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Searching file 26

Message Number 261583
Re: Dr. Paul S. Cooper View Thread
Posted by DebbiK on 10/27/09 at 21:02

Thanks for the info. I hear great things about him. Good luck with your foot!

Result number: 1

Message Number 261379

Re: Dr. Paul S. Cooper View Thread
Posted by GeritH on 10/19/09 at 10:14

I had a pylon fracture 3 years ago and and had initial surgery with Dr. Wowk at Suburban Hosipital. After taking off the cast I comlained about pain in my achillies but was given multile excuses as to the caause. I saw 2 other doctors and on reomended Cooper as he was the 'best in the country for my type of injury'. Last year Cooper went in and cleaned out the joint which had become arthritic. When I mentioned the achillies he asked if I had ever had an MRI. I said no as Wowk said the steel would distort the image. Cooper scoffed at that and immediately oreded an MRI only to discover that my achillies was also torn in the accident as well as several other ligiments. I am actually seeing Copper tomarrow and will schedule the surgery for the achillies. He is brief and quick becuase he is so busy but Dr Cooper is a great surgeon. I live in Las Vegas now and travelled back just for Dr Cooper.

Result number: 2

Message Number 261280

Haglunds? View Thread
Posted by jim p on 10/13/09 at 19:44

Help.....I need advice. I have been battling left foot heel pain(at the insertion of the achilles into the calcanious) for nearly four years. I've been to six different medical professionals. I am told I have a Haglunds deformity and need surgery. I do not have a large 'bump' and as a 54 year old male, I don't wear pumps!!

Has anyone any experience with Dr. Cooper for this type of surgery? He is highly recommended.

Result number: 3

Message Number 260973

urban legends and China Drilling View Thread
Posted by marie:) on 9/30/09 at 18:45

Just correcting an old urban legend that China is drilling oil 45 miles of the Florida coast. It all began when Cheney quoted George Will. Even Cheney admits he was mistaken. In fact George Will wrote an entire article correcting the issue. CHINA is NOT drilling of the shore of Cuba. ;)

http://www.factcheck.org/askfactcheck/are_the_chinese_drilling_off_the_coast.html

Cheney: As for other locations, George Will pointed out in his column the other day that oil is being drilled right now 60 miles off the coast of Florida. But we're not doing it, the Chinese are, in cooperation with the Cuban government. Even the communists have figured out that a good answer to high prices is more supply.

Associated Press Online: Cheney's office said in a statement to The Associated Press that the vice president had erred. 'It is our understanding that, although Cuba has leased out exploration blocks 60 miles off the coast of southern Florida, which is closer than American firms are allowed to operate in that area, no Chinese firm is drilling there.'

But the false claim has been repeated by those in favor of lifting a federal moratorium on drilling in offshore areas and in the Arctic National Wildlife Refuge. A variation on the theme was delivered by South Carolina Republican Sen. Lindsey Graham on June 22 on NBC's 'Meet the Press':Graham: Cuba is doing a deal with China, potentially, to drill off our shores.

Result number: 4

Message Number 260894

Re: Roman Polanskii View Thread
Posted by Rick R on 9/28/09 at 15:06

John,

Just because he got away with raping a 13 year old for all this time doesn't mean we should let it go. Some crimes including this one merit prosecution regardless of time. It isn't up to the victim, the crime is against 'the people.' Now if the victim chooses not to cooperate, I'd hate to drag her through this again. Was he convicted and simply fled prior to sentencing? If so let's let the spoiled rich sob spent the rest of his life being not so special. If we have to drag the victim through a trial and she would rather not, let's put the fear of God in him and others that think they are special, as far as possible without dragging the victim through the mess.

It could be argued that letting her out of a new phase of pain adds to the potential that somebody else will be victimized.


Rick

Result number: 5

Message Number 260884

Dr. Paul S. Cooper View Thread
Posted by DebbiK on 9/27/09 at 15:11

Has anyone received medical treatment from Dr. Paul S. Cooper/Georgetown U. in Washington DC? I am seeking a highly skilled OS who specializes in foot and ankle in the Washington DC/Northern VA/MD area.

Result number: 6
Searching file 25

Message Number 259809

Re: Health care, continued View Thread
Posted by john h on 8/18/09 at 10:00

Julie: I know nothing of Daniel Hannan. I was just making a point their will be different points of view no matter which side you are on. In poll after poll Americans say they do not want the current program scrapped in total for a system run by the government. The poll numbers are now over 70% for people who think Republicans will do a better job with healthcare than Democrats. Obama's approval rating is now down around 50% and continues to drop. Polls also indicate the public does not want a public option. From the day our Constitution was written the pubic has been fearful of a big federal government which is one of the main reasons we ended up with a House and a Senate with the Senate equalizing the power of the large states. If it turns out we have a public co-op then why is that not as good or better than having the federal government run a plan which anyone can plainly see will lead to a single payer system. The U.S. great majority of Americans do not want a public option and that is the clear reason Obama over the weekend stated the public option was not crucial to a health program. Only those who want a single payer system support a public option. Why should people in Europe or anywhere else care what kind of system we adapt? I do not care what kind of system other nations have. If it works for them and the people are happy what could be better.

As it stands now it seems Obama is prepared to give up on the public option although the left wing Democrats are not. The Senate Committee Chairman of finance said over the weekend there are not now and never have been enough votes in the Senate to pass a public option built. The turnout for these public hearings have been the largest in our history and anyone who thinks these people are not passionate about their protest has not really paid attention. The Democrats tried using that tactic but gave upon it very quick as it backfired.

Unless the left wing Democrats stop it their is a very strong chance we will have a health plan that will cover nearly everyone including those with any disease which is portable. The Democrats are very unlikely, when it gets down to a vote, to stop a bill which does not have a public option but does have nearly all the things we all want.

There have been several politicians who said we should adapt the Canadian system. Obama just last week said at a meeting with the Canadian Ministers said the Canadian system will no work in the United States. He was very clear on that. When the people scream loud enough politicians start to listen. With every Congressman and half the Senate up for re-election next year you can be sure these people will do what is best to get them re-elected. The uninsured will become insured and for any disease which seems to be your largest concerns. Why would a cooperative option bother you. It would be not for profit and offer many options beyond the 600 or more companies that already offer many options. Cooperatives have a long history in out nation from electricity to farms and have done well. You have the system you like why should I not have the system I like?

Result number: 7

Message Number 259682

Re: Finding Truth In Healthcare Reform View Thread
Posted by Rick R on 8/13/09 at 17:34

I like the concept of HSA's but in my experience it's been another system where the default behavior is to attempt to duck a contractual obligation. Then if the cutomer complains blackmail them via credit ratings. In manufacturing if we did that we'd bill for a product expect to get paid and never ship then blackmail if they complain. How long would we last? A stupid question on the surface but throw noncompetitive forces in the mix and that's what we have in the medical profession.

Great point, how about we let doctors do doctoring rather than fight the system. Talk about waste!

Ok here's my idea which I guarntee the government formerly of the people by the people will not allow:

You team up with a consortium of doctors covering the 80% of what the data show to be what people need, in the ratio they need. We the users pay in a monthly fee regardless of need or use, as we currently would pay a middleman, the insurance slug. A review board of users and providers arbitrates abuse issues. We users surrender our right to sue. No insurance per sey. Some of the monthly fee goes to a fund for the occasions when we go out of the cooperative. You in?

Rick

Result number: 8

Message Number 259676

Re: Finding Truth In Healthcare Reform View Thread
Posted by john h on 8/13/09 at 14:55

Wendy: The first thing to understand is there is no final plan with all the details for anyone to review. We have a broad outline in the house. If this plan were to be approved then bureaucrats would begin to write the long details of how to make the plan work. That is why it is expected to take at least until 2013 to put the plan into existence if passed. Until we know all the details that have not even been written we lack any specific information from Obama or his staff.

As a Medicare patient I can see any Doctor in the United States who will accept Medicare patients. That is most of them. No matter how good or famous these Doctors are they are still paid what all Doctors are paid by Medicare for a given procedure. I have traveled to Dallas to visit perhaps the best back clinic in the world. The Texas Back Institute. They are often used by the FDA to test new procedures and have often been on the Today Show. I consulted with the founder of the clinic. I did not have to be referred there. I just called up and made an appointment. Having injured my back in an aircraft crash when shot down I have long had a back problem. This was paid for by Medicare. Rich or poor you go on Medicare at age 65. There are two types of Medicare and you can pick one over the other. If you have the money you can go out and buy the most expensive plan available from any company even though you are on Medicare. Some companies pay over $40,000 a year for a plan for certain employees. If you are Bill Gates why would you even want any insurance?

Medicaid is not based on age as is Medicare but is a program for individuals who meet certain low income standards. You may be 22 years old and qualify for Medicaid. It is funded by both the Federal and State governments. You can be an alien and get on this program. The states and Feds are often at odds on this funding. If California is mandated to cover certain legal aliens to cover them under Medicaid then they perhaps have a right to complain as their state drifts towards bankruptcy. I think some of their cuts recently passed may come out of Medicaid.

Concerning high risk patients I heard a discussion that by taking in 45-million new insurance customers the insurance companies would have enough of a new base to cover the cost of those with serious health issues. Since the insurance companies have already basically agreed to this one should think their statisticians would already have concluded that to be the case. Many of the new customer will be young healthy people who will offset those in poor health.

In Canada you have enjoyed your system for many years and apparently are for the most part are happy with it. I suspect if your government proposed to totally change you system to some other you would have some heated town hall meetings. People generally do not like change and particularly change that has not even yet been defined. 78% of Americans are shown to like their insurance so it should come as no surprise that we are having heated debates. The English like small cars and Americans like big cars and pickup trucks. One is not right and the other wrong. We grew as nations in a different manner. Canadians like ice hockey and Americans like American football. Weather made all the difference. We are headed towards a better healthcare system we hope. How we get there will be a problem for all Americans to fight over and ultimately resolve. Our first attempt may fail. It may take more than three years to get there. It may take ten as we are being asked to totally chaned 1/6th of our total economic outut in a matter of a few months.

Medicare is not free. I pay around $94 a month for medicare as does my wife and it goes up each year. I think we have a deductible of $300 that must be met before the Medicare kicks in. We of course have to pay the usual 20% of any cost made by a Doctor or hospital. There are other limits in the system that limit the number of days you can stay in a hospital before you start paying, no chiropractic coverage, no eyeglasses, no dental for the most part and limited mental health care. I still like the program as all of us in this country prefer a Doctor of our choice and for the most part no one wants a bureaucrat making medical decisions on their life base on statistics issued by the government. That is a non starter for most Americans. Covering the uninsured and those with on going diseases like cancer is agreeable and desirable to most Americans. The two big worries are a government take over of healthcare which scares Americans dating back to when our Constitution was first written. Limiting Federal government was a major issue to the colonist. They wanted no part of a big government or a King. That is an underlying issue to this day. The other thing that has Americans scared is our federal deficit of 1.8 trillion dollars to which we are talking about adding another trillion with our new healthcare system. We all know we have only so much money and we cannot continue to just print it. We view the government option as the first step to a government take over of all medical-care. Rightly or wrongly that is the view. You can see in the crowds at the town hall meetings. These people are not shills they are more than just passionate. They are flat out angry no matter if their reasoning is right or wrong. Since Obama and his staff do not have a final plan or details they are left to defend the indefensible of something that does not yet exist. September is going to be more interesting than August once the details get into open debate. The Democrats have the numbers to force through anything they want so most talking head now say the government option now has a 50/50 chance of being part of the bill. I really do not see a difference between a government option and the proposed cooperative that some are proposing. Americans understand cooperatives. We have them everywhere and it is not a scary term like 'government option'.

Obama stated very clearly during questioning after his meeting withy your Prime Minister and the Mexican leader over trade that 'The Canadian system would not work in America'. He did not go into detail about that statement Following that statement then there was an immediate discussion brought up by journalist everywhere about the Canadian system. Her are some of the things presented as factual: I think it was an average of 16 weeks but I have seen blogs that report anywhere from 4 weeks to 6 months. It wan months to see a specialist. It was also reported that there were 36,000 Canadian waiting to get into a hospital. One commentator noted that by having long waiting lines for both GP's and specialist was one way to hold down cost. That seems simple enough to understand. Per capita the U.S. has three time more MRI and Cat Scan machines. It was reported that in England the average to see a 'new' GP was 101 days. Americans have never had to live with such restrictions no matter if the wait is 6 weeks or 6 months. You can see where that would be a very big problem . If we suddenly drop in 40-45 million new patients who now need a GP the system would immediately be over loaded. We do not have enough GP's to meet our current needs. What ever develops it is going to have to happen with careful deliberation. There is no way to suddenly drop a system as large as ours and start over. We have a much larger population than England and Canada which amplifies the problems that will develop. This is where the detail which have not been written comes into play and are so important.

Result number: 9

Message Number 259482

Government Option in Health Care View Thread
Posted by john h on 8/07/09 at 15:25

It is clear the Obamacare plan is falling into deep trouble with the public on the issue of a government type option. Around 70% of Americans profess their like of their current health insurance in poll after poll. There is also a deep dislike of the government option in poll after poll. With the Congress in recess and having barely began the Congressmen are getting an earful from their own constituents and most of it is negative on the government option.

Obama is starting to backtrack on his big requirement for a government option. He can still get a plan though Congress and declare victory even without a government option. I am sure the plans will all have to be tweaked as an even bigger problem is that the people of the U.S. are extremely worried about our enormous national deficits that continue to build. Obamacare will add another trillion dollars to the already record deficits. Talk continues to surface as trial balloons about a second stimulus. Obama continue to try and do to much to fast and in the process endangers many of his programs. It seems clear now that there are going to be taxes on people making less than $250,000 a year. Obama promised in no uncertain terms this would not happen during his campaign. If Cap & Trade make it through the Senate that guarantees all of us will see increased taxes. To pay for a one trillion dollar health care program is going to take taxes in one form or another from all of us. More and more talk is emerging about a European style Value Added Tax (VAT). We will get a health care bill but is is not going to be the one envisioned by Nancy Polosi and her minions.

Nanci Polosi is probably an albatrose around not only Obama's neck but every Democrat seeking re-election. She is going to be remembered you can be sure of that.

From todays news:

Aug. 7 (Bloomberg) -- President Barrack Obama may accept nonprofit health-insurance cooperatives in place of a new government-run plan as long as consumers are guaranteed more choice and competition in buying insurance, a top aide said.
'We would be interested in that' if those conditions are met, Nancy-Ann DeParle, director of the White House Office of Health Reform, said in an interview with Bloomberg Television’s 'Conversations with Judy Woodruff' airing today.

Result number: 10

Message Number 258614

Re: How Mayo Clinic is giving the BEST care for the least amount of money! View Thread
Posted by Dr. Ed on 7/04/09 at 13:00

Marie:

Judging the effectiveness of healthcare and quality can be tricky. There is a tendency for the large institutional providers of healthcare to make claims to quality based on a number of popular statistical items such as the percentage of individuals getting prenatal visits, immunizations and so on. The problem is that when such criteria are known, the organization will focus on improving those numbers while not necessarily addressing other issues with respect to quality.

We often hear that the US does not compare as favorably as some other countries that have national health plans in the area of infant mortality rates. Consider the following though: http://www.aapsonline.org/newsoftheday/00307

I agree that a team approach to patient care can be a very good way to go. In certain venues, it takes a well organized effort by a medical group to make that happen. Other venues may include communities where the medical community has a good level of cooperation between independent providers.

One area to note with respect to the Mayo Clinic article is the emphasis on the use of EBM or evidence based medicine. EBM, on the surface, sounds like a good thing. It encourages the use of treatments that are backed by sufficient research. But, EBM is a double edged sword. The bottom line is less than about 30% of the medical knowledge base used in treatment is backed by EBM. Proponents of EBM are often third party payors who attempt to use the 'requirements' of EBM to avoid payment for more traditional and inexpensive treatments that have long track records of safety and effectiveness. Additionally, the process of EBM promotion stifles creativity in treatment plans. There is encouragement of uniformity in treatment in the article. That works when the goal is to treat the largest number of patients possible by orienting the treatment at the center of the bell curve. That can yield impressive statistics.

Keep in mind that many posters here have responded poorly to that approach.

Ed

Result number: 11

Message Number 258184

Re: Netanyahu Agrees to Palestinian State View Thread
Posted by marie:) on 6/16/09 at 20:52

I don't have any favorites in this situation so I'm not sure what you're trying to convince me of. The one thing I do know is that I support a 2 state option. We have given Israel, which I believe is one of the wealthiest nations in the world, billions of dollars and I would hope our leaders are involved on the peace front stipulated in the agreement with the Bush administration or maybe they should not have taken the money.......and the same goes for the Palestinian people. 900 million is no where close to the billions we have given Israel but I expect our tax dollars to be spent wisely.

http://edition.cnn.com/2009/POLITICS/03/02/mideast.clinton/
The United States has offered more than $900 million to help the Palestinian people, particularly those in Gaza, Secretary of State Hillary Clinton announced Monday.

--------------------------------------
Science come on.....;) I'm not making excuses for Hamas but you have to admit it's kinda hard to do research when your not allowed access to the labs. It's improving though. Scientists speak the same language......in every country.

BTW have you ever heard of IPSO?
http://www.ipso-jerusalem.org/

Palestians and science....
http://www.sciencemag.org/cgi/reprint/312/5772/352a.pdf

http://www.nasonline.org/site/PageServer?pagename=NEWS_statement_council_02072007_access_palestinian_students&printer_friendly=1
Council Statement on Access to Institutions of Higher Learning for Palestinian Scientists and Students

February 7, 2007

The Council of the National Academy of Sciences has long promoted access to education and scientific cooperation and opposed academic boycotts, including those aimed at Israeli institutions of higher learning. (See statements of August 27, 2002, and May 12, 2005.) Since 2000 the Council has followed with concern the increasingly stringent restrictions imposed by the Israeli Defense Forces (IDF) on Palestinian students and scientists seeking to study in Israel and the West Bank.

We applaud and support recent efforts by the Israel Academy of Sciences and Humanities (statement attached) and the majority of the heads of Israel’s major universities and institutes of higher education supporting relaxation of these restrictions. We urge, as has the Israel academy, that “cases where security considerations are deemed to require placing restrictions on a person’s movements should be adjudicated as such, on an individual basis and with all due consideration for a person’s human rights.”

We also continue to urge, as we did in our August 2002 statement on the critical importance of continuing international collaboration in science, that “the members of the world scientific community ... actively support scientific exchanges, collaborations, and education as a wise and humane investment for peace in the future.”

Result number: 12

Message Number 258063

Re: Wake up America View Thread
Posted by Max K on 6/10/09 at 20:17

Quote: Actually Gary Cooper in High Noon isn't such a bad example. What ever happened to 'Speak softly and carry a big stick?' unquote.

