical therapy didn't
take the grin off her face.
Once again, she's walking -- haltingly, but without cane or walker.
While doctors will always need to monitor her condition, particularly
her hips, knees and hands, for signs of muscle wasting or weakness from
the progressive disease, therapy has stabilized her feet. Now she says
she knows she will one day live on her own, hold a job, drive a car. A
once-bleak future suddenly holds all kinds of possibilities.
Artan and Valon, say their parents, are similarly excited, despite
Cooper's acknowledgement that their medical future is uncertain. "We're
going the maximize their potential," he says, and that is what they
cling to.
Today, a year after the operations, physical therapy still takes up
much of their time. They do floor exercises and weight presses three or
four times a day to regain strength in healthy muscle groups that were
underutilized as the disease took hold and to fortify muscles against
future stresses from the disease.
But outside the clinic, the three former patients are now free to
indulge in such simple but once unachievable pastimes as getting to know
their new neighborhood, going to the mall or the basketball court to
watch their friends play. They can also now visit with other Albanian
refugee families who live in their apartment complex near Landmark.
"A year ago, they were always in the house," says Bregasi. "Now
their life is completely different."
Not that there are no more hardships facing the family. Back in
Pristina, their college-educated father, Nazmi Ademi, was a government
worker specializing in legal matters, until he -- along with thousands
of other ethnic Albanians -- lost his job in the poisonous political
climate of the early 1990s. His second son, Mentor, the only child
unaffected by the nerve condition, supported the family by selling
cigarettes on the street. In Virginia, both held jobs as field reps for
a Springfield auto-accessory firm, then were laid off. Now they are
doing maintenance and sanitation work at Reagan National Airport while
they seek something better.
But Bregasi says they are philosophical about such problems.
"Imagine if they were still in their country," she says. "Maybe Fllanza
would be crippled for the rest of her life. And her brothers, the same
thing. A lot of good happened that may never have been happened if they
had not been told to leave."
There is much to hope for. Fllanza, at 19, hopes to be able, once
again, to dance the "shotave" -- a traditional Albanian dance -- and
recover a portion of the youth she lost in Kosovo. Artan and Valon want
to learn to drive. They agree their journey has been miraculous in many
ways, but find it hard to describe, in any language, the dramatic
changes the last two years have brought to their lives.
"There are no words to describe what has happened, and what these
doctors have done for them," says their father, shaking his head slowly
and looking at his now-vital daughter and sons. "There are no words."
Kate McKenna is a Washington area writer.
© 2001 The Washington Post Company

Result number: 64

Message Number 134153

ESWT for Heel Pain View Thread
Posted by Dorothy on 10/16/03 at 15:37

This is from podiatrists's website that someone called to my attention. I have no affiliation with anything having to do with any of these matters we discuss on heelspurs. None. Thought this might be of interest to some here:

Heel Pain Treatment
Finally... a treatment for heel pain without surgery.
A Highly-Effective, Non-Surgical Solution in the Treatment of Chronic Proximal Plantar Fasciitis.
The First FDA Approved "EWS" System (Orthotripsy™) for Musculoskeletal Application
What Is The OssaTron©?
The OssaTron© is a high energy shockwave system that provides a non-surgical alternative for patients diagnosed with chronic proximal plantar fasciopathy (severe heel pain), usually referred to as fasciitis. This non-invasive out-patient treatment represents a breakthrough for this condition.
Using a unique process known as Orthotripsy™, the OssaTron© emits shock waves, similar to those used to treat kidney stones, to increase blood flow and stimulate healing of the affected heel.

What are the Expected Results?
Orthotripsy™ with the OssaTron© has been proven to be effective over 80% of the time with only one treatment. Some patients report immediate pain relief after treatment, although it can take up to four weeks for pain relief to begin.
Is it Safe?
Yes. Developed in 1991 and widely used in Europe, the OssaTron© is the first Orthotripsy™ device specifically designed and FDA-approved for orthopedic use. A wealth of medical experience, state-of-the-art engineering and optimal quality have been built into the OssaTron©, and extensive clinical studies and tests have confirmed its safety and efficacy.
Who should Consider OssaTron© Treatment?
Treatment is recommended for patients who have had chronic proximal plantar fasciopathy for six months or more and who have tried at least three other conservative (non-surgical) therapies without success.
What Other Treatments Are Available?
Some people who have plantar fasciitis get better with time, even with no treatment. Others get better after trying one or more conservative treatments, which may include rest from strenuous activity; application of heat and /or cold; conditioning and stretching exercises; use of orthotic devices (shoe insert or heel cup); physical therapy, including ultrasound; over-the-counter pain relievers such as aspirin or Tylenol (acetaminophen); prescription pain relievers; non-steroidal anti-inflammatory medications such as Advil (ibuprofen) or Aleve (naproxen); and steroid (cortisone) injections. In difficult cases of plantar faciitis, open or endoscopic surgery may be performed.
(back to menu)
Why Consider OssaTron© Treatment Versus Surgery?
Many times, invasive surgery leads to the development of thick scar tissue and a recurrence of equal or greater pain in the affected heel. Post-surgical protocol is four weeks or more of zero weight bearing, typically followed by casting and therapy. Total time for recovery and maximum medical improvement can be as much as a year.
The OssaTron© has a proven success rate that is equal to or greater than that of surgery-usually with just one treatment and without the inherent risks, complications and lengthy recovery time of surgery. The procedure takes about 30 minutes, is performed as an outpatient procedure, and requires no overnight hospital stay. Patients can bear weight (i.e., walk) and return to normal activity within a few days of the procedure.
Your doctor has recommended OssaTron© treatment as the most medically appropriate option for you based on your history.
Who Should Not Have OssaTron© Treatment?
The OssaTron© is not recommended for:
 anyone who is taking medication for bleeding problems or has a history of bleeding
or blood clotting problems.
 children
 pregnant women
(back to menu)
What If You Have A Special Health Condition?
The effect, safety and effectiveness of OssaTron© treatments has not yet been determined on people with the following health conditions:
 tarsal tunnel syndrome or other nerve entrapment disorders
 diabetic neuropathy
 fracture of the foot or ankle
 significant peripheral vascular disease
 severe osteoarthritis
 rheumatoid arthritis
 osteoporosis
 metabolic disorders
 malignancies
 Paget’s disease
 osteomyelitis
 systemic infection
Your doctor will provide you with information about how these and other health conditions might affect the decision to perform OssaTron© treatment.

What Will Happen On The Day Of Treatment?
Your doctor of healthcare facility will commonly ask you to arrive at the hospital or surgery center a few hours before your scheduled treatment. It is recommended that you should wear shorts or loose-fitting clothing that can easily be rolled up to the knee of your affected leg. You may be asked to change into a hospital gown. The staff may take your temperature, pulse and blood pressure, and ask some questions about your general health. They will also request that you sign a consent form for treatment, and indicate which side is to be treated.
The treatment can cause some discomfort or pain, so anesthesia is commonly given before the procedure is administered.
What Will Happen After The Treatment?
You’ll stay at the hospital or surgery center until the anesthetic wears off enough to walk safely.
Your doctor will probably ask you to restrict "stressful activity" such as jogging, heavy housework or yard work, and participating in sports for four weeks following treatment.
Pain relief begins for patients at different times. For some patients it is immediate; for others it may take four weeks. The full effect of the OssaTron© procedure may not be realized until the twelfth week following treatment. If you haven’t achieved any relief by then, you may consider having a second OssaTron© procedure. This is a decision you will make with your physician.

What Are Possible Side Effects/Complications?
OssaTron© treatment has minimal risks. In some cases it can cause skin reddening, bruising, tingling or the plantar fascia to tear. There may be changes in pain or temporary numbness.
Some patients reported a recurrence or episodes of pain following treatment, which may continue for a few days to several weeks. It is also normal to have some residual pain after intense exercise or a full day of work on your feet.
Treatment Procedure
1. Prior to administering anesthesia, the physician palpates the heel to determine the area of maximum tenderness (target tissue) and marks the area with a surgical marking pen. Once this has been completed, physician administers the form of anesthesia (either local or regional) he/she feels patient appropriate.
2. Once anesthesia has been administered, high viscosity ultrasound gel is applied to the area previously marked with the surgical marking pen (target tissue). The gel promotes shock wave conductance, enhancing treatment effectiveness.
3. The patient’s heel is firmly coupled to treatment head.
4. The OssaTron© Application Technician activates the shock wave via the shock wave release hand piece on the console.

Will My Insurance Pay For Treatment?
Many health insurance companies nationwide are incorporating Orthotripsy™ treatment into their policies. It is recommended that you ask your insurance provider if this treatment is a covered benefit. HealthTronics may be an out-of-network provider for the OssaTron© procedure. An out-of-network provider may increase your financial responsibility for treatment as well as the length of time you have to wait for an approval from your insurance company.
Your doctor and HT Orthotripsy™ Management LLC (the company that handles insurance processing for the OssaTron© procedure) will make every effort to obtain an approval from your insurance company. However, your insurance company has the final authority to approve or deny coverage. Patients themselves can and should be their own strongest advocates in obtaining approval for insurance benefits.
How Can I Get More Information?
Your doctor is the best person to talk with if you have questions or concerns about treatment with the OssaTron©. He or she has extensive knowledge and specialized training on all aspects of its use, safety and effectiveness. You can also learn more about the OssaTron© by visiting the HealthTronics web site at www.healthronics.com
HealthTronics Surgical Services . 1-800-464-3795 . 1841 West Oak Parkway, Suite A . Marietta, GA 30062

Result number: 65

Message Number 132174

Re: Low term results with ESWT View Thread
Posted by Ed Davis, DPM on 10/04/03 at 12:43

Dr. Z:
Thank you for your responses. The concept of cavitation has been discussed before in terms of comparing radial shock wave therapy (RSWT) which applies shock waves without the cavitation phenomenon. Its advocates claim efficacy. The creation of cavitation in terms of a necessaity fo tissue healing is uncertain.

As far as long term studies, there is a paucity of long term studies both in high and low energy ESWT. It may be somewhat easier to find such a study which you have due to the greater use and experience with low energy ESWT in Europe.

The number of variables that affect long term outcomes may be difficult to control. Once patients are effectively "cured" they often go back to the vocation/avocation that nay have been an instigating factor in the disease process, stop stretching, may not use their orthotics and stop payig attention to shoegear. These variables are difficult to control over the long term but any long term study would have to take these into account if a correlation is to be attempted.

It would be advantageous to have an objective parameter beyond the VAS scale to measure tissue level effects as that would enable us to get a better comparison. The only parameter we have is the measurement of plantar fascial thickness via MRI or ultrasound. It is true that the correlation between fascial thickness measured and the existence of fasciitis/fasciosis is problematic when applied to populations, different conclusions can be reached when that measurement is applied to individuals. When an individual (or group of individuals) has a specific thickness measurement and the application of one of the ESWT technologies leads to a measurable and significant change over time, a tissue level effect has been shown to have occurred. Keeping in mind that such patients entered ESWT with all of the other treatments in place, the only two parameters available to effect fascial thinning would be rest and/or ESWT. Most patients who I see already have moderated their activity level for an extended period of time so rest is apparently not the factor, ESWT is, with the thinning occurring irrespective of high or low energy use. This discussion has provided me an incentive to use diagnostic ultrasound imaging of the fascia more frequently in order to increase the numbers of patients I have made this observation on.
Ed

Result number: 66
Searching file 12

Message Number 129448

Re: Iraqi children View Thread
Posted by marie on 9/10/03 at 13:00

I thought this covered the problem in great detail I hope you like to read because it's a long report. I thought it intereting because it offered solutions and explained the situation very well.

marie


http://www.globalpolicy.org/security/sanction/iraq1/2002/paper.htm

Iraq Sanctions:
Humanitarian Implications and Options for the Future
Anglican Observer Office at the UN
Arab Commission for Human Rights
Center for Development of International Law
Center for Economic and Social Rights
Fellowship of Reconciliation • Global Policy Forum
New Internationalism Project, Institute for Policy Studies
Mennonite Central Committee
Middle East and Europe Office of Global Ministries of the United
Church of Christ and the Christian Church (Disciples of Christ)
Quaker UN Office-New York • United Church of Christ UN Office
World Economy, Ecology and Development Association (WEED)

in association with
Save the Children UK

August 6, 2002

--------------------------------------------------------------------------------

Contents

Executive Summary

Chapter 1 – Introduction

Chapter 2 – Comprehensive Economic Sanctions:
A Badly-Flawed Policy

Chapter 3 – Sanctions and the Civilian Population
3.1. Early Warnings
3.2 Steady Flow of Critical Reports


Chapter 4 – Causes of Human Suffering
4.1. Iran-Iraq War and Gulf War Campaign
4.2. Civil War, Regime Change, No-Fly Zones and Military Attacks
4.3. Responsibility of the Government of Iraq and the Politics of Vilification
4.4 Commercial Interests and Oil Politics


Chapter 5 – Oil-for-Food
5.1. Short Term Policy
5.2 Deductions and Delays
5.3 Blocked Contracts, Dual-Use and Holds
5.4 War Reparations Fund: Oil-for-Compensation
5.5 North vs. Center-South
5.6 Nutrition and Health
5.7 Deaths


Chapter 6 – “Smart” Sanctions, Price Disputes and Military Threats
6.1 Background
6.2 Smart Sanctions vs. Targeted Sanctions
6.3 Oil Pricing Dispute & Falling Humanitarian Revenue
6.4 US Military Threats and Appraisals of Iraq’s Rearmament


Chapter 7 – Security Council Obligations Under International Human Rights and Humanitarian Law
7.1. Legal Framework for the Security Council
7.2. Human Rights Law
7.3. Humanitarian Law


Chapter 8 – Conclusion & Policy Recommendations

Appendix I – Chronology

Appendix II – UK Select Committee Report

Footnotes



--------------------------------------------------------------------------------


Iraq Sanctions: Humanitarian Implications and Options for the Future
EXECUTIVE SUMMARY

1. Introduction The United Nations Security Council has maintained compre-hensive economic sanctions on Iraq since August 6, 1990. The international community increasingly views the sanctions as illegitimate and punitive, because of well-documented humanitarian suffering in Iraq and widespread doubts about the sanctions’ effectiveness and their legal basis under international humanitarian and human rights law.

2. A Flawed Policy In the early 1990s, many policy makers saw comprehensive economic sanctions, imposed under Resolution 687, as an ethical and non-violent policy tool. Though Iraq sanctions produced some significant disarmament results, they failed to achieve all their policy goals and they have deeply harmed powerless and vulnerable Iraqi citizens. The Security Council implicitly accepts such a negative assessment, since it no longer uses comprehensive economic sanctions in other security crises.

3. Warnings of Civilian Harm Civilian suffering in Iraq is not an unexpected collateral effect, but a predictable result of the sanctions policy. Security Council members have received warnings of the humanitarian emergency in Iraq and the damage done by sanctions since shortly after the Gulf War. Warnings have come from three Secretary Generals, many UN officials and agencies including UNICEF, WHO and WFP, and two Humanitarian Coordinators who have resigned in protest. A Select Committee of the UK House of Commons offered a very negative judgment as well.

4. Causes of Suffering Sanctions are not the sole cause of human suffering in Iraq. The government of Iraq bears a heavy burden of responsibility due to the wars it has started, its lack of cooperation with the Security Council, its domestic repression, and its failure to use limited resources fairly. However, the UN Security Council shares responsibility for the humanitarian crisis. The United States and the United Kingdom, who use their veto power to prolong the sanctions, bear special responsibility for the UN action. No-fly zones, periodic military attacks, and threats of regime-change block peaceful outcomes, as do vilification of Saddam Hussein, pro-sanctions propaganda, and other politicization of the crisis. Though real concerns about Iraq’s security threat undoubtedly are legitimate, commercial interests, especially control over Iraq’s oil resources, appear to be a driving force behind much of the policy making.

5. Oil-for-Food Sanctions advocates proposed Oil-for-Food under Resolution 986 as a temporary solution to the humanitarian crisis. Oil-for-Food materially improved conditions in Iraq in contrast to the early days of the sanctions. But Oil-for-Food failed to resolve the humanitarian crisis, much less provide a long-term solution for Iraq. Punitive deductions for war reparations weaken the program as do unacceptable delays in delivery (less than 60%f of all items ordered from oil sales since December 1996 have actually arrived in Iraq). Politically motivated blocks and “holds,” imposed almost entirely by the United States, have plagued the program as well. Consequently, there has been little repair and renewal of Iraq’s badly-deteriorated infrastructure, including water treatment, electricity, and public health. Oil-for-Food has failed to improve sufficiently the nutrition and health of Iraqi citizens, who continue to suffer from conditions drastically worse than the pre-sanctions period. Less than $200 per year per capita has arrived in Iraq under the program. Studies have amply documented a substantial rise in mortality of children, five years of age and under and credible estimates suggest that at least 400,000 of these young children have died due to the sanctions. Various reforms, including Resolution 1284 have proven ineffective in addressing these problems.

6. Smart Sanctions? The United States and the United Kingdom recently proposed “smart sanctions” as an answer to critics. This reform, embodied in Security Council Resolution 1409, offers small improvements, but it has little in common with the “targeted sanctions” that experts have proposed in recent years. Targeted sanctions would directly impact Iraq’s leaders, by freezing their assets and preventing their international travel, without damage to ordinary Iraqis. Resolution 1409 is grossly inadequate as a solution to the Iraq crisis. The enormous Goods Review List of items with possible military use suggests further blockage of goods and delays, as well as disappointingly little substantial advance. Meanwhile, a dispute over pricing methods has greatly reduced Iraq’s oil sales, drastically depleting the funds of the humanitarian program, while the United States threatens to attack Iraq and impose a change of regime.

7. International Law The Security Council has clear obligations under international human rights and humanitarian law, which provide means to assess its sanctions record. A number of policy papers by UN agencies and bodies, as well as studies by legal scholars, have determined that the Council is in serious violation of its responsibilities in the case of Iraq. The Council has committed both procedural and substantive violations, by failing to conduct regular assessments of the humanitarian impact of the sanctions and by directly violating a number of important rights including the rights of children to protection and the right to life itself.

8. Conclusion & Policy Recommendations A solution to the crisis in Iraq must be based on a comprehensive agreement between the United Nations and the Government of Iraq in which many important and interrelated issues would be addressed. The United Nations must begin with five steps:

Comprehensive economic sanctions must be lifted,
The UN “escrow account” must be eliminated,
Free trade (excepting military goods) must be re-established,
Foreign investments in Iraq must be permitted, and
Foreign assets of Iraq must be unfrozen so as to normalize its external economic relations
Such change will not be free of risk. The government of Iraq cannot be counted on to make benign and peaceful policy choices, or to promote automatically the well-being of its people. In this context

Robust weapons monitoring must be reintroduced, to insure disarmament and eliminate production programs for mass destruction weapons,
Disarmament in Iraq must be complemented by regional approaches to disarmament, especially elimination of mass destruction weapons and weapons programs in other regional states
The Government of Iraq must give firm assurances to the international community, as a part of reciprocal undertakings, that

It will renounce all plans to buy, build or use weapons of mass destruction and related delivery systems
It will cooperate fully with ongoing UN arms inspection arrangements
It will establish friendly and cooperative relations with neighboring countries
It will take all necessary steps to address the humanitarian emergency as soon as funds become available to do so
It will honor minority rights, including offering special status to the Kurdish areas, and it will take steps to honor its human rights obligations.
If the government of Iraq fails at any time to provide adequate means for inspection and arms control, then:

Narrowly-targeted sanctions, including financial and travel penalties, should be directed at Iraq’s leaders,
Time limits must be part of such a new sanctions regime,
Clear criteria for lifting and modification must also be part of the new sanctions regime,
Regular humanitarian assessments must also be part of the new sanctions as well, so that the Council will be aware of any possible impact on the broader Iraqi population.
If Iraq is to return to normalcy, and if it is to be persuaded to agree to international accords, it must be freed from constant military pressure, threats and intimidation. The Security Council’s decisions, not unilateral action by one or two powerful states, must prevail. In this framework

“No-Fly zones” must be eliminated and aerial threats and attacks halted,

Unilateral military attacks must be ruled out as completely unacceptable and illegal, and
Other efforts directed towards “regime change,” including force build-ups, military aid to opposition forces, and covert destabilization and assassination campaigns must cease.
Further elements in the design for post-sanctions Iraq are also required, in order to address immediate humanitarian concerns, long-term development needs and safeguards for minorities. In such a framework:

Emergency relief, to bring a speedy end to the human suffering, must be put in place with the help of the international community,
Large-scale physical reconstruction, to build a new infrastructure for Iraq, must be set in motion, including foreign investments, and
Safeguards for minorities such as the Kurds must be introduced, including federative structures and possibly a UN presence to monitor and promote human rights in the post-sanctions era.


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Chapter 1 - Introduction
The United Nations Security Council has maintained comprehensive economic sanctions on Iraq since August 6, 1990. (1) The international community increasingly views the sanctions as illegitimate and punitive, because of well-documented humanitarian suffering in Iraq and widespread doubts about the sanctions’ effectiveness and their legal basis under international humanitarian and human rights law. This paper examines key legal and humanitarian issues of the current sanctions arrangements and it argues for urgent, fundamental changes.

When first imposed, four days after Iraq’s invasion of Kuwait, under Resolution 661, the comprehensive sanctions appeared legitimate, as a short-term means to press Iraq to withdraw. When redefined on April 3, 1991, under Resolution 687, after the US-led military coalition had forced Iraq’s withdrawal, the sanctions likewise commanded broad support, as a means to compel Iraq’s compliance with Security Council resolutions and in particular to end Iraqi possession of weapons of mass destruction. (2) Iraq eventually met (however reluctantly) many of the UN requirements and the United Nations supervised substantial Iraqi disarmament, including extensive dismantlement of Iraq’s mass-destruction weapons, weapons programs and delivery systems. (3)

Questions still remain about the extent of Iraq’s compliance, but many experts believe that Iraq has been substantially disarmed and has little capacity left in the four banned weapons types. (4) Residual concerns and conjectures must be weighed against the sanctions’ present ineffectiveness, their great harm to innocent civilians, the clear option of targeted sanctions, and the discredit that the status quo brings to the United Nations, the Security Council and international law more generally. Though the overwhelming opinion of the international community favors change, comprehensive economic sanctions remain firmly in place and criteria for their lifting remain imprecise, fluid and subjective. (5)

A large majority of Security Council members now oppose the comprehensive sanctions or have serious reservations about them, but they cannot lift them, because vetoes of two Permanent Members, the United States and the United Kingdom, block action for comprehensive reform. Indeed, most discussions of Iraq sanctions have taken place in secret, among the Council’s five Permanent Members, side-stepping the ten Elected Members and keeping the international community in the dark. Ambassador Peter van Walsum of the Netherlands, Chairman of the Iraq Sanctions Committee in 1999-2000, spoke in an open meeting of the Council in November 1999 about the intense frustrations of elected Council members at this lack of information, transparency and accountability. (6)

Such secret diplomacy by the major powers shows disregard for the international community and for the lives and well-being of the people of Iraq. Recent adjustments by the Council in Resolution 1409 (May 14, 2002) fall far short of the needed fundamental change. Just two Council members negotiated in secret the Goods Review List, at the heart of the new resolution. Instead of such gestures, the international community should insist on the lifting of comprehensive economic sanctions. There must also be program to help re-build and restore the country’s civilian economy and to promote the democratic rights and human development of the Iraqi people.

All parties agree that the Iraqi people’s basic needs are unmet. Governments, UN agencies, the press, and international NGOs all acknowledge that the Iraqi population is living through a long humanitarian crisis. Those who defend the sanctions policy insist on blaming the government of Iraq and its leader, Saddam Hussein, for all the suffering, insisting that the humanitarian situation can only improve if the leader satisfies the demands of the US and the UK or, better still, relinquishes power. Such an approach holds Iraq’s humanitarian suffering hostage to international power politics, the hidden play of commercial interests, and the goal of “regime change.”

Sanctions do not cause all distress in Iraq. The government of Iraq must bear a large share of responsibility, because of its failure to comply with Council requirements and because of its failure to use all resources at its disposal to meet the humanitarian crisis. But as long as the United Nations maintains control over economic life in Iraq, the Security Council bears a joint responsibility with the Iraq government for the health and wellbeing of the population. The Council has the means to alleviate the economic crisis, but it has failed to discharge its responsibility to act in accord with universal human rights and humanitarian standards, as we shall see in more detail below.

The sanctions put economic pressure on the population and supposedly use civilian suffering as a tool in arms control negotiations with Iraq’s government. In theory, the deprived and angry populace will press their rulers to change policy. If policy does not change, the people are expected to reject the rulers and rise against them. This has proved to be a simplistic and false model. Politics in Iraq have not worked this way. To the contrary, the sanctions appear to have strengthened the government, by increasing its economic role and its symbolic appeal.

The suffering of Iraq’s civilian population must command primary attention and legal priority. The Security Council should not continue to pursue arms control goals with a mechanism that exacts such a high human cost. Rather, the Council should move towards alternatives that the overwhelming majority of international opinion has long favored:

lift comprehensive economic sanctions

abolish the UN “escrow” account

establish free trade in non-military goods

restore foreign investments

unfreeze Iraq’s foreign assets

establish robust UN weapons monitoring

require agreement by Iraq for disarmament, cooperation with arms inspection and friendly relations with its neighbors, in a framework of regional disarmament

impose, if needed, sanctions narrowly targeted at Iraqi government leaders, subject to time limits, clear criteria for lifting and regular humanitarian assessments

eliminate “no fly” zones, "regime change" programs and military threats directed at Iraq

provide international humanitarian assistance to help Iraq overcome its humanitarian crisis as swiftly as possible

organize programs to promote large-scale reconstruction of Iraq

establish safeguards for Iraq’s minorities, including special arrangements for the Kurdish areas in the North and possibly a UN presence to monitor and promote human rights
In the chapters that follow, this report will consider the flaws in comprehensive economic sanctions, the question of responsibility and the shortcomings of the oil-for-food program. The report will then consider the current “smart sanctions” in contrast to longstanding proposals for “targeted sanctions” aiming at political leaders. Finally, the report will look at the Security Council’s responsibilities under international humanitarian and human rights law and it will conclude with a discussion of recommended alternatives.

Chapter 2 - Comprehensive Economic Sanctions: A Badly-Flawed Policy
When the Security Council first imposed sanctions on Iraq in 1990, many diplomats, scholars and citizens believed that comprehensive economic sanctions were innovative, benign and non-violent. Some believed that sanctions offered an ethical foreign policy tool to combat threats to peace and security without causing unintended suffering. (7)

It is now clear that comprehensive economic sanctions in Iraq have hurt large numbers of innocent civilians not only by limiting the availability of food and medicines, but also by disrupting the whole economy, impoverishing Iraqi citizens and depriving them of essential income, and reducing the national capacity of water treatment, electrical systems and other infrastructure critical for health and life. People in Iraq have died in large numbers. The extent of death, suffering and hardship may have been greater than during the armed hostilities, especially for civilians, as we shall see in more detail below. (8) Comprehensive sanctions in Iraq, then, are not benign, non-violent or ethical.

The 1977 Protocols to the Geneva Conventions on the laws of war include a prohibition of economic sieges against civilians as a method of warfare. Ironically, legal consensus does not yet define economic sanctions as subject to these laws, which apply in warfare and which legally require belligerents to target military rather than civilian objectives. Sanctions operate in a hazy legal status between war and peace. (9) Unlike the dramatic, visible toll of military action, sanctions take their effect gradually, indirectly and with low visibility.

UN Secretary General Boutros Boutros-Ghali recognised the growing doubt about the legal and moral status of comprehensive sanctions when he wrote in 1995 that they

raise the ethical question of whether suffering inflicted on vulnerable groups in the target country is a legitimate means of exerting pressure on political leaders whose behaviour is unlikely to be affected by the plight of their subjects (10)
The Security Council has implicitly accepted this judgement. In recent years, it has always imposed either narrowly-targeted sanctions that seek to pressure rulers and elites directly, or embargos of arms sales to belligerents, or embargos of strategic resources fueling conflicts like diamonds. The Council has not imposed comprehensive economic sanctions since 1994 and no one expects that it will adopt this policy again. (11)
Iraq sanctions do not effectively target or affect political or military elites. Rather, they hit the weakest and most vulnerable members of Iraqi society, those with the least ability to influence decisions and who are least able to compete for scarce resources. The primary victims of the sanctions – children, the elderly, the sick, the poor -- are also those least responsible for government policy and least able to change policy. Even so, advocates in Washington have insisted that sanctions on Iraq are necessary and justified, as a means to pressure an evil dictator and keep him “in a box.” Such imperatives have found declining acceptance in the rest of the world, where people increasingly see comprehensive economic sanctions as a blunt and cruel weapon. As UN Secretary-General Kofi Annan stated in 2000:

just as we recognize the importance of sanctions as a way of compelling compliance with the will of the international community, we also recognize that sanctions remain a blunt instrument, which hurt large numbers of people who are not their primary targets. (12)
The sanctions on Iraq have left the country impoverished, isolated and socially disrupted, they resulted in widespread illness and death of innocent civilians, and they have tightened the grip of a repressive political regime.

Chapter 3 - Sanctions and the Civilian Population
3.1. Early Warnings

Iraq sanctions have not caused suffering as an unexpected collateral effect or a lesser evil that passed unnoticed. The suffering was not only foreseeable (and foreseen) in advance, but dozens of studies have documented it in great detail for more than a decade.