I read something today about TV westerns:

'In 1959 there were 29 prime-time western series running on American TV. Where did they all go?'

http://lesterhhunt.blogspot.com/2008/04/where-did-all-westerns-go.html

Result number: 13

Message Number 258057

Re: Unemployment View Thread
Posted by john h on 6/10/09 at 13:34

The Czar Tim Geithner has approved some of the larger banks to pay back $68 billion dollars of TARP money. Strange you need approval to pay back a loan. Wish my lenders were like that. Now what do you think should happen to that $68 billion payback? I think reasonable people would say use it to pay down the national debt since every household in America owes over $550,000.00 dollars. Makes sense to me. But not so fast John. Uncle Tim is going to put it into a slush fund for future emergencies. I read we now have appointed over 15 CZAR's and are about to appoint a TSAR. Am I in Russia. If I am then Tim Geithner is Ivan The Terrible. It seems that one branch of our government has gone suddenly silent. That would be Congress. They now take their orders from the Commander in Chief. Instead of Uncle Billy we now have Aunt Nancy burning as she goes. Am I the only one that thinks our leadership in Washington has lost their way and does not understand the meaning of debt. Our lenders will soon enough remind them.

Interesting reading:

'Czar Power
Ranjay Gulati, 01.07.09, 04:45 PM EST
The problem with silos in Washington is that issues fall between them.



Czarist solutions to our daunting array of national crises are suddenly everywhere. At current growth rates, we are likely to have a car czar, an energy czar, a financial sector czar and a health sector czar. Who knows how many more will be either named or in place by the time Barack Obama actually takes office?

It seems America is turning into pre-Bolshevik Russia. Can the Cossacks be far behind?
Don't get me wrong. Strong leaders and at least a partially unfettered hand are vital to pulling us out of the many messes we are in. To make any headway against Washington's--and the nation's--entrenched interests, these presidential designees must have the authority to cut through red tape and take quick action when necessary. But if our new czars are as autocratic as their nicknames imply, we could be in for worse, not better, times, even if they are all more like Peter the Great than Ivan the Terrible.

Almost inevitably, these appointments will go to forceful personalities celebrated for their leadership skills. Faced with rescuing entire sectors of our economy, the czars will hire A-list cadres of aides. Directives will follow; power will gravitate to the positions. And if history is any guide, Washington, instead of fostering solutions, will have added yet another tier of self-protective, self-interested silos to its already impressive landscape.

The fact is the dire state of America today is not only the result of faulty leadership but also of systemic organizational failures--specifically, the inability of highly differentiated but non-collaborative government entities to work with each other. Whether in government or business, these silo-type entities provide excellent local accountability and focus, but at a heavy price.

The downside usually comes in the form of structural blind spots of opportunity that are invisible because they lie between silos. Sept. 11 could have been prevented if someone had connected the dots across disparate intelligence branches. A poorly functioning czarist system can also lead to disconnected actions by individual units even when circumstances call for unity.

We saw these patterns during the aftermath of Hurricane Katrina. Rather than consider the suffering people on the ground and pool forces to deliver the relief they so desperately needed, the disparate government agencies involved argued over jurisdictional overlaps and fought to protect, not share, the products and services each was charged with delivering. And we will see the same behavior again if we turn inordinate authority over to men and women more adept at tough talk than coordinated action.

Comment On This Story
Sure, getting the domestic auto industry back on its feet requires some arm-twisting, but it also demands cooperation across multiple agencies--hardly the hallmark of a czarist approach. The Federal Reserve and the Treasury Department, which are dealing with the funding side, will need to work with Environmental Protection Agency, which will nudge manufacturers to produce environmentally efficient cars.'




I

Result number: 14

Message Number 258055

Re: Wake up America View Thread
Posted by Rick R on 6/10/09 at 11:48

So John, where were you when Uncle Billy ravaged his way to the sea?

Sorry, I just had to. I know you aren't quite that old, close though.

I think Rodney King diplomacy is as misdirected as puffy-chested cowboy bravado. Actually Gary Cooper in High Noon isn't such a bad example. What ever happened to 'Speak softly and carry a big stick?'

Rick

Result number: 15

Message Number 257781

A very good perspective. I may have already posted this. View Thread
Posted by john h on 5/28/09 at 12:51

545 PEOPLE
By Charlie Reese
Politicians are the only people in the world who create problems and then campaign against them.
Have you ever wondered if both the Democrats and the Republicans are against deficits, WHY do we have deficits?
Have you ever wondered if all the politicians are against inflation and high taxes, WHY do we have inflation and high taxes?
You and I don't propose a federal budget. The president does.
You and I don't have the Constitutional authority to vote on appropriations. The House of Representatives does.
You and I don't write the tax code, Congress does.
You and I don't set fiscal policy, Congress does.
You and I don't control monetary policy, the Federal Reserve Bank does.
One hundred senators, 435 congressmen, one president, and nine Supreme Court justices 545 human beings out of the 300 million are directly, legally, morally, and individually responsible for the domestic problems that plague this country.
I excluded the members of the Federal Reserve Board because that problem was created by the Congress. In 1913, Congress delegated its Constitutional duty to provide a sound currency to a federally chartered, but private, central bank.
I excluded all the special interests and lobbyists for a sound reason. They have no legal authority. They have no ability to coerce a senator, a congressman, or a president to do one cotton-picking thing. I don't care if they offer a politician $1 million dollars in cash. The politician has the power to accept or reject it. No matter what the lobbyist promises, it is the legislator's responsibility to determine how he votes.
Those 545 human beings spend much of their energy convincing you that what they did is not their fault. They cooperate in this common con regardless of party.
What separates a politician from a normal human being is an excessive amount of gall. No normal human being would have the gall of a Speaker, who stood up and criticized the President for creating deficits. The president can only propose a budget. He cannot force the Congress to accept it.
The Constitution, which is the supreme law of the land, gives sole responsibility to the House of Representatives for originating and approving appropriations and taxes. Who is the speaker of the House? Nancy Pelosi. She is the leader of the majority party. She and fellow House members, not the president, can approve any budget they want. If the president vetoes it, they can pass it over his veto if they agree to.
It seems inconceivable to me that a nation of 300 million can not replace 545 people who stand convicted -- by present facts -- of incompetence and irresponsibility. I can't think of a single domestic problem that is not traceable directly to those 545 people. When you fully grasp the plain truth that 545 people exercise the power of the federal government, then it must follow that what exists is what they want to exist.
If the tax code is unfair, it's because they want it unfair.
If the budget is in the red, it's because they want it in the red.
If the Army & Marines are in IRAQ , it's because they want them in IRAQ .
If they do not receive social security but are on an elite retirement plan not available to the people, it's because they want it that way.
There are no insoluble government problems.
Do not let these 545 people shift the blame to bureaucrats, whom they hire and whose jobs they can abolish; to lobbyists, whose gifts and advice they can reject; to regulators, to whom they give the power to regulate and from whom they can take this power.
Above all, do not let them con you into the belief that there exists disembodied mystical forces like 'the economy,' 'inflation,' or 'politics' that prevent them from doing what they take an oath to do.
Those 545 people and they alone, are responsible.
They and they alone, have the power.
They and they alone, should be held accountable by the people who are their bosses. Provided the voters have the gumption to manage their own employees.
We should vote all of them out of office and clean up their mess!
What you do with this article now that you have read it is up to you.

Result number: 16

Message Number 257670

Re: "Good Feet" Store and Arch Supports View Thread
Posted by BOB COOPER on 5/22/09 at 11:02

It's too bad that everyone on this post has an opinion without any experience with the good feet product. I googled good feet to find an outlet to buy my 3rd set. I have worn them about 10 years after having foot and knee problems from pronation most of my lift (I'm now 67 and do about 2 miles a day on my home tredmill). Wonderful product, I have recommended it to at least 6 other people 4 thought it was great, 2 others said they bothered their feet. I hate the pricing, but the stores have been around at least 10 or 15 years. That in itself says
something, word always gets around, good or bad. They must have some success. I LOVE MINE -- MY KNEES ARE PAIN FREE

Result number: 17

Message Number 257587

545 People by Charlie Rose View Thread
Posted by john h on 5/18/09 at 11:07


545 PEOPLE
By Charlie Reese

Politicians are the only people in the world who create problems and then campaign against them.
Have you ever wondered, if both the Democrats and the Republicans are against deficits, WHY do we have deficits?
Have you ever wondered, if all the politicians are against inflation and high taxes, WHY do we have inflation and high taxes?

You and I don't propose a federal budget. The President does.
You and I don't have the Constitutional authority to vote on appropriations. The House of Representatives does.
You and I don't write the tax code, Congress does.
You and I don't set fiscal policy, Congress does.
You and I don't control monetary policy, the Federal Reserve Bank does.

One hundred Senators, 435 Congressmen, one President, and nine Supreme Court justices , 545 human beings out of the 300 million are directly, legally, morally, and individually responsible for the domestic problems that plague this country.

I excluded the members of the Federal Reserve Board because that problem was created by the Congress. In 1913, Congress delegated its Constitutional duty to provide a sound currency to a federally chartered, but private, central bank.

I excluded all the special interests and lobbyists for a sound reason. They have no legal authority. They have no ability to coerce a senator, a congressman, or a president to do one cotton-picking thing. I don't care if they offer a politician $1 million dollars in cash. The politician has the power to accept or reject it. No matter what the lobbyist promises, it is the legislator's responsibility to determine how he votes.

Those 545 human beings spend much of their energy convincing you that what they did is not their fault. They cooperate in this common con regardless of party.
What separates a politician from a normal human being is an excessive amount of gall. No normal human being would have the gall of a Speaker, who stood up and criticized the President for creating deficits. The president can only propose a budget. He cannot force the Congress to accept it.

The Constitution, which is the supreme law of the land, gives sole responsibility to the House of Representatives for originating and approving appropriations and taxes.

Who is the speaker of the House? Nancy Pelosi. She is the leader of the majority party. She and fellow House members, not the President, can approve any budget they want. If the president vetoes it, they can pass it over his veto if they agree to.

It seems inconceivable to me that a nation of 300 million can not replace 545 people who stand convicted -- by present facts -- of incompetence and irresponsibility. I can't think of a single domestic problem that is not traceable directly to those 545 people. When you fully grasp the plain truth that 545 people exercise the power of the federal government, then it must follow that what exists is what they want to exist.

If the tax code is unfair, it's because they want it unfair.
If the budget is in the red, it's because they want it in the red .
If the Army & Marines are in IRAQ , it's because they want them in IRAQ .
If they do not receive social security but are on an elite retirement plan not available to the people, it's because they want it that way.

There are no insoluble government problems.
Do not let these 545 people shift the blame to bureaucrats, whom they hire and whose jobs they can abolish; to lobbyists, whose gifts and advice they can reject; to regulators, to whom they give the power to regulate and from whom they can take this power. Above all, do not let them con you into the belief that there exists disembodied mystical forces like 'the economy,' 'inflation,' or 'politics' that prevent them from doing what they take an oath to do.

Those 545 people, and they alone, are responsible.
They, and they alone, have the power.
They, and they alone, should be held accountable by the people who are their bosses.

Provided the voters have the gumption to manage their own employees.
We should vote all of them out of office and clean up their mess!

Charlie Reese is a former columnist of the Orlando Sentinel Newspaper.
What you do with this article now that you have read it is up to you, though you have several choices:

1. You can send this to everyone in your address book and hope 'they' do something about it.
2. You can agree to 'vote against' everyone that is currently in office, knowing that the process will take several years.
3. You can decide to 'run for office' yourself and agree to do the job properly.
4. Lastly, you can sit back and do nothing or re-elect the current bunch.

Result number: 18

Message Number 256723

How Useful Is the United Nations View Thread
Posted by john h on 4/07/09 at 22:50

North Korea has clearly violated UN rules. If they cannot deal with something like this or refuse to do anything then just what good is the U.N.? Why do we continue to waste our money on a do nothing organization. They are more suited to do something like the Red Cross. Certainly they are powerless in cases like North Korea and in cases like Iraq when Sadam tossed out their inspectors and refused to cooperate with them. As soon as they perfect this missile with a 4000 mile range you can be sure it will be in the hands of Iran and any other rogue nation that will pay for it. This is another good reason to keep our anti missile missiles. These anti missiles may have already been cut from our budget. From todays Reuters:

UNITED NATIONS (Reuters) – North Korea warned the U.N. Security Council on Tuesday that it would take 'strong steps' if the 15-nation body took any action in response to Pyongyang's launch of a long-range rocket.
'If the Security Council, they take any kind of steps whatever, we'll consider this is (an) encroachment on our sovereignty and the next option will be ours,' Deputy Ambassador Pak Tok Hun told reporters. 'Necessary and strong steps will ... follow that.'

If anyone thinks we can have a reasonable dialogue with North Korea then I have a bridge in Brooklyn I would like to sell you.

Result number: 19

Message Number 255394

Re: Berneke Tells Congress Today View Thread
Posted by john h on 2/24/09 at 15:40

Berneke's comments about recession ending at the end of this year has driven up the market almost 250 points today. Just a few positive words can do wonders for peoples outlook.

I ,however do think he is way off the mark on this. Do any of you really think the recession will end at the end of the year? Please let me know if you do and why? I think we have two more years and then only if the Chinese keep on buying our T-Bonds. I am afraid he will have to eat that forecast but at least he is saying something positive. If people chose to believe it then that is great to. Let us hope President Obama puts a positive spin on things tonight and does not wast time on blaming Bush for everything bad. That strategy will not help anything and especially cooperation between the parties.

Result number: 20

Message Number 255162

Re: for rick and others to ponder View Thread
Posted by Rick R on 2/17/09 at 16:45

John,

Sending more troops to Afganistan concerns me. Our success there is more dependent on the availibility of local cooperation which is not constrained by troop numbers. More troops beyond that which can be deployed with local intelligence are just more targets. This is more of a Vietnam scenario or classic Afganistan challenge over the centuries. Just like Vietnam, limited conventional forces to fight an unconventional war doesn't seem to compute. In Iraq it was a matter of having enough forces to sweep urban areas. Even that required adaptation. Do the Afganis want more of us hanging around? How does that effect their cooperation? We heard how the Iraq surge was going to turn off the Iraqis but that's not a concern now? I think one of the sucesses of the Bush administration was to avoid the Russian plan. What are these troops going to do?

Last week I had to agree with McGovern and now Clinton! He should know, I'm sure he has had time to reflect on the failures to take the first bombing of the towers seriously and the various attacks since the 70's, of course not all on his watch. I'm sure he has ponderd 'what ifs' more than most of us.

Again, all we need to do to the economy is unleash our productive capability and capacity. I agree it will work out and even overcome some of the 'cures' like when we treated disease with mercury and blood letting. Sometimes the patient survives.

Rick

Result number: 21

Message Number 254633

Re: Dr. Mike Downey View Thread
Posted by Dr. DSW on 1/31/09 at 16:16

There is no way to determine who is the 'best' at this surgery, because there is no way to determine that rating. There are too many factors and variables to consider. Each patient presents to the surgeon with different and complex symptoms, some more severe, etc., and each person heals differently. What one person or doctor considers a success may differ from another.

I believe that you are getting too hung up on statistics, and unfortunately those statistics are really not going to help you. You are an individual, and even though Dr. Z doesn't know if the success rate is 60% or 93% or whatever, the bottom line is that each doctor has successes and failures, and you can not compare the 'rates' between doctors.

One doctor may have a higher risk population because he may take on tougher cases or cases that have already failed multiple surgeries. Once again, there are SO MANY variables, that statistics and numbers can be twisted to become very unreliable.

You must simply understand the fact that Dr. Downey and Dr. Wapner fully understand the pathology and anatomy of the area. They also both fully understand how to surgically correct this problem. They are each fully capable of performing this surgery. In addition to their skills, Mother Nature also plays a role in this process, and your body has to cooperate in the healing process.

You will have to decide which one of these doctors your 'gut' tells you to go with, because there is no 'number' or 'percentage' that has any real value in my mind that is going to help you make that decision.

Result number: 22

Message Number 254317

Re: shoe recommendation? View Thread
Posted by Jeremy L, C Ped on 1/24/09 at 18:12

What I'd really like is some cooperation from the feds and larger insurance companies to finance a study on the the biomechanical effects orthotics combined with various footwear constructions. My thesis that improper footwear can potentially reduce the effective medical benefits of custom inserts, and thus lead to increased beneficiary payments has thus far fallen on deaf or disinterested ears.

Result number: 23

Message Number 253821

Re: C. Kennedy View Thread
Posted by cwk on 1/09/09 at 10:24

I believe senators need to have the intelligence to absorb vast amounts of information, analyze it and make decisions. CK is a graduate of Radcliffe and Columbia Law School, an author, successful fundraiser, a trustee of Concord Academy and a board member of several non-profits. I believe her life and career experience she has the intelligence to be an effective Senator.

Senators must work long hours and dedicate their lives to their office. CK has proven her passion for public service as Director of Strategic Partnerships for the NYC Public Schools.

I think senators should be able to network and communicate in DC. Obviously Carloine Kennedy can do this.

Ideally senators should be excellent communicators. Her prepared speeches are great but her press interviews have been less than stellar.

I think Caroline Kennedy has the intelligence, dedication and connections to serve effectively. She has not earned the political brownie points that others, like Andrew Cuomo, have. Of course he also got his start due to his name and his Kennedy in-laws helped.

Should all senators have long political resumes? Personally I do not think so.
HIllary Clinton did not have her own political resume and despite what one thinks of her style or positions she was a very hard working and extremely effective senator in her first term. I am not a fan but John Edwards went straight from cooperate law to the Senate. Arnold Schwarenegger was elected after a long career as an actor and body builder. ( I think he is a poor leader)

I know nothing of NY politics so I have no idea if CK can hold onto her seat if elected. I think that is an important consideration.

Result number: 24

Message Number 253795

Re: Peroneal Tendon Subluxation View Thread
Posted by Dr. DSW on 1/08/09 at 08:07

Aron,
If you continue this dialogue I will delete your future posts, since it CLEARLY states in bold red letters on this message board that responses are to be from medical professionals only. Therefore, I anticipate your future cooperation. Thank you.

AnnShh,

I allowed Aron's post to remain because unlike many that post responses on this board, his post was accurate. A subluxing peroneal tendon(s) may be the cause of your symptoms and can be from a shallow groove or injury to this groove. There are several ways to surgically correct this depending on the surgeon's preferred choice. Also accurately mentioned by Aron is the proximity of the sural nerve which can became injured or entrapped in scar tissue.

He is correct that you must choose an experience orthopedic foot/ankle surgeon or experienced podiatric surgeon that has performed this procedure many times. Since your doctor is sending you to Baltimore, I have a suspicion he may be sending you to Dr. Mark Myerson, who is considered one of the best.

If you do have a subluxing peroneal tendon(s) this can sometimes be visualized in 'real time' imaging if you have a radiologist experienced in diagnostic ultrasound. The radiologist can actually see the tendon sublux with the motion you described during movement under ultrasound. If this is occurring, other than bracing, surgical intervention is the only real permanent option.

Result number: 25

Message Number 252277

Re: GM may go under????? View Thread
Posted by marie:) on 11/14/08 at 20:42

As I recall the UAW cooperated and took on the responsibility of retirement healthcare benefits. That was a huge financial win for the big 3. The UAW is doing their part. They've given up many benefits just to keep things going. If Republicans sit on the sidelines this time they'll have get used to sitting there permanently.

I am waiting to see the final plan to come out in print but the Washington Post had an informative article today.I'm not in favor of any bailout that pays for top exec salaries as well as worker's salaries and would prefer aid be in the form of a loan. I do agree they will all have to take a cut in salries. I agree with Obama on creating an auto industry czar to oversee how taxpayers money is being spent. Since the biggest problem is keeping research and development going I do support full funding in that area alone as well as retooling costs.

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/13/AR2008111303804.html
At the pace GM and Ford are burning through their cash -- at a rate of least $4.9 billion a month -- $25 billion won't last much longer than five months. And that's not taking into account what Chrysler might need.

Result number: 26

Message Number 252064

Re: Obama and Nancy Polosi View Thread
Posted by john h on 11/10/08 at 10:30

cwk: I think this election was almost over before it begin. Obama looks like and and has the charisma that we look for in a President. He was clearly the better TV debater, if you forget the facts. Being black, locked in 95% of all African Americans and also attracted the many young whites who felt good about themselves for voting for a Black man+. The final hammer was the economy and the failure of the banks, mortgage companies, wall street, etc. It was almost written in stone that the public wanted change and that change would be to to remove George Bush and replace him with the charismatic Barrach Obama. I think the issues beyond the economy played little in this race. The fact that Obama spent zillions more than McCain did not make the difference. McCain ran a very poor campaign and Obama ran a brilliant campaign. McCain was also to old. Younger people were much more attracted to Obama. Bush has become the scapegoat in this election and I think history will judge him much less harshly than we do at this time. He will leave office with around a 30% approval rating. Harry Truman left office with a 23% approval rating. Has history judged Harry Truman a bad President? I think most people like and think Harry Truman was a good President. He is often criticized for dropping the atomic bomb on Japan. People forget that he probably saved at least one million American lives in avoiding an invasion of Japan. President Truman lived up to the sign on his desk 'The Buck Stops Here'.

President Elect Obama will soon be OUR President. It is in our best interest to support him as best we can. The political war is now over. President Elect Obama is new to this job and will have his plate full. He will make mistakes along the way as all Presidents do. The loyal opposition should be heard when they think he has made a mistake but should cooperate with him and the Democrats for the good of our nation. Obama said he would bring us together. That is a tall order in the Congress, I hope he is successful. He has said that his first mission is to help the middle class. I am very much in the middle class and I do not need any help. I do not need a tax cut. I prefer that this money go to reducing the national debt or helping revive the economy (If that can be done with money) alone).

I will very much support our new President but will question him when I think he needs to be questioned. There is no perfect President as all of them have the same flaws each of us have. I am not worried about President Elect Obama but I am concerned about our Congress. They pass the laws.

There is one great positive in having a Black President. One of the very articulate Little Rock Nine said on Mike Huckabee's TV show this week 'This finally ended the Civil War'. A Black child can now know there is no limits as to how far he can rise. If Barrack had lost, I feared there would be war in the streets.I think many Blacks will feel better about themselves which is a very good thing. This will not end violence in the ghettos as the gangs likely did not even know who was running for President. We will still have overwhelming numbers of African American mothers with children and no fathers. It is going to take generations to bring these people into the main stream.There will still be racial prejudice not only for blacks but for all races including Whites. That has been the history of this world. We will look better to the other nations, for the most part, not because of what Obama says but because of who Obama is. Israel is openly concerned and may act on their own when it comes to Iran. Many of the smaller Arab nations are very concerned about Iran. The President of Iran sent Obama a congratulatory letter but Obama has responded with a terse comment that made the President angry. Good for Obama.

Beyond race,I think it will be a decade before this nation can get back to where it once was. We may have lived in the golden years of the American experiment with Democracy and did not even know it. History will write the ending to this story.

Result number: 27

Message Number 251744

My pessimistic Saturday morning prediction View Thread
Posted by wendyn on 11/01/08 at 11:26

I'm not sure if it's the weather, my sore back, or the last 10 minutes I have listened to Palin's grating voice on CNN (I swear that her voice should be enlisted as one of the new torture practices that the American government now authorizes).

So, that's my caution and disclaimer. I'm in a horribly negative mood and I have decided that although I think Obama is a great man, a great leader, and that he would make a great president - I'm no longer certain that I would like to see him win. My predictions (and the predictions of many people) for the near and even relatively distant future are that things are going to get so much worse before they ever begin to improve. The world-wide economic problem is not something that is over or that will be easily corrected. We are in this for the long haul.

I suspect that whoever is elected on Tuesday will eventually (undeservingly) receive the brunt of the blame. Someone is going to take on a complex mess of such enormous proportions that I (honestly) would rather see it thrown at someone who I'm not terribly fond of.

I'm consistently amazed to hear Palin and McCain talk about how curent problems can be solved by 'fighting for America' and 'winning the war in Iraq'. I don't know how an economic situation can be improved by fighting for or over anything, and I don't think that 'winning' is an attainable or identifiable goal that can ever be achiveved in Iraq. How about figuring out how to just get out and stop spending 10 billion dollars a month without making the current situation there too much worse. That would be good enough - to hell with 'winning'. Seriously.

If Obama wins, I think that the only possibility for hope is that he might be able to help pull people together in hard times - and times will be very very hard. Obama might have a decent shot at smoothing over relationships with other countries and fostering a spirit of cooperation. That might help people psychologically, but it will still be very very rough.

I think that there is zero chance that Palin and McCain would try to encourage that type of cooperative attitude or improve any foreign relationships. Throughout their campaign they have made that very, very clear.

So I guess it comes down to whether or not one wants to go through very difficult times in an environment and country of division, negativity, isolation, and anger - or do one want to go through them with a resolute sense of purpose, compassion, care for each other and sense of cooperation?

Result number: 28

Message Number 250858

Re: More violence in Pakistan and US missile kills 20 View Thread
Posted by Rick R on 10/06/08 at 08:16

Marie,

Just a hunch, but to talk about what it appears we are doing in Pakistan could put the mission at risk. Talk about a touchy situation! Presuming Bin Laden is on Pakistan side of the border, to get to him means tinkering with the sovereignty of that nuclear nation. I believe Pakistan has played a delicate balancing game of cooperating with the US on one hand and hindering us for their status in the Muslim world on the other. To bully our way around seems quite risky, yet this transition time in Pakistan may be offering a unique opportunity. To garner needless attention for either our bullying or their willingness to look the other way, what ever is going on, could break bad.

Rick

Result number: 29

Message Number 250814

Re: The Debate View Thread
Posted by marie:) on 10/04/08 at 17:44

Here are a few quotes by Palin from the debate. Note she was a journalism major at 5 universities.

The challenge: diagram them

'Certainly, accounting for different conditions in that different
country and conditions are certainly different.'

'And we will do what is best for the American people in tapping into
that position and ushering in an agenda that is supportive and
cooperative with the president's agenda in that position.'

'But on the major principle things, no, there hasn't been something
that I've had to compromise on, because we've always seemed to find a
way to work together.'

'And that's why Tillerson at Exxon and Mulva at ConocoPhillips, bless
their hearts, they're doing what they need to do, as corporate CEOs,
but they're not my biggest fans, because what I had to do up there in
Alaska was to break up a monopoly up there and say, you know, the
people are going to come first and we're going to make sure that we
have value given to the people of Alaska with those resources.'

Result number: 30

Message Number 250595

Re: new MRI result View Thread
Posted by Jen R on 9/29/08 at 11:52

Sorry for the duplicated questions. Hopefully Scott can delete two of them. The darn thing just wouldn't cooperate!

Jen R

Result number: 31
Searching file 24

Message Number 249879

Re: Not so fast............... View Thread
Posted by marie:) on 9/05/08 at 20:18

Well ok then you want a list here it goes........;)

Education:

BA in political science (with a specialization in international relations) from Columbia University.

JD Graduate of Harvard Law School (Juris Doctor degree, magna__laude).

President of the Harvard Law Review (the first ever African American).


Experience:

Civil rights attorney (turned down a prestigious judicial clerkship1)

Constitutional law professor.

Community organizer.

State Senator.

Chairman of the Illinois State Senate Health and Human Services Committee.

US Senator.

Member of the US Senate Foreign Relations Committee, Environment and Public Works Committee, and Veterans ’ Affairs Committee.

Author.

Husband and father of two daughters.

Board member of the Joyce Foundation, the Woods Fund of Chicago, and the Chicago Annenberg Challenge.


Honors:

Grammy award winner (Spoken Word category).

Honored by the National Academy of Recording Arts & Sciences (for narration of one of his books).

Honorary doctor of laws degree from the University of Massachusetts Boston (for among other things, 'advancing and protecting the interests of the less fortunate'2)


Seems rather experienced to me...


References:

1. http://www.imdb.com/name/nm1682433/bio

2. http://www.umb.edu/news/2006news/releases/may/060526_ob...


http://www.barackobama.com /
http://hopefundamerica.com /

Still more..................

Nonproliferation: the poster child for issues that people ought to care about, but don't. Here Obama has teamed up with Richard Lugar (R-IN). How did this happen? Here's the Washington Monthly:

'By most accounts, Obama and Lugar's working relationship began with nukes. On the campaign trail in 2004, Obama spoke passionately about the dangers of loose nukes and the legacy of the Nunn-Lugar nonproliferation program, a framework created by a 1991 law to provide the former Soviet republics assistance in securing and deactivating nuclear weapons. Lugar took note, as “nonproliferation” is about as common a campaign sound-bite for aspiring senators as “exchange-rate policy” or “export-import bank oversight.”'


The way to a wonk's heart: campaign on securing Russian loose nukes. -- In any case, in addition to working on nuclear non-proliferation, Obama and Lugar co-sponsored legislation expanding the Nunn-Lugar framework (which basically allows the US to fund the destruction or securing of nuclear weapons in other countries) to deal with conventional arms. From an op-ed Obama and Lugar wrote on their legislation:

'These vast numbers of unused conventional weapons, particularly shoulder-fired antiaircraft missiles that can hit civilian airliners, pose a major security risk to America and democracies everywhere. That's why we have introduced legislation to seek out and destroy surplus and unguarded stocks of conventional arms in Asia, Europe, Latin America, Africa and the Middle East.

Our bill would launch a major nonproliferation initiative by addressing the growing threat from unsecured conventional weapons and by bolstering a key line of defense against weapons of mass destruction. Modeled after the successful Nunn-Lugar program to dismantle former Soviet nuclear weapons, the Lugar-Obama bill would seek to build cooperative relationships with willing countries.

One part of our initiative would strengthen and energize the U.S. program against unsecured lightweight antiaircraft missiles and other conventional weapons, a program that has for years been woefully underfunded. There may be as many as 750,000 missiles, known formally as man-portable air defense systems, in arsenals worldwide. The State Department estimates that more than 40 civilian aircraft have been hit by such weapons since the 1970s. Three years ago terrorists fired missiles at -- and missed -- a jetliner full of Israeli tourists taking off from Mombasa, Kenya. In 2003 a civilian cargo plane taking off from Baghdad was struck but landed safely.

Loose stocks of small arms and other weapons also help fuel civil wars in Africa and elsewhere and, as we have seen repeatedly, provide ammunition for those who attack peacekeepers and aid workers seeking to stabilize and rebuild war-torn societies. The Lugar-Obama measure would also seek to get rid of artillery shells like those used in the improvised roadside bombs that have proved so deadly to U.S. forces in Iraq.

Some foreign governments have already sought U.S. help in eliminating their stocks of lightweight antiaircraft missiles and millions of tons of excess weapons and ammunition. But low budgets and insufficient leadership have hampered destruction. Our legislation would require the administration to develop a response commensurate with the threat, consolidating scattered programs at the State Department into a single Office of Conventional Weapons Threat Reduction. It also calls for a fivefold increase in spending in this area, to $25 million -- a relatively modest sum that would offer large benefits to U.S. security.

The other part of the legislation would strengthen the ability of America's friends and allies to detect and intercept illegal shipments of weapons of mass destruction or material that could be used in a nuclear, chemical or biological weapon. Stopping weapons of mass destruction in transit is an important complement to our first line of defense, the Nunn-Lugar program, which aims to eliminate weapons of mass destruction at their source.'


Dealing with unsecured stocks of shoulder-fired missiles and other kinds of conventional weapons, stocks that might fall into anyone's hands, be sold on the black market, and end up being used against our troops or our citizens, or fueling civil wars that tear countries apart -- it seems to me that this is an excellent thing to spend one's time on.

Avian flu: Obama was one of the first Senators to speak out on avian flu, back in the spring of 2005, when it was a quintessentially wonky issue, not the subject of breathless news reports. There's a list of Democratic efforts on avian flu here; Obama shows up early and often. He has sponsored legislation, including what I think is the first bill dedicated to pandemic flu preparedness. It's a good bill, providing not just for vaccine research and antiviral stockpiles, but for the kinds of state and local planning and preparedness that will be crucial if a pandemic occurs. (I was also very interested to note that it requires the Secretary of HHS to contract with the Institute of Medicine for a study of 'the legal, ethical, and social implications of, with respect to pandemic influenza'. This is actually very important, and not everyone would have thought of it.)

He has also spoken out consistently on this topic, beginning long before it was hot. Here, for instance, is another op-ed by Obama and Lugar:

'We recommend that this administration work with Congress, public health officials, the pharmaceutical industry, foreign governments and international organizations to create a permanent framework for curtailing the spread of future infectious diseases.

Among the parts of that framework could be these:

Increasing international disease surveillance, response capacity and public education and coordination, especially in Southeast Asia.

Stockpiling enough antiviral doses to cover high-risk populations and essential workers.

Ensuring that, here at home, Health and Human Services and state governments put in place plans that address issues of surveillance, medical care, drug and vaccine distribution, communication, protection of the work force and maintenance of core public functions in case of a pandemic.

Accelerating research into avian flu vaccines and antiviral drugs.

Establishing incentives to encourage nations to report flu outbreaks quickly and fully.'


This is very good policy, especially the parts about increasing surveillance and response capacity here and abroad. (Effect Measure approves too.)

Regulating Genetic Testing: It was while I was reading about this issue that I first thought: gosh, Barack Obama seems to turn up whenever I am reading about some insanely wonky yet important issue. And this one is not just off the radar; it and the radar are in different universes. Anyways:

You might be surprised to learn that there is very little quality control over genetic testing. I was. If I offer some genetic test, I can basically say what I like about what it will reveal, so long as I avoid violating the laws against fraud. And if you think about how easy it would be to avoid those laws just by talking about, say, a test for some gene that has been found to be slightly associated with increased IQ, you can see how many deceptive (but not legally fraudulent) claims this allows.

Moreover -- and more seriously -- there is very little oversight of the quality of labs that do tests -- that is, whether or not they tend to get the right answers when they do those tests. There is a law (passed in response to evidence that significant numbers of people were getting incorrect results on pap smears) that requires what's called proficiency testing for labs. But though the law requires that the government develop special proficiency tests for labs that do work requiring special kinds of knowledge, and though genetic testing plainly fits that bill, the government has not developed any proficiency tests for genetic testing labs.

This is serious, and bad. Suppose you are mistakenly informed that you are a carrier for some horrible disease: you might decide never to have kids. Suppose you have a fetus tested and you are told that it has, say, Downs' syndrome: you might abort. To do these things as the result of a lab error would be horrible.

Not nearly as horrible as the results of some false negatives, though. Consider this case (from a very good report on the topic):

'A Florida couple both tested negative for the genetic mutation that causes Tay-Sachs, a fatal childhood disease. Two copies of the mutation are required to cause the disease. The couple learned that the test results were incorrect for both parents when their son began exhibiting symptoms of Tay-Sachs shortly after birth. He died eight years later'


Tay-Sachs is an unbelievably horrible disease:

'Infants with Tay-Sachs disease appear to develop normally for the first few months of life. Then, as nerve cells become distended with fatty material, a relentless deterioration of mental and physical abilities occurs. The child becomes blind, deaf, and unable to swallow. Muscles begin to atrophy and paralysis sets in. Other neurological symptoms include dementia, seizures, and an increased startle reflex to noise. (...)

Even with the best of care, children with Tay-Sachs disease usually die by age 4, from recurring infection.'


So imagine this: you know that you and your spouse are at risk for carrying this disease. You both get tested; neither is a carrier. You give birth to an apparently healthy child. But after a few months, the child you love stops developing normally, and it turns out that both your test and your spouses were misinterpreted, or screwed up, or whatever, and as a result your child is going to die a horrible death by the age of four. Oops!

In your copious free time, you can think of more cases in which screwing up a genetic test would be disastrous. After you get through with the cases involving children and inherited diseases, consider the effects of misreading a genetic test and informing a man that he is not the father of his child when in fact he is. The possibilities are endless.

You can probably guess who has introduced legislation that addresses this problem. The people who wrote the initial report think it's good.

Reducing medical malpractice suits the right way: Contrary to popular belief, medical malpractice claims do not do much to drive up health care costs. Still, medical malpractice litigation is a problem. Tort reform would address this problem at the expense of people who have been the victims of real, serious medical malpractice, who would lose their right to sue, or have it curtailed. If you read the medical literature, however, it turns out that there's a much better way to minimize malpractice suits, namely: apologizing. Strange to say, it turns out that people are a lot less likely to sue when doctors and hospitals admit their mistakes up front, compensate the patients involved fairly, and generally treat people with respect. It certainly would have helped in this case:

'A Sanford mother says she will never be able to hold her newborn because an Orlando hospital performed a life-altering surgery and, she claims, the hospital refuses to explain why they left her as a multiple amputee.

The woman filed a complaint against Orlando Regional Healthcare Systems, she said, because they won't tell her exactly what happened. The hospital maintains the woman wants to know information that would violate other patients' rights.'


I'd want to know what happened too, if someone cut off all my arms and legs. And in a case like this, if it was malpractice, limiting the damages a person can collect doesn't seem like the right answer, somehow.