From the early days of the sanctions, well-informed UN officials and envoys warned about dire humanitarian consequences. In March 1991, Under Secretary General Martti Ahtisaari reported that, directly after the massive bombing of the Gulf War, the situation was especially troubling:

most means of modern life support have been destroyed or rendered tenuous. Iraq has, for some time to come, been relegated to a pre-industrial age, but with all the disabilities of post-industrial dependency on an intensive use of energy and technology. (13)
Ahtisaari pointed out that Iraq needed more than just emergency relief of food and medicine. The power grid and the communications system had been badly damaged, he said, and needed repair.
The far-reaching implications of this energy and communications vacuum as regards urgent humanitarian support are of crucial significance for the nature and effectiveness of the international response. (14)
In July of the same year, the Secretary General's Executive Delegate, Sadruddin Aga Khan, submitted a comprehensive report based on a country-wide assessment of conditions. The Executive Delegate’s report spoke of immediate needs for reconstruction as well as humanitarian assistance, setting the cost of restoring pre-war conditions at $22 billion. Calculating only the most urgently-needed initial reconstruction costs, he estimated that Iraq would require $6.8 billion in the first year, for which substantial quantities of Iraqi oil would have to be sold. (15) Many well-known international experts and eminent persons, as well as more than a dozen agencies, were involved in producing the report, which said:
Our aim has been to be sober, measured and accurate. We are neither crying wolf nor playing politics. But it is evident that for large numbers of the people of Iraq, every passing month brings them closer to the brink of calamity. As usual, it is the poor, the children, the widowed and the elderly, the most vulnerable amongst the population, who are the first to suffer. (16)
The report concluded, issuing a clear call:
It remains a cardinal humanitarian principle that innocent civilians – and above all the most vulnerable – should not be held hostage to events beyond their control. Those already afflicted by war's devastation cannot continue to pay the price of a bitter peace. It is a peace that will also prove to be tenuous if unmet needs breed growing desperation. (17)
Instead of making such humanitarian provision to avert the impending catastrophe, the Security Council passed Resolutions 706 and 712 (August 15 and September 19, 1991) which put a low cap on Iraq’s allowed oil sales and deducted about a third of the oil revenues to pay for war reparations, weapons inspectors and UN administrative expenses. The oil sales ceiling would have yielded (after deductions) about $1.1 billion every six months for Iraq’s humanitarian needs, (18) a small fraction of Sadruddin Aga Khan’s estimate for essential spending. The stage was set for rejection by Baghdad and years of fruitless manoeuvring. Neither side gave priority to the growing humanitarian crisis.
Nearly five years later, on May 20, 1996, the Council and the government of Iraq finally agreed to an Oil-for-Food program, under Resolution 986. The agreement allowed for the sale of oil to pay for humanitarian and other vital imports. (19) This step, while significant in some respects, was to prove woefully inadequate as a solution to the humanitarian emergency. (20)

3.2 A Steady Flow of Critical Reports

Throughout the 1990s, regular surveys by the Food and Agriculture Organisation/World Food Programme documented the lack of food in Iraq and its effect on vulnerable groups. In 1996 the World Health Organisation reported on health, morbidity and mortality data for 1989-1994 and commented:

Comparing levels of the infant mortality rate (IMR) and the mortality of children under 5 years old during the pre war period (1988-1989) with that during the period of the sanctions (since 1990), it is clear that the IMR has doubled and the mortality rate for children under 5 years old has increased six times. (21)
Various agencies, including UNICEF, presented reports to the Council, cataloguing the suffering, but the US and the UK used their diplomatic weight and threatened use of the veto to block remedial action beyond the Oil-for-Food program. (22) These two countries also used their considerable influence with the news media to downplay the seriousness of the humanitarian situation in Iraq, accusing humanitarian agencies of bad science or even complicity with the Iraqi government. (23) The two partners portrayed themselves as well-meaning, innocent victims of Saddam’s finely-tuned propaganda machine.
Legal and interpretive reports also appeared that raised the broader issue of sanctions policy within international law and policy. In 1996, the Graca Michel report to the General Assembly on the Impact of Armed Conflict on Children concluded that sanctions’

humanitarian exemptions tend to be ambiguous and are interpreted arbitrarily and inconsistently.... Delays, confusion and the denial of requests to import essential humanitarian goods cause resource shortages .... [Their effects] inevitably fall most heavily on the poor. (24)
The following year, the UN Committee on Economic, Social and Cultural Rights, headed by the distinguished Australian jurist Philip Alston, issued a report expressing concern that the Security Council, in establishing and maintaining sanctions, did not adequately take into account its responsibilities under economic, social and cultural rights law. The report stated that sanctions
often cause significant disruption in the distribution of food, pharmaceuticals and sanitation supplies, jeopardize the quality of food and the availability of clean drinking water, severely interfere with the functioning of basic health and education systems, and undermine the right to work. (25)
As such, the report continued, sanctions “have a major additional impact on the enjoyment of economic, social and cultural rights.” (26)
The Council’s Oil-for-Food program eased the worst of the food shortages as supplies began to arrive in mid-1997, but reports from the field suggested that the situation remained very serious. (27)

Responding to the many troubling reports and to the waning political support for sanctions, the chairman of the Security Council’s Iraq Sanctions Committee, Ambassador António Monteiro of Portugal, convened a series of meetings with Council colleagues during 1998. He brought together the chairmen of the Council’s sanctions committees, all elected members, to discuss the Council’s humanitarian responsibilities and the steps that it should take to improve sanctions more generally. On October 30, the group circulated a paper to the whole Council, setting forth its concerns with a series of reform proposals. The reformers noted that sanctions

often produce undesired side effects for the civilian population, including children. The decisions of the Security Council to impose sanctions imply the Council's obligation to ensure that proper implementation of sanctions does not result in violations of human rights and international humanitarian law, and its responsibility to do all within its power for the respect of the basic economic, social and cultural rights, and other human rights of the affected population. (28)
The paper insisted on the Council’s responsibility to monitor the impact of its sanctions, the need for clear criteria for lifting of sanctions, and the need to move towards “targeted” sanctions that would impact on top leaders, not the general population of the offending state.
Towards the end of 1998, the legitimacy of the sanctions/disarmament regime was enormously compromised by evidence that the United States had used the UN weapons inspection teams of UNSCOM to carry out espionage and covert action. (29) UNSCOM issued an alarmist report about the state of Iraq’s disarmament, said to have been strongly influenced by US pressure. In December, the US and the UK threatened to attack Iraq, to force compliance with the inspections. With military action imminent, the Chairman of UNSCOM, Richard Butler, ordered the weapons inspectors withdrawn. US-UK aerial attacks, beginning on December 16, continued for four days. (30) Discredited UNSCOM was never to return.

Though Council membership changed at the turn of the year, momentum for sanctions reform continued. The reformers succeeded in getting a watered-down version of the October proposals embodied in a statement by the President of the Council on January 29, 1999, giving some of the ideas official status. (31) Also in the October spirit, elected members persuaded the Council to establish three assessment “panels” on Iraq under the chairmanship of Ambassador Celso Amorim of Brazil. One panel considered arms control issues, a second looked at prisoners of war and other issues, while a third focused on the humanitarian situation. In its report of March 1999, the humanitarian panel set forth the alarming decline in living standards in Iraq, including health, food, infrastructure and education

In marked contrast to the prevailing situation prior to the events of 1990-91, the infant mortality rates in Iraq today are among the highest in the world, low infant birth weight affects at least 23% of all births, chronic malnutrition affects every fourth child under five years of age, only 41% of the population has regular access to clean water, 83% of all schools need substantial repairs. (32)
The report concluded with an implicit call for re-development and normalization of the Iraqi economy:
In presenting the above recommendations to the Security Council, the panel reiterates its understanding that the humanitarian situation in Iraq will continue to be a dire one in the absence of a sustained revival of the Iraqi economy, which in turn cannot be achieved solely through remedial humanitarian efforts. (33)
The report provides a measure of how far the sanctions had lost support within the Council’s membership.
In Baghdad, UN Humanitarian Coordinator, Hans von Sponeck, was raising alarms. His predecessor, Dennis Halliday, had resigned in the summer of 1999, in protest against the sanctions. Now von Sponeck himself was shocked by what he saw and was beginning to speak out strongly to visiting UN officials and others. A visiting delegation reported on this conversation:

The oil for food program provides him with $177 per person per year – 50 cents a day – for all of the needs of each Iraqi citizen. He said, “Now I ask you, $180 per year? That’s not a per capita income figure. This is a figure out of which everything has to be financed, from electrical service to water and sewage, to food, to health – the lot . . . that is obviously a totally, totally inadequate figure. (34)
Meanwhile, UNICEF’s 1999 survey of child mortality in Iraq provided some chilling facts. In a summary of the study, prepared for the distinguished British medical journal Lancet, researchers Mohamed Ali and Iqbal Shah presented the following findings:
Infant mortality rose from 47 per 1000 live births during 1984–89 to 108 per 1000 in 1994–99, and under-5 mortality rose from 56 to 131 per 1000 live births. (35)
On June 21, the UN Sub-Commission on the Promotion and Protection of Human Rights published a working paper by Marc Bossuyt, its expert representative from Belgium, which called sanctions on Iraq “unequivocally illegal” and said they had caused a humanitarian disaster “comparable to the worst catastrophes of the past decades.” (36) Later, the outraged US ambassador, charged that the report was “incorrect, biased and inflammatory.” (37)
In addition to death, disease and general impoverishment, some reports showed that the sustained sanctions in Iraq were having numerous other negative effects. Emigration was sapping away many of the best and brightest. Workers’ skills were disappearing after years of mass unemployment. Women had lost jobs disproportionately in the shrunken workforce. Stress and psychiatric illnesses had ravaged families. Social cohesion had steadily unravelled. (38) The Security Council became increasingly aware of these broader issues. Its humanitarian panel spoke of such effects in 1999, noting that observers often report alarming signs such as:

Increase in juvenile delinquency, begging and prostitution, anxiety about the future and lack of motivation, a rising sense of isolation bred by absence of contact with the outside world, the development of a parallel economy replete with profiteering and criminality, cultural and scientific impoverishment, disruption of family life. WHO points out that the number of mental health patients attending health facilities rose by 157% from 1990 to 1998. (39)
Many Council members hoped that the panel reports would lead to remedial action and that the Council would eventually lift the comprehensive sanctions, moving towards sanctions targeted at Saddam Hussein and his inner circle. Many also hoped for regular monitoring of sanctions’ humanitarian impact, as agreed in the January presidential statement. Negotiations began towards a comprehensive new resolution, but Washington held firm against substantive change and the UK, unable to persuade its partner to adopt a more reform-oriented policy, chose to maintain a status quo posture as well.
Because of deep differences, the Council did not adopt a new resolution until the end of 1999. A divided Council finally adopted Resolution 1284 on December 17 with abstentions by three Permanent Members: Russia, China and France. It fell far below the earlier hopes of sanction reformers such as Argentina, Brazil, Canada, and Slovenia, though it did incorporate a few of the moderate panel suggestions. It lifted the cap on oil sales completely (40) and it marginally relaxed the system of goods review. It also set forth rules for an improved system of weapons inspection. But it proposed neither targeting, nor humanitarian monitoring procedures, the two most important reform proposals. Further, it left more vague than ever the conditions under which the Council would consider lifting or “suspending” the sanctions. (41)

Even in the UK parliament, scepticism about Iraq sanctions abounded. On January 27, 2000, after ten months of hearings, the House of Commons Select Committee on International Development issued a report that proved a sharp rebuke to the government’s sanctions policies. (42) The Executive Summary stated that:

There is a clear consensus that the humanitarian and developmental situation in Iraq has deteriorated seriously since the imposition of comprehensive economic sanctions whilst, at the same time, sanctions have clearly failed to hurt those responsible for past violations of international law as Saddam Hussein and his ruling elite continue to enjoy a privileged existence. (43)
In February, UN Humanitarian Coordinator von Sponeck announced his resignation and on 29 March, as he prepared to leave Baghdad, he explained that “I can no longer be associated with a program that prolongs suffering of the people and which has no chance to meet even basic needs of the civilian population.” (44) Later, he would declare that “lawlessness of one kind does not justify lawlessness of another kind,” and ask “how long must the civilian population be exposed to such punishment for something that they’ve never done?” (45) A few weeks later, UN Secretary General Kofi Annan expressed doubts of his own. At a meeting organized by the International Peace Academy and in the presence of most Council ambassadors he concluded that:
The record of the “Sanctions Decade” has raised serious doubts not only about the effectiveness of sanctions, but also about their scope and severity when innocent civilians often become victims not only of their own government, but of the actions of the international community as well.
When robust and comprehensive economic sanctions are directed against authoritarian regimes, a different problem is encountered. Then, tragically, it is usually the people who suffer, not the political elites whose behaviour triggered the sanctions in the first place.

...sanctions remain a blunt instrument, which hurt large numbers of people who are not their primary targets. (46)

On the same day, Canadian Foreign Minister Lloyd Axworthy spoke to the Council during a special session on sanctions and insisted that “sanctions must reflect the will of the international community – not just the interests of its more powerful members.” (47) Three months later, French Foreign Minister Hubert Védrine stated that his country considered Iraq sanctions “cruel, ineffective and dangerous.” (48)
In spite of these many warnings, pressures, legal opinions and expressions of humanitarian concern, the US-UK gave few concessions to the critics, insisting always on Iraqi perfidy. According to insiders, the US stepped up pressure on Council members for silence and conformity. The most reform-oriented ambassadors, including Amorim himself, were recalled by their governments or assigned to other postings. Activist junior diplomats likewise moved on. The reform vision faded, though deep opposition continued within the Council’s chambers.


Chapter 4 - Causes of Human Suffering
4.1. Iran-Iraq War and the Gulf War

Two wars, both started by Saddam Hussein, laid a basis for the harsh impact of comprehensive economic sanctions on Iraq. The Iran-Iraq War of 1980-88 greatly damaged Iraq and reduced it from prosperity to economic difficulty. The United States and the UK (as well as France and the Soviet Union) supported Iraq in that conflict, the longest conventional war of the twentieth century. The support included weapons sales, military advisors and intelligence sharing. The United States provided, among other things, economic assistance, political support, arms, satellite intelligence and the assistance of a US naval battle group. (49) Iran proved a resilient foe, however, and the war dragged out at great cost in life and material infrastructure.

In addition to great damage on the Iranian side, the Iran-Iraq War destroyed several Iraqi cities and much of Iraq’s oil production and refinery system. It caused several hundred thousand Iraqi casualties. It also caused environmental damage, stripped the government of cash, halted infrastructure building and government welfare programs, and caused large human displacement. (50) Saddam Hussein’s dictatorship and internal repression grew still more oppressive during wartime conditions, including a harsh campaign against the Kurds in the North, though both the United States and the UK governments deflected attention from the widespread human rights violations and the regular use of chemical weapons by their ally. (51)

In the Gulf crisis and War of 1990-91, Saddam Hussein again attacked a neighboring country – the oil rich emirate of Kuwait – and sought to annex it. This time, the United States and the UK opposed Hussein, along with many other countries. US President George Bush Sr. declared: “Our jobs, our way of life, our own freedom ... would all suffer if control of the world’s great oil reserves fell into the hands of Saddam Hussein.” (52) A series of United Nations Security Council resolutions called on Iraq to withdraw, imposed sanctions and authorized the use of force by member states. The United States took the lead in a coalition that eventually launched an air war against Iraq, followed by a brief ground campaign that drove Iraq from Kuwait and decisively defeated Iraqi forces. (53)

This second war resulted in many Iraqi casualties as well as grave damage to Iraq’s infrastructure with losses estimated at $170 billion. (54) Much of the damage was due to one of history’s heaviest aerial bombardments, a 43-day long campaign conducted largely by units of the US air force. (55) US President George Bush Sr. claimed publicly that

we do not seek the destruction of Iraq, nor do we seek to punish the Iraqi people for the decisions and policies of their leaders, (56)
yet US war planners created conditions for civilian suffering in the course of the intense bombing campaign. As a Washington Post article reported a few months afterwards:
Planners now say their intent was to destroy or damage valuable facilities that Baghdad could not repair without foreign assistance. The worst civilian suffering, senior officers say, has resulted not from bombs that went astray but from precision-guided weapons that hit exactly where they were aimed – at electrical plants, oil refineries and transportation networks... ‘What we were doing with the attacks on infrastructure was to accelerate the effect of the sanctions’… If there are political objectives that the U.N. coalition has, it can say, 'Saddam, when you agree to do these things, we will allow people to come in and fix your electricity.' It gives us long-term leverage’… Said another Air Force planner: ‘We're not going to tolerate Saddam Hussein or his regime. Fix that, and we'll fix your electricity.” (57)
United States war planners did not intend to march on Baghdad and install a new government. Instead, the coalition ground forces halted their offensive in southern Iraq and signed a cease-fire with Baghdad. US policy planners expected that the war had weakened Iraq militarily and economically, and that post war unrest and economic sanctions would succeed in toppling the Saddam regime soon afterwards.
4.2 Civil War, Regime-Change, No-Fly Zones and Military Attacks

After the Gulf War, United States radio broadcasts urged Iraqis to rise up against the Hussein regime. In March, the Shi’a populations in the South and the Kurds in the North staged an insurrection and a brief civil war followed. The uprising failed to topple the government, however, and Baghdad soon brutally repressed it in the South, while US unilateral military intervention under Operation Provide Comfort in the North eventually provided some protection for the Kurdish populations. (58) The United States continued to insist on “regime change” to sweep the dictator from power.

The Security Council never agreed, however, to “regime change” as a purpose of its sanctions against Iraq. Resolution 687 referred to disarmament and other issues, but it said nothing about a new government. Nevertheless, the United States openly pursued this other goal. On February 15, 1991, at the end of the Gulf War, President Bush had made the point quite bluntly: “(T)here’s another way for the bloodshed to stop, and that is for the Iraqi military and the Iraqi people to take matters into their own hands and force Saddam Hussein, the dictator, to step aside and then comply with the United Nations’ resolution." (59) To a greater or lesser extent, regime change has continued to be a goal of US policy ever since.

In April 1991, the US, the UK and France established a “no-fly zone” in the North, originally to protect coalition military operations in the area. This policy banned Iraqi aircraft from flying over the national territory above 36 degrees north latitude. To this the three allies added in August 1992 a “no-fly zone” in the South, excluding Iraqi overflight of territory below 32 degrees. The US and its partners claimed that Security Council Resolution 688 authorized these actions, though the resolution was not adopted (as would be required) under Chapter VII of the UN Charter and said nothing about military measures or Iraq’s aircraft or airspace. The protagonists said their no-fly enforcement overflights were undertaken to protect vulnerable populations of Shi’a in the South and Kurds in the North from further blows by Baghdad, but Turkey was not restrained from striking blows at Kurds in this zone or from repressing its own Kurdish population across the border. (60) Further, the no-fly zone did not even include several major Kurdish cities in the North. Nor did the southern no-fly offer any clear protection to populations there. France withdrew from northern “no-fly” enforcement at the end of 1996 and southern no-fly at the end of 1998. Thousands of overflights each year, mainly by US-UK military aircraft, enforced these zones on a daily basis.

In addition to no-fly, the powers launched military operations against Iraq, by aircraft and cruise missiles. France participated in the attack of January 13, 1993 involving 80 strike aircraft, but thereafter the French withdrew from this type of action. United States forces, operating from a variety of ground bases and naval ships, carried out most of these operations, sometimes with UK participation. The main events took place on January 17 (42 cruise missiles) and June 26 (23 cruise missiles), 1993, September 3-4, 1996 (Operation Desert Strike)(44 cruise missiles), and especially December 16-19, 1998 (Operation Desert Fox)(hundreds of strike aircraft and cruise missiles). (61) There were also a variety of military deployment operations intended to threaten Iraq, including US operations titled Phoenix Scorpion I, II, III and IV and phases of Operation Desert Thunder, together lasting from November 1997 to December 1998. (62)

Some of these attacks targeted sites in Baghdad or other populated areas and resulted in civilian casualties. Operation Desert Fox, in December 1998, an intense aerial attack, destroyed a Basra oil refinery and hit a number of targets in Baghdad and other cities, including civilian housing. (63) More US-UK air strikes followed Desert Fox as part of no-fly enforcement, under “enlarged rules of engagement” (64) and an enlarged no-fly zone (to the 33 degree parallel, near the southern suburbs of Baghdad). These more robust and provocative patrols led to hundreds of clashes with Iraqi forces, including attacks on radar and anti-aircraft missile sites, command and control centers, intelligence installations and more, including sites outside the no-fly areas. They resulted in regular civilian casualties. (65)

When the UN Humanitarian Coordinator, Hans von Sponeck, documented these strikes (as well as the destruction and death they caused, and the danger to UN staff), the US and the UK reacted with outrage and demanded his resignation. (66)

Such unilateral military attacks deepened confusion as to the economic sanctions policy and what steps the Iraqi government could be expected to take to cooperate with UN inspectors and to comply with requirements that might lead to the lifting of sanctions. The Russian ambassador at the UN, Sergey Lavrov, remarked in the Council that “it was not possible to ask the [Iraqis] to cooperate and, at the same time, bomb their territory.” (67)

4.3 Responsibility of the Government of Iraq and the Politics of Vilification

The government of Iraq under Saddam Hussein bears responsibility for the wars and the weapons programs that brought suffering to Iraq’s people and its neighbors. The government of Iraq has also been a notorious human rights abuser. The United States and the UK often point to these crimes as rationale and justification for the sanctions. But sanctions cannot legally, under the UN Charter or under any standard of international law, serve as punishment for past acts, heinous as they are. Nor, of course, should the punishment fall on the people of Iraq and not the responsible leaders themselves.

As the international community grew increasingly aware of the human costs of the sanctions, the US and UK worked tirelessly to shift responsibility away from themselves and onto Saddam Hussein. By charging Saddam with non-compliance, they sought to prove that the Iraqi leader was himself solely answerable and deserved full moral opprobrium. In fact, considerable compliance occurred up to 1998, in spite of the Iraq government’s obstruction and lack of full cooperation.

The US and the UK also accused the Iraqi leader of various kinds of malfeasance that deepened his people’s economic and social crisis. The accusations charged that Saddam built presidential palaces, a stadium and a lavish safari park, while his people were suffering, and that he built an artificial lake during a drought. (68) Many of the charges appear to be true and reflect the Iraqi government’s lax humanitarian priorities. However, these projects appear to have cost only a small portion of the country’s vast needs for humanitarian supplies and capital re-building. While outrageous, they fall far short of providing by themselves an explanation for Iraq’s humanitarian emergency. (69)

Other charges directly address the Oil-for-Food program. In 1998 and 1999, the Western press accused the Iraqi government of not ordering adequate baby foods, of failing to order pulses – a main ingredient in Iraqis’ diets — and even of exporting foods. (70) In many cases, these allegations have proved unfounded, as we shall see. (71) Where true, they confirm the government’s unacceptable priorities, but again do not explain more than a fraction of the humanitarian emergency.

UK Minister of Defence George Robertson accused Iraq’s government of preventing medical supplies in Iraqi warehouses from reaching the population. (72) This accusation was a serious misrepresentation, based on selective use of the UN Secretary General’s report issued in February 1999, where a number of reasons for holding stocks and slow delivery were clearly listed. (73) The same charge is repeated on the US State Department “Myths and Facts About Iraq” web site where it is said, falsely, that “Saddam has been criticised by the UN for intentionally hoarding medicines in warehouses.” In fact, the World Health Organization had urged the Iraqi government to increase its buffer stocks because of uneven and unpredictable supply chains, while computerization of records (likewise recommended by the UN) had temporarily slowed deliveries. Lack of transportation equipment, due to the sanctions, also slowed delivery of medicines at this time.

The US and the UK have also blamed Saddam Hussein not halting the sale on the black market of items such as medicine, food, and food rations that entered Iraq through the Oil-for-Food program. However, as the UN Humanitarian Coordinator Tun Myat has pointed out, desperately poor citizens sometimes sell a portion of their rations to raise cash for their household. (74) UN reports have repeatedly stated that Iraq has acceptably carried out the Oil-for-Food distribution plan (which must be previously approved by the Security Council).

The UN Office of the Iraq Programme has referred to the shortcomings of the government of Iraq in regular information provided to the Council, including Iraq’s failure to act on all approved contracts, its slow implementation of letters of credit and other financial transactions, and its other management failures. (75) The OIP has reported that the government of Iraq delayed issuance of visas to experts who were needed for electricity and other technical projects and that it has failed to cooperate fully with the UN programs. At the same time, OIP admits that serious delays are often due to UN procedures and to cumbersome arrangements mandated by the Security Council, such as UN contract checking procedures at Iraqi ports of entry that can greatly delay shipments. (76)

No one can condone the Iraqi government’s failings and its lack of proper concern for the well-being of its people. To blame the government of Iraq alone for the human crisis, though, is to ignore the responsibility of the Security Council and two of its leading members.

The politics of blame, instigated by the supporters of comprehensive economic sanctions, seeks to focus public discussion on the behaviour of a vilified Saddam Hussein, as the personification of evil and to absolve the Security Council (and the US-UK) from all responsibility. This line of argument reduces the Iraqi people’s plight to a single cause: the machinations of a demented dictator. It is quite possible to remain a vigorous critic of Saddam Hussein and to reject this distorting project of vilification as an excuse for the sanctions. The lead reforming delegations on the Council such as Canada and Slovenia clearly had no sympathy for the Iraqi leader and loathed his human rights record. Indeed, they proposed targeting him and his circle directly in a new sanctions approach. Paradoxically, those who proposed vilification insisted on sanctions that were least damaging to Hussein and worked most clearly to his advantage!

European inter-war history of 1919-38 shows that national humiliation and ruinous economic pressure by the victors breeds resentment on which dictatorships thrive. (77) The founders of the United Nations knew this lesson well. Some of their successors have tragically chosen to forget.

4.4 Commercial Interests and Oil Politics

Enormous commercial interests shape policies on Iraq sanctions, taking their toll in human consequences. Oil resources have greatly influenced Iraq’s own domestic politics, of course. Oil revenues created a welfare state with considerable benefits prior to 1990, but they also fuelled Iraq’s oppressive government, its army, its intelligence services and its weapons programs, laying some of the basis for the current conflict. Iraq manipulates its oil sales, trade contracts and future oil production agreements to gain external political backing. But the commercial dimension of Iraq sanctions do not end with Iraq’s own “oil rent” dictatorship and the regime’s manoeuvres for survival.

Neighboring states such as Jordan, Syria, Egypt, the United Arab Emirates and Turkey have clear interests in a lucrative export trade with Iraq, which greatly influences their policy towards this powerful neighbor. (78) They get oil-for-food contracts and they are involved in the smuggling trade as well. (79) Egypt saw its exports to Iraq soar from $105 million in 1997 to almost $1 billion in 2000. UAE exports to Iraq rose from $24 million to over $500 million in the same period. Syria and Turkey benefit from transiting Iraq’s oil exports, for they are bordering states through which Iraq’s oil flows, both legally and illegally. Additionally, Jordan has a special deal for Iraqi oil at reduced prices for its domestic use. France, Russia and China (permanent members of the Security Council) also have very substantial interests in commercial relations with Iraq, selling hundreds of millions of dollars in goods every year to Baghdad. Of the first $18.29 billion of oil-for-food contracts approved by the Security Council, $5.48 billion went to just these three countries. Further, Russia and France are owed billions of dollars by Iraq from arms sales prior to the Gulf War, loans they hope will be repaid through enlarged trade, oil deals, and growing Iraqi prosperity. Finally, Russian, Chinese and French companies are buyers of Iraq’s oil. Russian traders, in particular, have won a very large share of recent Iraqi oil-sale contracts. Iraq offers these commercial deals to curry favour and support. Commercial interests incline these states to support Iraq and to favor a more lenient approach to sanctions policies, though continued sanctions may offer some of them rich rewards in smuggling and “political” contracts that they could not win on an open market.

The most important commercial interest in Iraq is not trade but oil (and gas) production. Iraq possesses the world’s second largest proven oil reserves, currently estimated at 112.5 billion barrels, about 11% of the world total and its gas fields are immense as well. Many experts believe that Iraq has additional undiscovered oil reserves, which might double the total when serious prospecting resumes, putting Iraq nearly on a par with Saudi Arabia. Iraq’s oil is of high quality and it is very inexpensive to produce, making it one of the world’s most profitable oil sources. Oil companies hope to gain production rights over these rich fields of Iraqi oil, worth hundreds of billions of dollars. In the view of an industry source it is “a boom waiting to happen.” (80) As rising world demand depletes reserves in most world regions over the next 10-15 years, Iraq’s oil will gain increasing importance in global energy supplies. According to the industry expert: “There is not an oil company in the world that doesn’t have its eye on Iraq.”(81) Geopolitical rivalry among major nations throughout the past century has often turned on control of such key oil resources. (82)

Five companies dominate the world oil industry, two US-based, two primarily UK-based, and one primarily based in France. (83) US-based Exxon Mobil looms largest among the world’s oil companies and by some yardsticks measures as the world’s biggest company. The United States consequently ranks first in the corporate oil sector, with the UK second and France trailing as a distant third. Considering that the US and the UK act almost alone as sanctions advocates and enforcers, and that they are the headquarters of the world’s four largest oil companies, we cannot ignore the possible relationship of sanctions policy with this powerful corporate interest.

US and UK companies long held a three-quarter share in Iraq’s oil production, but they lost their position with the 1972 nationalization of the Iraq Petroleum Company. (84) The nationalization, following ten years of increasingly rancorous relations between the companies and the government, rocked the international oil industry, as Iraq sought to gain greater control of its oil resources. After the nationalization, Iraq turned to French companies and the Russian (Soviet) government for funds and partnerships. (85) Today, the US and UK companies are very keen to regain their former position, which they see as critical to their future leading role in the world oil industry. The US and the UK governments also see control over Iraqi and Gulf oil as essential to their broader military, geo-strategic and economic interests. At the same time, though, other states and oil companies hope to gain a large or even dominant position in Iraq. As de-nationalization sweeps through the oil sector, international companies see Iraq as an extremely attractive potential field of expansion. France and Russia, the longstanding insiders, pose the biggest challenge to future Anglo-American domination, but serious competitors from China, Germany and Japan also play in the Iraq sweepstakes.(86)

During the 1990s, Russia’s Lukoil, China National Petroleum Corporation and France’s TotalElfFina held contract talks with the government of Iraq over plans to develop Iraqi fields as soon as sanctions are lifted. Lukoil reached an agreement in 1997 to develop Iraq’s West Qurna field, while China National signed an agreement for the North Rumailah field in the same year (China’s oil import needs from the Persian Gulf will grow from 0.5 million barrels per day in 1997 to 5.5 million barrels per day in 2020, making China one of the region’s most important customers). (87) France’s Total at the same time held talks for future development of the fabulous Majnun field.

US and UK companies have been very concerned that their rivals might gain a major long-term advantage in the global oil business. “Iraq possesses huge reserves of oil and gas – reserves I’d love Chevron to have access to,” enthused Chevron CEO Kenneth T. Derr in a 1998 speech at the Commonwealth Club of San Franciso, in which he pronounced his strong support for sanctions. (88) Sanctions have kept the rivals at bay, a clear advantage. US-UK companies hope that the regime will eventually collapse, giving them a strong edge over their competitors with a post-Saddam government. As the embargo weakens and Saddam Hussein holds on to power, however, stakes in the rivalry rise, for US-UK companies might eventually be shouldered aside. Direct military intervention by the US-UK offers a tempting but dangerous gamble that might put Exxon, Shell, BP and Chevron in immediate control of the Iraqi oil boom, but at the risk of backlash from a regional political explosion.

In testimony to Congress in 1999, General Anthony C. Zinni, commander in chief of the US Central Command, testified that the Gulf Region, with its huge oil reserves, is a “vital interest” of “long standing” for the United States and that the US “must have free access to the region’s resources.” (89) “Free access,” it seems, means both military and economic control of these resources. This has been a major goal of US strategic doctrine ever since the end of World War II. Prior to 1971, Britain (the former colonial power) policed the region and its oil riches. Since then, the United States has deployed ever-larger military forces to assure “free access” through overwhelming armed might. (90)

To appraise the humanitarian and human rights impact of Iraq sanctions, we must take into account these commercial and oil interests and their substantial policy impact. Such factors do not alone determine the course of Iraq sanctions, but they appear to be an enormously powerful policy influence. Members of UN Security Council delegations are well-aware of this, and they privately refer to it often. Indeed, they cannot avoid a cynical posture towards their responsibilities under international law, as they become aware that oil politics and geo-strategic rivalry greatly overshadows humanitarian considerations that could protect and guarantee the rights of innocent Iraqis.


Chapter 5. Oil-for-Food
In the mid-1990s, as political support for Iraq sanctions declined, the Security Council decided to revise its earlier plan on humanitarian trade, proposing that Iraq export oil on a controlled basis and use the revenues, under UN supervision, to buy humanitarian supplies. The Council passed Resolution 986 as a “temporary” measure on April 12, 1995, with a restrictive cap on oil sales. The government of Iraq, facing an increasingly serious economic crisis, agreed to the Council’s conditions a year later. Though Oil-for-Food brought undoubted short term benefits to a desperate population, it never eliminated the humanitarian crisis.

5.1. A Short Term Policy

When the Security Council and the government of Iraq finally agreed in May 1996 to allow the sale of oil for the purchase of food and other necessities, no one supposed that six years later the UN would be still be operating on the same basis, running a program to provide the Iraqi population with an inadequate supply of even the most basic necessities. (91)

In November 2000 the UN Secretariat reported to the Security Council that

the humanitarian programme was never intended to meet all the humanitarian needs of the Iraqi population or to be a substitute for normal economic activity. Also the programme is not geared to address the longer term deterioration of living standards or to remedy declining health standards and infrastructure. (92)
The Secretary-General repeated this concern in his report of March 2, 2001, reminding the Council that Oil for Food "was never meant to meet all the needs of the Iraqi people and cannot be a substitute for normal economic activity in Iraq."
The US and the UK have consistently ignored the implications of such warnings. As year after year of this “short term” program passes, it results in further deterioration of the country’s dilapidated infrastructure, more human suffering, and deeper damage to Iraqi society. Officials in the United Nations with direct experience in administering Oil-for-Food, like Denis Halliday and Hans von Sponeck, concluded that the system was unworkable and should not continue.

5.2 Deductions and Delays

Under Resolution 986, the Council initially allowed Iraq to sell $2.0 billion worth of oil every six months. The resolution called for deductions of 30% from all Iraqi oil sales to finance the Compensation Fund. The resolution allowed additional deductions of about 4% for UN agencies including the Office of the Iraq Programme (OIP), the arms inspection units (the UN Special Commission - UNSCOM - and the International Atomic Energy Authority – IAEA), and for fees for the use of the Turkish pipeline for Iraq’s oil exports. Of the remaining 66%, the resolution earmarked 13% for the three autonomous Kurdish northern governorates of Dahuk, Arbil and Suleymaniyah, where a UN inter-agency group would run the humanitarian program, and the remaining 53% for the balance of the country where the government would be in charge of distribution. The government of Iraq accepted the resolution in May 1996, and oil started flowing in December 1996. Because of procurement and shipping lags, the UN humanitarian supplies did not arrive in Iraq until April 1997.