Barack Obama and Hillary Clinton teamed up to introduce legislation aimed at helping hospitals to develop programs for disclosure of medical errors. (They describe it in this NEJM article.) Again, I think it's good policy: this really is what the evidence suggests is the best way to reduce malpractice claims, and it does it without curtailing the rights of people who have already been injured through no fault of their own. Moreover, when people feel free to discuss their errors, they are much more likely to figure out ways to avoid repeating them. (The legislation provides support for this.) And that's the best way of all to deal with malpractice claims: by addressing the causes of medical malpractice itself.

***

Those are some of the more prominent things he's done. There are others: introducing legislation to make it illegal for tax preparers to sell personal information, for instance, and legislation on chemical plant security and lead paint. He has done other things that are more high-profile, including:


* His 'health care for hybrids' bill

* An Energy Security Bill

* Various bills on relief for Hurricane Katrina, including aid for kids and a ban on no-bid contracts by FEMA

* A public database of all federal spending and contracts

* Trying to raise CAFE standards

* Veterans' health care

* Making certain kinds of voter intimidation illegal

* A lobbying reform bill (with Tom Coburn), which would do all sorts of good things, notably including one of my perennial favorites, requiring that bills be made available to members of Congress at least 72 hours before they have to vote on them.

* And a proposal to revamp ethics oversight, replacing the present ethics Committee with a bipartisan commission of retired judges and members of Congress, and allowing any citizen to report ethics violations. This would have fixed one of the huge problems with the present system, namely: that the members have to police themselves.

Result number: 32

Message Number 246673

Re: Running Shoes - PF with Tibial Varus Alignment View Thread
Posted by Jeremy L, C Ped on 5/09/08 at 16:24

Based on your description, I already had an image in my mind prior to even getting to your doctor's recommednation. In addition to what you learned, much of what would also go into my suggestion of a shoe would be how much flexibility there is in the frontal and transverse planes from the ankle down. That would allow me to determine how much control is necessary in regards to both initial contact and stance phases.

The Adrenaline may be a good option, as it has a more rearfoot aligned medial post compared to the Asics models you used. It also is built in a tri-durometer technique that should keep it from being too aggressive at heel strike. My only caveat would be to ensure that when combined with your new insert, your arches are permitted to elongate naturally. Since the Adrenaline has a fairly pinched shank area, it may not be ideal. Should that Brooks model not suffice your needs, here are some others to consider:

Saucony Progrid Omni and Hurricane (I can't wear it, but the current version of the latter is an awesomely conceived and made shoe)

New Balance 1223 (a little heavier than some in this category, but it absorbs virtually everything at impact)

Asics Gel 3000/Kayano (both have a medial post that is a bit more posteriorly placed than the other Asics models you used, thus closer to what your doctor suggests)

I was going to suggest looking into a Saucony model, based on your fit description; however, their website isn't being cooperative. They are worth at least a look.

Result number: 33

Message Number 244545

GOP Campaign Money Missing View Thread
Posted by marie:) on 3/14/08 at 14:34

Why am I not surprised about this???? ;)

http://online.wsj.com/article/SB120546400834935651.html?mod=googlenews_wsj
The National Republican Congressional Committee, which helps elect Republicans to the House, dismissed its longtime treasurer, Christopher Ward, Jan. 28 after it said it discovered he had been submitting bogus financial audits of the committee's accounts since 2002.

The committee previously said it had notified the Federal Bureau of Investigation of the false audits, and that it was cooperating with the FBI's criminal investigation.

Result number: 34

Message Number 243268

Re: Dr. Ed and Dr. Wander - Hematoma View Thread
Posted by Dr. DSW on 2/16/08 at 15:24

IF it is a hematoma, warm (not hot) moist heat over the area can promote resolution and break down of the hematoma, combined with time and Mother Nature's cooperation. However, please do not apply any warm, moist heat until you are evaluated by your surgeon.

Result number: 35

Message Number 242101

Re: 2 mon. post-op View Thread
Posted by dawnl on 1/17/08 at 16:02

thanks for the info. Just so hoping that this surgery worked. I used to walk about 4 to 6 miles a day and once all this started over three years ago things really changed. Then when I started working again and standing on concrete it became too unbearable. Quit work and had the surgery after trying cortisone and nerve blocks. Now he tells me the worse thing I can do is work again on concrete. I'm up to 2-1/2 mile painful walks now but couldnt understand why the ankle and opposite side of foot gets so painful and stiff like it dont want to bend right. Oh, had the PF and TTS surgery at the same time. Still have a little pain in heel and nerve area but nothing like before. Now the rest of the foot and calf would cooperate it would be wonderful! Thanks for listening, its good to have a group that understands the pain and fustration. Happy feet to all!

Result number: 36

Message Number 241607

Re: Barack Obama View Thread
Posted by marie:) on 1/06/08 at 20:04

And so it begins. I guess I better help you out a little John. :)

The same can be said for Huckabee. Most people have no idea who he is or what he's done. That's why all of the potential nominees have websites. I've been through most all of them by now. The one thing I do know is Huckabee and Obama share a common goal to end partisan politics, reach across the isle and move forward. Perhaps Obama should consider Huckabee as VP. ;)

Obama reached across the isle in the Illinois Senate and created the Earned Income Tax Credit which provided over $100 million in tax cuts to families across the state. Obama pushed for early childhood education and won. After a number of inmates on death row in Chicago were found innocent he worked with law enforcement to require all interrogations and confessions be video taped.

The first law he got passed in the U.S. Senate, an effort he worked with Republican Senator Coburn, was 'Federal Funding Accountability and Transparency Act' and allows every American the ability to go online and account for every tax dollar spent. President Bush signed this measure into law in September of 2006. Obama was and continues to be a lead voice in ethics reform.

He's on the Veteran's Affairs Cmte, were he has worked to make sure Illinois veterans get the disability pay they so deserve. Recently he introduced a bill to 'Veterans Homelessness Prevention Act'.

He reached across the isle again traveling with Republican Senator Lugar to Russia to to begin a new non-proliferation efforts to locate and secure deadly weapons around the world. After visiting weapons stockpiles in Russia, Ukraine and Azerbaijan, Senators Lugar and Obama introduced the Cooperative Proliferation Detection, Interdiction Assistance, and Conventional Threat Reduction Act of 2006 in the 109th Congress, which would expand the cooperative threat reduction concept to conventional weapons. The Lugar-Obama bill would energize the U.S. program against unsecured lightweight anti-aircraft missiles and other conventional weapons and would strengthen the ability of America's allies to detect and interdict illegal shipments of weapons and materials of mass destruction. Funding would be provided to eliminate unsecured conventional weapons and to assist countries in improving their ability to detect and interdict materials and weapons of mass destruction. The Lugar-Obama bill was included in the Department of State Authorities Act of 2006 and was signed into law by President Bush in January 2007.

Result number: 37

Message Number 241217

Re: Abstract submission now OPEN View Thread
Posted by Dr. DSW on 12/25/07 at 10:15

Dr. Ed,
'Josie' is Dr. Z's little dog, so maybe one of us can hold the pooper scooper while the other one 'sweeps'!

Result number: 38
Searching file 23

Message Number 238985

Re: Scared of Surgery View Thread
Posted by Jen on 11/05/07 at 04:11

I have tried exercises (but have not done them consistently), orthotics (but not worn them consistently- don't wear them to work due to dress shoes), 4-5 cortisone injections (last ones weren't very effective), a dorsal night splint (which I can only stand about an hour during bedtime), and an ankle brace (due to twisting my ankle on a few of my falls).

I suppose I'm not a very good patient. The more I am in pain, the more I cooperate. I suppose, it's just not 'bad enough' in my mind to do the above. And I suppose that's why my doctor says surgery, because I'm not seeing results with the above.

Result number: 39

Message Number 238181

Re: Turkey View Thread
Posted by john h on 10/21/07 at 19:52

Ed: From what I read the Kurdish rebels (PDK) who are venturing into Turkey are Communist by nature and have killed a number of Turks. It would seem only natural for the Turks to retaliate. The U.S. for it's part wants to dissuade the Turks for venturing into the Kurdish territories but the Kurds may have their own agenda and could be backed by outside forces. Strange that we hear nothing about Polosi's resolution suddenly?? As Marie said it is not her resolution but she has the power to bring it to a vote or not. President Clinton had the same problem when he was in office but talked Speaker Dennis Hassert into not bringing it to a vote. The entire problem is obviously political in nature in an attempt to get a large block of Armenian votes in northern California. I wonder what the motive for the Armenians is to get this vote on the table at a time like this. After all it is nearly 100 years ago. There is probably a lot more to this than most of us know.

In the early 1960's I was flying a group of Turkish high ranking officers from the Army War College in the U.S. back to Turkey. As we approached the Turkish border I received an urgent recall to bring them back to Germany. There had been some sort of revolution or overthrow of the government and the Turkish Officers were likely to be shot had we landed. The air base in Turkey we use has been there for many many years and we have large forces there. The air traffic is like JFK due the the supplies moving in and out. I under stand some of our contengency plans now included air bases in Jordan? and some of the smaller Muslim nations that are friendly. That, however, does not solve the problem of the use of Turkish air space or the large quantity of oil they supply us for use in Iraq and Afganistan. The Turks are fierce fighters. The Kurds who attacked the turks this past week killing 12 Turks are known as the PDK and are listed as a Terriorist Organization. They seek autonomy/separate nation status for the Kurds in Northern Iraq. There are good arguments for this on both sides of the issue. The PDK however represents a small portion of the Kurdish popultion.

Turkey was the first nation with a Muslim majority to recognize Israel as a state (1949). Since them Israel has become a major supplier of arms to Turkey and they have diplomatic, strategic, and diplomatic cooperation with concerns over regional stability in that area of the world. Each allow the other to fly military training exercises over each others air space.
There is a plan in place to build a gigantic pipline from Turkey to Israel to supply water, gas, and oil. They hold joint military exercises together. Jews have lived in Turkey for over 2400 years.

Result number: 40

Message Number 237244

plantar fasciitis and swelling of top of foot View Thread
Posted by scooper on 10/06/07 at 12:02

Am a 54 yr old female jogger and have been dealing with plantar fascitis for about 2 months--had it before and know how to treat it. I have not quit jogging but have scaled back and do not run on very painful days. My problem is --it has caused the top of my foot to swell causing more pain. I have been icing and elevating my foot. I am using an insert in my shoes and loosing the laces. Is there something else going on?

Result number: 41

Message Number 237187

Re: None Dare Call it Fascism View Thread
Posted by Dr. Ed on 10/04/07 at 23:24

The assumption of power by the cooperative efforts of big business and big government each looking out for their joint interests and removing power from the citizens underlies fascism. Consider: http://www.wildcat-www.de/zirkular/16/z16histo.htm

The Clinton administration despite it support from the left was admired by corporate America. Hillary, in her first attempt at healthcare 'reform' attempted to hand over control of healthcare to the 5 largest insurance companies in America in a private-public partnership. Corporate interests are lining up behind Hillary again as her potential presidency would give them another chance at a power grab:

http://www.dailykos.com/storyonly/2007/10/2/105628/967

http://common-sense1.blogspot.com/2007/09/newspeak-2007-hillary-health-care.html

Result number: 42

Message Number 235526

Re: Catching up on posting View Thread
Posted by Kathy G on 9/05/07 at 10:41


Congratulations on making progress! And on the new expected grandchild. My first grandchild, a boy, is nearly five months old and I haven't seen him in nearly two months. I'm seeing him next week and I'm so excited. I sure wish I could hold him but my hand, on which I've had three surgeries, while better than it was, is still not cooperating so I doubt I can hold him very much. That's OK, I can still talk to him and as you all know, I love to talk! And I can probably feed him his bottle.

Do you have other grandchildren?

And because I've been away from the boards for a long time, would you mind telling me what your foot problem is?

Result number: 43

Message Number 234517

Some suggestions View Thread
Posted by marie on 8/16/07 at 17:32

Yes I am symptom free. For the longest time I was in a wheel chair and could only bare weight for a few minutes at a time. These are the things I did some directed by my podiatrist, physical therapist and lots of help and ideas from posters here who went through similar issues. I had tried cortizone shots but it didn't help after a while. Everyone with tts has differing underlying reasons so what may help one person may not help another. My problems began in 2000.

1.) I finally accepted the fact that this may take years to recooperate from and to focus all my energy on getting well.

2.) I purchased compression socks and support socks and wore them exclusively.
http://www.orthoathletic.com/compression-socks.htm

3.) Got off my feet. I purchased a used wheel chair I found in the Trader. Later I got a scooter for work. I was still working and trying to do what I had always done but my feet had other ideas and were screaming for rest. The best part was it gave me some of my freedom back. I could go to public again places with my family (football games, the mall etc).........I just had to be in my wheel chair.

4.) I purchased a pair of Arizona Birkenstocks soft bed. My orthotics were absolutely worthless. Once I began wearing the birks I felt immediate relaxation of my calf muscles. They aren't cheap but they are sooooooooooooooooooo worth it. I have several different styles in birks now and they are all I wear.
http://catalog.birkenstockcentral.com/cgi-bin/VirtualCatalog3/CatalogMgr.pl?cartID=b-3688&SearchField=category&SearchFor=clasarizona&template=Htx/template-a.htx

5.) Massage-----------Not only did I get massage at my physical theropist but my husband massaged my meta-tarsals, calves and thighs daily. If he wasn't available I did this myself. Never massage over the tarsal area.........never. Afterwards I iced my tarsal areas with cold peas about 5-6 minutes.

6.) I was perscribed Neurontin and a small dose of elavil according to my weight. I took 300 mgs of Neurontin 3x a day and 30 mgs. elavil. After several years I am down to taking only 100 mgs. of Neurontin before bed. HURRAY! There are some newer meds that some have tried here.........this is just what worked for me. The Neurontin helped relieve the twitching and spasms as well as helped my nerves connect. Plus I slept really well. A good nights sleep very important when dealing with nerve damage.

7.) I had to exercise to keep my muscles from wasting away. Any non weight bearing exercise is good. I kicked around on a float in our pond. Because of the spasms I was afraid to swim. But just kicking around my legs as they dangled off the float was great. I did leg lifts, worked out with weights on my arms and several other floor exercises. When I began I could only lift my leg a few inches but I kept at it........starting with 5 and building to 75. In the summer I go to the playground and swing. It's good exercise and it's fun.

8.) Light stretches helped but I didn't overdue......I went slower with them. If you do a search on this sight you will find Julie has some Yoga stretches posted. I preferred hers over what my PT had me doing. Here is the link to Julie's exercises............
bbv.cgi?n=170124

9.) Reduce the stress in your life. I really cut back on all my volunteer work. It takes time to heal and the less stress the better for healing nerves imho.

10.) Find something to do that will help you get your mind off your aching tootsies. Distraction!!!!! A class, reading, sewing, flying airplanes......whatever but it helps you to think about something other then the numbness, twitching and pain.

Result number: 44

Message Number 234456

Re: BOTH FEET DEGENERATIVE ARTHROSIS UNRESOLVED FRACTURE TENDINITIS SYNOVITIS PERIOSTITIS-ENTHESOPATHY & CRPS ON MY FEET HELP ME PLEASE ! View Thread
Posted by KITT4EVER on 8/15/07 at 17:42

Hi again. I just went to a Pain Management Clinic today that is also a Chiropractic Center & work injuries clinic, that says in their bussiness card and on their website that they can cure any pain on your body! Well when I was seen in the office today and they asked me what were my conditions, & what was hurting & bothering me and the reason of visit. I answered her what she asked me & She said to me she couldnt help me ! She was so quick in telling me that, that I felt like I was on a re-run tv show, cause Ive being told the same thing over and over.

Hey, I just broke my record again ! Now I have being seen by 10 doctors & no one wants to help me. They should all go back to medicine school & be re-evaluated. Or Should I move to another state that maybe have real doctors ? Maybe the doctors here got their licenses out of a cereal box as a prize ? I dont know.

Well I asked her,that why couldnt she help me if they were a Pain management Clinic? She said that Im in a chronic pain condition with all this conditions, and that she couldnt help me.
She said that she might be able to help me with my back & neck but she wasnt sure if she would succeed, but definely could not help me with my knees or feet. That Im gonna have to learn & live with the pain. Pain Management ehh...? Their slogan should be 'Pain Management, we'll manage to cause you more pain, Guaranteed'.

I might as well grab a saw and cut my foot off & throw it in the garbage before the garbage truck comes by tomorrow morning, or chop it up with a machete or something, might as well since is not doing any good for me...If no Pain Management cant help me with my severe foot pain, & the other pains, no Pain Management nor Foot doctor, who can ??????

Maybe I should hire a maniac agressive medical malpractice lawyer or a medical law lawyer and start sueing the whole group of doctors that havent cooperate and that have denied me treatment for medical incompetence, who knows, maybe Ill find out that they-lawyers could also be like that ...... This is not right, I know is not......

Sorry for all this anger jokes, but Im not ready to kill myself yet for medical incompetence, lol. I know, is not funny. Tell me about it.



Well, Thanks all for your time reading my problems and concerns. I wish I had a doctor as nice and as good listener and advicer as you people... Thanks.

Result number: 45

Message Number 233308

A unique birthday gift View Thread
Posted by Kathy G on 7/21/07 at 11:57


My husband presented me with a beautiful, wrapped birthday gift. I had said I didn't want any gifts as he bought me a beautiful pair of earrings for our thirty-fifth anniversary a few months ago and besides, we don't exchange gifts. He caught me totally by surprise with the earrings.

I proceeded to open the gift and discovered just what every fifty-eight year old semi-disabled woman dreams of: A pair of Heelys!

I have always said I wished I could try a pair of them because although they look dangerous, they look like so much fun! These are the proper size, and even look quite feminine being black with nifty pink trim!

Naturally it was a joke gift and he said to bring them back and use the cash for something else. I think he panicked when I looked them over and tried to figure out if I could try them and still return them. I seriously thought I could give them a go and just see how they worked but he said the store said they couldn't be returned if they had been used.

Don't they look like fun? My son used to roller blade and those looked like fun but an awful lot of work. Actually, in his roller blading days, I think he was in his best physical condition ever. I look at Heelys as being the lazyman's version of roller blades.

But I guess I'll never find out how it feels to use them.

If you haven't guessed, my husband is known for his ridiculous gifts and it's so much fun to see people, especially my daughter who's now twenty-six, try to figure out if he's serious or joking.

I'm going to return them as soon as my hand, which has not cooperated with the doctor and me in my quest to resume normal activities, allows me to drive. They are tempting, though, so if you hear a news story about a crazy woman in NH who lost control of her Heelys, it might just be me. :D

Result number: 46

Message Number 233114

The New NIE Report on Al-Qaeda threats etc..... View Thread
Posted by marie on 7/17/07 at 14:46

I know some of you don't read at government agency sites. Ed, noted here that he does not trust the NIE as such.......
http://heelspurs.com/m/23/23/t91.html

But I do read the reports and all citizens of the United States should. Today's NIE report release shares that Al Qaeda has grown and is a threat here in the homeland. Here is a snipet from the report which can be found here: http://www.dni.gov/index.htm

The pdf file here: http://www.dni.gov/press_releases/20070717_release.pdf

• As a result, we judge that the United States currently is in a heightened threat
environment.
We assess that al-Qa’ida will continue to enhance its capabilities to attack the Homeland
through greater cooperation with regional terrorist groups. Of note, we assess that al-Qa’ida
will probably seek to leverage the contacts and capabilities of al-Qa’ida in Iraq (AQI), its
most visible and capable affiliate and the only one known to have expressed a desire to attack
the Homeland. In addition, we assess that its association with AQI helps al-Qa’ida to
energize the broader Sunni extremist community, raise resources, and to recruit and
indoctrinate operatives, including for Homeland attacks.
We assess that al-Qa’ida’s Homeland plotting is likely to continue to focus on prominent
political, economic, and infrastructure targets with the goal of producing mass casualties,
visually dramatic destruction, significant economic aftershocks, and/or fear among the US
population. The group is proficient with conventional small arms and improvised explosive
devices, and is innovative in creating new capabilities and overcoming security obstacles.

Result number: 47

Message Number 232817

Iraq's security forces include officers working with insurgents. View Thread
Posted by marie on 7/11/07 at 15:07

Ok this is not new but it's still dang irritating!

US faced with Iraqi Army turncoats
http://www.csmonitor.com/2007/0710/p07s02-woiq.html
In interviews with Iraqi soldiers from the battalion based in Khalis, about 10 miles northwest of the provincial capital Baquba, some troops allege that Sunni and Shiite officers cooperate, respectively, with Al Qaeda-linked militants and Shiite militias. They say that this ranges from turning a blind eye to illegal checkpoints to actually facilitating the transit of weapons, ammunition, and cash through the checkpoints manned by the Iraqi Army.

Result number: 48

Message Number 232352

Question, what is considered a successful View Thread
Posted by Todd on 7/01/07 at 18:22

Regarding the previous discussion when my podiatrist quoted a 75% success rate for an osteotomy, what does success actually mean? No pain at all, subsequent to surgery? Some pain? Also does patient cooperation fall into the statistics? In other words, if you have a patient that doesn’t follow your post-op advice and as a result, his/her outcome is much less than optimal, how would that play into the statistics? Would that still be considered a successful surgery?

Result number: 49

Message Number 232274

Re: Question for Dr. Z on osteotomies View Thread
Posted by Dr. David S. Wander on 6/30/07 at 11:37

I remember the thread very well, and I was responsible for deleting the thread for reasons I will not discuss at this time. However, I will continue to philosophically disagree with the statements made by Dr. Z, since I personally do not agree with his statements, so I will 'politely' agree to disagree.

Although surgery is certainly an art, when I perform surgery I never at any time use any form of judgment which I even remotely consider a 'guess' or even an 'educated' guess. When I perform an osteotomy it is performed with a definite purpose. It is performed to reduce an angle, reduce a length, etc. Therefore, pre-operatively I have the ability to use the pre-operative x-rays to utilize to take angular measurements, length measurements, etc., to PLAN my osteotomy and to measure the angle of my osteotomy cuts, the amount that I plan to move the bone over to reduce the angle and/or the amount of bone to be removed to decrease or increase the length of the bone. Therefore, my surgery is well controlled and certainly NOT a guess.

Yes, mother nature will heal each patient differently, and after I perform my surgery there are certain factors that are no longer under my control. And not all post operative results are ideal. But I make sure that everything that IS under my control is done without guessing and is done as scientific as possible to assure that the results can be as predictable and as optimal as possible, pending mother nature's cooperation.

Result number: 50

Message Number 231162

Re: Israel Shows Interest in Syria's Peace Ideas View Thread
Posted by Dr. Ed on 6/05/07 at 22:14

Marie:

Syria is not comfortable with the concept of Iran's hegemony of the Middle East. They had been moving in lock step with Iran for a while but realize that they are more vulnerable than Iran. Assad was just 're-elected' (hah) for another extended term. Syria is a poorer country than Iran as it does not have vast oil reserves. It's major ally, France, just had a change of government. Assad could find himself isolated so talking peace is a good strategic move for him. The big question is how far Assad would be willing to move away from supporting terrorism in Lebanon and Israel as well as insurgents in Iraq. Certainly, it would be advantageous for the US efforts in Iraq if Syria could start cooperating.

Ed

Result number: 51

Message Number 231040

Re: So what are we going for in Iraq? View Thread
Posted by Dr. Ed on 6/03/07 at 20:09

Marie:

I am not sure it is about formally announcing a 'win.' It was about achieving a number of goals, some of which were achieved and some were not. The objective you may be looking for is the exit of US troops which is something that may happen once the Iraqi forces can take over more of the responsibilities of policing the country. Some US presence may persist. The situation need be further stabilized and that will be hard to do with Iran's efforts at destabilization.

When did Bush ever acknowledge that there were no WMDs in Iraq? Remember that the issue that was the ultimate cause of the invasion was Saddam's refusal to relinquish WMDs or at least provide evidence that he had no WMDs. Saddam not only precipitated the invasion with his refusal but had a multi-year history of not cooperating with UN inspectors and others on the issue.

Ed

Result number: 52

Message Number 230577

Re: Actually Chris Mathews is a Democrat........just as Anderson Cooper & Lou Dobbs areRepublicans. View Thread
Posted by marie on 5/25/07 at 20:25

I'm not sure why Susan thought my post above was addressed to her???? That was weird.

anyhoooooo btw iberals don't like Chris Mathews . They refer to him as 'Tweety'.

Result number: 53

Message Number 230564

Actually Chris Mathews is a Democrat........just as Anderson Cooper & Lou Dobbs areRepublicans. View Thread
Posted by marie on 5/25/07 at 15:55

Actually Chris Mathews is a Democrat........just as Anderson Cooper & Lou Dobbs areRepublicans. What I can't stand is people who don't like someone because of their political association. That drives me nuts........Liberal is ok. Everybody is something. I like a mix of differing political viewpoints.

Result number: 54
Searching file 22

Message Number 228313

Re: Saddam's WMDs View Thread
Posted by Rick R on 4/23/07 at 07:24

Of course not Ed, but I do think it was a few bad microwave ovens, yea that's it.

I have a hard time understanding how anybody could be surprised that the evidence of WMD was not spectacular. More astounding is that there are people that take the claim seriously that there was deliberate deception on the part of government.

We played our hand early, Bush made our intensions clear yet we allowed Saddam to stall for time over many months playing footsies with U.N. inspectors. And we are surprised that he hid/sold the goods! In this time we failed to assemble international cooperation to an extent closer to the first phase of the war.

This war should have been about the relevance of the UN and the resolutions associated with the cease fire that Saddam was stepping all over. The payola that destroyed the UN should be the issue, not Bush lied.

Rick

Result number: 55

Message Number 227690

Imus and the law of unintended consequences View Thread
Posted by john h on 4/13/07 at 12:24

In this morning's USA Today it is reported that CBS will lose $15 million in annual revenues because of firing Imus. Of course this is just the tip of the iceberg as local stations will also lose revenue and other entinities that have fired Imus will lose revenues. When you lose revnue you have to cut jobs. Probably many of the lost jobs will be African Americans. I think the Law of Unintended Consequences will come into play here.

Imus is the sole supporter of a Boys and Girls Ranch he, his brother, and wife created. It purpose it to help young boys and girls in need of help. I suspect he will still keep it up and running. I do not know but clearly think many of these young boys and girls are African American.

There is another Chairtable Foundation he is largely involved with. Once again I do not know if his loss of pay will effect the amount of support it will receive or any lost jobs.

This post is not to suggest that Don Imus should or should not be fired but to make people aware that there are consequences that may not be intended.

He is a wealthy man an hopefully can keep these very good foundations up and going. The following is a complete explanation of how the Ranch works. It is lengthy but if you are interested about its mission and how it works then here it is.

Introduction to the Imus Ranch
Related Stories
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Updated: 11:26 p.m. CT July 1, 2004
This is the place to learn everything you always wanted to know about the Imus Ranch, and probably quite a few things you don’t.

The Imus Ranch is an authentic, working cattle ranch nestled beneath a majestic mesa in the rolling hills near Ribera, New Mexico, 50 miles northeast of Santa Fe. Its sole purpose is to provide the experience of the great American cowboy to children suffering from cancer or serious blood disorders, and children who've lost brothers and sisters to Sudden Infant Death Syndrome (SIDS).

It is extremely important that all parents and children understand the fundamental philosophy of the ranch: it is not a camp! It is a working cattle ranch. Our objectives for the kids are to encourage in them a sense of achievement, responsibility and self-esteem through hard work and fun, while restoring their pride and dignity. Many have become convinced that because they are sick they are not normal. At The Imus Ranch they quickly discover they can do anything any other kid can do. Each child who visits the ranch is treated as a typical kid. Our policy forbids any mention of illness by ranch employees. The child life specialists, the doctors and nurses are responsible for addressing such issues when and if they come up.

Of course, the children themselves are free to initiate conversations on any appropriate matter with anyone. The Imus Ranch will always respond with patience, love and understanding.

The ranch is a magnificent facility. Nearly 4,000 open acres surround an old western town that rivals any movie set in Hollywood. All of the kids become part of our extended family living together in a stunning 14,000 square foot adobe hacienda; the architectural masterpiece that comprises the main ranch house. Their days are spent side-by-side with Don, Deirdre, Fred and the Ranch wranglers doing chores and learning to care for and ride their very own horse. As they round up our Texas Longhorns, herd and feed sheep, buffalo, chickens, goats and donkeys, the kids not only become intimate participants in the dawn to dusk rhythms of the ranch but also develop enriching lifetime bonds with animals. Often, it's been demonstrated that when children suffering from these frightening illnesses are given the opportunity to participate in programs such as those offered by the Imus ranch, the experience can actually contribute to healing and recovery.

The ranch also features a state of the art greenhouse and two acre garden, gigantic old-time barns, an indoor riding arena, an outdoor professional rodeo arena, a gorgeous, magnificently designed swimming pool, miles of trails and thousands of trees. There are two ponds for watering cattle that also contain hundreds of fish; trout in one, bass in the other.

The ranch has been designed to host ten children, two child life specialists, a doctor, a nurse, and EMT personnel for each session.


YOU AND THE IMUS RANCH

Think of your visit to the ranch as a summer job. Our experience has taught us that some kids think we're kidding when we say you will be working. We are not. You will be required to perform daily chores. You will be responsible for your very own horse and required to pitch in feeding all of the other animals. You should think of yourself as an unofficial employee of The Imus Ranch and a member of the Imus family. We understand that the ranch is not for everyone. There are certain fundamental physical requirements and other considerations that you should discuss with your parents, your doctors and your child life specialists. Below is a list of frequently asked questions and answers that may help you decide:

Who selects the children who go to the ranch?
The Tomorrows Children Fund and the C. J. Foundation for SIDS. New Mexico children and kids from other areas are selected by the hospitals or organizations they are associated with. The ranch provides advice about physical requirements but does not exercise any decision on who is ultimately selected.

How old do I have to be to come to the ranch?
Between 10 and 16 years of age.

What are the physical limitations?

You must be physically fit enough to work and ride a horse. The work can be demanding and you should consider that when making your decision whether to come to the ranch.

What does my trip to the ranch cost?
Nothing. All expenses are provided including airfare and transportation to and from the airport in New Mexico.

How far is the ranch from the airport?
A little over a hundred miles. Travel time is about an hour and a half.

How long will I be at the ranch?
Seven complete days. You leave on the morning of the eighth day.

What kind of activities will I be participating in?
You will be required to do daily chores (helping collect laundry, working in the garden and the greenhouse, pitching in in the kitchen, and performing other ranch chores). You will be responsible for feeding, grooming and care of your own horse.

What's a typical day?
6:00 a.m. Rise and shine
6:30 a.m. Feed your horse and other animals
7:00 a.m. Breakfast
8:00 a.m. Chores or horse lessons
12:00 p.m. Lunch
1:00 p.m. Rest and relaxation
2:00 p.m. Chores or horse lessons
5:30 p.m. Feed your horse and the other animals
6:30 p.m. Dinner
7:30 p.m. Evening activities (fun stuff)
9:30 p.m. In your room and lights out

What happens if I don't feel well and can't participate in regular activities?
It is important to remember when you choose to come to the ranch that you are agreeing to a certain level of responsibility. Not feeling well enough to do chores is understandable... not wanting to do them is not. We will always leave it up to you, the child life specialists and the doctors to make the final determination on the status of your health. Regardless, you will always have things to do and someone to love and help you.

What happens if I get sick and am not able to fly home?
The saloon (infirmary) has been designed, stocked, and staffed by the Hackensack University Medical Center. If you need special medical attention, but do not need to be hospitalized, there are two bedrooms in the saloon for you to stay in that are identical to those in the main ranch house (they are beautiful). All decisions on the status of your health, in these cases, will be made exclusively by the doctor. The ranch will ultimately do whatever is recommended, including flying your parents to the ranch, or you back home -- all at the ranch's expense.

What is the ranch telephone policy?
Parents may always call the ranch office. In the case of a genuine emergency, children will be available to take calls. In all other instances children are not allowed to make telephone calls. The ranch policy is identical to many camps kids attend in which they are not allowed to call home for the initial ten days they are at camp. Kids are at The Imus Ranch seven days.

May I bring a cell phone, computer, walkman or CD player?
No. The child life specialists are responsible for enforcing this policy.

What should I bring to the ranch?
a light windbreaker jacket
two swimsuits
hooded raincoat or poncho
two sweatshirts
two or three pairs of comfortable jeans
five long sleeve (light) shirts
one pair of hiking or other type of boots. (Remember, you will have cowboy boots and they are comfortable)
one or two pairs of sneakers
two pairs of pajamas
seven or eight pairs of socks
seven or eight pairs of underwear
five or six T-shirts

The ranch supplies all linens, blankets, pillows and towels. So remember... the ranch will supply cowboy boots, Wrangler jeans and shirts and Resistol cowboy hats. You'll be given Imus Ranch baseball caps and T-shirts as well. They are fabulous. You should bring a toothbrush and any other special toiletry items you require. The general store will be stocked with almost everything else you might need ...toothpaste, soap, shampoo, sun-screen... whatever.
If you do not have any of the above listed items contact Samantha Gordon at the TCF, or the Imus Ranch at (505) 421-IMUS. Anything you need will be provided so don't worry about it!

Is there a laundry policy?
Yes. We have complete laundry facilities so it's no big deal to wash, say, your favorite pair of jeans every night. You and the child life specialists are responsible for washing your own clothes and setting up your laundry routine. The head of housekeeping will help you master the machines in the laundry room. You're expected to observe all laundry room rules including removing lint from the dryers after each use and keeping the room clean. Please report any machine malfunction immediately. And very important: all of your clothes must be marked with a laundry marker.

What's the weather like?
New Mexico has a dry, warm, agreeable climate. The Imus Ranch elevation is nearly 7,000 feet. During the summer, our average daytime temperature is 85 degrees (though it can get into the 90's). The thin, dry air radiates heat quickly after sundown and summer nighttime temperatures average a cool 50 degrees. Summer also brings frequent gusty afternoon thunderstorms and breezes. It is comfortable even when it's hot, although you have to be especially careful when exposed to the sun because you can burn quickly. Plenty of sun screen is essential and should be applied every two hours. In the winter, snow falls throughout the state and January temperatures vary from about 55 degrees in the south to an average of 35 degrees in the north where the ranch is located. It is not uncommon to have three feet of snow at the ranch in December.

Is there a swimming pool?
Yes. The pool is chlorinated and swimming is strictly supervised and only allowed when there is an accomplished, accredited life guard on duty. The pool is a replica of an old time swimming pool hole and the design and landscaping are striking.

Will I be able to write and receive letters or send and receive E-mail
Letters, yes. E-mail, no.

Do I need spending money?
We can't think of any reason you would. In the unlikely event you do, the ranch will provide it.

What will I be eating?
A healthy diet of all-natural, organic whole foods, fresh fruits and vegetables. We are a vegan ranch. We serve no meat, fish, poultry or dairy products. We can and will respond to basic special dietary needs, but our menu generally reflects an all-American cuisine in both selection and preparation. We are non-denominational in all respects including the preparation and serving of foods.

What if I don't like the food? Will I starve?
No. We'll find something healthy that you do like (pizza?). Almost everyone who has been to the ranch loves the food and goes home with a new and enlightened attitude about their diets.

Where will I sleep?
In the main ranch house in your own room with one other child. Each room has its own individual bathroom and shower.

Do I get to pick whom I room with?
You should work that out on your way to the ranch with the advice of the child life specialists.

Will girls and boys sleep in separate rooms?
Yes.

Are sleeping quarters air-conditioned?
Yes.

Where do the child life specialists stay?
In the main ranch house in bedrooms next to yours.

Will there be someone at the ranch who I know?
Yes. Other kids, the child life specialists and the doctors and nurses.

If I get scared or lonely will there be someone to talk with?
Yes. The child life specialists. In addition, you will make new friends at the ranch.

How many nurses and doctors will the ranch be staffed with?
One doctor. One nurse. Two child life specialists. One or two EMT specialists.

Who are the medical staff?
The TCF and The Hackensack University Medical Center supply the medical staff personnel. When children sponsored by organizations other than TCF and Hackensack visit, the ranch itself will make arrangements for necessary medical personnel including child life specialists. The Emergency Medical personnel are supplied by the ranch and are licensed by the state of New Mexico.

Where is the closest hospital?
Santa Fe, New Mexico. 40 minutes by car.

If a medical emergency arises, will the infirmary be stocked with all necessary medications for each child?
We have been assured by the TCF and The Hackensack University Medical Center that to the degree that it is practical and possible, it will be. Each group of children will be accompanied by doctors and nurses who they're familiar with. They are ultimately responsible for your medical well being and we have placed our trust in them, as have you.

How will discipline be handled?
All discipline will be administered by the child life specialists with the exception of fundamental guidance from the ranch managers (Don, Deidre & Fred) and ranch hands in instructing the kids about chores and activities, and to insure safety. For example, if Don asks a child to perform a chore and the child refuses, a child life specialist would then be summoned to reconcile the matter. Under no circumstances will any ranch employee discipline, reprimand or chastise a child for any reason. All disputes will be resolved by the child life specialist. Children are expected to follow instructions and to cheerfully perform their chores and assignments and to follow safety instructions at all times. It cannot be stressed enough... in choosing to come to the ranch you have agreed to participate in all of the activities with good humor and enthusiasm to the best of your ability.