This arrangement contained a strange allocation of the deductions, taking them all from the portion allocated to the Baghdad-controlled population. Thus the 13% of the population in the Kurdish areas of the North got 13% of the total oil sales, while 87% of the population in the Baghdad-controlled areas in the Center and South got just 53% of oil sales – 61% of the rate available in the North. (93)

Contrary to common perception, the Oil-for-Food program is not “humanitarian aid.” No foreign government or NGO donates food, medicines or other necessities to Iraq under the program. The government of Iraq sells oil and then pays in hard currency (from a UN-controlled “escrow account”) for imports which the Security Council Sanctions Committee must approve. Thereafter, the UN distributes the imports in the North and UN staff oversee Iraqi government distribution in the Center and South.

From December 10, 1996 until July 19, 2002, a period of over five and a half years, the government of Iraq sold a total of $55.4 billion in oil through UN-controlled sales. This amount looks impressive. However, far less in value of goods has arrived in Iraq. After 33% deductions for a combination of war reparations, UN operations and other items, the Council and the UN Secretariat approved $35.8 billion in contracts. (94) As of July 19, 2002, only $23.5 billion worth of goods had actually arrived in Iraq. (95) A combination of factors explain this $10.2 disparity, including cumbersome procedures imposed by Security Council rules, poor or obstructionist Iraqi management, “holds” mostly imposed by the United States, and other factors.

Over a period of about five years, serving an Iraqi population of 23 million, the program has delivered roughly $200 worth of goods per capita per year, including oil spare parts and other goods not directly consumed by the population. Allowing for domestic production outside the Oil-for-Food program and for smuggling, the result still appears to leave Iraqi citizens an exceedingly low per capita income which may be at or below the $1 per day World Bank threshold of absolute poverty.

Responding to criticisms of slow delivery, the Security Council has streamlined procedures for contract approval since the early days of the program. By 2002, the UN Office of the Iraq Programme (OIP) had introduced procedural reforms including electronic submission of contract technical details, electronic signatures from border inspection personnel, several fast-track lists for items with no dual-use concern, a pre-vetting of contracts by OIP experts, and improved means for financial transactions. But OIP has been under-staffed and faced with a huge and growing task of contract management and oversight.

For the country as a whole, less than two-thirds of the ordered items have arrived during the whole program. Sanctions proponents argue that this discrepancy is largely due to deliberate Iraqi obstruction. The evidence, rather, is that the contract approval system put in place by the Security Council bears a substantial responsibility for these delays and delivery blockages. In spite of improvements and reforms and in spite of the good will of many UN officials who do their best to speed the process along, oil-for-food still suffers from heavy bureaucratic centralization and red tape, as well as political manipulation, for which the Iraqi people pay a heavy price.

5.3 Blocked Contracts, Holds and “Dual-Use”

In the period before Oil-for-Food, the Iraq Sanctions Committee reviewed proposed import contracts to determine whether they should be exempted from the import ban under Resolution 687. Foods and medicines considered strictly humanitarian most readily won approval, but even in this humanitarian area the Committee blocked contracts when a single delegation objected. The United States tended to block foods that might be inputs to Iraqi food processing industries as well as a range of medicines that were alleged to have potential military use. Additionally, the United States, blocked a large number of contracts for other goods, including wrist watches, paper, textiles, shoe soles and other ordinary items that had no possible military use. The US blocked shoe soles as inputs to Iraqi industry but allowed complete shoes to be imported, it blocked textiles but allowed ready-to-wear clothes to be imported. The Committee never developed any criteria, addressing each contract on an ad hoc basis. The United States and the UK were not the only delegations to propose blockage of contracts, but they were responsible for the great majority of blockages. Their actions appeared to many observers to be arbitrary, capricious and punitive. (96)

After the passage of Resolution 986, the ground rules changed, but barriers to contracts remained a major issue of contention. The United States and the UK insisted that Iraq be prevented from importing not only weapons but also items that appear to be for civilian use but which might in some way contribute to the government’s military capacity or be turned into weapons through re-manufacturing. Such items are known as “dual-use.” A Council member could place such items, or any other that they chose, on “hold” – blocking them as an agreed import. Of fifteen Council members, only two made regular use of holds: the United States and the UK. The United States imposed the overwhelming majority. As of July 19, 2002, no less than $5.4 billion in contracts were on hold, (97) up from $3.7 billion on May 14, 2001.

Holds have blocked vital goods. They have affected water purification systems, sewage pipes, medicines, hospital equipment, fertilizers, electricity and communications infrastructure, oil field equipment, and much else. Sometimes just a small part of these contracts is alleged to have dual use. Other Council members do not agree that these items represent a credible dual-use threat, and they have often noted that holds are imposed inconsistently – an item may be placed on hold on one occasion and let through on another, even on contract with the same firm. Because the Sanctions Committee works by consensus, a single member can block any contract, even if all other members are ready to approve. As a result of these holds, contracts for many critical infrastructure projects failed to gain approval, generating much international criticism of the holds process and contributing to the broad loss of credibility of the Iraq sanctions regime.

On December 18, 2001, the OIP weekly update noted that

The total value of contracts placed on hold by the 661 Committee continued to rise . . . The “holds” covered 1,610 contracts for the purchase of various humanitarian supplies and equipment, including 1,072 contracts, worth $3.85 billion, for humanitarian supplies and 538 contracts, worth $527 million, for oil industry equipment. During the week, the Committee released from hold 14 contracts, worth $19.8 million. However, it placed on hold 57 new contracts, worth $140.6 million. (98)
These numbers dwarfed the 161 contracts on the same date, worth $253 million, that were on “inactive hold,” that is, for which the problem was the result of some administrative irregularity. (99)
Many present and past members of the Council and other expert observers believe that the United States often has used the system of “holds” for political purposes and not because of real concerns over the dual-use potential in contracts. Even the UK, which has imposed a very small minority of holds, has quietly expressed concern that US holds are excessive and impossible to defend. The UK government took a diplomatic initiative in 2000 to persuade Washington to ease up on the holds and let more goods through. The United States, however, did not agree. Since the UK démarche, the value of contracts on hold has more than doubled, from $2.25 billion in October 2000 to $5.4 billion in mid-July 2002. As of February 2001, the most recent date for which we have a complete breakdown, the US was solely responsible for over 93% of all holds, the US and the UK together for 5%, and the UK alone for 1%, while 1% was attributable to all other Council delegations, past and present. Approximately the same breakdown has continued to July, 2002, according to knowledgeable delegates.

Though the holds add up to a very large figure, the numbers alone do not tell the full story. The United States delegation may have insisted on putting a “hold” on just one item in a large contract, with the result that the whole contract was blocked. In the worst case, one contract put on hold can endanger an entire investment project. As OIP Director Benon Sevan noted in 1999,

The absence of a single spare part or item of equipment, as small as it may be, could be sufficient to prevent the completion of an entire water injection project or well completion programme. (100)
Sevan notes that the oil sector is the source of all the humanitarian revenue. Yet this sector was at first prevented entirely from importing equipment and spare parts (101) and it continues to suffer severe dilapidation because of a large number of holds that result in permanent damage to oil wells, serious safety risks, dangers of environmental damage, and risk to the country’s future production capacity. (102) Sevan has noted that such vital items as pumping controls, exploration equipment, well-drilling, degassing, hydrostatic testing and much more have been placed on hold. (103) Such goods are vital for rehabilitation and modernization of the oil sector, a precondition for Iraq to produce more oil to pay for its immediate needs and long-term reconstruction.
Holds placed on pesticides and animal vaccines have resulted in serious loss of domestic food production. Even essential health care equipment has not escaped the dubious charge of “dual-use.” There have been holds on heart-lung machines, blood gas analyzers, and other equipment. In some cases, the US has argued that it has put holds on such orders because of associated computers or data processing capacity. Sevan expressed his scepticism of this approach in comments in February 2002:

Many of the items such as computers placed on hold are readily available in the markets and shops of Baghdad . . . what is being placed on hold is the utilization of funds from the escrow account. (104)
In one case, an ambulance contract suffered because it contained communication equipment. In the end, though, the vehicles got through, but only because they were delivered without radios, which had to be removed from the contracts as a condition of lifting the holds. (105)
The UN can track the end-use of imports and determine that they were used for stated, purely civilian purposes. This is known as the “end-use/user verification” process and some 300 UN staff are currently available in Iraq for this purpose. UN officials, including the Secretary General, have regularly criticised the “holds” and argued that the UN has a much-enhanced capacity for on-site inspections and end-use verification. (106) But the United States insists that it has little faith in such options, preferring to impose holds instead. While perfect verification is probably impossible, the US approach imposes a very high cost for a very slight benefit. Its holds prevent many critical goods from reaching Iraq, blocking essential humanitarian supplies and urgently needed equipment and infrastructure. The import of modern ambulances without communications radio suggests the unacceptably compromised humanitarian system that Iraq must endure under the UN flag.

Resolution 1409 of May 14, 2002 theoretically eliminates holds, but it will probably not eliminate blocked goods. The massive Goods Review List, with suspect items totalling more than 300 pages,(107) provides a substantial barrier to future importation of goods into Iraq. Further, the Iraq Sanctions Committee will continue to exercise oversight and we can expect, based on past practice, that the US will find ways to block large numbers of contracts and insist that the Goods Review List be administered in a restrictive way.

Some knowledgeable observers believe that the new arrangements under Resolution 1409, including the administration of the Goods Review List, may prove equally onerous than the system that preceded it. No one expects that shipments for vital infrastructure like water, sanitation, communications, and electricity will suddenly rise to acceptable levels. Nor is it expected that the oil industry, which provides the essential funding of the humanitarian program, will be able to obtain sufficient badly needed parts and equipment, much less new investment.

Looking at the accumulated records of holds, the biggest disparity between orders and deliveries exists in the Telecommunications-Transport sector, where the US has placed so many holds that the value of contracts on hold recently exceeded the value of all contracts delivered throughout the program. (108) The Electricity, Oil Spares and Water-Sanitation sectors likewise suffer from large numbers of “holds” on contracts that are vital to Iraq’s infrastructure. UN officials implementing the program have insisted repeatedly that such holds gravely damage the program. Sevan has spoken about holds’ “direct negative effect on the program,” about the “interminable quagmire,” and the “appalling disrepair” of Iraqi infrastructure” but to no avail. (109) Resolution 1409 may at least partially relieve this nightmare, but progress initially appears very slow. In the first week of implementation, just $7.6 million in holds were released, (110) a rate that if sustained would require more than 13 years to work down the entire backlog.

5.4 War Reparations Fund: Oil-for-Compensation

As we have seen, the United Nations deducts a substantial proportion of Iraq’s oil sales for payment into a fund to compensate for war damages. The Council set up the Compensation Commission with Resolution 692 and in Resolution 705 it set the deductions from the Oil-for-Food account at the very high level of 30%, against the advice of the Secretary General.

The Compensation Commission has considered a very large number of claims, including claims on behalf of many individuals. According to the Commission’s web site, the Commission received approximately 1,356,500 small individual claims and settled them all with payments of approximately $16 billion. Many of the claimants had been migrant workers from Egypt and other countries, working in Iraq and Kuwait at the time the war broke out. A strong case can be made for compensating these individuals. The Commission wisely gave priority to their claims. (111)

Corporations and governments have made most of the remaining claims, which come to an additional sum of about $290 billion. This includes claims by various Kuwait government ministries and by the Kuwait Oil Company concerning wartime losses. Considering the wealth of Kuwait and the absence of humanitarian problems there, the deduction of a large share of Iraq’s oil sales for war reparations to such claimants appears punitive and not attuned to Iraq’s urgent humanitarian and reconstruction needs. (112)

These are probably the most severe war reparations since the Treaty of Versailles, at the end of World War I. Taking a lesson from the interwar crisis, the victors of World War II did not impose war reparations on Germany and Japan, in spite of terrible damage they inflicted on other countries and personal hardship imposed on millions of people.

The Council has given the Compensation Commission unusual authority and power. The Commission operates secretively and allows Iraq only to comment on a summary of each case. The operations of the Commission alone absorb more than $50 million per year, also deducted from the Iraq’s oil export funds. (113)

The reparations process appears even more troubling when its results are compared with the results of the humanitarian goods going to Iraq. While the compensation fund received an allocation of about 29% on average, it actually awarded a total of $38 billion in compensation as of April 2002 compared to just $47 billion in humanitarian supplies ordered by Iraq as of the same date, putting the compensation fund awards at 45% vs. humanitarian orders placed at 55%. As of the same date, the compensation fund had paid out $16 billion to settle claims, while the humanitarian program had received only $21 billion in goods, putting the compensation fund at 43%, while the actual humanitarian outlays came to just 57%.

The reparations fund appears punitive and contrary to basic humanitarian principles due to its exceptionally large claim on total resources. Many Council members have taken this view, but they have been unable to persuade the sanctions protagonists that humanitarian needs should have priority over compensation claimants, especially wealthy claimants such as the Government of Kuwait, Kuwait’s state oil company, and other governments and large corporations.

Responding to growing criticism and a sharp controversy within the Council following a Compensation Commission award of $15.9 billion to the Kuwait Petroleum Corporatioin, the US and the UK agreed to reduce reparations deductions from 30% to 25% in Resolution 1330 of December 5, 2000, after the small claimants had been paid. Though very welcome, especially since the funds were allocated to the Center and South, this step fell far short of humanitarian standards. The reparations deduction should instead be eliminated completely until humanitarian needs in Iraq are completely met. Further, a limit should be placed on the corporate and government compensation level, so as not to hobble the Iraqi economy for decades to come and stoke future resentment.

5.5 North vs. Center-South

Sanctions advocates make much of differences in humanitarian conditions between the three Kurdish governates in the North of Iraq, where the UN directly administers Oil-for-Food and the 15 governates in the Center and South, where the Governmant of Iraq administers the program. Better conditions in the North are alleged to prove that Saddam Hussein’s misrule is the sole explanation of the difference. On March 24, 2000, Peter Hain, Minister of State at the Foreign Office told the UK House of Commons:

exactly the same sanctions regime applies [in the north] . . . The difference is that Saddam’s writ does not run there. Why do sanctions critics prefer to ignore that inconvenient but crucial fact. (114)
But Hain was seriously misstating the case. Other important variables enter the equation, some an integral part of the Security Council sanctions’ architecture, of which the UK was a principal author and defender.
First, as we have already seen, the system of deductions results in per capita spending in the Center-South that was only 61% of the rate in the North until December 5, 2000 (69% thereafter), a very substantial difference. Second, the sanctions allow contracts going to the North to contain a “commercial clause” that enforces the quality of goods received, whereas the Center-South cannot include such a clause and must accept shoddy and even unusable merchandise with no legal recourse. Third, the sanctions allow the North to derive cash from 10% of its oil sales allocation, while absolutely no cash is available in the Center-South. Cash is needed to pay for services in the local economy, including staff for health clinics and food distribution programs. Fourth, while many important contracts in the South are blocked by holds, the United States puts relatively few holds on goods for the North, resulting in real infrastructure improvement in such sectors as electricity and public health. The US and the UK designed these four differences into the sanctions regime, but their propaganda pretends that the differences do not exist.

Several other regional differences explain part of the humanitarian variation. There is very active clandestine cross-border trade (smuggling) in the North, invigorating the economy there and putting money in the pockets of local people. Also, the climate in the North is more favorable, with cooler weather and more rainfall, resulting in better water supplies, more local food crops, and better overall health conditions. The North, with just 9% of the land area of the country, has nearly 50% of the productive, arable land.

The Government of Iraq is the seventh variable. Its administration is clearly less concerned with human welfare than the UN efforts in the North. It has not used imported goods as well, and it has failed to effectively implement targeted programs. But a fair appraisal of the North/Center-South differences must conclude that the Security Council bears considerable responsibility by imposing exceptionally harsh sanction conditions on the Center-South region, where 87% of the Iraqi population lives.

Conditions in the North may be better than the Center-South, but they are by no means acceptable. According to a study published in January 2002 by Save the Children, 60% of the population in the North live in deep poverty – with 40% living on incomes of under $300 per household per year and a further 20% living on less than $150 per household per year. The report concludes that the sanctions and ration system has “destroyed normal economic life for the vast majority,” who subsist largely through “unprecedented levels of dependency.” Up to 85% of the population are “at risk” in case of any reduction of their food access through the ration system. (115)

5.6 Nutrition and Health

Survey information by the World Food Programme/Food and Agriculture Organisa-tion in 2000 indicated 800,000 Iraqi children “chronically malnourished.” (116) The UNICEF 1999 study, also based on extensive field surveys, had shown 21% of children under five underweight, 20% stunted (chronic malnutrition) and 9% wasted (acute malnutrition). Several recent reports have noted that the UN has created initiatives to help the most vulnerable in the Center and South through targeted nutrition programs. These have had some positive results, but it is clear that the government of Iraq has not adequately implemented them.

The FAO 2000 report pointed out that at 2,000 kilocalories, the universal ration provided under the UN program was insufficient in total yield, absent substantial local food additions. The same report insisted also that the composition of the food basket remained nutritionally inadequate:

Of great concern is the lack of a number of important vitamins and minerals such as vitamin A, C, riboflavin, folate and iron in the diet. Although the planned ration is reasonably adequate in energy and total protein, it is lacking in vegetables, fruit, and animal products and is therefore deficient in micronutrients." (117)
Despite the Oil-for-Food program and the $11 billion worth of food that has entered the country, infant mortality remains very high. Today, most child deaths are not directly due to malnutrition, though. Rather, they are water-related, from such conditions as diarrhoea. Poor water quality and lack of sanitation, combined with existing malnourishment, have taken over from poor nutrition as the prime killer of children in Iraq. UNICEF reported in July 2001 that “Diarrhoea leading to death from dehydration and acute respiratory infections (ARI), together account for 70 per cent of child deaths.” (118)
Deliberate bombing of water treatment facilities during the Gulf War originally degraded the water quality. Since that time, sanctions-based “holds” have blocked the rebuilding of much of Iraq’s water treatment infrastructure. Additionally, sanctions have blocked the rebuilding of the electricity sector which powers pumps and other vital water treatment equipment.

Health problems in Iraq arise from multiple factors, many of which can be attributed to the sanctions. Electricity shortages, in addition to shutting down water-treatment, seriously disrupt hospital care and disrupt the storage of certain types of medicines. Sanctions also result in shortages of medical equipment and spare parts, blockages of certain important medicines, shortage of skilled medical staff, and more.

There can be no doubt, based on health and mortality surveys, that Iraqis are suffering from a major public health crisis. The sanctions both deepen that crisis as a cause and also block measures that could mitigate it through public health measures and curative medical procedures. The health status of the Iraqi people has been a key indicator of the humanitarian consequences of the Iraq sanctions regime.

5.7 Deaths

None deny that Iraq sanctions have caused many deaths, but a debate has raged over how many. The larger the number, the greater the burden on sanction advocates to justify their actions. Unfortunately, wrangling over numbers obscures the unavoidable reality: a tragically large humanitarian disaster.

The measurement of deaths rests on the concept of “excess” mortality – those deaths that exceed the mortality rate in the previous, pre-sanctions period or that exceed a projection of the earlier trend towards further gains. The previous mortality rate is well-established, but two arguments arise – first, what is the present mortality rate (which, some argue, may be distorted by false Iraq government statistics) and second, what is the cause of such mortality increase. Neither of these questions has a simple answer. Not surprisingly, the government of Iraq claims a very large increase and blames most of its child mortality on sanctions. UNICEF, in a widely-publicised study carried out jointly with the Iraq Ministry of Health, determined that 500,000 children under five years old had died in “excess” numbers in Iraq between 1991 and 1998, though UNICEF insisted that this number could not all be ascribed directly to sanctions. (119) UNICEF used surveys of its own as part of the basic research and involved respected outside experts in designing the study and evaluating the data. UNICEF remains confident in the accuracy of its numbers and points out that they have never been subject to a scientific challenge.

Prof. Richard Garfield of Columbia University carried out a separate and well-regarded study of excess mortality in Iraq. Garfield considered the same age group and the same time period as the UNICEF study. (120) He minimized reliance on official Iraqi statistics by using many different statistical sources, including independent surveys in Iraq and inferences from comparative public health data from other countries. Garfield concluded that there had been a minimum of 100,000 excess deaths and that the more likely number was 227,000. He compared this estimate to a maximum estimate of 66,663 civilian and military deaths during the Gulf War. Garfield now thinks the most probable number of deaths of under-five children from August 1991 to June 2002 would be about 400,000. (121)

There are no reliable estimates of the total number of excess deaths in Iraq beyond the under-five population. Even with conservative assumptions, though, the total of all excess deaths must be far above 400,000.

All of these excess deaths should not be ascribed to sanctions. Some may be due to a variety of other causes. But all major studies make it clear that sanctions have been the primary cause, because of the sanctions’ impact on food, medical care, water, and other health-related factors. Though oil-for-food has changed the situation studied by UNICEF and Garfield, resulting in less malnutrition, recent field reports suggest that infant mortality remains high, due to water-borne disease. (122) The mortality rate for under-five children has probably not continued to rise since the 1999 studies, but the rate apparently remains very much higher than that reported in Iraq before 1990.

In the face of such powerful evidence, the US and UK governments have sometimes practiced bold denial. Brian Wilson, Minister of State at the UK Foreign Office told a BBC interviewer on February 26, 2001 “There is no evidence that sanctions are hurting the Iraqi people.” When denial has proved impossible, officials have occasionally fallen back on astonishingly callous affirmations. In a famous interview with Madeleine Albright, then US representative at the United Nations, Leslie Stahl of the television show 60 Minutes said: “We have heard that half a million children have died . . . is the price worth it? Albright replied, “I think this is a very hard choice, but the price – we think the price is worth it.” (123)

Six years after Albright’s statement and twelve years after Security Council Resolution 661, comprehensive economic sanctions continue to impose on Iraq a very high number of deaths of young children, as measured by careful and well-regarded estimates. Combined with the deaths of older children and adults, this adds up to a great and unjustifiable humanitarian tragedy.


Chapter 6 “Smart” Sanctions, Price Disputes and Military Threats
6.1. Background

Sanctions results in the 1990s suggest that comprehensive economic sanctions are ineffective and do not reliably persuade the leadership of an offending country to make required policy changes. (124) Secretary Generals Boutros Boutros-Ghali and Kofi Annan have made this point repeatedly in public statements. The Security Council itself no longer uses such broad sanctions in other international security crises and seeks instead to develop more “targeted” sanctions.

UN officials, academic experts and national policy makers have recently held a number of conferences to consider how sanctions could be better targeted on the arms trade and on the personal finances and travel of responsible leaders and elites. The most important such efforts are known as the Interlaken Process (sponsored by the Swiss government) which began in March 1998, the Bonn-Berlin Processes (sponsored by the German government) which began in November 1999, and the Stockholm Process (sponsored by the Swedish government) which began in February, 2002. (125)

The Security Council briefly imposed targeted sanctions on the Iraqi leadership through Resolution 1137 of November 12, 1997, prohibiting international travel of listed leaders until full compliance with UNSCOM inspectors had been restored. That resolution brought swift Iraqi compliance, and seemed a great success, but curiously the Council did not further use this effective and well-targeted measure.

As international and domestic opposition to Iraq sanctions mounted in the late 1990’s, and as pressure rose for targeted sanctions against the Iraqi leadership, United States and UK policy makers sought means to deflect criticisms while holding the comprehensive sanctions system in place. During the US presidential election campaign in 2000, candidate George W. Bush often spoke of the need for a new approach to Iraq sanctions. Secretary of State Powell, in his congressional confirmation hearings in early 2001, repeatedly stressed the need to shore up public opinion against Iraq through what he referred to as “smart” sanctions:

So this wasn't an effort to ease the sanctions; this was an effort to rescue the sanctions policy that was collapsing. We discovered that we were in an airplane that was heading to a crash, and what we have done and what we are trying to do is to pull it out of that dive and put it on an altitude that's sustainable, bring the coalition back together.” (126)
Early in 2001, after a tour of the region by Secretary Powell, the UK government (with US support) proposed to modify Iraq sanctions. The UK did not propose targeting the Iraqi leadership, however, ignoring several years of discussions about more effective sanctions. Rather, the UK proposed a further streamlining of imports, combined with more rigorous controls at Iraq’s borders to prevent smuggling. Eventually, after much discussion, this proposal bogged down in the summer of 2001 in the face of doubts by many Council members and a threatened Russian veto.
The events of September 11, 2001 changed the political equation on the Council and created greater unity among the permanent members through shared concern about terrorism and related issues. As a result, opposition by Russia, China and France to Iraq sanctions softened, opening the way for a modified version of the original UK resolution centering on a Goods Review List (GRL) to streamline imports. Resolution 1382 (November 2001) provided for a GRL to be adopted by the Council by May 29, 2002. The GRL theoretically offered a means to speed contract approval by compiling in advance a list of potentially dual-use items, with all remaining items exempted from automatic Sanctions Committee review. Committee members would retain the option, though, to block future contracts.

The United States and Russia negotiated the GRL list over the course of several months, with the Russians favoring a short list and the US favoring a long one. The United States lifted holds on $200 million in Russian contracts and it promised to lift holds on $550 more as a means to secure Russian agreement. (127) France and China allegedly asked for holds on their contracts to be lifted also, as a condition of their agreement. (128) Since the policies of the US and the UK are widely believed to be driven by commercial interests in the oil sector, this bargaining fed the perception that the Security Council sanctions are dominated by commercial dealing among the permanent members, not by concerns about “peace and security” or arms control.(129) The elected members of the Council were kept, as usual, entirely in the dark until the resolution was finally submitted to the Council on a take-it-or-leave-it basis.

6.2. Smart Sanctions vs. Targeted Sanctions

Reconstruction and economic revival, not the relief-based approach of the Oil-for-Food program and its “smart” variant, are essential to human development and the human rights of Iraq’s people.

US-inspired smart sanctions, mainly in the form of a Goods Review List, completely fail to address the major problems of the current sanctions against Iraq. Four pillars of the present sanctions effectively prevent the rebuilding of Iraq’s economy:

Targeting the entire population, not just leaders

Controlling Iraq’s oil export income through a cumbersome UN-administered “escrow account”

Controlling Iraqi imports in ways that limit access to key goods, especially items for Iraq’s infrastructure and for its oil sector, and that drastically slow the delivery of most contracts

Prohibiting foreign investment and freezing all foreign assets
The four pillars have remained the basic operating method of the (new) sanctions. No government could restore a healthy domestic economy within the confines of such sanctions. As the Security Council itself concluded in 1999, Oil-for-Food cannot provide a framework for rebuilding Iraq and restoring its vital infrastructure. (130)
The “smart” sanctions initially envisaged by the Security Council in Resolution 1382 and finally adopted in Resolution 1409 are not smart. They do not follow the recommendations of the Interlaken or Bonn-Berlin process. (131) They do not reflect a focus on the culprit regime or a better targeting of military equipment. While theoretically speeding up delivery of certain goods, these proposals also allow the blocking of vital imports. Iraq needs foreign investment projects and contact with the outside world to train a new generation of Iraqi managers, scientists and technicians. An open Iraq would almost certainly lead to positive political changes. Instead, “smart” sanctions shore up the old, failed system.

Judging by the experience of “fast-track” lists drawn up in 2000, the new “smart” sanctions could increase the volume of humanitarian goods arriving in Iraq, but this is by no means sure. Some well-informed observers think that the new system will be no better than the old and possibly worse, depending on how UNMOVIC, IAEA and OIP are able to handle the new process of contract compliance scrutiny. Even if the new arrangements result in some marginal improvement, they offer far too little to address the pressing humanitarian crisis. So much effort for such small gain suggests that the US and the UK are more interested in “public relations” (New York Times) or “cosmetic surgery” (The Economist) than in speeding up goods shipments to Iraq. (132)

6.3 Oil Pricing Disputes & Shrinking Humanitarian Revenue

A new crisis quickly overshadowed Resolution 1409. A clash over oil pricing methods resulted in rapidly falling Iraq oil sales and a severe shortfall of funds for the humanitarian program.

The crisis had its origins in late 2000 when oil traders buying Iraqi oil started to sell the oil at marked-up prices and kicked-back to Baghdad a portion of the premium they received. This scheme gave the Government of Iraq the cash it eagerly sought. Russian traders acted as the major intermediaries and profited handsomely. The kickback varied, but in early 2002 stood at 25-30 cents per barrel, or over 1% of the oil price, with price premiums running at 30-45 cents. (133) Had it continued, this scheme might theoretically have provided the government of Iraq with about $100 million in cash revenue annually, based on recent prices and export levels. Such a sum is relatively small in comparison to Iraq’s estimated smuggling revenues of at least $1.5 billion.

The US and UK demanded that the Security Council take steps to prevent these kickbacks. Some delegations objected, but ultimately the US-UK prevailed. In October 2001, the Iraq Sanctions Committee introduced a new system known as “retroactive pricing,” which reduced premiums to 10-15 cents per barrel by July 2002 and nearly eliminated all kick-backs. But the Council’s new pricing system left oil buyers uncertain of final prices at the time of purchase. Increased uncertainty for buyers and reduced profit margins for oil traders reduced demand for Iraqi oil by a third or more. (134)

The shrinking market took a heavy toll on the humanitarian program. In mid-February OIP Executive Director Benon Sevan spoke to the Council of the program’s “financial crisis.” (135) Iraq’s refusal to sell oil for a month (April 8-May 8, 2002), announced as a show of support for Palestinians, further worsened the situation, as did weakening oil prices. As the demand crisis wore on, the pricing method had an increasingly negative effect on the humanitarian program. By July 26, a funds shortfall left the UN unable to act on 1,001 approved contracts worth $2.1 billion. (136)

Many in the Council came to believe that the US-UK pricing system was punitive and unacceptable. (137) The French circulated proposals in June to escape the impasse and restore acceptable prices, an initiative that attracted broad support. But the US-UK refused, insisting that the Council must dutifully block cash to the Iraqi government and blaming Iraq entirely for negative humanitarian consequences. Though many in the Council pressed for a speedy resolution, negotiations dragged on, while revenue shortfalls grew. Once again, the people of Iraq were forced to pay a heavy price.

6.4 Regime Change, Military Threats and Appraisals of Iraq’s Rearmament

The United States government has consistently pursued a policy favoring a change of regime in Iraq. This policy has included clandestine support for Iraqi opposition groups and efforts to promote a military coup against Saddam Hussein. On October 31, 1998, shortly before Operation Desert Fox, President Bill Clinton signed the Iraq Liberation Act, which clearly identified regime-change as US policy and authorized spending and policy action in this direction.(138)

Since the fall of 2001, Washington has increased its commitment to regime-change. In President Bush’s State of the Union address in January 2002, he branded Iraq as a “terrorist state,” part of an “axis of evil” (139) and many reports have since circulated about plans for a military strike against Iraq. This dogmatic “good vs. evil” approach, endangers peace and ignores humanitarian considerations as well as opportunities for peaceful solutions. It does, however, provide a rationale for US military and political control of Iraq’s oil fields.

The US now alleges that Iraq possesses (or that it will soon acquire) weapons of mass destruction. This concern cannot be categorically rejected as implausible, in view of such weapons programs by Iraq in the recent past. But considerable doubt exists, among well-informed experts, like former weapons inspector Scott Ritter. (140) CIA reports recently concluded that there is no hard evidence for such claims. (141) And Senator Bob Graham, Chairman of the Intelligence Committee of the US Senate was reported on May 14, 2002 by USA Today to have said that “Based on the intelligence briefings he has received… Iraqi president Saddam Hussein is not on the verge of developing weapons of mass destruction.” (142)

It should be recalled that other countries have actually developed and deployed weapons of mass destruction without US-led military threats. Israel, South Africa under apartheid, India and Pakistan are cases in point. Such programs are extremely dangerous to world peace wherever they emerge, but Washington has applied drastically different standards in appraising them and claimed “global responsibilities” to act (or not) against each as its sees fit. Regional and international disarmament agreements would be far better guarantee of peace than unilateral decisions of a single superpower.

In the present political climate, the “hawks” in Washington are ready to disregard the weak evidence concerning Iraqi rearmament. Instead, they insist that Iraq poses such a grave and immediate danger that humanitarian considerations do not count and that a military strike is urgently necessary. (143) In such a heated atmosphere, the opportunity for lifting Security Council sanctions against Iraq may have temporarily diminished. Many Council delegations, though critical of the sanctions, are concerned primarily about averting a full-scale invasion of Iraq by the United States.

Such a dismal prospect need not prevail for long, however. The United States may draw back from the dangerous war option and members of the Security Council may again raise their voices for sound policy and for conformity with international law. The temporary unity of the Permanent Members is likely to weaken, making room for elected members of the Council to advance such proposals successfully, with broad backing from the international community. Public opinion, acting directly and through governments, is likely to pressure the Council in a more critical direction. A new dynamic can promote the values that gained ground in the late 1990s, a dynamic of far-reaching reform inspired by humanitarian concerns and legal mandates, not cynical commercial interests or expansionist geopolitical strategies.