Will there be volunteers assisting at the ranch?
No. All employees are paid and have passed stringent security clearances and background checks. They will abide by a basic manual instructing them in their relationships with the children. They and the children will be closely supervised at all times by Don, Deidre and Fred Imus. Remember, there are only ten kids per session. Close personal supervision and care are assured.

What is the role of the child life specialists while they are at the ranch?
To supervise the children when they are not engaged in ranch activities... in the evening, from dinner until breakfast the next morning and during the hour or so they have after lunch. We have discovered that when child life specialists or doctors or nurses participate in ranch activities with the kids it detracts from the experience of the children and defeats the fundamental purpose of the experience of The Imus Ranch. It is important to remember the child life specialists and the doctors and nurses are not volunteers. They are paid full salaries and on occasion need to be reminded that they are not on vacation. We remind them. The ranch requires that the doctor and nurse be present at the infirmary (not out jogging or bird-watching) during the hours the kids are engaged in ranch activities. Similarly, EMT personnel stationed at the infirmary are expected to be present there, available and ready for immediate duty when and as needed.

Who selects the doctors, nurses and child life specialists?
The Hackensack University Medical Center, the Tomorrows Children's Fund, The C.J. Foundation for SIDS and other organizations who send children to the ranch. The Imus Ranch ultimately reserves the final determination on the suitability of all personnel.

May staff (doctors, nurses, child life specialists, EMT personnel) bring family members?
No, they may not.

Where do the doctors and nurses sleep?
In one of the bunkhouses in the town or near the main house.

What if my child cannot attend the entire session?
We are not prepared to accommodate partial sessions.

If it rains, what happens?
The animals still have to eat. Aside from that, we're prepared with an indoor riding arena, an art barn and a great house for lots of interesting things to do, rain or shine.

If a child gets homesick, what happens?
Parents can help a lot by letting kids know that getting homesick is not unusual (even for adults). Remember, the kids are going to be with people they know. Further, the child life specialists we've met have terrific natural rapport with the children which will help enormously to ease any anxieties. In the end, the ranch will do whatever it takes to make everyone happy.

May kids leave the ranch and return home before their session ends?
Of course.

Will the ranch allow children who are on medical maintenance?
Yes. As long as they meet the basic physical requirements the ranch has outlined and have been approved by the hospital.

Will there be formal religious services?
No, but children and staff will be allotted the time they request for any observance they feel appropriate.

Is there a policy manual for the ranch?
Yes. Each employee has one and much of the information is contained in the information you are reading.

Malpractice insurance?
Malpractice insurance is the responsibility of the hospital, the TCF and any other organization that provides doctors, nurses and child life specialists. The ranch carries significant liability insurance and each child and their parent will be required to sign a standard release/consent form.

Is Hanta virus an issue?
We will take every precaution and will not place the children at unnecessary risk while always relying on the advice of medical staff.

Guns?
All guns are under lock-and-key and protected by trigger locks. It is a cattle ranch in New Mexico and there are coyotes, mountain lions and wild dogs. Our only goal is to protect the children and we will be rigorously responsible in that effort.

Well then, is the ranch safe?
Yes. It is foolish, however, not to be prepared.

There are lots of animals -- horses, cattle, sheep, buffalo -- are they safe?
Yes. Accidents, of course, can happen. But with close supervision, a competent medical staff and cooperative kids we should keep mishaps to a minimum and of little consequence. But again, it is a working cattle ranch in New Mexico and we can't be too careful.


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Result number: 56

Message Number 227476

Re: To Sara & Lisa View Thread
Posted by sara d on 4/11/07 at 13:02

Hi Ralph and Lisa,

Just want to let u guys know that according to the nursing staff, Hope slept last nite (although maybe a bit restless). Scott spoke with the nurses this a.m and plans to see Hope this morning. She does have an appointment with her pain management doc tomorrow. That is the best update i can give u.

Ralph...i need to tell u that i would not feel comfortable talking with Hope's lawyers, although maybe Suzy would...and i will certainly mention it to Suzy. BTW Suzy would have posted but her computer is not cooperating when she tries to post to heelspurs.

I e-mailed Hope several times and we had many discussions about why i have difficulty continuing to 'chit chat' with her while she doesnt eat . I also told her that if I continued to 'chit chat' with her that there would most likely come a time when i would 'get angry' with her....and Hope did not feel comfortable with my anger. According to Hope, when Scott gets angry with her it only made her wants to eat less. I told Hope that i did not feel it was right for her to deny me (and Scott) this very human emotion. In any event, i am telling u this because i Know that because i express my anger to Hope, she does not always feel comfortable with me. ....so i guess our relationship is a bit strained....that is one reason i would not feel comfortable contacting her attorney.

Another reason i would not feel comfortable contacting her attorneys is because i sense that we (and i mean all of us ) have at one time or another 'coddled' Hope. At times I feel she is becoming to dependent on us. Calling her attorneys i feel should be handled within the family.

Suzy and i will certainly continue to keep u guys posted. If either of u would like to e-mail me....please do. My e-mail is rshathse at earthlink.net.

luv to both of u,
sara

Result number: 57

Message Number 227100

Why does Muqtada al-Sadr hate us? View Thread
Posted by marie on 4/08/07 at 11:55

It seems to me he should be grateful for removing Saddam Hussein. al-Sadr is an opportunist who has no regard for the people that follow him. His faith is not in line with Allah but with worldly goods and possesions. I can understand why he might be angry at the troop surge since it targeted his stronghold but what have we done personally to him to make him hate us so? It seems to me if he stepped back for a couple of years we would be gone, so why now?

http://news.yahoo.com/s/ap/20070408/ap_on_re_mi_ea/iraq;_ylt=AgzxKQ7TNgtx0uFCCi0ftc934T0D
BAGHDAD - The renegade cleric Muqtada al-Sadr urged the Iraqi army and police to stop cooperating with the United States and told his guerrilla fighters to concentrate on pushing American forces out of the country, according to a statement issued Sunday.

The statement, stamped with al-Sadr's official seal, was distributed in the Shiite holy city of Najaf on Sunday — a day before a large demonstration there, called for by al-Sadr, to mark the fourth anniversary of the fall of Baghdad.

Result number: 58

Message Number 226960

Re: To Ralph View Thread
Posted by Hope on 4/06/07 at 20:13

Hi Ralph,

To be honest with you I don't understand everything myself. But When I first started this lawsuit is was to make sure that my medical would be covered now and for the future. That is all we have ever wanted. So, my attorneys sent out letters to my doctors and other doctors and got the cost of what it would be to replace my SCS,remote,reprogaming just whatever will be needed for my future care. So, we wanted WC to carry me on there policy indefinitely. There insurance is call Indiana Insurance. But they were fighting that so then our attorney said then we have to go for a dollar amount that will cover what I'm going to need. Then that money will be put in the bank into a trust or a medical fund of some sort so I will have it everytime I need to see a doctor or surgery or even a prescription refilled. But as I said if they carry me. Then the only thing that I will receive or want is what I have lost. Like the time I have missed at work. As I have said time and time again my main concern it my medical care because now I have a pre existing condition and it is going to almost impossible for me to coverage for my ankle/leg,RSD/CRPS. A couple places Scott has called said that if I would stop taking all my meds and not see a doctor for 2 years for what I'm being treated for, then they will cover me. So, this is going to be hard. I hope I have explained this a bit better.

I have another letter for you. Dear Jane; Attached please find a copy of the November 16,2006 correspondence that I sent to Workermen's Compensation in regards to my client in the above referenced matter. I have been contacted by my client who indicated that they had turned the prescriptions into Walgreens. My Client has been contacted by Walgreens pharmacy who indicated that they need specific authorization for the Magnesium Glycinate from the Insurance carrier as this is not a prescription that Walgreens normally carries and it has to be speical ordered.

I have also attached for your convenience a copy of the medical report of Dr. Kondamuri indicating that my client has a follow up appointment scheduled for December 21,2006 and a copy of the medical bills and out of posck expenses that we are asking be paid and reimbursed. Please advise as to when my client can anticipate on receiving the authorization for the prescription and reimburement of the out of pocket expenses at your earliest possible convenience. Also please advise to whether the appointment of December 21,2006 with Dr. Kondamuri is authorized. Thank you for your cooperation in the matter.

This was a shorter letter. and an older one. As you can see I was having trouble getting meds and out of pocket expensive. I still have trouble getting my meds and I still have yet to get amy reimbursment at all. There are 2 more bills I think we are going to have to pay soon because they are threating to turn over to a collection place. One is for blood work that I had done for my last surgery on my SCS and the other one was for a xray of my back from my last SCS surgery also to see where the leads were at.

Anyway I just really want some answers. We have had a lot of out of pocket things that we have paid and have not got one penny back. Also you are surpose to get a check once a month based on what you made at work while you are off. I got that until October of last year and have not gotten one since. We have been also asking about that also. But whatever. That is the least of my worries but I guess I could use it for my out of pocket expenses.

Well, I will check back later. Tomorrow is Scott's and mine anniverary. But we are not going to do anything and that is okay with me. I don't feel good anyway.

Take Care
Hope

Result number: 59

Message Number 226897

Re: To Hope View Thread
Posted by Hope on 4/05/07 at 20:45

Hi Ralph,

That is a REALLY good idea. We would have not thought of that. I think that guilt can eat you up!!

I just got a copy of a letter in the mail today from my attorney that they sent to WC's attorney. I hope you don't mind me typing it to you. But this is what it says, Dear Jane, Please allow this correspondence to follow up with you in regards to my previous letter of March 23, 2007 in which I had forward to you a copy of Dr. Kondamuri's recommedation that my client see Dr. Lotak. Please advise as to your client's position of this authorization as soon as possible.

Also,plwase note that my client currintly has an appointment scheduled with Dr. Kondamuri on April 12, 2007. She is experiencing a great deal of pain and is requesting authorization to move this appoinment forward if possible.

Also, Our client was previously fitted with an AFO brace due to her work related injury. This brace is currently not fitting the proper way due to lack of weight loss and lack of mobility and needs to be readjusted. Please advise your client of the same.

I have been advised by my client that she has yet to receive any reimbursements for the out of pocket prescription expenses that we have forwarded to you with previous corresponences. I have attached a copy of these prescriptions which my client had incurred due to the work related injury of January 7,2005. The total reimbursement that my client is currently seeking for her prescriptions is $1009.54.

Please asvise me as to the above issues as soon as possible and as to when my client can anticipate on receiving this reimbursement check. Thank you for your cooperation in this matter.

What are your thoughts on the letter?

These are the kind of letters that I have been getting from my attorney a lot. It still did not cover the eletric scooter or my OS appointment or about this appointment in Indy he was talking about. So, I hope to hear something soon. I did want my appointment sooner because my pain is so high but by the time I get it approved my appointment will be here. So, why bother. I think if I need to be seen because I'm having a problem, I think there should be no question asked. But I guess people have abused this so that is now why they do it this way. They should go case by case. Not make it a rule for all because now I have to suffer!! And you wonder why I well, never mind.

I hate it when people say I want to wish you luck!! So, I'm not going to say that, I just wanted to tell you that I know everything is going to be fine tomorrow. It has to be because I would not know what to do without you. I will be saying an extra speical prayer for you tonight!! Please tell Catherine that I will be thinking about her also and I know things will be fine. Please let me know as soon as you can becasue I will be waiting to hear!!

Take Care
Hope

Result number: 60

Message Number 226716

MBTs for foot pain--cautiously optimistic-but still have metatarsal pain View Thread
Posted by theresa g on 4/04/07 at 03:25

I went to the Foot Solutions store, with the intent to try on some Spira shoes (the one sample they had was not comfy) because another medical technologist recommended them. Then, they let me try two other pairs of shoes....MBTs and some oriental sounding name....can't remember and the shoes felt terrible. I liked the feel of the MBTs in the store and spent a week with them at home, testing them out, getting used to them, not getting them dirty so I could take them back. After a week, I opted to wear them to work in the research/medical lab of a busy hospital. I made it about 3 hrs on Sunday and switched to my birks (which I am not supposed to do due to OSHA regs). This experiment went well. The next night I made it 7 hrs before switching shoes. Tonight, we had a major instrument failure and I did 10 hrs in them. I like them, even though my metatarsals still hurt by the end of the night, just not as intensely.

On the way to getting used to them, I've developed some pain in my shoulder blade areas, which I attribute to the slight change in my gait to walk in these shoes with the rocker sole. I don't really see how they mimic walking in the bush of africa or on sand, but they do feel good to me.

However, I am still enduring metatarsal pain, to the extent that I will take a lortab at work to 'take the edge off'. I find my self walking a little more 'toed-in' in these shoes. Is this something that others have experienced? Maybe need some extra padding in this area?

These shoes were going to be the 'last try before going back to my primary care doc and stating that I haven't been helped by stretching, surgery, orthotics, large amounts of ibuprofen (800 mg tid), small amounts of lortab and copious amounts of money to shoe stores and now I want a referral to an orthopedist'. In a couple of days, I hope to have a better idea of how this is helping me or not. Those custom orthotics don't feel too good in the MBTs, so I haven't used them, just the insole that comes with the shoe. To the positive side of the custom orthotics, the guy who has been adjusting them for the past few months finally 'injected some gel stuff' into the metatarsal and heel areas for additional cushioning. I noticed it right off at work that night. I was able to delay my lortab relief for an extra hour or so.

Previous history is PF in both feet for years. Operated (open) on right foot 4 yrs ago and operated (EPF) on the left foot in fall 2005. I still have metatarsal pain and occasionally feel what I would describe as burning on the soles of my feet. Feet actually FEEL hot to the touch. I slather on the lotion, but it doesn't help. Probably my next purchase will be night splints....like the cub splint. It seems a little more likely to be able to keep it on for a night.

I did a search for MBTs on this site and found a bit of info, not enough to really say these work good for PF. Although, since I'm long post surgery on both feet, I don't think PF is my problem. I'm not sure WHAT my problem is, really, but my metatarsals hurt a lot.

I'm looking for more cushioning, I think. Can something be done with these MBTs? For this price, I'd expect a little cooperation from the retail store.

Also, I'm not totally convinced that I don't have nerve damage. However, when I try a tinel's sign in the area around the inner ankle bone, it feels tender, but I'm exquisitely ticklish. I also have some sort of restless legs.....once I get into bed, it takes 1-2 hrs to get comforatble. This is with a tempur pedic mattress pad and nice sheets. Already taking ambien, usually with a lortab and, on bad nights, a glass of wine.

Result number: 61

Message Number 225806

SILICONE DYNAMIC ORTHOTICS TRIAL View Thread
Posted by Dr KIper on 3/23/07 at 12:00



Instructions

KEEP THESE INSTRUCTIONS



Your orthotics were mailed today. When you get them, follow the instructions INSIDE THE PKG. (see video- if you DON’T have DSL or cable speed, you may not be able to view videos, let me know.
(THE BEST SHOE TO USE FOR BREAKING IN THE BEST FIT IS A RUNNING SHOE -

THE SHOE INSTRUCTION VIDEO IS AT: WWW.DRKIPER.COM/VIDEO

PLEASE FOLLOW THE INSTRUCTIONS BELOW



I want to remind you what you should expect and what we are doing.

You are about to wear a pair of silicone fluid cushions for your arches that will be comfortable to wear as much of the day as possible.


In fact that is the premise about this orthotic

We will do this by testing the Rx for each foot. How each foot responds, what does it feel? Too full—too little? Comfy/not comfy? How the volume of fluid affects you will give us those answers. Do not relate whether the orthotics are working based on your symptoms, success depends on the fit. Once they fit, it will just take whatever time it takes for you to feel it and to start to feel better. Getting better isn’t WITHOUT pain, but rather WITH pain. Changing the way your muscles are used to may cause some aches and groans. I’ll help you with this.

Getting completely better can take years; our goal is to get you started on that road to recovery.

In the beginning we may need to make an adjustment or two in the prescription,

Eventually your progress will plateau. It will be difficult to know exactly when, but I’ll help you through it. As your feet change, the fluid volume prescription (Rx) will change (like with glasses).

On average it takes about 1-2 years for most to get the most healing out of the first Rx
Then we’ll start the process of refitting you for a new Rx.

The only way I can do this depends on your cooperation in following my directions.

1st
loosen your laces all the way to the bottom, then with the orthotic in the shoe, retighten, comfortably)

Wear no more than 2-3 hours/day, OR until soreness begins (if you’re comfortable you can wear them all day)


DAILY REPORT

post a daily report by answering the 7 questions below (1-2 minutes worth) to me starting with the first day. Here’s what I want to know.

1- How many hours did you wear it? What happened?
2-how did it feel? (comfortable/not comfortable) –and remember we are fitting 2 feet
3-did one or both feet get sore (after how many hours?)
4-did it hurt like ….? (can you describe how they hurt?)
5- Can you say there was any level of comfort noticed?
6-we need to determine what is your regular pain and the pain the orthotic might stimulate.
7-Which foot was least comfortable? BE SPECIFIC
8- ADDITIONAL COMMENTS-(OPTIONAL)

If you are asked to switch them DO NOT WRITE ON THE ORTHOTICS, if you need to keep them straight, use a piece of Scotch Tape and put a R or L on it in the way that they arrived—THANK YOU.

Here are some extra things to think about:

Cut the Criteria of the Fit from this page and put up on your refrigerator door so you will continue to think about how they feel while you are transitioning to them.

Criteria of the fit


1-It must fill the arch so that you feel the support, up to comfortably snug.
2-It must be comfortable to wear (not in the sense of relieving your symptoms) but that it doesn’t create new problems or pain [if you continue to feel your pain, that is normal] while you wear it all day.
3-You must feel stable on your feet when you are on the ground. It’s normal to feel some rolling motion under your foot, but not unsteady or wobbly side to side

Comfortable overall?

Strange?

Hurt or felt more pain or did it lessen pain?

Felt pressure under…

Lifted my…

I felt it under

Felt like a rock, like a balloon, like a lump

Felt great

Didn’t like it


REMEMBER:

The more we push the foot up, the more uncomfortable it may get, while you are healing. However, the Rx is that, which is most comfortable to you most of the time, so depending on activities and shoes, your pain reaction may vary.




FIRST WALK--DO NOT RUN IN THE SDO
Until we have determined this prescription is correct
This following is intended as a workout
Please concentrate


I strongly recommend that you start to wear your orthotics in a running shoe . This is best and will give us the most accurate information necessary to determine what kind of an adjustment is to be made if necessary.

The Velcro enclosed is primarily for running, it is not necessary for walking.

Walk around 2-3 days first, then:
Begin walking test (WT): (anywhere you have a straight line)

Concentrate on only one foot at a time: (bring the questions below with you while you walk, take a pad and pencil with you.)
Answer the questions specifically for each foot


KEEP THE QUESTIONS BELOW. Over the course of fitting you we may need to perform a few WTs. YOU MAY EVEN WANT TO POST THEM ON YOUR REFRIGERATOR DOOR [along with the Criteria of the Fit ]

Walking Test [WT]
Walk at a comfortable pace and concentrate (one foot at a time) on of how the support feels.
(30-50 steps)
1- Is it strange but comfortable? [can u rate it 1-10?]
2- Is the pain you have the same as before or do you feel something new? If there is, try to continue for at least 10-20 steps in order to be able to answer the questions)
3- Do you feel the arch supported?
4- Does it feel full or snug ? [or can you hardly feel it?]
5- Do you feel stable on the ground or wobbly?
6- Do you feel like your foot is rolling over to the outside?
7- Is there any motion felt?
a-If so, what direction? (front to back or side to side?)
8- Does it feel squishy ? (like the fluid is spreading out in all directions underfoot? i.e. stepping in mud barefooted)
9- Can you tell if there is any difference in the way the L & R fullness feels?
If so, which feels fuller?
Which is more comfortable?

If it’s not comfortable, can you say one side is more uncomfortable than the other?


.Answers to Questions:

Question L R
1-comfortable
2-pain from orthotic or regular?
3-is the arch supported
4-full or snug?
5-feel stable?
6-feeling of rolling?
7-motion felt? [side to side or front to back]
8-squishy?
9-any problems wearing shoes
10-any difference in fullness



IF YOU’RE COMFORTABLE:
continue to walk in your orthotics the rest of the day or until tolerance and repeat every day after that **many people can wear the SDO much or all of the day right away. NOTE: there will be times your feet need a break or rest from the orthotics too. You may find that if you have your other traditional orthotics, because your muscles are used to walking on that we may use them to get you comfortable once in a while because the SDO may stimulate a painful reaction—This can be perfectly normal. I’ll help you there.

IF YOU’RE NOT COMFORTABLE:
If you have trouble getting used to the SDO’s (it’s painful?- we must go more slowly and determine if we need a Rx change or is it just your muscles transitioning to a new way of walking)

Up to 40% of you may experience more pain after wearing the orthotics after the first few days. It’s not really the orthotics that are hurting but rather the reaction of your muscle memory walking a new way. we have to retrain those muscles to walk a new way.


As long as it meets the criteria of the fit , regardless of your reactions and symptoms we know it’s working.

You are always responsible for returning all extra orthotics at your earliest convenience.

Be sure to use delivery confirmation or insure the package back to me.

HOLD onto your receipts for at least 6 months.

The mailing address is: [please put this where you’d want to find it]

REGULAR MAIL: or UPS OR FedEX [only]:
PO Box 90141 7855 Fay Ave, Ste 250
SD, CA 92169 La Jolla, CA 92037



TERMS AND CONDITIONS

1- There is a one year warranty from date your receiving it.

2- ADJUSTMENTS:
There are 3 adjustments within 90 days included in the initial price of $346.00 [not incl S&H].

3- Warranty replacements will be charged $6.00 S&H (after 60 days) and the broken orthotic must be sent back [within 30 days] delivery confirmation or insurance in case of loss is suggested. There is no charge for postage for adjustments.

4-The factory demands the return of extra orthotics through adjustments, warranties or testers. A reminder note is included in the package where a replacement is being made. This is your reminder as I do not follow up.

If you continue. Your foot will go through changes slow/or fast
and that will involve new prescriptions as needed [adjustments are always 90 days from a new Rx].

You are responsible for extra orthotics or unreturned warranties.

Please,reply to me confirmed as having READ this e-mail.

Result number: 62

Message Number 224079

Re: To Ralph View Thread
Posted by Ralph on 3/03/07 at 18:43

Hope,
I think Lisa being a nurse could provide you with the best and most technical answers on this.

What I think about is that your body almost has to be retrained to accept food after being deprived of it for so long. I would think the way that they do that and I'm certainly not a medical person would be to give you supplemental nutrition like the kind you are having, then maybe gradually adding to it with things by mouth. Baby steps until you can keep things down and not feel sick to your stomach. You may even need a better antinausea medication to help.

That's why it's important that your doctor knows that you can't eat and you throw things up. Without this knowledge he can't fix the problem because he doesn't have a clear picture of what is happening to you. Tell him everything.

I'm confident this part of your life can improve it will just take time and the correct medical treatment. Pulling your feeding tube now without you being able to eat and drink would be counter productive.

Your doctor may think all he has to do is get your electrolytes up because you are eating and drinking normally. That's not the case but he won't understand that unless you tell him what is actually happening and that you can't eat or drink on your own.

Nothing to be ashamed of at all. It just means you've gotten so ill that your body is refusing to cooperate. It just needs to be set back on the right course. The nutrition tube assists the process until your body stops rejecting food and liquid by mouth.

Lisa indicated that your tube can be relocated so ask them to relocate it so you don't have the pain in your hand. It's no big deal, but you've got to speak up and tell them the problem.

You need your nutrients and they have to get in some way so until you are able to eat again by mouth think of that tube as your friend. A buddy that is helping you.

I bet Lisa has seen this happen before and knows how they get people back on track again.
Ralph

Result number: 63

Message Number 223952

Sounding more alarms View Thread
Posted by Dorothy on 3/01/07 at 16:38

Inside Bush's prosecutor purge
Why has the administration fired U.S. attorneys with sterling track records? To make room for its political loyalists, critics say, and exert its last shred of control.
By Mark Follman

Feb. 28, 2007 (PIPE) Ever since the Bush administration shocked the legal community by dismissing eight U.S. attorneys in December, Justice Department leaders have vigorously denied that the firings were politically motivated. "I would never, ever make a change in the United States attorney position for political reasons," Attorney General Alberto Gonzales said in Senate testimony in early January. In a Feb. 6 hearing, Deputy Attorney General Paul McNulty told lawmakers, "When I hear you talk about the politicizing of the Department of Justice, it's like a knife in my heart."

But at least three of the eight fired attorneys were told by a superior they were being forced to resign to make jobs available for other Bush appointees, according to a former senior Justice Department official knowledgeable about their cases. That stands in contradiction to administration claims that the firings were related either to job performance or policy differences. A fourth U.S. attorney was told by a top Justice Department official that the dismissal in that attorney's case was not necessarily related to job performance. Meanwhile, U.S. Attorney David Iglesias in New Mexico -- who officially steps down from his post on Wednesday, and who says he was never told by superiors about any problems with his work -- plans to go public with documentation of the achievements of his office.

"I never received any indication at all of a problem" regarding performance or policy differences, Iglesias told Salon on Monday. "That only leaves a third option: politics."

Iglesias acknowledged that U.S. attorneys serve at the pleasure of the president and can be dismissed without cause. "But it's really been maddening," he said, that the administration is pointing to job-performance issues to defend the firings. Iglesias, who was appointed by Bush in 2001, noted that his office got a "very positive" evaluation in the Justice Department's own internal ratings system as recently as last fall and that he received a letter from the Executive Office of U.S. Attorneys in January 2006 commending him for his "exemplary leadership in the Department's priority programs," including antiterrorism, community crime prevention and law enforcement coordination.

Iglesias said he was "shocked" by the phone call on Dec. 7 telling him to resign. He added, "I think Americans need to have full confidence that their federal prosecutors are above politics."

Suspicions about the unusual purge of eight U.S. attorneys in December exploded into the open across the legal community and on Capitol Hill after McNulty conceded in Senate testimony on Feb. 6 that the U.S. attorney in Arkansas, Bud Cummins, was pushed out for no reason other than to give someone else a shot at the job. Using a little-noticed provision in the Patriot Act allowing interim appointments, Gonzales gave the post to Timothy Griffin -- who had been both an operative for the Republican National Committee and a deputy to senior White House advisor Karl Rove -- in what many believe was a maneuver to sidestep the traditional Senate confirmation process for U.S. attorneys.

More recently, U.S. attorney Carole Lam, who is best known for nailing corrupt Republican Rep. Randy "Duke" Cunningham and his partners in crime, was replaced on Feb. 15 by Karen P. Hewitt, who according to a Justice Department press release, "will serve on an interim basis until a United States Attorney is nominated by the president and confirmed by the Senate." According to an Op-Ed in Monday's New York Times, Hewitt has a résumé with "almost no criminal law experience" and is a member of the Federalist Society, a conservative legal group.

While Cummins was first informed of his dismissal last June, it wasn't until Dec. 7 that Michael Battle, a top Justice Department official, informed the rest of the group of U.S. attorneys in phone calls that they would be required to step down. That group included Daniel Bogden in Nevada, Paul Charlton in Arizona, John McKay in Seattle, Carole Lam in San Diego, and David Iglesias in New Mexico -- all of whom had received positive job reviews before they were dismissed and some of whom are viewed by colleagues and law enforcement officials as exceptional leaders. Most of them have said publicly that they were never told of any management or policy problems by their superiors.

According to the former senior Justice Department official, one of the U.S. attorneys in the group was told by Battle on Dec. 7: "It's hard not to think you did something wrong when you get a call like this, but that's not always the case." Two other U.S. attorneys in the group, upon seeking clarification from superiors in Washington, were told by a different top Justice Department official that they were being pushed out to give other Bush appointees their posts. A current senior Justice Department official confirmed that one of those two was Bogden in Nevada.

When asked about those conversations with top officials, Bryan Roehrkasse, a public affairs spokesman for the Justice Department, declined to comment about "specific personnel matters."

Former officials, legal scholars and U.S. lawmakers from both parties have publicly questioned the administration's stated rationale for the firings and have suggested troubling theories about the real reasons for the purge, which experts say is without precedent. Some former Justice Department officials say they believe the administration's moves are a politically driven power grab -- aimed not only at a tighter grip on policy from Washington, but also at creating openings with which to reward their friends and build up a bench of conservative loyalists positioned to serve in powerful posts in future administrations.

"It's really remarkable to have a wholesale removal of an administration's own U.S. attorneys, particularly this deep into the term," said John Kroger, a federal prosecutor under Clinton and Bush who now teaches at Lewis & Clark Law School in Portland, Ore. "Clearly there was a concerted decision made to ask a bunch of them to leave. It suggests a desire to more tightly control policy. With the Democrats in control of Congress, perhaps it's because this is one of the few levers of government they have left."

Many point to the Cummins firing as proof that the administration is lying. "It is simply not believable that these were all performance-based dismissals, and everyone knows it," said a veteran prosecutor who served for a decade in the Justice Department until 2005. He also noted that he found it interesting that half of the posts cleared out are in the Southwest, where immigration is a key issue.

Kroger added that a stint as U.S. attorney is often a springboard to federal judgeships or other prestigious appointments. "Being a U.S. attorney is a huge credential, one a lot of people would like to have," he said. "It certainly looks like they're clearing out spots to reward loyalists in the last two years of the administration."

To support their claim that the dismissals were performance related, Bush officials have pointed to one among the fired U.S. attorneys, Kevin Ryan in San Francisco, who has been widely reported to be a focus of management complaints. The firing of Margaret Chiara in Michigan, the eighth U.S. attorney caught up in the December purge, was not made public until last Friday. To date, no explanation for her dismissal has been provided by Chiara or administration officials, but the former senior Justice Department official confirmed she was asked to resign in December and was in negotiations to stay in her post.

Realistically, federal appointments are never apolitical. But while U.S. attorneys serve at the pleasure of the president, they are traditionally recommended by federal judges and senators from the regions they serve, and are ultimately confirmed by the Senate. But thanks to a change put into the Patriot Act by Pennsylvania Republican Arlen Specter when it was reauthorized in late 2005, Gonzales and the White House gained the power to fill vacancies with interim appointees who can hold office for indefinite terms. Earlier this month, the Senate Judiciary Committee put forth legislation to restore limits for those terms (and thereby congressional vetting for long-term hires), but a full Senate vote on the bill was blocked by Republicans.

Incoming presidents are known to overhaul the corps of U.S. attorneys installed by prior administrations. Upon taking office, both Presidents Clinton and Bush replaced nearly all of the head prosecutors serving in the Justice Department's 94 districts nationwide. But it is rare for even one U.S. attorney to otherwise be dismissed during a president's term -- and in this case, all those dismissed by Bush were his own appointees.

Experts see a continuing pattern that began long ago: A Bush White House seizing greater executive power to the detriment of democratic principle.

"No doubt this is a threat to the independent stature that the Justice Department as an institution has enjoyed over the years," said Sam Buell, an associate professor at Washington University School of Law in St. Louis and a former federal prosecutor under the current President Bush. "It goes against the 'hands off' tradition, which has insulated U.S. attorneys from criticisms of politics influencing their choices and handling of cases. This doesn't look like a decision that's been made in the best interest of law enforcement."

Indeed, several of the fired attorneys had stellar track records. Like Iglesias in New Mexico, Daniel Bogden steps down Wednesday from the helm of a U.S. attorney's office in Nevada that saw unsurpassed achievements in law enforcement during his tenure. In a phone interview Monday, Bogden cited a record number of cases targeting guns, drugs, identity theft and sexual exploitation, among other criminal issues.

"To this day, I've never been told of any deficiencies in my performance or that of my office," Bogden said. "I've never been called by anyone suggesting that I should do something differently on policy, or that I was going against their policy."

In Seattle, John McKay's record as U.S. attorney has left many observers baffled by his dismissal. The raison d'être of the Bush White House is supposed to be the war on terrorism -- and McKay, by many measures, was an invaluable lieutenant in that battle.

McKay was appointed by Bush shortly after terrorists struck the United States on Sept. 11, 2001. Over the next five years, in a major port city and a border region critical for antiterrorist operations, he personally handled high-profile prosecutions, including that of Ahmed Ressam, who had driven across the Canada-U.S. border with plans to bomb Los Angeles International Airport at the turn of the millennium. In 2004, at a time when poor coordination among law enforcement agencies had been judged at least partly to blame for the 9/11 attacks, McKay developed an innovative data-sharing system that continues to be rolled out today in law enforcement offices nationwide.

Just over five months ago, on Sept. 22, 2006, the Justice Department completed a comprehensive evaluation of McKay's office, filled with high marks on both criminal and counterterrorism matters, including McKay's efforts to build greater cooperation among law enforcement agencies in both the United States and Canada. McKay "has been responsible for major advances in a cooperative cross-border effort," the report said. "All involved in these efforts pointed to U.S. Attorney McKay as the individual most responsible for the dramatic increase in cooperation."

"The report says nothing about me with regard to management or policy differences," McKay said in an interview last week. "Counterterrorism was our No. 1 priority, and I put an enormous amount of my personal time into it." He added, "If there were performance issues of any kind, they didn't tell me about it, and to this day I'm unaware of any."

"This is a huge loss," said Gil Kerlikowske, Seattle's chief of police. "I've worked with a lot of U.S. attorneys in my time and John is absolutely at the top of the ladder, not only on issues of terrorism but on law enforcement in general. I can tell you that if they're saying John's dismissal was performance related ... I find that almost inconceivable." Kerlikowske noted that McKay had crucial perspective, having served as a White House fellow at the FBI. "He knew how tough the barriers could be between law enforcement agencies, and he really helped break down those walls with information sharing."

"He was a champion with all the federal law enforcement agencies, but especially with ATF," said Kelvin Crenshaw, a 19-year veteran of the Bureau of Alcohol, Tobacco and Firearms and the special agent in charge of the Seattle field office. "He's one of the best U.S. attorneys I've ever worked with."

Administration officials have declined to provide further explanation for any of the attorneys' dismissals, including McKay's. On Feb. 14, McNulty, the deputy attorney general, gave a private briefing to the Senate Judiciary Committee, but afterward, Patty Murray, D-Wash., said, "I heard nothing from Department of Justice officials that changed my mind about John McKay's performance." Other senators who were present concurred with that view, according to a Democratic congressional aide briefed on the closed-door session.

Questions remain about how the Bush administration will seek to fill the newly vacant posts. Some former Justice Department officials say they believe that the administration has since revised its plans to reward political loyalists with the jobs, due to the backlash against the decision to push out Cummins in Arkansas and hand his post to Griffin. Earlier this month, the administration withdrew Griffin's name from consideration for a permanent appointment, though he remains in office indefinitely.

But if other recent appointees are an indication, the administration may be intent on installing conservatives with close ties to the White House. According to a Jan. 26 report by McClatchy Newspapers, since last March the administration has named at least nine U.S. attorneys who fit that profile, most of them hand-picked by Gonzales under the little-noticed provision of the Patriot Act that has since become law. They include Jeff Taylor, previously an aide to both Gonzales and former Attorney General John Ashcroft; Alexander Acosta, a protégé of conservative Supreme Court Justice Samuel Alito; and Edward McNally, a former senior associate counsel to President Bush.

And some critics expect that, despite the recent uproar over Cummins and the other attorneys' firings, the Bush White House will continue to find ways to erode the independence of the Justice Department.

"This is an administration that has not hesitated to discard conventional wisdom just because people say it's wrong," said Buell, the former federal prosecutor under Bush. "This is an administration that looks at the landscape and isn't afraid to rewrite the rules and say, 'We're going to do it our own way.'"


-- By Mark Follman

Result number: 64

Message Number 223803

air france thwarted hijack View Thread
Posted by larrym on 2/28/07 at 11:49

This is an older one but the common thread is guess waht?....the religion of peace. Looks and see what happened to those peaceful hijac....er Imean freedom fighters

On December 24, 1994, at Houari Boumedienne Airport, Algiers, Algeria, four men dressed in Air Algerie uniforms boarded Air France Flight 8969 bound to depart for Charles de Gaulle airport, Paris at 11:15. Immediately the terrorists demanded that the passengers close all of the window shutters and empty their personal belongings into a black plastic bag. Twenty five year old Abdul Abdullah Yahia and three other members of the Armed Islamic Group (Groupe Islamique Armé, or GIA) brandished their AK-47, Uzi, automatic weapons and demanded cooperation from the 220 passengers and 12 flight crew.

At 14:00, one of the terrorists discovered that there was an Algerian policeman onboard the flight and quickly brought him to the attention of Terrorist Leader Abdul Abdullah Yahia. The hijackers dragged the passenger up to the front of the passenger compartment and shot him in the back of the head. A few minutes later the hijackers made contact with the control tower at Houari Boumedienne Airport and demanded that the plane be allowed to take off. After their initial request was not met, they dumped the body of the Algerian Police officer onto the runway and stated that if their demands were not immediately met, they would execute another hostage.
http://www.liveleak.com/view?i=994_1172665173

Result number: 65

Message Number 223456

Re: Slick Willie gushing over Hillary..vomit alert View Thread
Posted by Dorothy on 2/23/07 at 11:53

Some things ARE simple: lying under oath is lying under oath.
You don't get to pick which oaths are worth honoring and which are not, in the eyes of the law.