Chapter 7 – The Council’s Obligations under Human Rights and Humanitarian Law
7.1. Legal Framework for the Security Council

The UN Charter gives the Security Council broad authority to maintain international peace and security, including the use of sanctions and international military action. The Charter also obliges member states to abide by Security Council resolutions even when such resolutions conflict with other treaties.

However, Article 24 of the Charter directs the Council “to act in accordance with the Purposes and Principles of the United Nations” when acting to maintain peace and security. The promotion of human rights is one of these fundamental “Purposes and Principles.” (144) Human rights have been elaborated in the Universal Declaration, the two International Covenants, and a variety of other international instruments including the Convention on the Rights of the Child, creating a legal framework for member states of the UN. While the Security Council may not be bound by human rights requirements in the same manner as a state, it must nevertheless act in conformity with these principles in fulfilling its duties under the Charter. The contrary view, that the Council is not bound by international law, defies not only the Charter but also common sense.

When responding to a threat to peace and security, it may not be clear whether the Security Council should abide by the war-time legal regime of humanitarian law or the peace-time regime of human rights. While both are grounded in humanitarian norms, they offer different levels of protection to the individual. Humanitarian law, the laws of war, permit belligerents to inflict collateral civilian casualties when attacking legitimate military targets, provided that the harm to civilians is not disproportionate to the value of the military target, that it was unavoidable and that all efforts have been made to minimise it. The human rights regime, on the other hand, provides stricter protection to civilian life, health and property. The Council is therefore under an obligation to respect both humanitarian law and human rights norms and to apply them in the framework of its actions on sanctions. But, some members believe that the Council enjoys a specially privileged position and is subject to no legal authority other than its own political judgements.(145)

The Security Council’s failure to address the human rights and humanitarian impact of sanctions has prompted regular expressions of concern from UN agencies, commissions, panels and other bodies – the Machel Report to the General Assembly (1996), the Comment by the Committee on Social, Economic and Cultural Rights (1997), the Statement by the Inter-Agency Standing Committee (1997), UNICEF’s Hoskins Report (1998), the Bossuyt Report of the Commission on Human Rights (2000) (tellingly entitled The Adverse Consequences of Economic Sanctions on the Enjoyment of Human Rights), (146) the Report of the UN High Commissioner for Human Rights entitled The Human Rights Impact of Economic Sanctions on Iraq,(147) as well as reports of the International Committee for the Red Cross and many more. Human rights NGOs including Human Rights Watch and the Center for Economic and Social Rights have likewise raised serious questions about Iraq sanctions. A variety of international conferences have also raised these concerns, including Interlaken, Bonn-Berlin, Stockholm, the Symposia of the International Peace Academy, and the Colloquium on “United Nations Sanctions and International Law” of the Graduate Institute of International Affairs (1999). (148) There has not yet been a direct legal challenge to the Council on this issue, but there could and should be, possibly through the International Court of Justice.

7.2 Human Rights Law

The Security Council is bound to respect the full range of human rights standards in the major international legal instruments as an extension of its underlying obligations under the UN Charter. (149) It must ensure that its actions comply with these standards. Thus, the Security Council may not violate human rights, even when acting to maintain peace and security. The Council has two basic human rights duties:

procedural duties to recognize its human rights obligations and take concrete measures to monitor its actions to comply with these obligations; and

substantive duties not to undertake any actions that violate human rights, especially the rights of vulnerable groups with special legal protections, and to undertake immediate corrective measures in the case of violations.

The two sets of duties are closely linked. Procedural duties provide an essential safeguard against human rights violations by allowing the Security Council to monitor its activities for early warning signs of adverse human rights impacts. Since no outside body has yet successfully reviewed the legality of Security Council decisions, the Council must judge its own actions and hold itself accountable to human rights standards. Given its recently-expanded role in international affairs, the Security Council has an increased obligation to monitor and check its own actions.

Procedural Human Rights Violations

The Security Council has clearly violated its procedural human rights obligations throughout the course of its sanctions against Iraq. Given the extent of civilian suffering and the clear knowledge available, the Council has taken only token steps to measure the human rights impact of its sanctions or to modify its actions in accordance with human rights principles. At the very beginning of the sanctions, UN Secretary-General Javier Perez de Cuellar called for “close monitoring” as an essential tool for avoiding a humanitarian crisis:

The maintenance of food supply and consumption as well as the close monitoring of the nutritional and health status of the Iraqi population over the next few months are absolutely necessary to prevent full-scale famine and major human disasters developing in the country. (150)
Apart from the 1999 panels, however, the Council has never authorized an ongoing assessment of the sanctions’ humanitarian impact, due to vigorous opposition by the United States and the UK. Given the importance of the sanctions, such an assessment should be functioning on a permanent basis and offering regular reports to the Council. But the pro-sanction members vigorously resist such a step. As Hans von Sponeck said,
every attempt that I made with the United Nations in New York to get an agreement to prepare an assessment of the humanitarian condition in Iraq was blocked. (151)
In Resolution 1302 of June 8, 2000, the Council spoke of a “comprehensive report” to be prepared by a group of experts, but the US-UK insisted on language that other Council members understood as effectively ruling out Iraqi cooperation, (152) demanding that the mandate of the study exclude any mention of human rights or of the impact of sanctions. The US also rejected a proposal by other Council members that a report should be prepared based on information available outside Iraq.
The Council has ordered impact assessment studies of sanctions in the case of Liberia and Afghanistan. (153) The absence of such assessment in the case of Iraq appears as a gross procedural lapse with extremely serious consequences.

Substantive Human Rights Violations

The Council has a clear share of responsibility for the death and suffering of hundreds of thousands of Iraqi civilians under sanctions. These deaths carry the clearest implication of a substantive violation, since the UN Human Rights Committee considers the right to life to be “the supreme right from which no derogation is permitted even in time of public emergency.” (154) Sanctions have also contributed to violations of the rights to health, education, and an adequate standard of living. The Council clearly cannot act in pursuit of international peace and security without causing some degree of inadvertent harm, but very large casualties, caused in such a routine way, cannot be accepted. The Council would thus appear to be in violation of rights guaranteed by the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, and other solemn international agreements.

Iraqi children have suffered disproportionately under sanctions. Human rights law considers children uniquely vulnerable to abuse and therefore grants them special protections in the Convention on the Rights of the Child. Among other provisions, the Convention specifically recognises that “every child has the inherent right to life” and calls on all states “to ensure to the maximum extent possible the survival and development of the child” and “to take appropriate measures to diminish infant and child mortality.” (155) It is hard to think of a graver breach of child rights in modern history than the death of hundreds of thousands of Iraqi children.

The Iraq government’s own human rights violations in no way excuse the Security Council for its violations. The Council remains always obligated by the UN Charter to “promote and encourage respect for human rights.” The human rights of individual Iraqis are not forfeited because of their government’s misconduct, particularly when these citizens have no voice in the decisions of the government. Iraq’s failure to comply completely with Security Council resolutions therefore does not give the Council license to disavow its independent obligations to respect the human rights of Iraqi civilians.

7.3 Humanitarian law

Even under the more permissive framework of humanitarian law, Security Council sanctions on Iraq violate well-established legal norms. The basic principles of the laws of war are those of distinction and proportionality. Under the principle of distinction, belligerents are required to distinguish between civilians and combatants at all times and to direct attacks only against military targets.(156) This is the fundamental principle of the laws of war. The corollary principle of proportionality is designed to ensure that attacks against military targets do not cause excessive civilian damage. The Geneva Conventions define the principle of proportionality as prohibiting any “attack which may be expected to cause incidental loss of civilian life, injury to civilians, damage to civilian objects (...) which would be excessive in relation to the concrete and direct military advantage anticipated.” (157) Sanctions are tantamount to acts of war and so should be subject to this restriction.

Indiscriminate weapons, which cannot be directed solely against military targets, by their very nature violate the principle of distinction. Comprehensive economic sanctions can also be considered as such an indiscriminate weapon, which two Secretary Generals have for good reason called a “blunt instrument.” (158) Such sanctions fail to target the real offenders and instead harm the weakest and most vulnerable members of society. Sanctions in Iraq thus clearly violate the principle of distinction under humanitarian law.

Sanctions also violate the principle of proportionality. (159) The Security Council originally re-imposed economic sanctions after the Gulf War with high expectations of successfully eliminating mass destruction weapons in Iraq. Initially the sanctions were proportional to the aim. But after substantial disarmament was achieved and the humanitarian crisis deepened, the judgement on proportionality must be revised. Many innocent lives continue to be claimed by the sanctions with scarcely any potential benefit.

Proportionality is a malleable and subjective standard, prone to manipulation by belligerents to justify civilian casualties. Nevertheless, the authoritative ICRC legal commentary on the laws of war sets out guidelines for interpretation:

A remote [military] advantage to be gained at some unknown time in the future would not be a proper consideration to weigh against civilian loss. (...) The advantage concerned should be substantial and relatively close. (...) There can be no question of creating conditions conducive to surrender by means of attacks which incidentally harm the civilian population.” (160)
The Iraq case illustrates why, contrary to conventional wisdom, comprehensive economic sanctions are not a humane alternative to war. Public opinion could never have tolerated a military campaign against Iraq that killed so many innocent children, especially not a war carried out in the name of the world’s people under the authority of an organization dedicated to defend human rights.
The case of Iraq underscores the need to clearly define legal constraints on the Security Council. The Council’s significant power to act in international affairs must be bounded by accepted principles of international law. For twelve years, the Security Council has maintained comprehensive sanctions without referring to its legal obligation to act in accordance with human rights and humanitarian principles.


Chapter 8 – Conclusion & Policy Recommendations
The international community must press the Security Council to honor its legal obligations in Iraq sanctions policy. World public opinion now recognizes comprehensive economic sanctions as a seriously flawed policy tool, a “blunt instrument” almost certain to do massive harm to innocent civilians. The Council itself no longer uses such sanctions, choosing to use exclusively targeted sanctions instead. But two Permanent Members have prevented the Council from reforming Iraq sanctions so as to meet the widely-agreed new standards.

When the Council first imposed sanctions on Iraq, its members may have reasonably believed that the sanctions would be effective and that the goal of disarmament was worth a few months of civilian suffering. Now, twelve years later, with clear evidence of negative consequences and with no further positive outcome to be expected, the Council can no longer excuse its inaction. The Council’s failure to lift the comprehensive economic sanctions is a breach of its humanitarian responsibilities and an abject failure to use the principles of proportionality.

In recent years, Council members have received many learned and thoughtful reports, setting forth the humanitarian crisis in Iraq, the flaws in the sanctions regime, and the international legal principles that should be applied. The Council cannot say that it is uninformed about the conditions on the ground or that it is unaware of the legal aspects of its responsibilities. Oil-for-Food sought to accommodate the strongest objections, by allowing Iraq to sell oil for the purchase of some humanitarian resources. But it was designed as a short term policy, and is subject to bureaucratic bottlenecks, manipulated by the pro-sanction powers, and throttled by US-imposed blocking and holds. The Goods Review List and associated new procedures under Resolution 1409 are far from sufficient as an improvement.

A number of UN agencies and organs have called on the Security Council to lift or deeply modify the sanctions. Several Secretary Generals have raised questions that pointed in this direction. Two respected UN humanitarian coordinators have resigned in protest, urging an end to the punitive sanctions. Scholars, journalists, religious leaders, NGOs, diplomats, health authorities, human rights organizations, parliamentarians and citizens have joined in a compelling call for change. A majority of Council members have long concluded that Iraq sanctions are a repugnant failure and world opinion has clearly mapped out the road towards legality and accountability:

Comprehensive economic sanctions must be lifted,

The UN “escrow account” must be eliminated,

Free trade (excepting military goods) must be re-established,

Foreign investments in Iraq must be permitted, and

Foreign assets of Iraq must be unfrozen so as to normalize its external economic relations
Clearly, though, such change will not be free of risk. The government of Iraq cannot be counted on to make benign and peaceful policy choices, or to automatically promote the well-being of its people. In this context
Robust weapons monitoring must be reintroduced, to insure full disarmament and to guarantee no future production programs for mass destruction weapons, and
Disarmament in Iraq must be complemented by regional approaches to disarmament, especially elimination of mass destruction weapons and weapons programs in other regional states.
The Government of Iraq must give firm assurances to the international community, as a part of reciprocal undertakings, that
It will renounce all plans to buy, build or use weapons of mass destruction and related delivery systems
It will cooperate fully with ongoing UN arms inspection arrangements
It will establish friendly and cooperative relations with neighboring countries
It will take all necessary steps to address the humanitarian emergency as soon as funds become available to do so
It will honor minority rights, including offering special status to the Kurdish areas, and it will take steps to honor its human rights obligations
If the government of Iraq fails to provide adequate means for inspection and arms control, in future, then:
Narrowly-targeted sanctions, including financial and travel penalties, should be directed at Iraq’s leaders,
Time limits must be part of the new sanctions regime,
Clear criteria for lifting must also be part of the new sanctions regime,
Regular humanitarian assessments must also be part of the new sanctions as well, so that the Council will be aware of their possible impact on the broader Iraqi population.
If Iraq is to return to normalcy, and if it is to be persuaded to agree to international accords, it must be free of constant military pressure, threats and intimidation. The Security Council’s decisions, not unilateral action by one or two powerful states, must prevail. In this framework:
“No-Fly zones” " must be eliminated and aerial threats and attacks halted, and
Unilateral military attacks, as a means towards “regime change,” must be ruled out as unacceptable and illegal.
Other efforts directed towards "regime change," including force build-ups, military aid to opposition forces, and covert destabilization and assassination campaigns must cease.
Security Council members must find the courage and the wisdom to move forward, to reflect at long last the Council’s compelling responsibilities and its accountability to the overwhelming majority of world opinion. For this reason, the Security Council should seek a wide-ranging agreement with the government of Iraq that ends comprehensive sanctions and threats of violence on the one hand while introducing on the other hand a program for securing Iraq’s physical and political renewal and its peaceful re-integration into the world community. In such a framework:
Emergency relief, to bring a speedy end to the human suffering, must be put in place, with the help of the international community,
Large-scale physical reconstruction, to build a new infrastructure for Iraq, must be set in motion, including foreign investments, and
Safeguards for minorities such as the Kurds must be introduced, including federative structures and possibly a UN presence to monitor and promote human rights in the post-sanctions era.
The Council has recently made great and impressive progress in East Timor, Sierra Leone, Ethiopia-Eritrea and Angola, each a very difficult and challenging task. A peaceful and constructive solution to the Iraq crisis is surely not beyond its grasp.



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Appendix I
Chronology of main events
1990
Aug 2 After months of tension, the Iraqi army invades Kuwait. The United Nations Security Council passes Resolution 660 condemning the Invasion and demanding Iraq's immediate and unconditional withdrawal.
Aug 3 Arab League calls for Iraq's withdrawal from Kuwait.
Aug 6 Council passes Resolution 661, imposing comprehensive sanctions on Iraq and establishes a committee (the 661 or Sanctions Committee) to monitor the sanctions.
Aug 12-15 Iraq offers two peace plans which are rejected by the US.
Aug 28 Jordan proposes a peace plan which is accepted by Iraq but rejected by the US.
Sep 19 Morocco proposes a peace plan which is rejected by the US.
Sep 24 France proposes a peace plan which is accepted by Iraq but rejected by the US.
Nov 22 Most expert witnesses to US Senate Armed Services Committee reject military option towards Iraq.
Nov 29
Security Council Resolution 678 authorizes use of force against Iraq if it has not withdrawn from Kuwait by 15 January 1991.
Nov 30 US proposes talks; Iraq accepts.
Dec 5 CIA director, William Webster tells US Congress that ``economic sanctions and the embargo against Iraq ... have dealt a serious blow to the Iraq economy. ... In late November, Baghdad cut civilian rations for the second time since the rationing program began ... In addition, services ranging from medical care to sanitation have been curtailed." Although sanctions are hurting Iraq's civilian economy, they are affecting the Iraqi military only at the margins.
1991
Jan 9 US-Iraq talks fail.
Jan 13 UN Secretary-General's talks with Iraq fail.
Jan 16 Air war begins, destroying much of Iraq's civilian infrastructure.
Jan 21 Iran protests scale of bombing.
Jan 29 French defence minister Chevènement resigns in protest against scale of bombing.
Feb 3 Pope John Paul II rejects the claim that the war against Iraq is a "just war."
Feb.28 War ends.
Mar 20 Ahtisaari Report to Security Council on humanitarian crisis in Iraq and Kuwait. "…Most means of modern life support have been destroyed or rendered tenuous." "Sanctions in respect of food supplies should immediately be removed." No remedy to humanitarian need, "without dealing with the underlying need for energy."
Apr 3 Resolution 687 begins cease-fire, establishes UN Special Commission on weapons, extends sanctions by tying them to Iraq's weapons. UK ambassador Sir David Hannay states in the Council that "it will in fact prove impossible for Iraq to rejoin the community of civilized nations while Saddam Hussein remains in power."
Apr 5. Resolution 688 condemns "the repression of the Iraqi civilian population" in the ensuing civil war.
Mid-Apr US, UK and France organize a "no-fly" zone in northern Iraq, while Operation Provide Comfort carves out an autonomous zone in a large part of the Kurdish areas.
Jul 17 UN mission to Iraq led by Sadruddin Aga Khan concludes that Iraq needs $22 billion that year to provide civilian services at pre-war levels.
Aug 15 Resolution 706 acknowledges the Sadruddin Aga Khan Report and calls for oil sales not to exceed $1.6 billion over 6 months to be placed in escrow account, deducting 30% for a Compensation Commission, plus UNSCOM and other international obligations, leaving less than 1/3 of the Report's recommended amount for humanitarian aid.
Sep 19 Resolution 712 proposes that Iraq be allowed $1.6 billion oil sales over six months, of which $900 million would be available for civilian needs, disregarding the Secretary General's request that the cap be raised.
1992
Feb 1 Iraq rejects 706 and 712.
Feb 5 Council declares that Iraq "therefore bears full responsibility for their humanitarian problems."
August US, UK and France establish no-fly zone in southern Iraq
1993
Jan 13 US, UK and France attack Iraq with aircraft and cruise missiles. US and UK continue air strikes on January 17 and June 26.
1995
Jan UN Secretary General Boutros Ghali issues a report calling sanctions a "blunt instrument"
Apr 14 Resolution 986 allows Iraqi government $2 billion in oil sales every six months. 13% of total available funds set aside for UN use in the northern governorates. Sanctions Committee must review and approve all supplies purchased through escrow account.
1996
May 12 US Ambassador to the UN Madeleine Albright, in response to claims of half a million child deaths in sanctioned Iraq, replies: "I think this is a very hard choice, but the price - we think the price is worth it."
May 20 Iraq is no longer able to provide survival sustenance for its civilian population. Iraqi government and UN reach agreement on implementing Resolution 986.
Sep 3-4 In Operation Desert Strike, US fires cruise missiles at Iraqi targets
Dec 10 First oil sales start, beginning the Oil-for-Food program. It has since been renewed mostly in six month phases.
1998
Feb 20 Oil-for-Food oil sales cap increased to $5.256 billion per six month phase.
Dec UNSCOM's credibility is undermined by evidence that staff members seconded to the agency by the United States have compromised the independence of the agency and engaged in espionage and covert action to overthrow the Iraq government.
Dec 15 UN weapons inspectors withdraw from Iraq due to impending aerial attacks by the United States and the UK.
Dec 16-19 Operation Desert Fox air campaign by US and UK
1999
Mar 30 Security Council panel report finds that Iraq had ``experienced a shift from relative affluence to massive poverty'' and predicted that ``the humanitarian situation in Iraq will continue to be a dire one in the absence of a sustained revival of the Iraqi economy, which in turn cannot be achieved solely through remedial humanitarian efforts.''
Aug 12 UNICEF estimates that an additional half million children under five who would be alive under normal circumstances had died in Iraq between 1991 and 1998.
Dec 17 Resolution 1284 offers improvements in Oil-for-Food, although less than those recommended by the Security Council panel, and expresses its intention to suspend sanctions with the ``fundamental objective of improving the humanitarian situation'' in Iraq. The oil sales cap is removed and some items are allowed into Iraq with automatic Security Council approval.
2000
Jun 8 Resolution 1302 establishes a team of "independent experts to prepare by November 26, 2000 a comprehensive report and analysis of the humanitarian situation". Iraqi government does not allow the team to enter its territory. Security Council rejects the alternative of a report based on UN agency information and other reliable external sources.
Dec 5 Resolution 1330 further expands lists of humanitarian items. Compensation fund reduced to 25% from 30% of oil revenues with the additional resources targeted to vulnerable groups.
2001
May-Jun UK, French, and Russian draft resolutions propose various new approaches. The UK proposes a Goods Review List of potential dual-use items and land-based border monitoring of Iraq trade. Objections by Russia and by Iraq, as well as differences among Permanent Members blocks Council action.
Jun 6 One month extension of Oil-for-Food under previous conditions.
Jul 4 Lacking agreement with Iraq, five month extension of existing Oil-for- Food.
Nov 29 Oil-for-Food program extended by six months in Resolution 1382. Resolution proposes a Goods Review List to be adopted in May.
2002
Jan 29 US President George W. Bush declares Iraq to be part of an "axis of evil" in his State of the Union message to Congress. Thereafter, reports abound of plans for a large-scale US military attack on Iraq.
Feb 26 OIP Director Benon Sevan warns the Security Council of a "financial crisis" in the humanitarian program due to the dispute over oil pricing.
May 14 Resolution 1409 adopts Goods Review List.
Aug 1 Iraq Foreign Minister Naji Sabri writes to UN Secretary General Kofi Annan suggesting that Iraq may be ready to allow arms inspectors back into Iraq, but scepticism remains that inspections will resume




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APPENDIX II
“The Future of Sanctions”A Report of The Select Committee on International Development, of the UK House of Commons, 27 January 2000. Excerpt…Comprehensive Economic Sanctions — Iraq (paras 17-42)

There is a clear consensus that the humanitarian and developmental situation in Iraq has deteriorated seriously since the imposition of comprehensive economic sanctions whilst, at the same time, sanctions have clearly failed to hurt those responsible for past violations of international law as Saddam Hussein and his ruling elite continue to enjoy a privileged existence.

Not all this humanitarian distress is the direct result of the sanctions regime. It appears that Saddam Hussein is quite prepared to manipulate the sanctions regime and the exemptions scheme to his own ends, even if that involves hurting ordinary Iraqi people. This does not, however, entirely excuse the international community from a part in the suffering of Iraqis. A sanctions regime which relies on the good faith of Saddam Hussein is fundamentally flawed.

Whatever the wisdom of the original imposition of sanctions, careful thought must now be given as to how to move from the current impasse without giving succour to Saddam Hussein and his friends. Any move away from comprehensive sanctions should go hand in hand with measures designed to target the real culprits, not the poor of Iraq but their leadership. Possibil-ities include a concerted attempt to target and either freeze or sequester the assets of Saddam Hussein and those connected to him, and the indictment of Saddam Hussein and his close associates as war criminals.

We find it difficult to believe that there will be a case in the future where the UN would be justified in imposing comprehensive economic sanctions on a country. In an increasingly interdependent world such sanctions cause significant suffering. However carefully exemptions are planned, the fact is that comprehensive economic sanctions only further concentrate power in the hands of the ruling elite. The UN will lose credibility if it advocates the rights of the poor whilst at the same time causing, if only indirectly, their further impoverishment.




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Footnotes
(1) The sanctions, imposed under Resolution 661, barred imports and exports, except medical and humanitarian supplies and they also forbade foreign investments. Foreign assets of Iraq were also largely frozen. Resolution 986 (1995) allowed for exceptions to the sanctions for the export of oil and the import of approved humanitarian supplies, eventually implemented in 1996.
(2) The sanctions, as redefined under Resolution 687, seek to eliminate Iraq’s weapons of mass destruction and delivery systems; they also seek return of prisoners of war and property taken during the Gulf War, they establish the principle of compensation for war damage, they insist that Iraq’s international debts be honored and they demand that Iraq refrain from terrorism.

(3) This issue is discussed further below, in chapter 6, with a number of opinions cited.

(4) The four banned categories are: nuclear weapons, chemical weapons, biological weapons, and missile delivery systems. For an assessment by the Council itself, see the reports of 1999 in S/1999/356. In August 2000, US Undersecretary of State Thomas Pickering told journalists that Iraqi President Saddam Hussein “has not, at least in so far as we can tell, reconstituted his weapons of mass destruction.” (transcript of digital video conference, August 3, 2000, source US Department of State). For a discussion of this issue see chap. 6.4 below.

(5) Security Council Resolution 1284 (1999) added additional criteria to those specified in Resolution 687 (1991) and all criteria remained vague. Many at the UN have spoken of “moving the goalposts,” but the metaphor of precise goalposts is itself misleading, since criteria have never been clear.

(6) See verbatim transcript of the Council meeting of November 19, 1999. Van Walsum said his frustrated delegation was beginning to refer to the Council’s permanent members as the “Hereditary Five.”

(7) For a discussion of the early optimism about sanctions, see Thomas G. Weiss, David Cortright, George A. Lopez and Larry Minear, Political Gain and Civilian Pain (Oxford, 1997).

(8) See especially section 5.2.

(9) A case an be made that Iraq sanctions, first imposed response to armed aggression, should be subject to the Geneva Conventions.

(10) United Nations document A/50/60, Supplement to an Agenda for Peace, January 1995.

(11) After Iraq, the Council imposed two further comprehensive economic sanctions – on the Federal Republic of Yugoslavia (Resolution 757of May 30, 1992)(suspended November, 1995); and on Haiti (Resolution 917 of May 6, 1994)(lifted September 1994). For well over six years, the Iraq sanctions have been the only sanctions of this type in force. The Council may be moving towards (renewable) time-limited sanctions. Such limits reduce the likelihood of sanctions lasting for a very long period.

(12) Press Release, “Secretary-General Reviews Lessons Learned During ‘Sanctions Decade’ In Remarks To International Peace Academy Seminar,” April 17, 2000, SG/SM/7360.

(13) UN document S/22366, 20/3/91, paragraph 8.

(14) Report to the Secretary-General on humanitarian needs in Kuwait and Iraq in the immediate post-crisis environment by a mission to the area led by Martti Ahtisaari, Under-Secretary-General for Administration and Management, March 20, 1991, paragraph 9, available online. http://www.un.org/Depts/oip/reports/S22366.html

(15) UN document S/22799, July 17, 1991, paragraph 29.

(16) Report to the Secretary-General dated July 15, 1991 on humanitarian needs in Iraq prepared by a mission led by the Executive Delegate of the Secretary- General for humanitarian assistance in Iraq, S/22799, July 17, 1991, available online at http://www.cam.ac.uk/societies/casi/info/undocs/s22799.html .

(17) Ibid.

(18) UN Security Council Resolution 706 specified a ceiling of $1.6 billion worth of oil sales every six months. From that amount, deductions for the Compensation Commission and UN expenses had to be made, equalling about one third. For an analysis of this period, see Ian Johnstone, Aftermath of the Gulf War: An Assessment of UN Action. Occasional Paper of the International Peace Academy (Boulder, 1994).

(19) On this date, a Memorandum of Understanding was signed between the UN Secretariat and the Government of Iraq.

(20) For a detailed discussion of the Oil-for-Food Program and its deficiencies, see Chapter 5 below. Initially, Iraq was severely restricted in its oil sales, but, as we will show below, the program had more fundamental flaws.

(21) WHO, March 1996, The Health conditions of the population in Iraq since the Gulf Crisis: Section 4, Impact on Child malnutrition.

(22) See: UNICEF, “The Status of Children and Women in Iraq: A Situation Report,” September 1995; WFP, News Release: "Time running out for Iraqi children," September 26, 1995; CESR, “Unsanctioned Suffering,” May 1996, available online at http://www.cesr.org/text%20files/sanct.PDF; UNHCR, “Humanitarian situation in Iraq: Sub-Commission decision 1997/119,” UN Document E/CN.4/SUB.2/DEC/1997/119, August 28, 1997; FAO Press Release, “FAO Warns of Danger to Near East if Outbreak of Animal Diseases in Iraq is not Contained - Situation Could Threaten Near East Food Security,” February 10, 1999.

(23) See for example the State Department’s web site on Iraq sanctions and spokesman James Rubin’s comments on the television program “Paying the Price: Killing the Children of Iraq” by John Pilger, first broadcast on ITV in the UK on March 6, 2000.

(24) Graca Michel, Impact of Armed Conflict on Children A/51/306, annex, par 128.

(25) “The Relationship Between Sanctions and Respect for Economic, Social and Cultural Rights,” UN Committee on Economic, Social and Cultural Rights, E/C.12/1997/8.

(26) Ibid.

(27) For details on Oil-for-Food, see Chapter 5 below.

(28) This text, known as a “non-paper,” was never issued as a publication of the Security Council. For the full text see http://www.globalpolicy.org/security/sanction/committee-chairs/1998/1030papr.htm.

(29) See Barton Gellman, “U.S. Spied on Iraq Via U.N.,” Washington Post, March 2, 1999.

(30) Republican members of Congress charged US President Bill Clinton with having launched these attacks to draw attention away from his impeachment hearings. Such charges demonstrate how very political and subjective the Iraq issue had become.

(31) S/1999/92.

(32) Report of the second panel established pursuant to the note by the president of the Security Council S/1999/100 concerning the current humanitarian situation in Iraq, UN document S/1999/356, 15, para 43.

(33) Ibid., para 58.

(34) From a report on a meeting with a delegation from Physicians for Social Responsibility on April 5, 1999, available at www.scn.org/ccpi/UN andUSreports.html.

(35) Mohamed M Ali and Iqbal H Shah, “Sanctions and childhood mortality in Iraq”, The Lancet 2000; 355: 1851–57. See Section 4.3 for a discussion of the debate about sanctions and mortality. The “autonomous region” refers to the North, where a separate and better-funded program was in place.

(36) The Adverse Consequences of Economic Sanctions for the Enjoyment of Human Rights, E/CN.4/Sub.2/2000/33).

(37) The US ambassador, George Moose, made his comment when the report was being considered by a UN body in August 2000. See http://www.us-mission.ch/press2000/0817moose.htm.

(38) “Special Topics on Social Conditions In Iraq, An Overview Submitted By The UN System To The Security Council Panel On Humanitarian Issues,” Baghdad, March 24, 1999.

(39) UN document S/1999/356, Annex II, “Report of the second panel established pursuant to the note by the president of the Security Council of January 30, 1999 (S/1999/100), concerning the current humanitarian situation in Iraq”, March 30, 1999, paragraph 25.

(40) Though the Council lifted the cap, it was clear that Iraq could not produce or sell much more oil, because the ban on investments and the holds on oil equipment contracts left Iraqi oil facilities in bad disrepair.

(41) For another interpretive overview of Iraq sanctions, see David Cortright and George Lopez, Sanctions and the Search for Security, (New York, 2002), ch. 2, “The Iraq Quagmire.”

(42) Select committees are all-party committees, not subject to party discipline. It would appear that the UK government has not commanded a majority in the Commons on this issue for some time and maintains the policy only by imposing party discipline on its recalcitrant backbenchers in regular parliamentary votes.

(43) United Kingdom, House of Commons, Select Committee on International Development, Second Report, Executive Summary, para 17 (For a more extensive quotation from this report, see Appendix II).

(44) Reuters, “Top UN Official Leaves Iraq, says programme failed,” 29 March 2000.

(45) Open Letter to Mr. Peter Hain, The Guardian, January 3, 2001.

(46) Press Release, “Secretary-General Reviews Lessons Learned During ‘Sanctions Decade’ In Remarks To International Peace Academy Seminar,” April 17, 2000, SG/SM/7360 The conference was largely sponsored by the Canadian government.

(47) Speech by Lloyd Axworthy to the UN Security Council, April 17, 2000, text as posted on the Canadian Mission web site at www.un.int/canada/html/s-17apr2000axworthy.htm.

(48) Interview with al-Hayat daily, August 1, 2000, text from the web site of the French embassy in Washington at www.info-france-usa.org/news/statmnts/2000/iraq0108.asp.

(49) See Dilip Hiro, “Outside Powers,” in The Longest War (New York, 1991). Though France, Germany and the Soviet Union were the main arms suppliers, the United States and Britain also quietly provided arms and related military assistance. See Mark Phythian, Arming Iraq: How the U.S. and Britain Secretly Built Saddam’s War Machine (Boston, 1997).

(50) For an account of the war, see especially Hiro, op. cit. and also Efraim Karsh, The Iran-Iraq War (Houndmills, 1987), and Charles Tripp, Iran and Iraq at War (Boulder, 1991). Iraq received a large amount of war financing from the oil rich states of the Gulf and as a result purchased a lot of very expensive military hardware.

(51) For policy in Washington, see for example Samantha Power, “A Problem From Hell “ (New York, 2002), 171-245. Iraqi forces used chemical weapons in battle approximately 195 times between 1983 and 1988, and also against Iraqi Kurdish civilians, including the notorious case of Halabja, but US military and economic support continued. See also Human Rights Watch, Human Rights in Iraq (New Haven, 1990), 113ff.

(52) New York Times, August 16, 1990.

(53) For an account of this war, see John Bulloch and Harvey Morris: Saddam’s War (London, 1991) and Dilip Hiro: From Desert Storm to Desert Shield (New York, 1992).

(54) Peter Sluglett and Marion Farouq Sluglett, “Iraq,” in Joel Krieger (ed.), Oxford Companion to Politics of the World, p. 435.

(55) The bombing campaign dropped over 88,000 tons of explosives through the course of six weeks – more explosives than were dropped by the US in the Vietnam war. This comparison was made by Parker Payson, “Figure it Out” in the Washington Report on Middle East Affairs in 1991, drawing on Pentagon and Department of Defense figures. http://www.washington-report.org/backissues/0491/9104055.htm . See also the Federation of American Scientists information: www.fas.org/man/dod-101/ops/desert_storm.htm .

(56) Transcript of President Bush Press Conference, quoted in Washington Post, February 6, 1991, A21.

(57) Quoted in Barton Gellman, “Allied Air War Struck Broadly in Iraq; Officials Acknowledge Strategy Went Beyond Purely Military Targets,” Washington Post, June 23, 1991. See also Thomas J. Nagy, “The Secret Behind the Sanctions: how the U.S. intentionally destroyed Iraq’s water supply,” The Progressive (September, 2001).

(58) For an excellent discussion of weak and contradictory justifications of the no-fly policy, see Sarah Graham-Brown, Sanctioning Saddam: the politics of intervention in Iraq (London, 1999), 107-121.

(59) George Bush, Voice of the Gulf, February 15, 1991, quoted in CNN special: www.cnn.com/SPECIALS/2001/gulf.war/unfinished/war/index2.htm

(60) Turkish aircraft attacking Kurds in the northern zone operated from the same Incirlik Air Base that the US aircraft operated from in their allegedly protective mission. On several occasions, Turkish ground forces crossed the border to attack Kurds, including a force of 10,000 in December 2000. For a good overview of no-fly, see Sarah Graham-Brown, “No-Fly Zones: rhetoric and real intentions,” MERIP Press Information Note No. 49 (February 20, 2001).

(61) The Federation of American Scientists web site provides considerable information on these and subsequent military operations in Iraq.

(62) The United States has also built up permanent basis in the Gulf region and it has pre-positioned large amount of supplies and military equipment, mostly directed at Iraq. See Greg Jaffe, “Desert Maneuvers: Pentagon boosts U.S. military presence in the Gulf,” Wall Street Journal, June 24, 2002.

(63) William Arkin, “Desert Fox Delivery, Precision Undermined its Purpose,” Washington Post, January 17, 1999.

(64) Enlarged rules of engagement meant that US-UK warplanes operated under fewer restrictions and could “engage” Iraqi planes and targets in a much wider set of circumstances. As journalists reported, pilots understood this to mean that they could taunt Iraqi forces and provoke confrontations.

(65) For a revealing account of US operations in the northern no-fly zone, see Thomas E. Ricks, “Containing Iraq: A Forgotten War,” Washington Post, October 25, 2000. Ricks reports that in 16,000 sorties since the beginning of 1997 [to October, 2000], air force pilots have launched more than 1,000 bombs and missiles aginst 250 targets in northern Iraq. The pilots he quotes are very sceptical about the enterprise. No-fly enforcement also has proved very costly.

(66) “Impact of air strikes on UN operations in Iraq, January 1, 1999 – September 15, 1999”, prepared by the Humanitarian Coordinator for Iraq, Baghdad, September 26, 1999. Von Sponeck acted on the grounds that the air strikes had humanitarian consequences that fell within his mandate. He resigned less than a year later, under enormous pressure from the US and the UK.

(67) United Nations Press Release, SC/6833 http://www.un.org/News/Press/docs/2000/20000324.sc6833.doc.html .

(68) U.S. Department of State, “Saddam Hussein's Iraq”, September 13, 1999 (updated 3/24/00) http://usinfo.state.gov/regional/nea/iraq/iraq99.htm .

(69) The State Department speaks of “multi-billion” dollar projects but this is not supported by reliable evidence.

(70) Patrick Clawson, “A Look at Sanctioning Iraq: The Numbers Don’t Lie, Saddam Does,” The Washington Post, February 27, 2000.

(71) Associated Press, August 17, 2000.

(72) Robertson first made the charge in a House of Commons debate on January 25, 1999 and repeated it in “Bombing Iraq, Letter,” The Times (London), March 6, 1999.

(73) Report of the Secretary-General Pursuant to Paragraph 6 of Security Council Resolution 1210 (1998), S/1998/187, February 22, 1999, available online at: http://www.un.org/Depts/oip/reports/90day5.htm .

(74) Tun Myat, “Press Briefing by UN Coordinator in Iraq,” October 19, 2000, http://www.un.org/News/briefings/docs/2000/20001019.myatbriefing.doc.html .

(75) Security Council Committee established by resolution 661 (1990), Statement by Benon V. Sevan, Executive Director of the Iraq Programme, At the 221st meeting of the Committee, held on Thursday, July 12, 2001, http://www.un.org/Depts/oip/latest/BVS120701.htm . See also his statement on the number of ‘holds’, criticising: “the very large number of applications placed on hold, in particular those concerning electricity, water and sanitation, transport and telecommunications, which impact all sectors. The same applies also for the very large number of holds placed on applications for spare parts and equipment in the oil sector which is the only source of revenues for the programme.” United Nations Office of the Iraq Programme, Oil-for-Food, Briefing by Benon V. Sevan, Executive Director of the Iraq Programme, on Thursday, April 20, 2000, http://www.un.org/Depts/oip/latest/benonsc20apr00.htm .

(76) Sevan raises this point in a number of his briefings.

(77) John Maynard Keynes’ famous book The Economic Consequences of the Peace (London, 1919), written immediately after participating in the conference at Versailles, provides a cautionary tale.

(78) The information in this paragraph draws heavily from Raad Alkadiri, “The Iraqi Klondike: oil and regional trade,” Middle East Report, No. 220 (Fall, 2001), 30-33.

(79) Current estimates of smuggling range from $1.5 to $3 billion per year. The government of Iraq would participate in only part of the smuggling. Though far less than the Oil-for-Food program, it is a lucrative market.

(80) Conversation with the authors, June 5, 2002.

(81) Ibid.

(82) See, for example, Daniel Yergin, The Prize: the epic quest for oil, money and power (New York, 1991).

(83) In order of size these firms are: Exxon Mobil, Royal Dutch-Shell, British Petroleum-Amoco, Chevron-Texaco, and Total Fina Elf. Royal Dutch Shell is often described as a British-Dutch company, while Total Fina Elf is sometimes described as a French-Italian company.

(84) Major shareholders in IPC were: Shell, BP, Esso (later Exxon), Mobil, and CFP, the French national company.

(85) For an account of this period, see Joe Stork, Middle East Oil and the Energy Crisis(New York, 1975), 188-194. Since 1918, France had considered Iraq to be its main source of international oil reserves and its main means to gain parity with the Anglo-American companies (see Yergin, op. cit., 188-191).

(86) See Michael Tanzer, “Oil and Military Power in the Middle East and the Crimean Sea Region, The Black World Today (web site), two parts, February 28 and Mar 6, 2002.

(87) From US Department of Energy, International Energy Outlook, Table 13.

(88) Text as posted at www.chevrontexaco.com/news/archive/chevron_speech/1998/98-11-05.asp At the time, Condoleeza Rice, currently US National Security Advisor, was a board member of Chevron and one of the company’s supertankers was named after her. Though it is tempting to insist on the many oil and energy industry connections of the Bush administration, including the President and Vice President Cheney, oil issues have consistently had a heavy influence on US foreign policy, regardless of party or personalities.

(89) Testimony to the Senate Armed Services Committee, April 13, 1999.

(90) See Michael T. Klare, Resource Wars: the new landscape of global conflict (New York, 2001), esp. ch. 3, “Oil Conflict in the Persian Gulf.”

(91) “Informal consultations of the Security Council held on Monday, November 26, 2001, Introductory Statement by Benon V. Sevan, Executive Director of the Office of the Iraq Programme.

(92) UN report S/2000/1132, page 2 point 5.

(93) The Center-South per capita percentage rose to 69% with Resolution 1330 of December 5, 2000, which reduced the deduction for the Compensation Fund from 30% to 25%.

(94) These and subsequent data on sanctions trade are from the Office of the Iraq Programme web site (www.un.org/Depts/oip). See “Weekly Update,” 13-19 July, 2002.

(95) OIP site.

(96) See Paul Conlon, United Nations Sanctions Management: A Case Study of the Iraq Sanctions Committee, 1990-1994 Procedural Aspects of International Law Monograph Series, Vol. 24 (Ardsley, NY, 1995).

(97) See Office of the Iraq Programme, weekly update, www.un.org/Depts/oip/latest/wu020521.

(98) Office of the Iraq Programme, Oil-for-Food, December 18, 2001, Weekly Update, December 8-14, 2001, http://www.un.org/Depts/oip/background/latest/wu011218.html .

(99) Ibid.

(100) Briefing by Benon V. Sevan to the Security Council, July 22, 1999.

(101) Oil spares gained Council approval only on June 19, 1998 with Resolution 1175 that allowed $300 million in spares imports per six-month phase. The Council doubled this sum to $600 million with Resolution 1293 of March 31, 2000. But US holds continued to block most important oilfield imports.

(102) The UN and many independent experts have pointed out that the Iraqi oil industry is very seriously dilapidated and that production under such unfavourable condition depressurizes the reservoirs and may make future production impossible in these fields. See, for example, Middle East Institute [Washington, DC], “Iraqi Oil After Sanctions,” February 29, 2000 http://www.mideasti.org/html/020900b.html .

(103) Ibid.

(104) Briefing by Benon V. Sevan to the Security Council, February 26, 2002.

(105) Secretary General's report to the Security Council, S/2001/505, para 67.

(106) See several sectoral briefings of UN agencies working in Iraq to the Security Council, in the fall of 2001.

(107) The GRL circulated to delegations at the time of the adoption of Resolution 1409 was 302 pages in length, but the GRL that we have accessed on the OIP web site and dated May 16, 2002 is 486 pages in length. Since each page lists many categories of items, tens or even hundreds of thousands of items could be covered by the list.

(108) As of December 31, 2001, data from OIP.

(109) Statement by Benon V. Sevan, Executive Director of the Office of the Iraq Programme to the 661 Committee of the Security Council, April 20, 2000.

(110) “Weekly Update,” 20-26 July,l 2002, Office of the Iraq Programme.

(111) The Commission posts extensive information about its work at www.uncc.ch.

(112) No current estimates for the reconstruction needs of Iraq are available. The report on the state of the oil industry calls for $1.3 billion annual operating expenditure only, not counting capital expenditure. Other damaged sectors in Iraq are equally capital-intensive. See http://www.un.org/Depts/oip/reports/oilexpertsreport.pdf (p.35).

(113) See Alain Gresh “L’Iraq paiera: enquête sure une commission occulte,” Le Monde Diplomatique, October, 2000, pp. 1, 16-77.

(114) House of Commons, Hansard, March 24, 2000, column 1291. Hain made this false point on a number of other occasions, including a speech to the Royal Institute of International Affairs on November 7, 2000.

(115) Alastair Kirk and Gary Sawdon, “Understanding Kurdish Livelihoods in Northern Iraq: Final Report,” Save the Children (London, 2002). The study was based on a household economy study carried out by Save the Children during 2001.

(116) FAO ibid, p. 17.

(117) FAO ibid, page 10.

(118) “Urgent Need for Health and Immunisation Interventions”, UNICEF Humanitarian Action, Iraq, Donor Update, July 11, 2001, http://www.unicef.org/emerg/Iraq11Jul01.PDF .

(119) UNICEF and Ministry of Health of Iraq, Child and Maternal Mortality Survey 1999 Preliminary Report (July, 1999) and UNICEF, Questions and Answers (August 16, 1999).

(120) Richard Garfield, “Morbidity and Mortality among Iraqi Children from 1990 to 1998, Assessing the Impact of Economic Sanctions.” Occasional Paper of the Joan B. Kroc Institute of International Peace Studies, University of Notre Dame (1999).

(121) Communication with the authors, April 8, 2002.

(122) FAO report, op. cit.

(123) CBS Television, May 12, 1996. With thanks to Eric Herring and his outstanding paper “Between Iraq and a Hard Place, Review of International Studies (January, 2002), vol. 28, no. 1

(124) Robert A. Pape, “Why Economic Sanctions Do Not Work,” International Security, Vol. 22, No. 2 (Fall, 1997).

(125) The Interlaken Process focused on financial sanctions while the Bonn-Berlin Process focused on arms embargoes, while the Stockholm Process seeks an integrative approach.

(126) US Senate Foreign Relations Committee, Hearing, “The Fiscal Year 2002 Foreign Operations Budget,” March 8, 2001.

(127) See “Cosmetic Surgery,” The Economist, May 16, 2002; “US unfreezes Russian contracts in oil for food program with Iraq,” Alexander’s Gas & Oil Connections, News & Trends: Middle East, April 4, 2002.

(128) According to the Washington Post (July 6, 2001), the US had lifted blocks on $80 million of Chinese contracts in June 2001, at an earlier stage of the negotiations.

(129) The GRL negotiations took place only between the US and Russia, with even the UK reportedly excluded. The United States apparently rejected a special deal of lifted holds for France and China.

(130) Security Council Humanitarian Panel Report, March 1999 http://www.un.org/Depts/oip/panelrep.html .

(131) These proposals set out model Security Council resolutions, recommend a UN sanctions unit, etc. The entire exercise has aimed at targeting leaders, their personal finances, travel and arms supplies. The reports are posted on the web.

(132) New York Times, May 15, 2002. The Economist, “Cosmetic Surgery” May 16, 2002.

(133) UN Oil Overseers Report, March 14, 2002 notes the premium level. Estimates of the kickback have appeared in the Financial Times (June 7), Middle East Economic Survey (July 1 and 8), and Reuters (July 16).

(134) UN Oil Overseers Report, March 14, 2002. For some comment on the pricing issue see David Cortright, Alistair Millar and George A. Lopez, Sanctions, Inspections and Containment (Goshen, Indiana, 2002)

(135) Statement by Benon V. Sevan, Executive Director of the Iraq Programme at the Informal Consultations of the Security Council, February 26, 2002 (as posted on the OIP web site).

(136) “Weekly Update,” 20-26 July, 2002, Office of the Iraq Programme web site.

(137) Not surprisingly, the Russians took the most vocal position. See, for instance, “In Connection with problems in implementing UN humanitarian program for Iraq,” Press release of the Government of the Russian Federation, June 17, 2002. Many other, more disinterested delegations, opposed firmly but quietly the US-UK stance.

(138) The New York Times quoted a US National Security spokesman as dating the regime-change policy to the mid-1990s: “Our policy remains the same. It has been the same since 1995 and that is ‘regime change’.” (August 3, 2002). But evidence suggests that regime-change has been official policy since 1991.

(139) State of the Union Address, January 29, 2002.

(140) Scott Ritter, a member of the UN disarmament team in Iraq, has argued that while every single item was not accounted for by the UNSCOM monitors, Iraq was found to be “qualitatively” disarmed, that is, “the elimination of a meaningful, viable capability to produce or employ” nuclear or chemical-biological weapons. See “Redefining Iraq’s Obligation: The Case for Qualitative Disarmament of Iraq,” Arms Control Today (June, 2000).

(141) Unclassified Report to Congress on the Acquisition of Technology Relating to Weapons of Mass Destruction and Advanced Conventional Munitions, January 1 through June 30 2001.

(142) On July 5, the New York Times reported that European governments believe that the evidence for Iraq’s possession of mass destruction weapons remains “murky” (European intelligence sources have in fact been saying that no clear evidence for such programs currently exists.) A month later the Times concluded from Congressional hearings that “the United States simply does not know” how advanced Iraq’s weapons programs may be.” (August 3, 2002).

(143) Recent attacks on the arms control record of UNMOVIC head Hans Blix (as first reported in the Washington Post) suggests that Paul Wolfowitz and others in the Bush administration fear UN inspections that would determine Iraq to be free of weapons of mass destruction.

(144) ‘The Purposes of the United Nations are (...) to achieve international cooperation in (...) promoting and encouraging respect for human rights (...)’ (article 1(3)). ‘The United Nations shall promote universal respect for, and observance of, human rights and fundamental freedoms for all ...’ (Article 55(c)).

(145) See Mohammed Bedjaoui, The New World Order and the Security Council (Dordrecht, 1994) for an extensive review of the arguments from a legal scholar who believes that the Council is not above the law and even that its decisions should be reviewable by the World Court. A well-known World Court opinion by Justice Lauterpacht (1993 L.C.J. 325, p. 440) argues that the Council’s work is obviously subject to the limits imposed by international humanitarian law.

(146) IASC Statement S/1998/147; Eric Hoskins, The Impact of Sanctions: a study of UNICEF’s perspective (New York, 1998); Bossyut Report: The Adverse Consequences of Economic Sanctions on the Enjoyment of Human Rights, E/CN.4/Sub.2/2000/33.

(147) Background Paper prepared by the Office of the High Commissioner for Human Rights for the meeting of the Executive Committee on Humanitarian Affairs, September 5, 2000.

(148) For the GIIS event, see Vera Gowlland-Debbas, United Nations Sanctions and International Law (The Hague, 2001).

(149) Every major human rights treaty derives from and grounds itself in the principles of the United Nations, as made explicit in its Preamble or Statement of Principles.

(150) Report of the Secretary General, September 4, 1991, S/23006, 15.

(151) Open letter to Mr. Peter Hain, published in the Guardian, January 3, 2001.

(152) See paragraph 18 of Resolution 1302 (8 June 2000).

(153) For Liberia: UN Document S/2001/939. For Afghanistan: UN Document S/2001/1215.

(154) UN Human Rights Committee, General Comment 6/16 (July 27, 1982).

(155) Articles 6 and 24, ‘States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health (...)’ and they ‘shall pursue full implementation of this right and, in particular, shall take appropriate measures (...) to diminish infant and child mortality’ (Ibid.)

(156) Additional Protocol to the Geneva Convention of August 12, 1949, Relating to the Protection of Victims of International Armed Conflicts (Protocol 1) of June 8, 1977, article 51 (5) (b).

(157) Article 51 (5)(b), Protocol 1, Additional to the Geneva Convention, June 8, 1977.

(158) See e.g. Boutros Boutros-Ghali in Supplement To An Agenda For Peace: ibid, para 70.

(159) For a much more extensive argument, see Thérèse O’Donnell, Iraq and the Proportionality of UN Sanctions After Ten Years A report compiled for Save the Children (London, 2000) (unpublished).

(160) Ibid.



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We publish this report on the twelfth anniversary of the date on which the Security Council first imposed comprehensive economic sanctions on Iraq

Principal contributors to this report are: Richard Morran, Roger Normand, James Paul, John Rempel and Christoph Wilcke.

With thanks for extensive and helpful comments from: Gerard McHugh, Colin Rowat, Hans von Sponeck and Joe Stork.

Note: Though this report has been produced in association with Save the Children UK, the views and recommendations expressed do not necessarily reflect the position of Save the Children UK



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More Information on Sanctions Against Iraq
More Information on the Iraq Crisis

Result number: 67

Message Number 128692

Re: PF and Neuropathy View Thread
Posted by kellys on 9/03/03 at 11:30

Donna

How are you doing now? After ~ 3 years of trying everything except surgery for PF/TTS, I was diagnosed with `idiopathic peripheral neuropathy' 6 months ago. I got suspicious when I developed new but similar pain in my hands/forearms so finally got to a neurologist. I was hesitant to try drugs for pain relief since I am relatively young and otherwise very healthy, but I've been working with my neurologist and pain doctor to find the combination that works for me. The side effects are annoying but tolerable and overall my quality of life has improved dramatically. I'm also trying out alternative therapies to complement the conventional prescriptions. I checked out a book from the library called "THe Chronic Pain Solution" by a Dr. James Dillard. He is affiliated with Columbia U (NY) pain clinic and advocates for a multi-pronged approach to chronic pain(conventional/alternative). There's a section in there specifically on peripheral neuropathy. Typical conventional drugs used to treat PN-related pain are tricyclic antidepressants, certain anti-convulsants (e.g. Neurontin), ultram (tramadol). A good pain doctor will be willing to work with you to find the right single drug or combination. Individuals respond differently to each drug, so what's right for someone else may not work for you. I'm converging on a good combination now after about 6 months and really am a lot happier. The pain isn't ever 100% gone, but for the most part it's at what I'd call a "manageable" level where I can generally exercise (bike, swim, weights) 5 days a week and handle the daily activities (cleaning, errands) much more readily. Still have some ups and downs but it's never anywhere near as bad as before I started on the drugs, and I am learning to not be so hard on myself.

You may also wish to check out the message board at www.neuropathy.org.
Good luck, and know that it's ok to seek out help for your pain. I am glad I finally got to a neurologist, pain dr, and physiatrist (rehab dr). Not to mention a terrific yoga instructor :).

Result number: 68

Message Number 128420

Re: A rant about podiatrists - what's going on with those folks?? View Thread
Posted by Sharon W on 8/29/03 at 22:00

Dorothy,

I have a friend in "psych" who prefers the term "compassion fatigue" to "burnout" -- and I do think that seems more accurate and descriptive of what really happens. I also like the term "vicarious traumatization" -- that describes another component of what health care workers go through as they try to "advocate" for their patients.

I should probably add that one way a nurse "advocates," traditionally, is to act as kind of a go-between for doctors and patients -- the nurse finds out what is going on with the patient and then relays to the doctor whatever info she has learned that SHE thinks the doctor really ought to know. Unfortunately, this process does mean that the patient's words and concerns are being reported to the doctor second-hand and what the nurse says to the doctor may be what the doctor acts upon, rather than the doctor responding to the patient's own words.

(I have mixed feelings about that...)

Sharon
.

Result number: 69

Message Number 128409

Re: A rant about podiatrists - what's going on with those folks?? View Thread
Posted by Sharon W on 8/29/03 at 18:47

Dorothy,

I think that's the first time I've EVER heard anyone advocate in favor of the "anal-retentive" personality!!

However, you are right that the role of nurses as patient advocates has also changed. Most nurses DO still see themselves in that role... But now, more than ever, nurses are being required to work faster, to take care of more patients at one time, and to produce more and more pages of mandatory documentation. SOMETHING has to give... and all too often the only thing that CAN "give," is the role of patient advocate.

From personal experience I can remember evenings when I always meant to go back to a depressed patient's room, pull up a chair for at least a COUPLE fo minutes, and offer her a listening ear... but unfortunately that night I just was never able to find the few "extra" minutes that would have taken. I really did TRY, and usually I DID manage to spend those moments with my patients that make all the difference in establishing trust and an "advocacy" relationship. But it isn't easy to do, not easy at all. There were long nursing shifts when I never stopped for a break of ANY kind, not even to go to the bathroom -- that's how busy it was!

So I do understand where "burnout" comes from, and why so many health professionals fall prey to it... why some people involved in health care seem to STOP caring about anything except how much longer it will be before they get to go home.

Sorry to ramble on so.

Sharon
.

Result number: 70

Message Number 128405

Re: A rant about podiatrists - what's going on with those folks?? View Thread
Posted by Dorothy on 8/29/03 at 17:25

So true - I think doctors have written and commented on this change in their perceptions of their role with patients and patient care, and patients have certainly noted it. Nurses have also traditionally been patient advocates, but that seems to have changed as well, under the same pressures.

I just think a big diffence is in the affects of these changes. Patients feel more helpless and vulnerable, and may, in fact, BE more vulnerable. I realize that there has never been perfection in medical treatment and that the expectation of perfection is irrational. At the same time, I think each and every one of us could recount some "horror tale" of medical care gone awry, not because perfection was an irrational expectation and unattainable, but because of easily preventable lapses. I think that it's the quality of "attention to detail" that makes a huge difference. Whether it's in the plumber, the carpenter, the architect, the police officer, the lawyer or the doctor. We need people who lean toward the 'anal-retentive' personality if we want to have good attention to detail.

Result number: 71

Message Number 128399

Re: A rant about podiatrists - what's going on with those folks?? View Thread
Posted by Dorothy on 8/29/03 at 16:18

It would actually be an interesting (maybe depressing or enraging) thread to post all of the personal or otherwise personal knowledge of Amazing Stories with doctors. I honestly don't think that the kind of incident(s) that you describe are uncommon. I have been in life a teacher, a counselor, a case worker, a therapist, a social worker, and other things as well that don't pertain to this thought - in those areas of work, as well as in my own personal life, I have experienced or witnessed some amazing things. Yes, some of them have been amazing in positive ways, but some were far from positive. This is one reason that I earlier said everyone needs an advocate when engaging with the medical 'system' - and even a team of advocates would be good!

Result number: 72

Message Number 127793

Re: INJECT THEM ALL AND LET GOD SORT THEM OUT View Thread
Posted by Sharon W on 8/24/03 at 00:36

As far as advocates go -- it looks to me like this patient has BG! ;)

I've always areally ppreciated those special medical professionals who took the extra couple of minutes and showed the kindness and consideration to offer "a word to the wise". (It usually can be done without openly and directly criticising another practicioner, too...)

Sharon
.

Result number: 73

Message Number 125791

Re: Egoscue Pain Free and related Questions View Thread
Posted by rose on 7/31/03 at 12:40

Yes. He advocates going barefooted, but also doing various exercises to relieve the cause of the foot pain and realign evrything so the cause will disappear.

Result number: 74

Message Number 122381

The wisdom of government regulations and toilets View Thread
Posted by Ed Davis, DPM on 6/19/03 at 16:07

I cannot buy a toilet nowadays that does not clog or I don't have to flush twice ever since the government mandated that flushes be limited to 1.6 gallons per minute:



HELP!
FAQs

~~1.6 Gallon, Low-consumption Toilets~~
The need to conserve water has pushed governments everywhere to look for every means possible to reduce the amount of water used by the customers of municipal water companies. Since toilets account for a major amount of the water used year round, many of the municipal programs and new laws have focused on how to make a toilet flush with less water.

Before the 1950s, toilets typically used 7 gallons or more for each flush. By the end of the 1960s, toilets were designed to flush with only 5.5 gallons, and in the 1980s the new toilets being installed were using only 3.5 gallons. Today, a new toilet uses no more than 1.6 gallons of water.

While some states mandated the 1.6 gallon toilet standard some years ago, in 1995 the National Energy Policy Act (H.R. 776) went into effect and mandated 1.6 toilets for the entire U.S. In addition to dealing with radioactive waste disposal and metallurgical coal development, the federal law also determined in an obscure part of the Act what kind of toilet you can have in your bathroom. By federal decree, new toilets must flush with no more than 1.6 gallons of water, less than half the amount they used in the '80s..

At first, manufacturers tweaked the valves and floats in the tank to reduce the water used without making any changes to the tank or bowl. The two most common adaptations were to install a flush-valve flapper which closes before all the water escapes the tank (early-close flapper) or to install a plastic bucket, or toilet dam, which retains some water in the toilet tank behind the dam, thus lowering the volume of flush. Some manufacturers switched to low-capacity tanks with a standard flapper, and others chose to utilize new pressurized flush technology.

Since the 1995 mandate went into effect, there have been numerous outcries from the public regarding the poor flushing of many models of toilets that have been available. Many of the articles published in the newspaper have been based on anecdotal accounts of problems. But a recently published report by the Water Resources Research Center at The University of Arizona is supported by research. This report concludes that, despite the skepticism that greeted their introduction and a history of early problems, most low-consumption toilets are doing their job. Unfortunately, the research also shows that, over time, a significant fraction of the anticipated water savings is lost due to poor toilet design and performance modifications. Some of the modifications are inadvertent on the part of homeowners.

Jim Henderson and Gary Woodard, then with the Water Resources Research Center at the University of Arizona, studied 170 households which participated in a Tucson Water rebate program to encourage replacement of older toilets with 1.6 gallon low-consumption models. Toilets studied were purchased between 1991 and 1992, just a few years after the low-consumption toilet was introduced into the American market.

The report was prepared for the Water Conservation Office of the City of Phoenix Water Services Department, and the U. S. Bureau of Reclamation. The researchers installed special devices called data loggers on these homes to monitor the amount of water used by the then seven-year-old toilets. Combined with surveys of more than half of the households, the study revealed some problems with the aging toilets. The report confirmed the worst fears the water industry has had about these products -- that long-term savings are not reliable.

Nearly half of the low-consumption toilets in the study had problems with high flush volumes, frequent double flushing and/or flapper leaks. The average flush volume for all of the toilets was 1.98 gallons of water per flush, or about 24 percent higher than the 1.6 gallon maximum they were designed to use. About a quarter of the households had at least one low-consumption toilet that averaged more than 2.2 gallons per flush.

Visit the University of Arizona Water Resources Research Center to read or download the full report.


http://ag.arizona.edu/AZWATER/toilet/toilet.htm
FUNCTIONING OF AGING LOW-CONSUMPTION TOILETS IN TUCSON
A FOLLOW-UP WITH REBATE PROGRAM PARTICIPANTS
Water Resources Research Center
The University of Arizona
Issue Paper #22
October 2000
A report prepared for: The City of Phoenix Water Services Department, Water Conservation Office and, The U.S. Bureau of Reclamation, Phoenix Area Office. By: Jim Henderson, Water Consultant, and Gary Woodard, SAHRA, University of Arizona


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The following is a collection of articles that have been published since H.R. 776 went into effect in 1995:


According to the The Washington Post for 28 May 1996 (page A1) supplies of the old toilets are nearly depleted, and frustrated flushers are now living with the reality of H.R. 776. While manufacturers are insisting they have resolved many of the early problems with the low-consumption in their new models; the consumer is left to decide for themselves how to cope with the problems associated with the early low-consumption models. Marjorie Johnson, spokesperson for the Washington Suburban Sanitary Commission, the water company in Montgomery and Prince George's counties, Maryland says, "I simply double-flush, and that's not conservation." Some areas have put real teeth into implementing this law. In Fairfax County, Virginia willful violation can result in criminal misdemeanor charges and fines of up to $2500 a year. Craig Simounet, vice president of Atlas Plumbing in Manassas, Virginia says there is only one thing to tell people. "Flush again!"



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Christine Gorman writing in Time Magazine for 1 July 1996 in an article titled "Toilet Wars, Big flushers Circumvent New Environmental Laws" reported that homeowners are picking up large-capacity models at yard sales. She quoted toilet manufacturers as admitting that they were slow to find good low-consumption designs. But their latest models use various tricks such as wider pipes and extra air pressure-to make up in flush power what they lack in volume. That, say bowl-makers, should eliminate most complaints.


THE DEBATE LIVES ON
In spite of improvements in design and operation, there are still many opponents of low-consumption toilets. The Washington Post for 21 March 1997 (page G1) reported that Rep. Joe Knollenberg, Republican from Michigan, has proposed changes to the Energy Policy and Conservation Act of 1992 that mandates the 1.6 toilets. Knollenberg is responding to a torrent of complaints about backed-up and overflowing toilets. Knollenberg considers the mandate and the rules that go with it government meddling into people's private affairs. He thinks states and municipalities should be allowed to set their own limits, depending on their local water problems. The proposal has been referred to the Commerce Committee for further consideration.


The toilet debate flows on. As reported in The Washington Post for 2 April 1998, a new study shows that tiny toilets are fine and people like them. The report is titled, "Saving Water, Saving Dollars -- Efficient Plumbing Products and the Protection of America's Waters." This new report claims flushers registered overwhelming satisfaction with the new toilets.

But the credibility of this report is a bit suspect when the article points out that the author of the new 69 page report, Ed Osann, is a Washington consultant paid by the lobbyists and advocates who wrote the law -- a toilet consortium of interest groups, including the California Urban Water Conservation Council, made up of 100 California public utilities; the Water Conservation Council of Puget Sound, 17 towns and utilities in Washington state; and the Plumbing Manufacturers Institute, 45 plumbing fixture companies.

It has been a number of years since the 1992 Energy Policy Act went into effect. In the meantime, manufacturers have gone through as many as four generations of designs to meet the new standards. Needless to say, a manufacturer would not have to redesign if the previous model was satisfactory. So one wonders who were all the "flushers" who registered such overwhelming satisfaction; only those who owned the latest models?

In response to the report, Glenn Haege, host of Ask the Handyman, wrote to the editors of The Washington Post suggesting that if Congress were to replace the vacuum-flush style toilets in use at the Capitol with the 1.6 gallon gravity feed toilets, elected officials might better appreciate the gravity of the problem. Haege claims that each week on his radio program, he hears cries of dissatisfaction with the performance of the 1.6 gallon toilets.

Another response came from Ben Lieberman, Research Associate at the Competitive Enterprise Institute in Washington. Lieberman says the conclusion of the study about the misguided and unpopular legislation is strongly contradicted by the opinions of many low-consumption toilet owners. If the water-stingy models really are as good as the study indicates, they should dominate a free market without the need to legislate their use. The fact that the proponents of low-consumption toilets are so reluctant to allow choice in the marketplace reveals much more than their study does.



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A MORE OBJECTIVE STUDY ...
was completed in August 2000 by the General Accounting Office. At the request of Rep. Michael Bilirakis and Rep. Sherwood L. Boehlert, the GAO made an assessment of the costs of repealing the water use standards contained in the 1992 Energy Policy Act. That report is dated August 31, 2000 and is GAO/RCED-00-232. You can download a copy of the 45-page report in Acrobat Reader *.pdf format from the GAO site at: http://www.gao.gov.
Here is a brief summary of that report:

No studies estimating the impact of the national water efficiency standards on water consumption or wastewater flows nationwide have been completed so far. However, studies designed to measure the impacts of using water-efficient plumbing fixtures in specific locations have shown that, compared with their less efficient counterparts, low-flow fixtures conserve water, particularly in the case of toilets. The best example is a comprehensive study of water use in nearly 1,200 homes at 12 study sites that determined, among other things, that homes with low-flow toilets used about 40 percent less water for flushing than other homes in the study.1 Estimating the impact of the national standards is difficult because some use of low-flow fixtures would likely occur for other reasons—that is, even in the absence of the standards. These reasons include (1) state and local laws that preceded the national standards and (2) incentives, such as rebate programs sponsored by local governments, that encourage the replacement of less efficient fixtures. Nevertheless, major studies initiated by the American Water Works Association and the Environmental Protection Agency (EPA) are developing long-term projections of the nationwide impact of the water efficiency standards, using precise measurements of the water savings per fixture as a starting point and taking into consideration expected population growth, the average replacement rate for plumbing fixtures, and other data. Preliminary results indicate that by 2020, water consumption could be reduced by about 3 to 9 percent, depending on the location, and wastewater flows to publicly owned treatment works could be reduced by an estimated 13 percent nationwide by 2016.

Although their precise impact is uncertain, repealing the national standards could affect the extent to which reductions in water consumption and wastewater flows are achieved and, thus, limit the extent to which local communities’ investments in drinking water or wastewater infrastructure can be deferred or avoided. For example, an ongoing study estimates that for the 16 localities analyzed to date, the standards will cause water consumption to be reduced enough to save local water utilities from $165.7 million to $231.2 million by 2020 because planned investments to expand drinking water treatment or storage capacity can be deferred or avoided.2 1 See Residential End Uses of Water, American Water Works Association Research Foundation (1999). 2 The dollar amounts presented here represent the present value of the net savings discounted at 7 and 3 percent, respectively.

Location-specific estimates for wastewater treatment facilities indicate that reductions in wastewater flows can also lead to significant savings. For example, one regional authority estimates savings of $12 million to $14 million for each million-gallons-per-day reduction in wastewater flows. However, the estimates for both drinking water and wastewater infrastructure are only as accurate as the predictions that individual utilities are able to make about future investment decisions and, for the most part, do not account for the fact that some use of water-efficient fixtures would continue in the absence of the national standards. Repealing the national water efficiency standards could exacerbate the financial pressures facing local communities by forcing them to build or expand treatment and storage facilities sooner than planned. However, even if the standards were repealed, state and local officials told us that imposing moratoria on new residential or commercial construction would be considered only as a last resort. Background The Energy Policy Act of 1992 established water conservation standards for the manufacture of four types of plumbing fixtures: toilets, kitchen and lavatory faucets, showerheads, and urinals. With limited exceptions, the standards apply to all models of the fixtures manufactured after January 1, 1994.


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The Subject Won't Die ...
A nationwide survey of 1270 builders and homeowners conducted in the summer of 1999 by the National Association of Home Builders Research Center found that roughly four out of five people experienced problems with low-flush units in the past year. A majority of the builders reported problems from more than one of their clients, and many reported hundreds of problems. Most builders surveyed also said that they receive more call-backs on low-flush toilets than on anything else.

In his article titled "An Update on Low-Flush Toilets" for The Washington Post, Mike McClintock reported that unlike other problems that turn up even in well-built houses, most builders and homeowners say that the toilet trouble can't be fixed. (14 October 1999, Page 1)



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For another opinion on this subject, read "Potty Politics", The Battle for a Better Flush, By Bob Allen, a professional plumber in Houston, Texas.



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Dave Barry, syndicated columnist, on several occasions has poked fun at the Congress for mandating the 1.6 toilets. In one column, Barry challenged his readers to write their "congress-humans" in support of Rep. Knollenberg's bill to change the law. Barry later said that as a result of that column, he got a huge amount of mail, "from Americans who care deeply about the issue of their toilets, and the vast majority of them HATE the new ones." As a result of his taking issue with the legislation, Barry was contacted by a member of Contractors 2000, an association of independent plumbing contractors. He was told that after much testing this association had a toilet they wanted Barry to try. Barry doesn't mention the brand name of the toilet, but he says, "I cannot speak highly enough of this toilet. It is an inspiring example of American ingenuity and engineering know-how." For the name of this toilet, you'll have to write Contractors 2000, 2179 Fourth St., St. Paul, MN, 55110.

On 1 Nov '98, under the title "Maple Leaf Menace for The Washington Post Magazine Barry opens his column by saying, "I say it's time "leaders" in Washington stopped blathering about sex and started paying attention to the issues that really MATTER to this nation, such as whether we should declare war on Canada." He goes on the reveal that Americans are crossing the Canadian border near Detroit to purchase 3.5-gallon-per-flush toilets. Barry rants on in shock that people can simply waltz across our borders with illegal toilets supplied by ruthless Canadian toilet cartels headed by greed-crazed Canadian toilet kingpins who will stop at nothing to push their illicit wares on our vulnerable society.

Fast forward to 10 June 2001. Barry is still ranting against the government attempt to "cripple our toilets". Barry opens his column Wit's End in The Washington Post Sunday Magazine with a warning ... TASTEFULNESS ADVISORY: Do not read this column if you are eating, or plan to eat ever again. Thank you.

Then goes on to explain: "Recently I watched as a professional engineer attempted to flush fermented bean curd down a toilet. This was not some fun engineer prank. This was a laboratory test conducted at the research center of the National Association of Home Builders, which is trying to develop a laboratory test for toilet per-formance that simulates the challenges faced by toilets in the real world." For the rest of the story ...



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John O. Nelson, a Civil Engineer, retired manager of a water utility and Warren Liebold who ran New York's toilet replacement program have put together a report of customer satisfaction responses on different ULFT brands by Water Conservation Professionals responding to an e-mail survey from the American Water Works Association's WaterWiser Conference.



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WHICH ONE IS BEST ?


Water Management, Inc. Toilet Testing Labs

After testing many different types of flushing mechanisms in their labs for their installation programs, they selected the PF/2® Energized Flush® mechanism for use inside their toilets tanks.
Water Management, Inc. (WMI), (a sponsor of Toiletology 101) designs and implements water efficiency programs for Multi-unit Residential Properties, Public Housing Authorities, Federal and State Facilities, Military Complexes, Hotel, Industrial, Commercial, and Institutional properties. The majority of their business comes from long-term, performance-based programs in which their compensation is based on a share of the savings generated by their work. This long-term orientation guides every decision they make; their bottom line depends on quality equipment being installed. They install the PF/2® Energized Flush® in their toilets. Although, WMI does not sell directly to the public, the PF/2® Energized Flush® can be found in Eljer, Gerber and Peerless Pottery toilets available at plumbing supply stores and The Home Depot Stores.





"Purchasing Low-Consumption Toilets and Toilet Replacements" written by the Seattle Public Utilities is intended as a guide so you are better informed for discussions with your plumber or retailer. This very useful guide covers, Types of Toilets, Questions To Ask When Shopping for a Toilet, Be Sure The Toilet Will Work In Your Building, and Tips for Toilet Replacement.

Terry Love, a plumber in Redmond, WA has written a Consumer Report on toilets. He has added comments from other professional plumbers regarding their experiences with the low flow toilets.

There is also lots of information on "Water Efficiency Plumbing Standards" at the WaterWiser web-site. You'll find: Facts About Water Efficiency Plumbing Standards; Benefits from Using Water Efficient Plumbing Products: Questions and Answers: Water Efficiency Plumbing Standards; and some great Consumer Tips on buying new toilets.

For those of you who are in the market for a new toilet, you'll find information on 13 low-flush toilets from eight of the leading manufacturers ($75 to $940) in the May 1998 issue of Consumer Reports (P.O.Box 53029, Boulder, CO 80322-3029) on page 44. "In search of a better toilet" gives an explanation for the differences among the gravity-flush, the pressure-assisted, the pump assisted, and the vacuum-assisted; these are the different types of toilets available today in the U.S. The engineers at the Consumer Report lab consider the Gerber Ultra Flush the best value and highest performing toilet of the thirteen they tested.

The last time Consumer Reports tested toilets was for their February 1995 issue. The report is now several years old, regardless, it is still worth reviewing (check it out at your public library.) The report rates 32 brands or models that range in price from $65 to $815 for waste-removal, dilution, wash down, soiling and odors, drain carry and noise. Eight of the top ten toilets are pressure-assisted rather than the gravity-flow that is the traditional technology. The report includes a sidebar with the telephone numbers for 12 manufacturers of the low-consumption toilets mentioned in the article.



According to an article in Fine Homebuilding Magazine Thomas Pape, chairman of the Indoor Plumbing Committee for the American Waterworks Association Conservation Committee, says homeowners should consider buying the rounded-bowl toilets instead of the elongated variety. "These just seems to work better than the elongated bowl," according to Pape. "That's especially true in a setting that might be abusive. You get a better vortex action out of a round bowl."



There are a number of factors that play into how well the low-consumption toilets work -- the size of the drain; the design and shape of the bowl, the tank and it's fittings; how often they are used; their location in relation to the other fixtures in the bath as well as the house, etc.

Seattle plumber Hill Daugherty says, "houses that have 4-in. to 6-in. cast-iron drains are a problem. When you put a 1.6-gal. toilet in with that diameter pipe, it just barely makes the bottom of the pipe wet. As a retrofit in a house with old plumbing, it's lousy. Now I run high-use fixtures, like the washing machine, just after the toilet. The washing machine will help move that waste down the line." Washington, D.C., plumber Ken Goldman believes that retrofitting 1.6-gal. toilets is the biggest source of problems plumbers have with the new fixtures. "We're using plumbing fixtures designed for the 1990s and putting them in plumbing systems designed for the 1920s," Goldman said.


Testing Toilets for Drainline Carry
According to R. Bruce Martin, President of WC Technology Corporation in the article, Is the Drainline Carry Test Really Necessary?, "... no one had any idea as to how far a WC had to transport waste. No one had ever paid attention to this aspect of performance. As a result, the TG (American National Standards Institute Task Group) had to start its development from a "zero" knowledge point. They did know that the carry capability of 5-1/2 gpf toilets was satisfactory, that those designs didn't have problems. Thus, the TG decided that the first thing to do was to quantify the transport capability of 5-1/2 gpf WCs. Additionally, the TG agreed that the new test had to be objective, so that other could replicated test results from one laboratory location to another, somewhere else. For the rest of the story you can read the details in "Is the Drainline Carry Test Really Necessary?"

Here are some ideas for improving the flush of any toilet..
First carefully remove the tank cover (put it flat on the floor on a towel out of the way so it won't get knocked over and cracked) and just observe what goes on when you flush the toilet. Is the water level as high as it could be? Is the flush valve staying open long enough to empty almost all the water out of the tank? Make sure the trip lever does not hit the underside of the lid when you turn the handle. If so, the flapper or tank ball will close prematurely.

Don't let the water go to the very top of the overflow, but you could adjust the refill valve to raise the water level to 1/4 inch below the top--make sure it stays below the top. There are two things that limit the water level in the tank: the height of overflow pipe and the hole in the tank wall where the handle enters the tank.




~~ IMPORTANT NOTE ~~
When either replacing the flush valve entirely or raising its height make certain that the top of the overflow pipe NEVER is higher than the bottom of the hole for the handle. If a refill valve malfunctions and turns the water on, water will flow indefinitely through the hole for the handle when the overflow pipe is too high.



--------------------------------------------------------------------------------

Does the flush valve stay open or does it closing before all the water in the tank leaves? Some flush valves have devices on them that can be adjusted to make the flapper stay open longer.

Regarding the bowl not refilling after the toilet is flushed -- is the refill tube directing water into the top of the overflow pipe? Make sure it is firmly attached to the top of the overflow. Is the refill valve (ball-cock) shutting off before the tank is filled? If so, it is not allowing enough water to flow into the bowl. You may be able to bend the arm of the float ball up a bit, or adjust the refill cup, or you may find there is an adjustment screw on the refill valve to keep it open longer.



--------------------------------------------------------------------------------

~~ Worth a try ... ~~
The answer to a better flush may be found in the toilet tissue used, according to Bruce Case of Case Design/Remodeling Inc. of Bethesda, MD. Case claims in his personal experience switching from a thick fluffy tissue such as Charmin to a light tissue such as White Cloud his family found their toilets worked better.



--------------------------------------------------------------------------------





Lesson Plan
FAQs

Class Register Web Mistress Kay Keating © Copyright 1996-2001
Toiletology 101 ~~ http://www.toiletology.com/index.shtml/
To The Plumbing Book Shelf


Be aware that I don't want to interact with any violators. It is my expectation that Bill, Pauline and Scott D. from the ESWT Board do not have any toilets in their house with more than a 1.6 gallon per flush volume. If they do, I may report them to the government toilet police.
Ed

Result number: 75

Message Number 122145

Re: I think I have TTS, can anyone help and answer a few questions? View Thread
Posted by marie on 6/17/03 at 17:18

lauriel,

I am sorry to hear about your hands.....I learned about magnesium deficiancy from a physiologist in Ft. Wayne who advocates a magnesium supplement for arthritis and Fibro. Do you get leg cramps?

You really should ask the doc for a magnesium deficiancy test. Good luck and best wishes.

marie

Result number: 76

Message Number 121905

Re: Pauline ,give up you always harass somebody leave them alone View Thread
Posted by Sunny Jacob on 6/15/03 at 08:34

John,
If Scott has given you the authority to edit the message board, you should have done it a long time ago. One of the best web sites available for ESWT has now deteriorated to the level of the National Enquirer. Is this the expectation of the editorial board?
Under the cover of ‘patient advocates’, some individuals confuse the readers with irrelevant, too technical and at times wrong information. This is a disservice to patients or those who come to this message board to learn about the available choices in order to make a well informed decision.

ESWT is so far one of the best alternatives available for various tendonitis and PF. High energy, low energy, or any of the proven and approved ESWT equipment will do the job. Of course, well selected equipment can make a difference in any modality and manufacturers continue to improve their products through R&D. However, an experienced therapist and a well-defined treatment protocol will make a substantial difference. If I were a consumer, I would consider any fees above $2,500 for an ESWT treatment (single or multiple session) somewhat greedy.

Approximately a year ago we had a patient from Colorado with bilateral PF. He came with two bags full of orthotics (cost in 3 years approx. $7,000) because he was told that everyone who prescribed said that the last one was poorly made, etc. He spent $9000 for ESWT in one of the States. The final result was that the pain was still at VAS level 8 to 9. He had a treatment at our clinic (total cost of $2,100 for bilateral) and today he is a satisfied patient

Result number: 77

Message Number 120298

Re: Your experiences with alcohol sclerosing injections ?? View Thread
Posted by Ed Davis, DPM on 5/29/03 at 14:44

Dr. Z:

I haven't but understand that that concept has been pushed by a number of EPF advocates. They use the endoscope to release the transverse metatarsal ligament.

Here is a situation where we have a procedure, in simple neuroma excision, that is so simple and relatively successful that alternative approaches carry a burden of proof to show why they could be better.

Ed

Result number: 78
Searching file 11

Message Number 117447

Re: please answer today if possible. View Thread
Posted by lara t on 4/30/03 at 15:51

I don't really have an answer - but given your situation, I wanted you to know people were reading what you had to say - for all the good that does :$. Is there any agency, a not-for-profit of some sort, that would have liaisons, or social workers, or advocates to help? and support you? Sometimes communities happen to have something like that. I might bring a friend along that wasn't going to participate (so probably excludes your husband) to take notes on everything that happens and is said. I've been in positions where I needed to advocate for my kids, and despite training in advocacy I always brought along someone to observe and take notes. When I'm the parent, I have the parent hat on and it helps to have someone else who isn't involved. If you are the patient, it's even more difficult to wear two hats (patient & observer) If they have an understanding of the medical world it helps.


Good luck.

Result number: 79

Message Number 113407

Re: Peace as viewed by Ike View Thread
Posted by BGCPed on 3/18/03 at 21:28

Well letting him and others go on with their sickening behavior is a bigger crime. I dont think that the 80% of the world will be very accurate in the next few days, even more after we wipe up that region.

I think the backlash against certain "peace" advocates is shared by more than they want to believe. Sheen, Penn,Dixie Chick, Chirac,Michael Moore, Daschle and the idiots that attacked the lady and her display in California are out of touch. Yes it is free speach but it is also American right to boycott and denounce these people

The word peace is not bad and I would say there are no people on the right that are getting off on the war. What it is that many good people are tired of the crap from the left about give the inspectors a chance blah blah. Sorry but that is just stalling and he has had 12 years.

Many of the so called peace activists are more Bush and the right haters. They said nothing when Clinton went into Bosnia without UN approval. In fact Sheryl Crow serenaded the soldiers and hung out with Hillary for a few weeks kissing up and supporting them.

That is just the tip of the iceberg. Many good solid people want Saddam and his regime to finlly meet justice. The fact that many of the activists and the left ignore the human rights and torture aspects that Saddam and his sons have visited on millions.

So peace is not a bad word. It is the ones that cloak themselves in the word to sugar coat their other agendas. I will maintain many Americans are apathetic and sometimes ignorant of history. That said many are smart enough and have a sense of right and wrong. In short most Americans do the right thing so to speak.

I am thankful Bush and Blair have the stones to do this.

Result number: 80

Message Number 111189

USA Today View Thread
Posted by john h on 2/28/03 at 15:40

An interesting article in USA Today this morning about the value of Hollywood stars becoming advocates for war against Iraq. To much for me to cover here but polls indicate that 83% of Americans say their views have no effect on how they feel. Also noted that there is now a protest group against the protesters with 40,000 members and a web site. now that is great a protest against the protesters. is America great or what? maybe we can invent some sort of cyber protest or has that already been done?

Result number: 81

Message Number 111116

pacifists View Thread
Posted by Ed Davis, DPM on 2/27/03 at 23:53







The following editorial has been produced by the Ayn Rand Institute's MediaLink department. Visit MediaLink at http://www.aynrand.org/medialink/.



Dec. 9, 2002

Peacenik Warmongers
Pacifism necessarily invites escalating acts of war against anyone who practices it.


By Alex Epstein

There is an increasingly vocal movement that seeks to engage America in ever longer, wider, and more costly wars—leading to thousands and perhaps millions of unnecessary deaths. This movement calls itself the "anti-war" movement.
Across America and throughout the world, "anti-war" groups are staging "peace rallies" that attract tens and sometimes hundreds of thousands of participants, who gather to voice their opposition to an invasion of Iraq and to any other U.S. military action in the War on Terrorism. The goal of these rallies, the protesters proclaim, is to promote peace. "You can bomb the world to pieces," they chant, "but you can't bomb it into peace."
If dropping bombs won't work, what should the United States do to obtain a peaceful relationship with the numerous hostile regimes, including Iraq, that seek to harm us with terrorism and weapons of mass destruction? The "peace advocates" offer no answer. The most one can coax out of them are vague platitudes (we should "make common cause with the people of the world," says the prominent "anti-war" group Not in Our Name) and agonized soul-searching ("Why do they hate us?").
The absence of a peacenik peace plan is no accident. Pacifism is inherently a negative doctrine—it merely says that military action is always bad. As one San Francisco protestor put the point: "I don't think it's right for our government to kill people." In practice, this leaves the government only two means of dealing with our enemies: to ignore their acts of aggression, or to appease them by capitulating to the aggressor's demands.
We do not need to predict or deduce the consequences of pacifism with regard to terrorism and the nations that sponsor it, because we experienced those consequences on September 11. Pacifism practically dictated the American response to terrorism for more than 23 years, beginning with our government's response to the first major act of Islamic terrorism against this country: when Iranian mobs held 52 Americans hostage for 444 days at the American embassy in Tehran. In response to that and later terrorist atrocities, American Presidents sought to avoid military action at all costs—by treating terrorists as isolated criminals and thereby ignoring the role of the governments that support them, or by offering diplomatic handouts to terrorist states in hopes that they would want to be our friends. With each pacifist response it became clearer that the most powerful nation on Earth was a paper tiger—and our enemies made the most of it.
After years of American politicians acting like peaceniks, Islamic terrorism had proliferated from a few gangs of thugs to a worldwide scourge—making possible the attacks of September 11.
It is an obvious evasion of history and logic for the advocates of pacifism to label themselves "anti-war," since the policies they advocate necessarily invite escalating acts of war against anyone who practices them. Military inaction sends the message to an aggressor—and to other, potential aggressors—that it will benefit by attacking the United States. To whatever extent "anti-war" protesters influence policy, they are not helping to prevent war; they are acting to make war more frequent and deadly, by making our enemies more aggressive, more plentiful, and more powerful.
The only way to deal with militant enemies is to show them unequivocally that aggression against the United States will lead to their destruction. The only means of imparting this lesson is overwhelming military force—enough to defeat and incapacitate the enemy. Had we annihilated the Iranian regime 23 years ago, we could have thwarted Islamic terrorism at the beginning, with far less cost than will be required to defeat terrorism today.
And if we fail to use our military against state sponsors of terrorism today, imagine the challenge we will face five years from now when Iraq and Iran possess nuclear weapons and are ready to disseminate them to their terrorist minions. Yet such a world is the goal of the "anti-war" movement.
The suicidal stance of peaceniks is no innocent error or mere overflow of youthful idealism. It is the product of a fundamentally immoral commitment: the commitment to ignore reality—from the historical evidence of the consequences of pacifism to the very existence of the violent threats that confront us today—in favor of the wish that laying down our arms will achieve peace somehow.
Those of us who are committed to facing the facts should condemn these peaceniks for what they really are: warmongers for our enemies.

Alex Epstein is a writer for the Ayn Rand Institute in Irvine, Calif. The Institute promotes the philosophy of Ayn Rand, author of Atlas Shrugged and The Fountainhead.



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Result number: 82
Searching file 10

Message Number 102400

Re: Severe heel pain View Thread
Posted by Julie on 12/09/02 at 17:00


Hello Annette

I'm in London too. You might want to make an appointment with my podiatrist, Ron McCulloch. He's good: he is head of podiatric medicine at Guy's, and practises privately in Lewisham and also out of Harley Street. He has a website that you can check out: http://www/londonpodiatry.com. If you see him he will give you a full examination and evaluation, watch you walking (and video it) on a treadmill, and advise you based on what he observes. My only reservation about him is that - like many other DPMs - he advocates aggressive stretches like the wall stretch, which in my experience and that of many others here do more harm than good. Non-weight bearing exercise is best.

Read the heel pain book (click on the blue link here) for plenty of information about PF and its treatments. But do see a podiatrist. You need to establish the cause of your PF so that it can be appropriately addressed. Also follow the message boards: there's a lot of accumulated knowledge here, and lots of support too, from folks who've been through it and know what you're going through.

Result number: 83
Searching file 9

Message Number 97317

When the pain becomes unbearable, another article View Thread
Posted by BrianG on 10/11/02 at 11:18

This is another interesting read. The doctor who wrote this was actually talking about back pain, but I think you can very easily substitute heel pain, for back pain. This is for everyone who is suffering needlessly, for those people who have tried "everything", and still have chronic pain so bad that it rules their lives. If you think that you have run out of options for your pain, this might be just what you are looking for.

Regards
BrianG


Study: Don't Avoid Opioids to Treat Back Pain

Researchers say the drugs are sometimes abused, but they can offer great benefits for people who are suffering.
By Holly VanScoy
THURSDAY, Oct. 3 (HealthScoutNews) -- Doctors and pharmacists tend to avoid prescribing them, patients are afraid of becoming addicted to them, and government officials are concerned about their abuse. It's little wonder that opioids have acquired something of an unsavory reputation in medicine.
But is it all deserved?
A new study suggests it's a mistake to ignore the potential value of these powerful pain relievers for chronic conditions, including musculoskeletal pain and lower back pain.
There's evidence that opioids such as morphine, oxycodone, and fentanyl can help and should be the treatment of choice for some patients, says Dr. J.D. Bartleson, a Mayo Clinic neurologist and lead author of the study. It appears in the latest issue of the journal Pain Medicine.
"The prejudice against the use of analgesic opioids is unfortunate," Bartleson explains. "Especially since it results in their being underutilized in situations where they can contribute to improving patient outcomes. Opioids can provide significant relief for patients experiencing severe pain. I believe physicians and patients should be considering them more often than they presently do, including use in the management of chronic, nonmalignant pain."
Bartleson bases his conclusion on extensive analysis of all studies of opioid use in the treatment of chronic lower back pain. Despite longstanding controversies over opioid misuse and potential dependence, Bartleson found there is a place for their carefully considered and closely monitored use in treating this persistent, debilitating condition. In particular, he says, opioid use may provide a better alternative than back surgery and other pain medications for many patients whose lower back pain is persistent.
"Fewer than half of all back surgeries are successful in relieving chronic back pain," Bartleson says. "Other medicines for pain -- including aspirin and acetaminophen -- can cause permanent adverse effects. Opioids have been demonstrated to provide pain relief, without long-term side effects."
John Giglio, executive director of the American Pain Foundation, concurs. He adds the recent controversy over the opioid OxyContin has further muddied the waters over the benefits of this entire class of prescription medications.
"There is mounting evidence that physicians are being deterred from using opioid drugs for patients in pain, not only because of the bad publicity about certain ones of these medications, but also because they are concerned they will be investigated by the U.S. Drug Enforcement Agency if they prescribe them," Giglio says. "Even where there is no arrest, no indictment, no evidence of physician or pharmacist wrongdoing, an investigation sends a strong negative ripple through the medical community."
Giglio says chronic back pain is only one of the conditions for which negative publicity has overshadowed opioids' legitimate and proven medical benefit. Even in the treatment of serious malignant conditions, doctors and patients tend to shy away from the powerful drugs.
"In a recent survey of cancer specialists in California, for example, only about 60 percent of the oncologists reported being certified to prescribe opioids," Giglio says. "Of these, only 40 percent had ever done so -- which means that only one in four physicians specializing in cancer treatment in California are presently using the most powerful painkillers available in their practice."
Giglio and Bartleson agree that additional, longer-term and better-designed studies are needed to study how opioids can be best used in medical care.
Although Bartleson now counts himself among believers in opioids' benefits in the treatment of chronic back pain, he doesn't advocate their use for every back pain patient. "Opioids definitely have a role to play," Bartleson says. "But a physician has to make sure that whatever treatment is pursued is the best for the individual patient. Opioids aren't for everyone."
Bartleson adds that, more than anything else, his study points out the need for additional well-designed studies on treating back pain, including the role opioids can legitimately play in such treatment.
What To Do
Learn more about policies governing opioid use in the United States from the Pain Policy Study Group at the University of Wisconsin. The American Pain Foundation advocates for those who hurt.
SOURCES: J.D. Bartleson, M.D., neurologist, Mayo Clinic, Rochester, Minn.; John Giglio, executive director, American Pain Foundation, Baltimore; September 2002 Pain Medicine
Copyright © 2002 ScoutNews, LLC. All rights reserved.
 

Result number: 84

Message Number 93866

A.D.A. Workers rights View Thread
Posted by BrianG on 8/29/02 at 08:21

I think some will find this usefull.....BrianG



Americans With Disabilities Act a Decade Later

The disabled have made great strides, but the most vulnerable still don't get hired.
By Teresa Moore
CONSUMER HEALTH INTERACTIVE
About seven years ago, journalist Betsy Bayah noticed she was having an increasingly hard time hearing. At the time, Bayah, who was in her early 30s, was a staff reporter for the largest public radio station in Northern California. Her livelihood was directly tied to her hearing -- or so she thought.
Bayah was devastated, but once she got over her initial panic, she did what any good reporter would: she started asking questions. Her research took her to the Hearing Society of California where she spoke with a work-rehabilitation counselor, who told her, much to her surprise, that the Americans with Disabilities Act could help her stay in her job and her profession. Hearing aids, an amplifier on her phone, and lots of email were the simple alternatives to shutting down a career. "That was a really good feeling," she recalls. "There are a lot of people who are realizing you can keep working, and there is a law to help you do that."
When the employment provisions of the Americans with Disabilities Act went into effect in 1990, disability-rights advocates hailed the law as the tool that would move the minority group with the highest unemployment rate into the work force. Ten years later, the legislation hasn't done much to help most severely disabled people find work. But there is another group that has benefited enormously from the 10-year-old law: employees who have used it to hold onto their jobs after injuries or illness.
The ADA's promise
The Americans with Disabilities Act, conceived during the Carter Administration and signed into law by the senior President Bush, was designed to make American society more accessible to the 43 million Americans with disabilities. This means that every workplace with 15 or more employees would have to make its facilities accessible to workers, provide them reserved parking and equipment -- and most importantly, hire qualified people, regardless of disability. The law also dictates that people with disabilities gain access to government services and public places. In its report looking back on the past decade, the Department of Justice says the ADA is "making the dream of justice a reality."
Certainly the ADA's effects are apparent in a casual walk down the street. Access to restaurants, town halls, ballparks, and shopping centers has improved. Bus lifts are more reliable and paratransit services more widespread. Public restrooms have bigger doors and grab bars; elevators are wider; wheelchair ramps lead into in office buildings, courthouses, and town halls. Many cities and towns have curb cuts for wheelchair users, so parents with strollers and urban skateboarders have also benefited from the act.
But as for access to jobs, disability-rights advocates say that at best, there's been no improvement, and at worst, employment among disabled people has actually decreased.
According to a U.S. Census Bureau study, between 1994 and 1999, while the unemployment rate for all Americans dropped from 6.6 percent to 4.1 percent, the rate of unemployment among disabled people increased. In those five years, the percentage of unemployed disabled people rose from 71.8 percent to 78 percent.
Joshua Angrist and Daron Acemoglu, two labor economists at the Massachusetts Institute of Technology, also concluded that the ADA appeared to have a negative effect on employment for people with disabilities, even after adjusting for such factors as the strength of the economy.
"The stereotype of the guy in the wheelchair who would be great in an office job -- there are very few people like that out there," Angrist said. Instead, he said, most ADA lawsuits are filed by people claiming wrongful termination or failure to promote. The reason: during the early years of the law, many employers were wary of hiring people with disabilities because they were afraid of lawsuits and feared exorbitant costs for accommodations. Angrist says now employers are more comfortable with the law.
Half of all accommodations cost between $1 and $500, while 20 percent cost nothing, according to Anne Hirsch, assistant manager of Job Accommodation Network (JAN), a government arm of the ADA that helps people find jobs. The organization confirms that the major beneficiaries have not been the people for whom the law was intended. In July 2000, Barbara Judy, project manager for JAN, testified before Congress that currently only 4 percent of her organization's 40,000 yearly calls for assistance concern the newly hired; 15 percent are from people seeking employment; while 75 percent concern retention and improvement for disabled employees. "The trend seems then to be that the business community is increasingly concerned with accommodating current employees," Judy told Congress.
Although that attitude leaves many people in the dust, it's been a boom for people like Bayah. "Before the ADA, the trend was if you were disabled in an essential function, you couldn't work anymore," said Erica Jones, executive director of one of JAN's assistance centers in Berkeley, California. "The law was the force behind people looking at things differently."
Helping cops and CPAs
A case in point is former Denver police officer Jack Davoll, who filed a complaint with the Justice Department, which led the department to successfully sue under the ADA. Some years ago, Davoll's squad car was slammed broadside, giving him a major back injury that knocked him out of commission as a beat cop, according to the Justice Department's 10th anniversary report. When he asked for a civilian job for which he was qualified, the city refused, saying it was against the city charter to transfer a police officer to a civilian job. In November 1996, a jury found that the city of Denver had violated the ADA by not reassigning Davoll to another available job. He was awarded damages and lost wages that totaled more than $500,000.
Rod Jex, who is deaf, hit a barrier when he tried to become a Certified Public Accountant. Enrolled in preparatory classes to take the CPA exam, Jex found that without a sign-language interpreter, he was at an extreme disadvantage. The company refused to supply one until he filed a lawsuit under the ADA.
But Deborah Kaplan, executive director of the World Institute on Disability in Berkeley, California, believes it will take a long time before people with serious disabilities will be able to take full advantage of the ADA. "A year or so ago, there were several articles saying that the employment provisions of the law haven't worked," she said. "Many of us said, 'Duh.' The ADA is an essential part of solving the employment problems of people with disabilities but it's not enough."
For example, Kaplan said that many people who would like to work don't because they risk losing Social Security benefits that pay for care they couldn't afford with entry-level jobs. "You don't see people with more severe disabilities filling in those (employment) numbers because they would lose their personal assistants, Medicare and Medicaid," she said.
Fear may be diminishing
Critics of the ADA say that the law leads to frivolous lawsuits and coddling of malingerers. Kaplan believes some of this resistance springs from fear and misunderstanding of disability.
"There's this incredible legacy of hundreds of years of stigma associated with disability," Kaplan said. "People have wanted to preserve a line between 'us' and 'them.' On the other hand, the ADA is making life easier for a lot of people, and in the process it's eroding the line between 'us' and 'them.' People are starting to think, 'Maybe that back problem I have or that hearing problem I have is a disability, but I'm still not like them.'"
Kaplan notes that change will occur as more baby boomers become disabled. "It just happens with age," she said. "As more people experience disability themselves, more attitudes will change."
For Bayah, who is now an associate producer of documentaries, the power of the ADA was not the legal leverage it gave her -- her employers and colleagues at KQED-FM in San Francisco were very supportive. The presence of the law changed the way she thought about her future. "It's not whether I'll be able to work," she said. "It's how will I adapt my work environment to fit me."
-- Freelance writer Teresa Moore is a former San Francisco Chronicle staff writer, a past editor of Youth Outlook (YO!), and an associate of Pacific News Service.
Know your rights
Nolo, a self-help legal rights organization in Berkeley, offers this on disabled workers' rights:
• ADA protections extend to any job applicant or employee with a physical or mental impairment that substantially limits a major life activity or someone who has a history of such impairments.
• An employer cannot refuse to hire a qualified person just because he or she is disabled, but by the same token, a prospective employee has to be able to perform the essential functions of the job. An employer may ask whether you can perform the duties of the job with or without reasonable accommodation.
• Employers are required to extend "reasonable accommodations" to the disabled, based on the employer's size and resources. In summary, these include ergonomic arrangements that fit each person's needs; hours flexible enough so that workers can get regular medical treatments; modifying exams and training materials as necessary; hiring readers or interpreters, and providing training specialists.
• The ADA requires that you work with your employer to find an accommodation suitable to both of you. If that fails, you can file a complaint with the Equal Employment Opportunity Commission, which enforces the ADA.
-- Teresa Moore is a media studies instructor at the University of San Francisco and an award-winning health writer. A former San Francisco Chronicle staff writer and a past editor of Youth Outlook (YO!), she has also written for the Family Therapy Networker, the Washington Post, Parenting, and other publications.
Further Resources
Equal Employment Opportunity Commission (EEOC)
800/669-4000
http://www.eeoc.gov/teledir.html
Presidential Task Force on Employment of Adults with Disabilities, Links to Disability Employment Sites:
http://www.dol.gov/dol/_sec/public/programs/ptfead/joblinks.htm
World Institute on Disability
http://www.wid.org
WorkLink A.D.A. Solutions in Berkeley
510/848-8363
http://www.worklink.net
Disability Resources Monthly
http://www.disabilityresources.org
Job Accommodation Network (JAN)
http://www.jan.wvu.edu
References
Enforcing the ADA: Looking Back on a Decade of Progress. U.S. Dept. of Justice; Civil Rights Division, Disability Rights Section. July 2000.
http://www.usdoj.gov/crt/ada/pubs/10thrpt.htm.
Americans With Disabilities Act Handbook: Basic Resource Document. U.S. Equal Employment Opportunity Commission Staff. Dec. 1993. pp. 907.
Reviewed by Robert Goldberg, MD, FACOEM, the 84th president of the American College of Occupational and Environmental Medicine and an assistant clinical professor of medicine at UCSF.
Our reviewers are members of Consumer Health Interactive's medical advisory board.
To learn more about our writers and editors, click here.
First published October 20, 2000
Last updated May 27, 2001
Copyright © 2000 Consumer Health Interactive
 

Result number: 85

Message Number 92616

Re: the neutral hip View Thread
Posted by Sandy H. on 8/15/02 at 19:45

I better not describe it. Best to go to a physiotherapist who specializes in this. It doesn't stay in place unless you develop the lower layer of stomach muscles that control posture through pilates and other exercises. By the way I don't know if this is going to work but I do know that sportsmen and women are big advocates of pilates. If your problem is related to a desk-bound lifestyle like mine is then this is worth looking into.

Result number: 86

Message Number 90003

there's a difference between "hard" & "aggressive" View Thread
Posted by elliott on 7/18/02 at 18:26

"Hard" is where you tug it too hard. No one advocates that. It tears and it's bad.

"Aggressive" is one which will stretch more deeply than another, and may hurt before it helps, but it can be done slowly and carefully. There can still be debate about this one. Why not try the stretch in my post below?

-----

Result number: 87
Searching file 8

Message Number 89215

Combining night splints and shoes that immobilize the fascii -- any data? View Thread
Posted by KeithW on 7/06/02 at 15:30

Now completed 7 years of "intractible" plantar fasciitis -- and have tried nearly everything (including ESWT twice, endoscopic plantar fasciotomy (partial release), acupuncture, injections (under care of pain management specialist / anesthesiologist), numerous mediations (vioxx, neurontin, high doses of ibuprofen).
On my second serious try of night splints (since early April) and seeking information about combining these with shoes that immobilize the fascii during the day. I've tracked down a Dr. who advocates this, and am awaiting feedback from his consultation (long distance) with my local doctor, and thought I'd do a little digging for data. Anyone know of data on this strategy?

Result number: 88

Message Number 85910

Re: To: Susie, Re: Blocks View Thread
Posted by Janet C on 5/31/02 at 13:20

Hi Susie ~

It sounds like you have a very good PM plan. And I’m glad to hear that the SNB’s are giving you positive changes in your color and temp, I think that’s a good sign, although you said that the blocks don’t seem to give you pain relief that lasts. Does the small amount of relief that you’re getting only last for a couple of hours while you’re still numb in the hospital, or does it perhaps last even a week or two? In any case, it seems you have a wise Dr, who is approaching your treatment with a complete regimen, focusing on all aspects of your recovery.

I hope you know that it is very important your PT be specifically trained and understand that the patient with RSD needs extra gentle care. Don’t let your PT’s push you beyond your comfort level, as that can do more harm than good. And Therapeutic Massage sounds like it would be good for you – and would probably help desensitize your skin.

But I’m surprised that they have determined that you will have reached "maximum improvement" in four weeks, and they’re going to cut you off of the WC checks! It sounds like something WC would do though, so it honestly doesn’t surprise me that much. I sincerely hope that you will be feeling well enough then to find some sort of employment that you enjoy, and isn’t too hard on your body. But realistically, RSD can spread and change any time, even years later, and I know others who have had to re-open their WC cases, because the RSD progressed after they were P&S. And it’s good that you’ll have continued medical coverage, the blocks and everything can get very expensive.

All the power to you if you can manage to get by without taking many meds – I sure wouldn’t want to talk you out of that, because it sounds like you have your best health at heart, and a really good attitude about it. I drink lots of water too, and I believe that it really helps me to feel better. But an interesting fact, is that opioid meds like OxyContin are actually far less damaging to the liver and kidneys, and it also does not irritate the stomach, when taken over a long term, in comparison to Tylenol and NSAIDs. And when used properly by legitimate chronic pain patients, it does not cause any kind of high, and it does not cause addiction. When everything else has failed, and the patient is in chronic pain, there is no reason in this day and age with our medical advances, for people to suffer. For those people who have to live with chronic pain, opioids can give an amazing amount of quality back to their life, and are much less damaging to the internal organs.

And you’re absolutely right – the mind is a very powerful thing, which is apparent when you get the chance to experiment with Biofeedback. I have been going to Biofeedback for a couple of years now. It is a training technique in which the patient is taught how to relax their breathing, heart rate, blood pressure, muscle tensions, and other bodily functions that are not normally controlled voluntarily. The patient is hooked up to an EMG machine, which makes a beeping sound. By taking slow, deep breaths and relaxing, one can slow down, and lower the octave of the beeping. And when the muscles are no longer as tense, the pain levels will decrease. It is not a cure, but it has made a substantial difference in my quality of life. After the technique is taught, one can repeat the results at will, without being attached to the machine's sensors. I highly recommend it. I don’t need to continue to go to treatments, but I feel like my Biofeedback Dr. is one of my biggest advocates, I sense he is one physician who really has my best interest at heart, he keeps good records for my Drs. and my case, and he gives me great advice.

There is another group of Message Boards that I frequent that I think you might find enlightening. They have MB’s specifically for RSD, another one of my favorites on the list is Chronic Pain 2, and they also have MB’s to discuss WC and SS issues... I think you might find it helpful and informative. Here’s the URL if you’re interested:

http://neuro-mancer.mgh.harvard.edu/cgi-bin/Ultimate.cgi?action=intro&BypassCookie=true

Oh, I also have been told that I have Fibromyalgia... Can you explain the difference between that and Fibromatosis?

(Sorry this has been so long… I hope I haven’t bored you.)

Wishing you the very best, always ~ Janet

Result number: 89

Message Number 85184

Re: "Gordon's cure" View Thread
Posted by paula on 5/25/02 at 10:12

i was a patient of dr cathcard in calif. years ago. he is , was?. one of the biggest advocates of high dose vitamin c. he has a web page i think for those interested in his ideas. there wasnt time enough in a day, or stomach room to shove in all the vitamin c he wanted me to take. by the way and aprapos of nothing he also invented the cathcart hip for hip replacement years ago.
a book i read about high dose vitamin c is by linus pauling. can't remember the name. aprapos of also nothing he won two nobel prizes.
are these guys right, wrong, on to something? don't know but pauling at least seems like a guy worth reading to me.
i take two to four thousand mg vit c a day but always feel i should take more beccause of cathcart-pauling. on the other hand dr. ed always gave me great advice and i take his opinions very seriously. i will be thinking about what he just said too.
just wanted to give everyone a place to read some unconventional views. right now i'm reading about vitamin c helping calcium work for bone health and as a 55 year old woman i'm finding that interesting.

Result number: 90
Searching file 7

Message Number 74074

wendyn View Thread
Posted by elliott on 2/17/02 at 21:52


Even by my standards, I thought your tone was rather strident.

Completely disagree about TTS being secondary, especially with the unusual surgery that transpired. Not that RSD is a certainty yet either. One can go to random doctors for RSD and get random evaluations, or one can go to a doc with great TTS experience who not only knows TTS but has seen loads of failed surgical cases resulting in RSD and who knows how to diagnose it and treat it or at least refer to the doc that does. Regardless, no one ever said to wait a long time before seeing a doctor and allow something possibly to spread.

For such a smart lady, it's amazing how you continue to misread what I'm all about, not that I'll spill all the beans to correct you. Regarding email, there's both a time and a stress issue I just don't want to deal with (such correspondence, once started, seems to take on a life of its own). And I'm the type to be close friends with just one or two rather than the whole world. I keep an email conversation with a woman who once visited this board and who no longer posts nor visits here. Probably because she is a sufferer, she understands heel pain better than my wife (who is great to me). We're from very different backgrounds, yet it's a match, however these things happen. We talk a lot about other things too (but not about these boards at all), about life in general and of course how our feet affect it. Call that my heel pain social needs. I honestly don't want private social email correspondence with anyone else; I am content with what I have, given my time constraints and desires. That's all there is to it. Nothing to do with attention-getting or lack of it. If you don't want to believe me, that's fine too. But maybe think twice before throwing out speculation about me.

TTS is an interesting and complicated beast. It's amazing how easy it is even for great docs to make a major mistake with it. They are relying on your description of pain as to whether you have TTS, whether surgery is warranted, and what type to perform. We have to be our own advocates. Read a lot, find out a lot, express yourself well, and you and your doc can be more certain you have what you think you have. As one example, come in to the doc and say, "gee, my feet are numb" instead of saying "the numbness started in my toes and has been moving backwards since" and the diagnosis and treatment might be very different in each case. I myself was 10 days away from a major surgery--the wrong surgery--cancelled only because my other foot blew up in pain. It is only now that I feel I know enough to likely avoid such a mistake. A focus more on a careful exchange of information about such things to prevent such tragedies from happening and increasing our chances of finding the right path to healing is what I see in a TTS board. Maybe I have a different vision of what these boards should be about, but hey, I see others do not share it and can accept that.

Not sure what questions left unanswered you're talking about. Sometimes it's better for another to have the last word even if I have something to say back; things can go too far.

Result number: 91
Searching file 6

Message Number 67209

Re: hallux limitus and pf View Thread
Posted by josh s on 12/17/01 at 14:21

I've recently been reading the series of articles about functional hallux limitus by Howard Dananberg DPM. Regarding the medial band and the 1st metatarsal, Dr. Dananberg advocates a modification of low dye strapping- sending the tape plantarward as it comes around the medial heel. Rather than anchoring this strap on the medial side of head of 1st metatarsal, it is brought along the bottom of the first ray and anchored just distal to the 1st MTP joint; while the hallux is held in slight dorsiflexion. Dr. Dananberg claims (in Advances in Podiatric Medicine and Surgery, 1995) that this variation encourages 1st metatarsal plantarflexion and thus hallux dorsiflexion.
Dananberg has developed a biomechanical model that appears on first look to put the cart before the horse. His explanation, as per his articles, of hallux limitus is the inverse of what Dr. Reid has explained. He states that functional hallux limitus and limited ankle dorsiflexion create a situation where forward progress of the stance leg is impeded. He describes various compensation strategies employed by the feet and also the hips, trunk,etc. For example, the scenario of excessive late stance phas pronation is seen as one of these strategies. As the center of mass progresses over the stance foot in walking, if the hallux cannot dorsiflex due to lack of 1st metatarsal plantarflextion the progression forward will be impeded. If hallux dorsiflexion is thus impeded, the windlass mechnism of Hicks will fail to function and the foots "autosupport mechanisms" will fail to engage. The forward progression of mass, in this situation, will force the longitudinal arch to collapse just as it needs to be rising- had the hallux dorsiflexed at the proper time and wound the plantar fascia up. The situation is the same with limited dorsiflexion, the joint restricting forward progression is just different. He calls these restrictions sagittal plane blockades and apparently considers them causal to the pronatory compensation. One interesting thing about his work is that (According to his chapter in Sports Medicine of the Lower Extremity, Subotnick)the orthotic devices he uses for these problems tend to be based on principles of motion assistance rather than the motion control paradigm asserted by most functional orthotics. His thinking is apparently that if motion forward (in the sagittal plane) is restored (with proper hallux dorsiflexion or ankle dorsiflexion) with an assist device, the "autosupport mechanisms" will engage and compensations will be eliminated.

A summary of the sagittal plane blockade theory is here: www.latrobe.edu/podiatry/sagittal.html

Dr. Reid, what do you make of this theory and it's apparent inversion of orthodox biomechanics? One author (Michaud, T.) noted that Dananberg's kinetic wedge design to treat functional hallux limitus by allowing space under the 1st metatrsal head (to encourage plantarflexion) may simply allow the forefoot to collapse medially- causing late stance pronation and the 1st metatarsal dorsiflexion it was designed to combat.

I've always wondered about forefoot varus posts. With rearfoot posts and forefoot valgus posting the post is influencing weightbearing portions of the foot. The heel and lateral side of the foot are designed to contact the ground and bear weight. The medial metatarsal shafts are not. Would'nt the influence of a forefoot varus post, by acting on the metatarsal shaft, serve to push upward on the 1st metatarsal and thus encourage functional hallux limitus? Would'nt the orthotic reaction forces serve to cause hypermobility of the 1st ray in this area?
In Root's Vol. II he mentions in the section on static stance that despite their attempts to discover it, the means whereby the 1st ray became locked in stance had eluded them. Whereas they had discovered the lateral arch locking mechanism of the calcaneo-cuboid joint, they could not explain how the first ray became rigid during static stance. They noted how this rigidity could not be produced in a non-weightbearing situation. Has anyone figure this out yet? Any journal articles adress this?

Thanks.

Result number: 92

Message Number 63623

Dr. Z, ever heard of IDET? View Thread
Posted by elliott on 10/26/01 at 11:57


IntraDiscal Electrothermal Therapy. Sounds a bit like another zap device, doesn't it? :-)

Saw an article about it in some small newspaper. It's a new treatment for chronic lower back pain which is, surgically speaking, minimally invasive. There is an 80-patient study currently going on at East Texas Medical Center, and its advocates hope the results will persuade the insurers to pick uo the $5000-$8000 tab as acheaper alternative to traditional surgery for torn and ruptured spinal discs. According to the Knight Ridder article,

"A long needle is used to place a thin, wire catheter into a torn or ruptured disc. Using the X-ray-like images of a fluoroscope, a doctor guides the needle and the wire it carries into the outer cartilage of a spinal disc. The wire then heats the cartilage for about 17 minutes.

"The heat strengthens the damged tissue, sealing exposed nerve endings and changing the disc wall's composition much like heat thickens and toughens an egg white. said D. Kevin Pauza, the spinal specialist leading the study.

"'A disc is primarily protein. When one heats proteins, the bonds change', he said. 'The process, in common-sense terms, is like frying an egg.'

"The procedure was developed by two Stanford University back specialists and received FDA approval in 1998...Back pain afflicts nine out of 10 adults older than 30, ranking second only to the common cold among causes of missed workdays."

Of course, the article gives the mandatory success story, a mother of two who had back pain for years and whose brothers with similar pain had failed operations. She had the new procedure, and "was on her feet and headed home within hours after emerging from a hospital operating room. Within weeks, the 32-year-old was jogging and mulling the possibilty of holding down a job again."

If this is shown to really work, I wonder if this could be used for, say, the L4-L5 disc-induced sciatica I have (although my neuro claimed the recovery for such surgery is rather quick anyway--a day or so--but I'm afraid of the usual recurrence problems, and I'm just turned off right now given the outcome of my TTS surgeries).

Dr Z, could you see any potential use of IDET for, say, heel spur? If so, you better get one quick! You don't want another pod to gain an IDET advantage over you! :-)

Result number: 93
Searching file 5
Searching file 4

Message Number 41900

Re: Information on Methadone (Long Post) View Thread
Posted by Kim B. on 3/19/01 at 21:00

Methadone is a long acting, opinoid medication. It's all natural which is the good part. Doctors are stingy about using it, is the bad part. It is a controlled substance and Doctors have to answer to state and federal officials about whom and why it is given. But when everything is legitmate, they have nothing to fear. It is preferably, a last resort for managing many severe pain illnesses and again, is not administered lightly, because of the red tape that surrounds it. I tired a number of different pain meds before we reluctantly gave the Methadone a try. It has a misunderstood reputaion for being addictive mainly because of it's misuse by people who abuse drugs or use them as "recreational drugs". Because of this abuse history, some doctors and branches of the drug inforcement agencies are "throwing the baby out with the bath water!" It is not so much that it is "addictive" so to speak, although one could definitely get addicted to good pain control, after a lot of suffering with a life altering illness. I don't understand everything about it, but as your liver learns to metabolize a certain amount, to get the same level of pain control, some people will have to "go up" on their dose. Of course, it's best to stay at low doses for as long as possible. To do this, you still have to manage your ailment in other ways. Don't start over using and abusing the parts that you are trying to get healed, for one example.

For those who have real pain, there is no euphoric feeling received from it, but because of it's abuse by persons that don't need it, it is highly controlled and considered "addictive". This is a strong misrepresentation. From what I understand, it is the drug abusers who become addicted to it because of the high they might get. Persons with real pain issues will not get a high or buzz from it. The pain receptors absorb it, and turns the pain signal off.

And because the body gets used to metabolizing it, it can't be quit cold turkey and like many other meds has to be tapered off slowly when it is no longer needed, or a persons will go through terrible withdrawal symptoms, like stomach pain, chills and fever, sweats, etc. It is a medicine that must be administered and over-seen by a very competent Physician.

I work with an Internist physican for my FM problems. Pain Management Specialist are also very knowledgeable and experienced with the use of long acting opiniods. Unfortunately, women who are at risk of becoming pregnant may be more liability than most docs care to take on. Since I am no longer able to have kids, that is one of the things that makes my doc, at least a little more comfortable, in prescibing it for me. Men shouldn't have this complication to deal with.

It takes 3 days to line out in your system, meaning, the does I take today is for 3 days from now. Likewise, the dose I took 3 days ago is easing my pain today.

It is not a short-term pain medication. Moreover, there is a lot to learn and consider about it before using it as a treatment. My husband even had to be consulted and agree to the use of the drug for my pain problems, so as you can imagine, we put it off until my quality of life was so bad that it made more sense to give it a try than not. It is more for long-term control for a long-term problem. Persons with new PF are not good candidates because if their case is not chronic, the Vioxx and other meds may make more sense. However, for many people with long term or chronic PF that is not going away in a few months, it may be a solution to getting back into life.

I've lost weight on this mediation because, I think it raises my metabolism AND because since my pain is greatly diminished, my activity level is so much higher. That for me is one of the reasons that this med makes so much sense for person's with PF, since the docs say, loose weight, etc. This med helps with excess weight and in my case cancels a lot of the pain. IT IS A DAMN TWO FOR ONE! I do not understand why docs have this med at their disposal yet still allow people to suffer while they watch their livelihoods go down the drain.

I found out by accident that my PF pain would benefit from this medicine. As I said, I started taking it for my FM, on a trial basis to see if it would respond. My feet pain being relieved was a side benefit. May be that my PF is FM related, or it may be that EVERYONE with foot pain would benefit from it. It is good for nerve type pain, and so even the TTS folks might.

I hope to taper off and discontinue it when and if my Fibromyalgia (FM) problems are ever resolved. ESWT is still a possibility for my feet too, if insurance and the doctors decide it is a good option for me.

Long acting opinoids like Methadone have been around for so long that they are very inexpensive, which means even people without health insurance can probably afford them. 3-month supply was about $37, I think. Less for those with health insurance. Why is this readily available, inexpensive medicine being kept from people who are good candidates for it? In addition, unlike other pain meds that have a lot of synthetic man made crap in them, I have no stomach upset from the use of Methadone. My only complaint is some constipation, but I had that in the form of IBS, irritable bowel syndrome, anyway. Hope this information helps someone out there regain their life and/or keeps someone from loosing their mind. I was at my wits end with the FM and the PF illnesses, and I cannot forget the anguish and suffering even if I try.

Study and learn as much as possible about it and whether it may or may not be right for you. Find a compassionate doctor and ask for a low dose trial of the medicine. If your feet respond to it, great! If not, at least you tried. From what I understand, the Methadone dose lasts for 24 hours. At first, I only took a low dose once a day. Now that my body had adjusted to it, I do require more in my system, but this medicine has made a world of difference and for many, it is worth investigating.

Btw, here is a web site that advocates the use of appropriate use of these stronger types of pain medicines. There is a section on how to go about locating a doctor that is compassionate, experienced and unafraid to prescribe this stronger type of pain treatment.

http://www.widomaker.com/~skipb/skiphome.htm.html is ASAP the American Society for Action on Pain.

Regards from me.

Result number: 94

Message Number 40273

Prolotherapy and ESWT View Thread
Posted by Scott R on 3/02/01 at 11:52

For those doctors using ESWT, I wonder if adding 10% dextrose to the lidocaine injection will help....

Dr. Julian Whitaker (a popular alternative medicine doctor with a newsletter, books, and products) has endorsed and is using prolotherapy. A search revealed only two heelspurs.com visitors that have tried it (neither reported success). But I think it has merit. Osteopaths are using it. Dr Koop also supports it.
=========
Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated.
============
Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.
==========

Dr Weil:
(Published 2/26/99) Prolotherapy has been around a long time but isn't widely known or accepted. It's based on the theory that in a significant number of patients, pain is caused by ligament dysfunction. Treatment involves injections of dextrose and sodium morrhuate -- extracted from shark liver -- or dextrose, glycerin and phenol into ligaments to promote new growth of fibrous tissue that might improve the attachment of the ligaments and tendons to bone. Sodium morrhuate and phenol are both tissue irritants, but proponents claim the injections trigger the growth of new, healthy tissue to stabilize bones and joints, thus relieving musculoskeletal pain and stiffness.

Advocates say that expert needle placement is vital to the safety of the procedure but insist that when performed by a well-trained clinician, the technique is safe and effective and can relieve pain arising from a wide variety of musculoskeletal conditions, from degenerative arthritis to carpal tunnel syndrome to jaw (TMJ) and chronic back pain.

From another website:
WHAT IS PROLOTHERAPY?

Prolotherapy, also known and reconstructive therapy, is a permanent treatment for chronic pain. It involves injections of ligaments and tendons, considered to be the source of chronic musculoskeletal pain. The most common solution used is composed of Dextrose (sugar water) and lidocaine (anesthetic). After each series of injections a controlled reaction occurs, that causes the laying down of collagen. It is collagen that gives ligaments and tendons the necessary strength to endure the stress loads of every day life.

Reconstruction thus uses the body's natural healing process to releive pain, strengthen injured tissues and restore function. It is important to emphasize that prolotherapy is not a pain treatment -it's a strenghtening treatment that leads to reduced pain!

HOW DOES IT WORK?

Ligaments hold bones together at the joints, while tendons, being somewhat like ligaments in structure, hold muscles to bones. Due to injury or repeated use, the ligaments and tendons may become torn, stretched or loose, which causes pain, lack of endurance, loss of strength and perhaps arthritis. Contrary to popular belief, arthritis is the body's way of attempting to strengthen a joint. With prolotherapy, solutions like dextrose or a derivative of cod liver oil are injected into the lax or torn areas causing healing cells to migrate to the weakened area and create new, strengthened tissues. Studies have shown that the ligament that regrows is 30-40% stronger than the previous ligament and this is permanent.

THE PROCEDURE

We start with a thorough diagnosis of the patient's problem and an orthopedic, neurological and Osteopathic musculoskeletal exam accompanied with appropriate X-ray, MRI and laboratory studies if needed. Then a series of injections are given generally every 2-4 weeks for approximately 4 to 6 treatments. It takes about 6 weeks before a new ligament grows although sometimes a new ligament will grow earlier than that. As with any invasive procedure, there are risks associated with it. Even though the percentage is small, there are risks of infection, bleeding or hemorrhage.

=========
Medline returned 6 hits, 2 had abstracts:
TITLE: Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy.
AUTHORS: Reeves KD; Hassanein K
AUTHOR AFFILIATION: Meadowbrook Rehabilitation Hospital, Gardner, Kansas, USA. dreeves1@kc.rr.com
SOURCE: J Altern Complement Med 2000 Aug;6(4):311-20.
[Record as supplied by publisher]
CITATION IDS: PMID: 10976977 UI: 20431489
ABSTRACT: OBJECTIVES: To determine the clinical benefit of dextrose prolotherapy (injection of growth factors or growth factor stimulators) in osteoarthritic finger joints. DESIGN: Prospective randomized double-blind placebo-controlled trial. SETTINGS/LOCATION: Outpatient physical medicine clinic. SUBJECTS: Six months of pain history was required in each joint studied as well as one of the following: grade 2 or 3 osteophyte, grade 2 or 3 joint narrowing, or grade 1 osteophyte plus grade 1 joint narrowing. Distal interphalangeal (DIP), proximal interphalangeal (PIP), and trapeziometacarpal (thumb CMC) joints were eligible. Thirteen patients (with seventy-four symptomatic osteoarthitic joints) received active treatment, and fourteen patients (with seventy-six symptomatic osteoarthritic joints) served as controls. INTERVENTION: One half milliliter (0.5 mL) of either 10% dextrose and 0.075% xylocaine in bacteriostatic water (active solution) or 0.075% xylocaine in bacteriostatic water (control solution) was injected on medial and lateral aspects of each affected joint. This was done at 0, 2, and 4 months with assessment at 6 months after first injection. OUTCOME MEASURES: One-hundred millimeter (100 mm) Visual Analogue Scale (VAS) for pain at rest, pain with joint movement and pain with grip, and goniometrically-measured joint flexion. RESULTS: Pain at rest and with grip improved more in the dextrose group but not significantly. Improvement in pain with movement of fingers improved significantly more in the dextrose group (42% versus 15% with a p value of .027). Flexion range of motion improved more in the dextrose group (p = .003). Side effects were minimal. CONCLUSION: Dextrose prolotherapy was clinically effective and safe in the treatment of pain with joint movement and range limitation in osteoarthritic finger joints.
==================
TITLE: Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity.
AUTHORS: Reeves KD; Hassanein K
AUTHOR AFFILIATION: Bethany Medical Center, Kansas City, Kan., USA.
SOURCE: Altern Ther Health Med 2000 Mar;6(2):68-74, 77-80.
CITATION IDS: PMID: 10710805 UI: 20176140
ABSTRACT: CONTEXT: Use of prolotherapy (injection of growth factors or growth factor stimulators). OBJECTIVE: Determine the effects of dextrose prolotherapy on knee osteoarthritis with or without anterior cruciate ligament (ACL) laxity. DESIGN: Prospective randomized double-blind placebo-controlled trial. SETTING: Outpatient physical medicine clinic. PATIENTS OR OTHER PARTICIPANTS: Six months or more of pain along with either grade 2 or more joint narrowing or grade 2 or more osteophytic change in any knee compartment. A total of 38 knees were completely void of cartilage radiographically in at least 1 compartment. INTERVENTION: Three bimonthly injections of 9 cc of either 10% dextrose and .075% lidocaine in bacteriostatic water (active solution) versus an identical control solution absent 10% dextrose. The dextrose-treated joints then received 3 further bimonthly injections of 10% dextrose in open-label fashion. MAIN OUTCOME MEASURES: Visual analogue scale for pain and swelling, frequency of leg buckling, goniometrically measured flexion, radiographic measures of joint narrowing and osteophytosis, and KT1000-measured anterior displacement difference (ADD). RESULTS: All knees: Hotelling multivariate analysis of paired observations between 0 and 6 months for pain, swelling, buckling episodes, and knee flexion range revealed significantly more benefit from the dextrose injection (P = .015). By 12 months (6 injections) the dextrose-treated knees improved in pain (44% decrease), swelling complaints (63% decrease), knee buckling frequency (85% decrease), and in flexion range (14 degree increase). Analysis of blinded radiographic readings of 0- and 12-month films revealed stability of all radiographic variables except for 2 variables which improved with statistical significance. (Lateral patellofemoral cartilage thickness [P = .019] and distal femur width in mm [P = .021]. Knees with ACL laxity: 6-month (3 injection) data revealed no significant improvement. However, Hotelling multivariate analysis of paired values at 0 and 12 months for pain, swelling, joint flexion, and joint laxity in the dextrose-treated knees, revealed a statistically significant improvement (P = .021). Individual paired t tests indicated that blinded measurement of goniometric knee flexion range improved by 12.8 degrees (P = .005), and ADD improved by 57% (P = .025). Eight out of 13 dextrose-treated knees with ACL laxity were no longer lax at the conclusion of 1 year. CONCLUSION: Prolotherapy injection with 10% dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis. Preliminary blinded radiographic readings (1-year films, with 3-year total follow-up period planned) demonstrated improvement in several measures of osteoarthritis severity. ACL laxity, when present in these osteoarthritic patients, improved.
===========
Other articles use higher concentrations (0.2% to 0.5%) of lidocaine but "pepper" injections only 0.1 to 1.0 ml at each point along a ligament. 10% dextrose seems to be the standard. This requires sedation because of the number of injections.

A list of doctors using it can be found at http://www.sonic.net/~nexus/listdocs.html

or you might find more by paying $20 at http://www.sonic.net/~nexus/ordtmp.html

Here are some more:

Tammy Geurkink-Born, D.O.
Born Prevention Health Care Clinic, P.C.
3700 52nd Street Se
Grand Rapids, MI 49512 USA
Phone: (616) 656-3700
Email: tammy@bornclinic.com
Website: http://www.bornclinick.com
Type of Practitioner: Family practice, D.O.s
Type of Treatments: Chelation therapy, acupuncture, anti-aging, laser surgery, allergies, cellulite therapy, gynecology, prolotherapy.

Hemwall Family Medical Center
1740 Broadview Dr.
Glendale, CA 91208
tel.: 818-957-3000
Dr. Donna Alderman, Medical Director

San Francisco: 415-566-1000

A practitioner near you: 1-800-992-2063 or 302-996-0300

Result number: 95
Searching file 2

Message Number 22283

Achilles tendonitis, in both feet View Thread
Posted by Nancy S. on 6/23/00 at 15:35

Hi Beverly, Bob, and John, thanks for your replies and for your nice message today, Beverly. I'm sure I knew when I posted that I should see a doc, but there's always that little hope that someone will post, "Oh it's that, here's what you do."
I went to the medical center walk-in clinic and saw a very good gp, who diagnosed Achilles tendonitis not only in my PF foot but the other one too. (No big surprise, since the other one has been hurting for the last week.) It's all tissue problems, no bone or anything unusual. She was adamant that I need physical therapy and should have had it some time ago. She also said that I need to elevate them, do hot and cold immersions, and stay off them as much as possible -- "REST"! That was the only bad news -- like I haven't had enough rest in the last year, I almost went crazy -- but this is a new problem that also needs rest. She believes it's from changes in gait during the worst of PF and from trying to get back on my feet too much too soon after the 3-month PF rest. The getting back on my feet has seemed SOOOOOO SSLLOOWWWW to me, but it hasn't been slow enough, apparently. So here I aM, one of the big rest advocates, needing a doctor to tell me to rest MORE! But I'm grateful it's turned out to be nothing worse than it is; I can deal with it.
I never had physical therapy before -- my ex-pod pooh-poohed it. But for starters they set me up for six appts. at their PT center starting July 14, every 4 or 5 days, and more will be arranged if I need it.
I'm mostly optimistic about it because I flounder around too much by myself with that stuff, but a few PT stories have scared me, like Pauline's recent one. Does anyone know of any PT method or attitude or something that I should be wary of? I have no idea how to evaluate the competence of a physical therapist.
By the way, this doc. said Birks are excellent.
Anyway, I have three weeks in which to be fearful and hopeful about PT before I start. I'm both, but mostly hopeful. I just don't want it to undo my PF progress. Without the Achilles and ankle problems, I'd be flying high about now!
--NancyResult number: 96

Message Number 21016
Re: Here is some info. View Thread
Posted by Kim B. on 5/28/00 at 23:42

Hi Linda,

While you wait for a reply from Mike W. let me clairfy a couple of things that you may or may not have already gathered from reading the posts.

Mike W. advocates using a fairly new, non-weight bearing exercise device that he developed called the "Personal Foot Trainer" (PFT). At the first page of this site you can get a look at it and learn more about ordering it. It is listed along with some other PF products that Scott, our troop leader, (the site master), is comfortable recommending.

It has been Mike's position that non-weight bearing exercises and stretches are always better than weight bearing exercises and stretches. You can read his posts to learn more about his exact position on this. He is a physical therapist who is a former PF sufferer. His approach and teachings offer a new perspectives and many of us are still learning from him. We kind of like having him around 'cause we like picking his brain.

Stair drops are a weight bearing exercise, so I don't think Mike advocates this practice. Some people feel that stair drops can actually do more damage, so do a search on "stair drops" before you proceed with them. You'll probably get a mixed bag, but you can draw your own conclusions.

The non-bearging exercises I mentioned that are done at the computer are something that Bob G. has told us he does. I believe he uses a device called the "FootFlex". It is also featured on the first page of this site. Another device that stretches the calf muscles is called the "Step Calf Stretch" which I have seen for sale at the www.feelgoodfast.com catalog site. It is featured on this page: http://www.feelgoodfast.com/product-list.asp?AID=279

I don't mean to step on Mike's toes before he gets a chance to respond to your questions, but you mentioned being new here, and I know there is a world of information at this site for a newbie to digest. Hope I have helped and not confused.

Mike and Bob, please correct any incorrect statements.

Regards, Kim B.


Result number: 97
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Message Number 18622

Re: Breaking in $500 orthotics
Posted by alan k on 4/12/00 at 00:00

hard orthotics take more than a few days to see if they are going to work and may be uncomfortable for a few days, especially if "broken in" at the too-fast (in my opinion) schedule they recommend. They do need to be given a chance (according to their advocates). This is just info-- I myself had a bad experience with hard orthotics and so agree wholefootedly with dfeet. But we have to be cautious too in our cautions. But (another but)I also agree with dfeet that when trying something as radical as orthotics (I think a problem lies in classifying orthotics as "conservative" treatment) it is best to go back daily if necessary and badger the pod as much as you feel necessary in order to be sure you are not hurting yourself.

Many people report good results from orthotics (but not me).


alan k

alan kResult number: 98

Message Number 16436

Just a word about massage
Posted by BJC on 2/25/00 at 00:00

Massage can certainly make you fell better, but I don't believe you can "work out the inflammation" with massage. There is a technique developed by John Barnes called Myofascial Release, which is used for many different types of patients who have neuromuscular disabilities. Very simply, he advocates using the heat from a therpist's fingers(?) in a massaging (stretching) motion to "stretch" or elongate the underlying fascia, thus allowing greater range of motion for muscles. Many therapists (PT, OT, etc) use this technique as part of their therapeutic approach. There are many questions yet to be answered about this, but it does somewhat explain why massage makes feet feel better. While some therapists claim to be very successful using this approach, there have been few documented cases of "cures". My bottom line: if it makes you feel better, go for it!Result number: 99

Message Number 14959
Re: rest vs. exercise may be an individual issue
Posted by Robin B. on 1/20/00 at 00:00

I can see that devotees of rest AND advocates of continued exercise are both replying, so I suspect that as usual, one size doesn't fit all on THIS board. That's the continual message around here -- what works for some doesn't necessary work for everyone.

At this point, I am one of the long-termers around here. I have been here since November 1998 and discovered my PF around 8 months prior to that. Happy to say, I have turned the major corner in fighting this condition and am recovering -- not as fast as some have, but recovering nevertheless.

For me, rest for my feet was critical. I did very little on my feet at all. In fact, I got off them as much as I could. (Had been an avid walker, 4 or 5 miles a day, sometimes more, until PF.) However, I used a stationary bike and swimming pool for exercise -- not as much as I should have, but definitely better than nothing. I am convinced that the aerobic exercise helped me to recover -- and especially since it was non-weight bearing aerobic exercise.

Am finally back to walking -- not much, but 1 or 2 miles a day is like a major miracle for me after 20 months of not walking. Even if plopping in a wheelchair WERE the best thing for your feet, it's not the best thing for the rest of your body and I would imagine that inertia would be detrimental at some point. So from my point of view, rest for the feet but exercise for the body is part of what has helped me. I think everyone must find his or her own happy medium in the rest vs. exercise issue.Result number: 100

Message Number 14628

Re: a pretty decent medical article about plantar fasciitis and heel pain:
Posted by Nancy S. on 1/12/00 at 00:00


Dave, thanks for posting this! It's a good article, one I hadn't encountered in my many web searches, tho I'm certainly familiar with Dr. Barrett's name. It is interesting especially in that it clearly advocates types of treatment sorely missing from the treatment many of us here have received from our podiatrists. I hate to keep sticking pins in those people, but the lack of imagination or effort or interest on the part of many podiatrists is astounding. Dr. Barrett emphasizes PATIENT EDUCATION and many types of CONSERVATIVE HOME SELF-TREATMENTS. We are familiar with them now because of Scott and message boarders, but how many learned them from their own doctors? My disgust grows.
Thanks again, Dave.
-- NancyResult number: 101

Message Number 14166
Re: about variations on low-carb
Posted by Robin B. on 12/28/99 at 00:00

If you search the archived messages on the board, you will find a great many posts about low carb diets and their influence on both PF and connective tissue disorders. There are some die-hard advocates, a few nasty debates and even a handful of wing-ding responses. You will find many people pro, many con -- a little of everything.

A MODERATELY low carb diet has definitely influenced my PF for the better. Specifically, however, I have eliminated all caffeine, wheat and flour products -- no pasta, no bread, no rolls, not even rice, brown or otherwise. I DO (to the chagrin of the die-hards I am sure) eats fruit, along with vegetables, plus protein of course. I have also eliminated diet soda to get rid of excess sodium.

I can tell you that I followed a typical low-carb diet for many months and saw not much benefit. Then one day I cut out grains and wheat, flour, all rice -- and that seemed to help me a lot.

It's boring as all get-out. Sometimes I think I will kill for a bagel or a sub. I am tired of making tuna-melts WITHOUT the bread -- yuch. However, today marks the 4th straight day that I have been able to walk at least a mile outside -- which I haven't done in almost 2 years. I figure I am getting better, and I think dietary changes deserve some of the credit. By the way, I do drink -- not a ton, but a few here and there. More than wine too. Haven't noticed any favorable or unfavorable impact based on liquor consumption.

My recommendation would be -- experiment. Anyone who has spent even a night reading past messages knows that what works for one, doesn't work for another. Set up a plan for yourself adding and eliminating those things you think may help or harm -- give it a few weeks and see how you are. PF takes time and patience -- plus creativity.Result number: 102

Message Number 13059

Tolerance, moderation and Ossotron/Mohez/John W debate (long)
Posted by Robin B. on 11/23/99 at 00:00

At one level, I have been enjoying the jousting that goes on around the Ossotron/Mohez/John W. debate. On another level, it's getting semi-vicious and kind of nasty. This particular debate does not represent the first time this board has become nasty. It has happened before, and I myself remember being a target of it because I offered words of caution about an extreme low-carb diet. I got clobbered and my first reaction was -- PF is tough enough, who needs THIS kind of abuse from fellow PF sufferers?

It's easy for me to offer my opinion: I am increasingly getting bettter, and my PF is far less of a difficulty than it used to be. But last year at this time I was in terrible pain. It was 24 hours a day, and it didn't matter whether I was standing, sitting or lying down. My feet constantly hurt me to the point of crying. I was depressed, angry, despondent and jealous of people who were getting better. I was frustrated, terrified, confused -- and mostly, so horribly tired of always being in pain. So -- I will offer my comments with great respect and with empathy for people such as Mohez and many others who have suffered with PF far longer than I.

1. I wish Mohez and all the Ossotron patients wonderful and 100% success, and I personally don't give a hoot WHO pays for their procedures. I hope they are CURED. However, I think part of the issue on this board was and is disclosure. I for one didn't realize, reading all of Mohez' weekly posts, that his treatment was paid for by the treatment sponsors. Does it make a difference? Not to me personally since I am not now considering Ossotron for treatment, but it might if I WERE considering Ossotron, yes. So my recommendation would be simply this: If you're undergoing any type of new or potentially controversial or hot treatment, and if you're going to post the results -- simply indicate if the sponsors of the treatment or some other body has paid for it on your behalf, or if you have been "favored" in any way for trying something. Every reader of this board is an adult. Everyone can weigh the evidence for him or herself and make up his or her mind like an adult. How much or how little you trust individuals' opinions of treatment and treatment approaches is up to you and you alone, as an adult. Use your own skills -- discernment, judgment, investigation, evaluation -- and make up your own mind. But don't blame other people for the actions THEY have chosen to take.

2. This board is getting a little snipey. I'm not running John W's fan club and I'm not waving any Ossotron banner either -- but I am getting weary of seeing John W. and Ossotron patients get jumped and clobbered with snide and curt remarks every time they post. We all know and understand John W's affiliation. He hasn't kept it a secret -- and frankly, I don't think John has posted anything that's not in keeping with the professional interests he represents. It seems to me that if Scott is comfortable with the nature of John's posts, then perhaps we should all let it be. If you don't feel that Ossotron is worthy of your consideration or you don't trust the results that are currently being achieved as representative of long-term results, that's your choice. Voice an opinion that indicates that you are skeptical or you woder about long-term effects. But I don't think John W. or Ossotron patients need to be chided every time they post here. Again, use your personal judgment skills to sort through what's on this board and make your own decisions for your own future.

3. I've been on this board for a long time. A few of you "veterans" were my only understanding friends for many of my early months. There were LONG stretches of time when I would visit this board every day, two or three times a day, not so much hoping for a quick fix -- but more to be in the company of people who understood my pain, my fear, my dilemma -- because no one immediately around me did. Then one day I posted some cautionary remarks about exteme low-carb diets, and I got the daylights kicked out of me by low-carb devotees and leaky-gut advocates. (I should insert here, I myself follow a moderately low-carb diet myself and it has been very beneficial. I was simply saying, "exercise caution and do your homework before you try something radical.) Believe me, my tendency was to back off for several weeks, because my life is already too full without getting into Internet-based fights with a bunch of people I don't even know.

I don't come here for abuse -- so I presume that no one else does either. I presume we can all voice our individual opinions about what we THINK will work and why, and what we recommend from our own experiences -- without getting blasted, jibed, sniped at or torn apart for it. The sarcasm, the snipiness, the caustic comments, the aggressive behavior make this an increasingly unappealing place to visit -- when it should be, and for me personally it HAS been, just the opposite.

I DO understand the pain that causes anger and frustration and venting. This isn't the place to discharge it. This is where you should come first for information, secondly for a friendly arm around the shoulder and a pat on the back. Result number: 103

Message Number 12582

Re: Laurie, what works for me
Posted by Robin B. on 11/13/99 at 00:00

Hi Laurie. Well, I can tell you what has worked for me -- but I can also warn you that what works for many people on this board DOESN'T seem to work for me, so I may be one of those "exception" cases.

First of all, I wear Birks all the time. (I now have 8 pairs, and no money) I started wearing Birks about 6 months after the PF presented itself. I tried all kinds of athletic shoes, Rockports, other expensive shoes, plus Spenco OTC orthotic inserts, etc. I was ready to spend the $400 for custom orthotics -- almost. That was when I bought Birks.

I'm not recommending Birks in particular. Lots of people can't wear them. But my rationale was -- first, I had to find a brand of shoes (any brand or type, I didn't care what) that could at least support my foot enough to: 1) ease the pain a little; 2) help me get through the day, just enough that I could then concentrate on finding a treatment that worked. I have been very lucky with Birks -- they helped to relieve the agony almost from the first day. Don't get me wrong -- my feet still hurt like crazy, but at least I actually could walk in them and get around -- major factor. So-- my recommendation is, try clogs, try Birks, try Mephistos, try any shoe that will give you even minor relief to get through the day and just manage the "gotta' do" stuff.

Here's what I do now. 1) I do a little stretching -- not the vigorous stretching that many on this board recommend. I do that runner's calf street (you know, pushing into toward a wall -- it's on Scott's main document I think) once or twice a day for about 30-45 seconds on each leg. 2) I take bromelain religiously. I take 3 or 4 capsules a day. Each cap is 500 mgs and 600 gdus. Gel dissolving units (I think that's what it stands for) are apparently the main indicator with bromelain, rather than mgs. I take them between meals, NOT WITH meals, for anti-inflammatory effect. When I forget to take bromelain, I can feel the difference. I started at the end of July and felt the difference in about a week to 10 days.

3) If I am out walking for quite a awhile, I do ice my feet for about 15 minutes when I get home. When I used to be in a lot of pain, I tended to ice quite a bit-- and it seemed that the more I iced, the more I needed to. I tried to reduce the number of times I iced during the winter months and part of me wonders if maybe it didn't help to cut down the frequency.

4) Diet. Here is what I believe has also helped me, along with Birks and bromelain. It's horrible, really -- boring as all get out -- but I know it helps because I can tell the difference when I cheat. I don't eat products with flour, wheat, refined sugar or junk snacks. That has meant the end of pasta, rice (even brown, although my health food friends tell me I'm dead wrong and maybe I am),and hardest for me, all bread products. I don't eat sugar and of course I try to elminate salt whenever possible. I have eliminated caffeine from my life -- that was very hard. To tell the truth -- I really hate eating like this. I don't like meat, so I am down to fish, chicken, vegetables and fruit, which I do eat even though many low carb advocates swear against it. Once a week I will have a sandwich with bread or I will have an English muffin, and it doesn't seem to do much damage. If you research low carb diets on this board, you will find an enormous amount of conflicting opinions and even some sort of nasty debates. Ignore them. Here's the point: Take what you think will work for you, or what you are willing to try, and try it.

5) Exercise. I feel better -- my feet feel better -- when I get some aerobic exercise every day. I use a stationary bike. I really hate it because I used to be a big-time walker and I find a bike boring boring boring. (Also, I have a bad left knee, so I have to go at it in 15-20 sesssions throughout the day -- inconvenience as all get-out.) But -- I feel better when I have aerobic exercise in my life, and more pain when I don't. It took me about 2-3 weeks of steadily exercising morning and night to observe an improvement in my feet.

6) Rest. Ugly truth is, I have rested my poor feet for about a year. I simply refused to "push" any more than I had to just to get through the day. This behavior won't win you friends and it won't necessarily make your family happy. Why? Because you DO look otherwise perfectly normal and they truly can't understand how you can have THAT MUCH pain and still look perfectly normal. My advice is -- ignore them. Do whatever you have to do to feel better.

Here's what else I recommend. If you have a good doc you like, stay with him or her. If not, either switch or simply take the case into your own hands. I tried very very hard to monitor my own symptoms against those of people on this board (who serve as a great benchmark). I spent a lot of time isolating and identifying my own symptoms, and then trying to identify remedies that would match.

I am definitely NOT in favor of invasive treatment right off the bad. I ruled out cortisone to begin with. I have taken non-steroid anti-inflammatories -- and they are wonderful relief because they can reduce inflammation and mask symptoms. Problem is, once you quit the symptoms come back and they can also damage your liver or kidneys. I also ruled out surgery. I was leaning towards Ossotron, but not for another year or two and more of my own efforts.

Laurie, I am not sure I will ever be cured of PF. I still have it. I still have pain on occasion. On a scale of 1 to 10, I used to be at a 9. Now, I'd say 2 or 3. I would love to be cured, but I am not sure what it will take -- and I am unwilling to risk the success I have already experienced because a sizable portion of my life has been returned and I am thrilled. I guess the point is -- take charge of your treatment and look for what will give you enough NATURAL (i.e., not drug-related) relief that your day-to-day agony is over. Try everything that makes sense to you, and give it a couple of weeks anyway to work. Ignore people who don't understand. Remember -- we ourselves may have been people who didn't understand before we got struck with PF. I'll never be that kind of person again, and I bet,neither will you. Take heart and take care. Honestly -- for the first 6 months, I thought nothing would ever work for me. I was thinking about a wheelchair and was wondering if I could actually live with this condition forever -- and contemplating alternatives. Sometimes I wished I could go to sleep and never wake up, just to escape the pain. Take it from me -- SOMETHING will give you relief. It's a matter of finding those things and the right combination of things. Don't give up. Try it all till you land on the right stuff.Result number: 104

Message Number 11170

Re: To Jean B and Ivy L---regarding low-carb diet---
Posted by Robin B. on 9/23/99 at 00:00

I tend to not put an over-abundance of carbohydrate into my daily meal plan. However, there is a large medical and scientific community who would certainly debate the premise that low carb diets cause no physical health danger as long as you drink a lot of water. I think the premise that you can drastically cut carbs and just drink a lot of water is a bit misleading. Carbs are a necessity for healthy living; the scientific community is fairly consistent on this.

What's clear is that pasta, white bread, frozen dinners, breakfast cereals, mac and cheese and a large number of other comforting carbohydrates are not necessary for good health along with sugar products. But there are indeed dozens of vegetables and also real fruits that people can easily eat, in moderation, that will not by themselves lead to weight gain. I think we are all aware that there is no scientific study out there -- either from low-carb advocates or others -- that specifically relates certain dietary habits to a reduction of plantar fasciitis pain. There are doggone few real studies of PF by itself, let alone the impact of low-carb diets on PF.

I am also arthritic -- and believe me, there is a multitude of literature about which foods are triggers for arthritic pain and which are not. As you might expect -- they all vary, they frequently contradict one another -- and it is STILL a pretty individual matter. Dr. A says this, Dr. B say that, Arthritis Diet Plan C says something else -- it's real easy to go nuts from a simple trip to your local library.

Even though I tend to prefer a lower carb level myself, I don't believe that any one diet plan or guru represents the entirety of scientific knowledge.

Albert Einstein said, "What you see and feel and experience in a situation depends largely on your presence, on what you bring to the situation." My personal belief is, that is fairly true in the area of appropriate dietary planning for plantar fasciitis.


Result number: 105

Message Number 11165

To Jean B and Ivy L---regarding low-carb diet---
Posted by Carol E. on 9/23/99 at 00:00

I'm happy that you have both settled on a variation of the low-carb diet that you feel good about---but to clear up the wrong information or impression that I feel you left in your posts, I would like to clarify a few things.

First of all--Jean--the reason you felt so bad for the first two weeks is because of withdrawel from your carbohydrate addiction. Addictions are very hard to break and it doesn't feel too good going through it---ask anyone who is giving up caffeine or cigarettes(or worse). After the first two weeks you are home free. You commented about the lack of vegetables and fruits. I have commented several times that I have been following the Protein Power Plan which allows 30 grams of carbohydrate a day including a few low carb fruits(as opposed to Atkins which advocates 20 grams a day). For 30 grams of carbohydrates a day you could eat all of the salad you can physically consume(unlimited salads) plus 4 cups of cooked green beans, or 6 cups of cooked zucchini, or 7 1/2 cups of cooked broccoli, or 75 asparagus spears, or 9 cups of cooked cabbage, or 12 cups of cooked cauliflower-----jeez!!! How many vegetables to YOU like to eat in a day!!!

And Ivy--Neither plan advocates NO carbohydrates. And NO damage will occur to the kidneys if adequate water is taken in to keep your body flushed out. I drink a gallon or more a day. I frequent several low-carb sites with many, many people who have been following this diet for extended periods of time, who fully understand that drinking the water is an important part of the diet and no one has reported any problems with their kidneys---that is just part of the false hokum that people like to spread. I don't mean to criticize, but it sounds to me like you kind of created your own diet here, because it doesn't sound to me like you were following Dr. Atkins diet very closely.

Again, I am happy that you have found a reduced carbohydrate diet that you are comfortable with and I sincerely hope that it helps your PF to feel better. I realize that there is a limit beyond which some people are just not willing to go no matter the benefit. Good luck. Result number: 106
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Message Number 9556

To Jake: Diet, Nutrition and PF by Carol E.
Posted by Raleigh on 8/07/99 at 23:01

BY CAROL E (re High Protein diets and increased inflammation).

Your doctor is no doubt referring to egg yolks and red meat as the offending proteins on the Atkins Diet. MOST people are not bothered by them but some people are sensitive to the high arachidonic acid content.
I was reading a very interesting chapter in my Protein Power book about current research into the effects of good and bad eicosanoids (which our bodies manufacture). Good ones act as vasodilators & immune enhancers, they decrease inflammation and pain, increase oxygen flow and endurance, dilate airways, and decrease cellular proliferation(yes, cancer). Bad eicosanoids accomplish the opposite(note---they increase pain and inflammation). My book says that excess insulin from a high carbohydrate diet (and too much arachidonic acid if I am sensitive to egg yolks and red meat)cause the body to produce too many bad eicosanoids. Proteins help promote good eicosanoids. This is not some crackpot theory---the 1982 Nobel Prize was awarded for research in eicosinoids.

If you are sensitive to the AA, you can increase your egg whites and cut down your egg yolks in omelets and such and for the red meat, you can eat other meats or even just buying very lean cuts and trimming off all excess fat(the AA is mostly in the fat). Another thing they said you can do is take fish oil(omega 3 fatty acid) as it helps offset the AA.

This is really too complicated to go into here but it may be of interest because it may give us a clue into why so many of us have had a lot of pain relief on this low-carb diet. Not only pain relief, but the mosquitos don't bite me(no sugar--my blood must not taste very good anymore)and for the first time in 20 years I have had NO HAY FEVER this summer(and I just mowed and baled our 40 acres of hay by myself!!!)

In case you are interested. My book is called Protein Power by Drs. Michael and Mary Dan Eades, M.D. It is a diet VERY similar to Atkins and is actually the one I am doing. It advocates a slightly higher 30g carb level(including a bit of low-carb fruits) and suggests an amount of protein needed to maintain your calculated lean body mass(you can eat more if you are still hungry). I kind of do a combination of the two diets---less carbs, a bit more protein but I do eat a few berries on occassion. It is a VERY informative book. The chapter I discuss above is Chapter 12---The Microhormone Messengers.
Result number: 107

Message Number 9518

Possible foods that could cause inflammation. . . .
Posted by Carol E. on 8/06/99 at 20:50

Your doctor is no doubt referring to egg yolks and red meat as the offending proteins on the Atkins Diet. MOST people are not bothered by them but some people are sensitive to the high arachidonic acid content.

I was reading a very interesting chapter in my Protein Power book about current research into the effects of good and bad eicosanoids (which our bodies manufacture). Good ones act as vasodilators & immune enhancers, they decrease inflammation and pain, increase oxygen flow and endurance, dilate airways, and decrease cellular proliferation(yes, cancer). Bad eicosanoids accomplish the opposite(note---they increase pain and inflammation). My book says that excess insulin from a high carbohydrate diet (and too much arachidonic acid if I am sensitive to egg yolks and red meat)cause the body to produce too many bad eicosanoids. Proteins help promote good eicosanoids. This is not some crackpot theory---the 1982 Nobel Prize was awarded for research in eicosinoids.

If you are sensitive to the AA, you can increase your egg whites and cut down your egg yolks in omelets and such and for the red meat, you can eat other meats or even just buying very lean cuts and trimming off all excess fat(the AA is mostly in the fat). Another thing they said you can do is take fish oil(omega 3 fatty acid) as it helps offset the AA.

This is really too complicated to go into here but it may be of interest because it may give us a clue into why so many of us have had a lot of pain relief on this low-carb diet. Not only pain relief, but the mosquitos don't bite me(no sugar--my blood must not taste very good anymore)and for the first time in 20 years I have had NO HAY FEVER this summer(and I just mowed and baled our 40 acres of hay by myself!!!)

In case you are interested. My book is called Protein Power by Drs. Michael and Mary Dan Eades, M.D. It is a diet VERY similar to Atkins and is actually the one I am doing. It advocates a slightly higher 30g carb level(including a bit of low-carb fruits) and suggests an amount of protein needed to maintain your calculated lean body mass(you can eat more if you are still hungry). I kind of do a combination of the two diets---less carbs, a bit more protein but I do eat a few berries on occassion. It is a VERY informative book. The chapter I discuss above is Chapter 12---The Microhormone Messengers.Result number: 108

Message Number 9225

Sorry folks, I'll try to be more civil. Why does ATkins seem to help?
Posted by Gordon on 7/29/99 at 00:00

I know a lot of people disagree with the ATkins diet (me included) but it seems to have a very postive impact on how our feet do. If we knew why the atkins diet seems to help most (chronic types)who have tried it, we may be able to get studies done in this direction. In my book on Fibromyalgia it also advocates low carb high protein to releive symptoms ( this was written by an MD). Acording to my nutritonalist the low carb diet starves an intestinal yeast overgrowth which he claims is the root of our problems. I don't follow Atkins diet directly, I stay away from greasy meats and eat complex carbs and certain vegetables that are recommended on the yeast killer diet. I wish more people would get tested for intestinal yeast or at least try a low carb diet. THe diet doesn't cost you anything and the results are worth it.

Gordon

Result number: 109

Message Number 8813

Disney World & Mephistos long post
Posted by BarbannJ on 7/18/99 at 00:00

I recently returned from a 78 day trip to WDW. I was very concerned about being able to traverse the great expanses of hot pavement with becoming incapacitated.

I am one of the great advocates of Birks Arizona and Boston styles. I had been feeling that they wouldn't be right for long treks and I was unhappy with my Easy Spirit Walking shoes that I had recently purchased as they did not have enough support.

Two weeks before leaving for my trip I went to a Mall to a store that sold Mephistos. They just didn't have my size in any of the shoes I liked or even didn't like. They finally fit me in the Holiday style for men size 10. I am a woman but this fit. They were supposed to get them in white for me before my trip. I also stood on a mat to get charted for an insole that was supposed to be fit to my foot pressure and size. Two days before my trip this store at Woodfield Mall in Illinois had neither item and no good explanation. Now two weeks later I have still not received the insoles that I paid for up front.

Two days before my trip I went to a tiny store in Oak Park Illinois that sells only Mephistos. I was fit for a shoe that looks like the Birk Arizona Mans 10 in Brown leather, stap holes punched to get them to my size. I was also fit for the Holiday in white. I also bought 5 pairs of Acrylic socks. I spent a fortune and it was worth every penny of it.

My trip involved a huge amount of walking and I was mostly okay. I used moleskin on the front of my foot just under the edge of the front strap where it was touching my foot. I did this each time I wore them.
They were perfect and great in the heat.

I wore the Holiday walking shoes too with the Acrylic socks and they wicked the moisture away from my feet and left my feet nice and dry. No blisters perfect fit from the first day. I usually switched shoes at some point in each day.

The only new symptom I had was some shin pain for a couple of days. I also stretched out every time I was in a ladies room and when waiting in lines. I did this frequently.

My pf pain was minimal or absent. I am religious about always having either birks or mow Mephistos on my feet even as houseslippers.

Between Birks, stretching, Mephistos, Ibuprophen, Glucosamine and good socks I had a good trip. I can't imagine buying any other brand of shoes now than Mephistos.

I also have had surgery for a herniated disc and had a long period of residual very serious sciatic pain. The sciatica acted up only in a minor and manageable way. Another kind of leaning sideways stretch up against a wall can get it back under control. These shoes were so great. Just amazing, stable, supportive and comfortable.

Barb

Result number: 110

Message Number 7948

Lisa and Alicia, progress report
Posted by Gordon on 6/20/99 at 00:00

I have been sticking close to the diet and continuing to see more and more improvement. I am allowing myself to eat larger variety of foods now but am still sticking to " comlex carbs only, no bread products, no sweets, no fruit juice, lots of vegetables, limited fruit (more than most people probably eat) and protein (lots of salmon). Taking 4000 mg Vit C, 800 iu E, HTP, calcium magnesium and zinc(because no dairy), high quality non-dairy acidophilus (powder form). Lots of exercise.

Worked in the yard putting in landscaping timbers all day yesterday and went on a 2 hour hike today(uphill both ways, against the wind snow, and ice) and am doing great. Seriously, my feet are not slowing me down hardly at all. Building muscle back up in my legs is actually a higher priority right now.

I don't know if I'm killing the yeast or what, but the diet and exercsise does it.
From the reports of others doing the Atkins diet which is similar (the long term version, not the weight loss version) I think more people should try this. I think the Atkins approach of too much emphasis on meat may not be good for the long long term though.

Contrary to what Atkins and other high protein advocates say,if you research the diet of early man and other primates with similar jaw/tooth contruction you will find that for the most part, the natural diet does not contain significant amounts of meat, nor cultivated wheat/barley/rice type crops(of course) , but instead is mostly nuts, seeds,leaves, roots, fruit, and vegetables.

I beleive that our overly high concentration of simple carbohydrates, refined sugars etc. combined with high amounts of meat protein is the root cause of many health problems and even if it only affects a small portion of the population, it is case of probablities and the many other unknowns that catch up to us.

I still love a juicy steak, but I keep it to a minumum and have smaller portion. Nowdays when we have steak we usually split one steak between three people (wife, son , and myself).

Gordon

Result number: 111

Message Number 4680

Re:You need a new MD
Posted by Alicia on 2/09/99 at 00:00

if she was "affronted" by your inquiry. We MUST be advocates for ourselves - no one else will be. Good luck.

Result number: 112

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