If as you say he was "testifying against himself" - what you are referring to is actually incriminating oneself - he could have "taken the Fifth".... Or he could have told the truth AND made a statement about what he believed to be the nefarious motivations behind what he thought to be a witch hunt, and so on.

He was the president. He was an attorney. He lied to a Grand Jury under oath. It is a crime. If it is only a crime when the offense was a REALLY bad one (and who will decide that? You?), then it is without any meaning. The "glue" that holds a society that is based on laws together is pretty fragile and is there by agreement and cooperation among the governed. You don't get to pick and choose. Clinton did himself in because he is a narcissistic arrogant sexual reprobate who had every opportunity to act like a responsible, decent adult male who might encounter an amoral girl about the age of his daughter: you say no, thanks; go away. It's pretty simple. He is a disgusting individual and no effort from others with similar - low - values will ever persuade me otherwise.

Should he have been impeached? Probably not. But he certainly should have been pressured to resign by his own party. He should have been pressured to resign by his own conscience, but Clinton is a paragon of self-love and self-importance if we've ever seen one so his ever voluntarily leaving ANY stage and bright lights is unlikely. But THAT would have been the decent thing to do, to resign. He put us all into his life's little obscene movie and made us go through it with him - and he damaged the country in the process. We are a WORSE place because of Nixon, Clinton and Bush-Cheney - much, much worse. Nixon shocked and angered us out of national innocence; Clinton mesmerized and disgusted us and Bush-Cheney terrify and paralyze us. However, those national responses are inappropriate: we have a Constitution and a Congress to balance power. That is a foundational feature of the Constitution. It should be used. Pelosi is to blame for the fact that her misuse of power, her fiat decision, results in impeachment not EVEN BEING DISCUSSED for Bush-Cheney. She has debased the system for that reason alone.

Result number: 66

Message Number 222465

If You Think The U.S. is the only country the terrorist are---- View Thread
Posted by john h on 2/14/07 at 12:15

Posted by U.P. today:

By KIRSTEN GRIESHABER, Associated Press Writer 52 minutes ago
NEW YORK - The risk of terror attacks in Europe is high and is increasing, France's leading anti-terrorism judge said, warning that a recent alliance between al-Qaida and a North African terrorist group poses a grave threat.

The Salafist Group for Call and Combat, known by its French initials GSPC, staged seven nearly simultaneous attacks in Algeria on Tuesday, targeting police in several towns east of Algiers, killing six and injuring around 30, according to officials, police and hospital staff.

Al-Qaida in Islamic North Africa, the new name for the GSPC, claimed responsibility for the strikes.

"The GSPC wants to carry out attacks in Europe, especially in France, Italy and Spain, and destabilize North Africa," Jean-Louis Bruguiere told The Associated Press on Tuesday night in New York.

French counterterrorism police arrested 11 suspects as part of efforts aimed at dismantling an alleged al-Qaida-linked recruiting network to send radical Islamic fighters to Iraq, police officials said Wednesday.

Nine suspects were detained in and near the southern city of Toulouse before dawn Wednesday, following the arrest of two others late Tuesday at Paris' Orly airport, police said. The two had been sent home by Syrian authorities, investigators said.

Bruguiere said the threat to Europe is "pretty high." France rates four on a scale of one to five, he said

He linked the increased threat level to the U.S.-led war on Iraq.

"Actors of jihad have become radicalized and have tried to demonstrate that their means have not been diminished since September 11," he said.

As Western countries have developed new measures to fight attacks by Islamic radicals, the terrorists have also come up with a strategy to fight globally, he said.

Despite the growing danger of further Islamist strikes in Europe, there have also been successes in anti-terrorism efforts. An attempted attack by GSPC in France was foiled by domestic counterterrorism groups, and the French government is cautiously monitoring the group's activities, Bruguiere said.

European countries are working closely together to prevent further attacks and international cooperation. He said that cooperation with the United States in particular has improved significantly in recent years.

Bruguiere, who spoke at the French-American Foundation in New York, has been instrumental in rounding up hundreds of suspected militants in France over 20 years and more recently earned a global reputation as having a key role in the fight against al-Qaida.

Some of the operations that Bruguiere and his colleagues have foiled over the years include: the storming of the hijacked Air France airliner by Algerian militants who planned to blow it up over the Eiffel Tower in 1994 and the plot to bomb the eastern French town of Strasbourg on New Year's Eve 2000.

Result number: 67

Message Number 221768

Re: question for Dr.goldstein on non union View Thread
Posted by Dr. David S. Wander on 2/07/07 at 11:02

First of all:

Know Them,
This ONCE AGAIN proves you are an idiot that loves to bash all the "butchery" performed by podiatrists, yet as per my suspicions the surgery was performed by one of your esteemed ORTHOPEDIC SURGEONS. So I'll just sit back and wait for your apology, but you won't be man enough to admit your error.......again.

Jon,

It's difficult to comment on a case where I haven't seen the pre-op x-rays, intra-operative x-rays, post operative x-rays, CT scans, etc., and can not evaluate the position of the original arthrodesis or placement of the hardware. As previously stated in a prior post, a lot of things can go wrong during an arthrodesis. If the bones are not aligned properly, if inadequate articular surface is removed, if the hardware is not immobilizing the area well, if the blood supply is not adequate, if there is motion across the fusion site or if mother nature is not cooperating, these are all factors that can contribute to a failed fusion.

At this point, if you have been immobilized and have used a bone stimulator, the only viable option would be additional surgical intervention. Once again, a bone stimulator is totally useless IF the area is not immobilized. The bone stimulator can not be beneficial if there is still unlimited activity and motion at the fusion site.

Surgery will involve removal of the hardware and "cleaning up" the surfaces of the fusion site and the probable use of a graft. The best type of graft is an autograft, meaning one taken from your own body due to the blood supply. These are most often take from the area of the hip, though depending on the size of the graft and skill of the surgeon, grafts can be taken from the fibula or calcaneus. Grafts from a "bone bank" can be used but are not vascular and would not be my first choice in a failed fusion.

But once again this is up to YOUR surgeon and is dependent of the findings at the actual time of surgery. Once again, post operatively immobilization is paramount to success, and your surgeon may want to consider the use of the bone stimulator immediately post operatively since you've already had one failed fusion.

Have confidence in your doctor and his judgment. So far, the only decision that I would question is the use of the bone stimulator while still allowing you unlimited activity. That one made absolutely NO sense.

Result number: 68

Message Number 221384

Re: success rate of exogen 4000+ View Thread
Posted by Dr. David S. Wander on 2/02/07 at 11:41

There are several important factors. First of all, is the hardware still intact? Sometimes fusions are performed with external frames and sometimes with internal hardware, that's why I've asked the question.

Secondly, I hope your surgeon is not depending on the bone stimulator to heal the fusion site and still allow you to function with unlimited activity. Because if that is the case, you might as well return the bone stimulator.

Bones don't fuse due to inadequate fixation, poor alignment, inadequate blood supply, too much motion at the fusion site or simply because mother nature isn't cooperating. Additionally, patient's that are smokers can contribute significantly to non unions.

With that being said, it is IMPERATIVE that a non fusion be immobilized in order for it to heal or given a chance to fuse. If there is continued weightbearing or activity, with or without a bone stimulator and there is motion at the fusion site (or attempted fusion site), there will continue to be a non union.

Other important questions such as how long has it been since the surgery and how long were you initially immobilized must be answered.

And IF you are a smoker, you should really attempt to stop that habit for dozens of reasons, and healing the fusion is just one. But unlimited activity on an area that is a non union is absurd and will continue to guarantee a non union despite the use of a bone stimulator.

Result number: 69

Message Number 221364

Iran is a huge problem, no doubt about it. View Thread
Posted by Tim M. on 2/02/07 at 08:21

The policy of the Bush Administration, to not even talk to them, is absolutely crazy.

Our actions in Iraq make it doubly difficult to do anything about it. It is as if we have gone into a neighborhood and are knocking on the door of one house to let the guy who lives there know he is in violation of some city ordinance, while at the same time we have knocked down the front door of the house next door in order to beat up and handcuff all the residents and haul them away for violating exactly the same ordinance. How much cooperation can we expect? Why are we surprised we are hated and treated with suspicion?

Before we can even begin to address the problems with Iran, before we can even develop plans, we need to solve Iraq. We should have solved Afghanistan before we even started "solving" the problem with Saddam Hussein and Iraq.

There are, still, only three choices with Iraq. Either we get in and do it with enough troops, we deploy some kind of WMD of our own in order to substitute for a lack of troops, or we get out. Which do you want to do?

Result number: 70

Message Number 220973

Re: Peace Movement hurt by Jane Fonda View Thread
Posted by marie on 1/28/07 at 16:30

"There is absolutely no excuse for what she did."

Have to agree with you on that. It's one thing to voice your opinion and another to cooperate with the enemy.

Result number: 71

Message Number 220794

25 Rules for being a Good Republican View Thread
Posted by Denise on 1/26/07 at 19:06


25 Rules for being a Good Republican

1) Being a drug addict is a moral failing and a crime, unless you are
millionaire conservative radio jock, which makes it an illness and
needs our prayers for your recovery.

2) You have to believe that those privileged from birth achieve success
all on their own.

3) You have to believe that the US should get out of the UN, and that our
highest national priority is enforcing UN resolutions against Iraq.

4) You have to believe that government should stay out of people's lives
but it needs to punish anyone caught having private sex with the wrong
gender.



5) You have to believe that pollution is ok, so long as it makes a profit.

6) You have to believe in prayer in schools, as long as you don't pray to
Allah or Buddha.

7) "Standing Tall for America" means firing your workers and moving their
jobs to India.

8) You have to believe that a woman cannot be trusted with decisions about
her own body, but that large multi-national corporations can make decisions
affecting all mankind with no regulation whatsoever.

9) You have to believe that you love Jesus and Jesus loves you, and that
Jesus shares your hatred of AIDS victims, homosexuals, and Hillary Clinton.

10) You hate the ALCU for representing convicted felons, but they owed it
to the country to bail out Oliver North.



11) You have to believe that the best way to encourage military morale is
to praise the troops overseas while cutting their VA benefits.

12) You believe that group sex and drug use are degenerate sins that can
only be purged by running for governor of California as a Republican.

13) You have to believe it is wise to keep condoms out of schools, because
we all know if teenagers don't have condoms they won't have sex.

14) You have to believe that the best way to fight terrorism is to
alienate our allies and then demand their cooperation and money.

15) You have to believe that government medicine is wrong and that HMO's
and insurance companies only have your best interests at heart.



16) You have to believe that providing health care to all Iraqis is sound
government policy but providing health care to all Americans is socialism
personified.

17) You believe that tobacco's link to cancer and global warming are "junk
science", but Creationism should be taught in schools.

18) You have to believe that waging war with no exit strategy was wrong in
Vietnam but right in Iraq.

19) You have to believe that Saddam was a good guy when Reagan armed him,
a bad guy when Bush's daddy made war on him, a good guy when
Cheney was doing business with him, and a bad guy when Bush needed a
we-can't-find-Bin-Laden diversion.

20) You believe that government should restrict itself to just the powers
named in the Constitution, which includes banning gay marriages and
censoring the internet.



21) You have to believe that the public has a right to know about the
adulterous affairs of Democrats, while those of Republicans are a private
matter.

22) You have to believe that the public has a right to know about
Hillary's cattle trades but that Bush was right to censor those 28 pages
from the Congressional 9/11 report because you just can't handle the truth.

23) You support state rights, which means Ashcroft telling states what
locally passed voter initiatives he will allow them to have.

24) You have to believe that what Clinton did in the 1960's is of vital
national interest but what Bush did decades later is stale news and
irrelevant.

25) You have to believe that trade with Cuba is wrong because it is
communist, but trading with China and Vietnam is just dandy.

Result number: 72

Message Number 220478

Re: plantar fasciitis Slow down- ScottR View Thread
Posted by Carolyn on 1/23/07 at 13:53

Please, please add me to the list to be in the trial. I will cooperate fully. I am in good health; I just want my PF gone. Thanks

Result number: 73
Searching file 21

Message Number 219473

Why are the DRX9000 guys suing me???? View Thread
Posted by Oma Z on 1/11/07 at 20:02

Axiom DRX9000- Why are these guys suing me????

THE CHIROPRACTIC JOURNAL - JANUARY 2007

Read and respected by more doctors of chiropractic than any other
professional publication in the world.
A publication of the World Chiropractic Alliance January 2007

Device championed by JC Smith under fire as fraudulent

The "DRX 9000 spinal decompression system" is the subject of recent lawsuits and legal investigations as a fraudulent device being promoted by false advertising. The device has been widely promoted and touted by JC Smith, DC, winner of the American Chiropractic Association's 'Service to Chiropractic'award.

In one article, Dr. Smith stated that "The most effective form of care for failed back surgery, severe low back pain, or for patients with back pain in most cases of patients who complete the program." Speaking of his own "Spinal Care Clinic," Smith proudly announced, "Without hesitation I can say the DRX 9000 ranks
among the best treatments for many types of low back pain, and when combined with our spinal rehab program, patient improvement is assured."

It is widely accepted that the "success" of Smith's back pain clinic depended on his use of this device. Yet, according to prosecutors, the device is "questionable" and advertised claims that the device has an "86 percent success rate for treating debilitating back pain without surgery" is unfounded.

According to a report in the Monterey (Calif.) Herald, the "District Attorney's Consumer Protection Unit demanded substantiation of the claims from the chiropractors and the device's distributor, Axiom Worldwide Inc., but has received none. He said a multi-agency task force is investigating avenues of possible civil and criminal actions against the company."

Two California DCs were fined $25,000 for violating false-advertising laws by publishing the claims made by the company. One of the doctors cooperated with prosecutors and had $17,000 of his fine suspended.

One claim was particularly blatant to investigators. Although the company states that the device was based on "an accidental NASA discovery" that outer space quickly and easily solved most back pain, prosecutor John Hubanks said that, in fact, NASA has determined space travel has a detrimental impact on the spine.

Smith's article echoed the claims made by the company, which also assert that pre- and post-treatment MRIs demonstrate a greater than 50% reduction in the size and extent of herniation after four weeks of treatment, and that it has an 86% treatment success rate with persons suffering from herniated or bulging lumbar discs, degenerative disc disease, post-surgical relapses, or facet
syndromes.

Ironically, in an article for Journal of Chiropractic Humanities (1999), Smith accused the chiropractic profession of unethical behavior, citing "tacky Page 1 of 2 Device championed by JC Smith under fire as fraudulent advertising and outlandish claims" as two of its more grievous shortcomings.

"However topical any discussion about ethics may be," he wrote, "it is a subject in dire need of debate because the chiropractic profession appears to some in the public arena to be the least ethical of all the health professions, due to years of intense medical misinformation/slander as well as the use of tacky advertising, outlandish claims, sensational leadership and cases of insurance fraud that appear on news programs such as '60 Minutes.'"

California isn't the only state to investigate the claims made by the DRX 9000. In Nov. 2006, the Oregon Board of Chiropractic Examiners announced that it was questioning the company's claims about its device's link to NASA research.

The Oregon Board noted: "A typical claim is that an 'Accidental Discovery by NASA in Outer Space Quickly and Easily Solves 86% of Back Pain... Astronauts that left with back pain would come back without it...."

Yet, according the to Board's press release, information obtained by the Board "casts doubt on the validity of these advertising claims. One study published in Psychosomatic Medicine in 2001 states, 'Back Pain is one of the most frequently occurring medical problems during space flight. It has been reported by 68% of astronauts.' Another 2001 article in the same journal states, 'astronauts grow
taller in space, and stretching of the spinal nerve roots can lead to back pain.'"

The Board cited several other references that clearly refute the company claim. The Board contacted the company for substantiating evidence but never received a response.

In addition, Oregon Board Executive Director Dave McTeague noted that "The Board is concerned about high pressure marketing to potential patients using questionable claims. The typical treatment protocol calls for twenty treatments over a six-week course of therapy. Add to that the financial pressures of purchasing a DRX 9000 type device (upwards of $65,000 to $125,000, Used 2005 model on ebay for $65,000) and there may be other motives for the treatment program than optimal patient care."

The profit potential for the device was apparent in a report by American HealthChoice, Inc. (AHC) that operates 13-company owned clinics in Texas and more than 30 affiliated clinics in Texas, Tennessee and Kansas.

According to the company report, AHC installed a DRX 9000 system at its Katy, Texas clinic August 2004. "The Company anticipates net revenue of approximately $100,000 per quarter in fiscal 2005 from this one system," it noted, adding that "the capital investment for the DRX 9000 is approximately
$95,000 per system."

http://www.worldchiropracticalliance.org/tcj/2007/jan/d.htm

Result number: 74

Message Number 219063

Re: Post op pain is this normal View Thread
Posted by Kate on 1/07/07 at 13:36

My first (left) TT release was almost 2 yrs ago and for the most part, it is behaving OK. EMG/NCV test shows that the TTS worse than before the release. I'm having the re-release with nerve wrap (which I wish had been offered to begin with!)on the right foot that was released in June of '06. I was supposed to have the left re-done first but the right foot is so sensitive at the scar that even applying lotion triggers the numbness. Plus there is a piece of vicryl poking out from a deeper suture. Both scars are horrible to look at but the right has remained raised and rope-like.

I was able to hike the Boundary Waters in less than 6 mo after the left release but he right is just not cooperating.

Result number: 75

Message Number 217781

Re: Surgery Dec13th View Thread
Posted by mgall on 12/22/06 at 22:05

I'm sorry about your anesthesia experience. Your surgery sounds a lot like what my docotr had told me. I'm curious about you having no pain though? Im the opposite side of that spectrum I guess. Are you taking any pain killers? Wow, what method of bandage did you have after your surgery? (stiches/staples/cast or nothing) I have a lot of stiffness and bruising. The feeling in my toes feel really akward as well. That was my main problem that my toes have been severly numb for months. I cant believe that in a litle bit of time my leg has lost most of its muscle density.

So I hear that the recliner is the preferred recooperating device, I so need one! It is a little late now! And a wheel chair would be nice, every hope on my crutches adds a throbing pain in my incision, but it is feeling better today.

Thank you for the support and info.

Happy Holidays
Matt

Result number: 76

Message Number 216867

Re: Shoes to wear on concrete after fusion View Thread
Posted by meg s on 12/07/06 at 10:46

They were the tarsal-metatarsal cuniform joints in the midfoot. So the screws one parallel through the joints and cadaver bones and not horizontally across the toes. I hope that makes sense :).
Looking forward to your answer. Still another 3 weeks before I'll be out trying them on as the 4th metatarsal is just not cooperating.
Thank you for the help. By the way I have a very narrow heel. Sure was easier when I was a child and my Dad owned a shoe store! At 98 he still comments on peoples feet and how they are walking.

Result number: 77

Message Number 216842

Re: DRX9000 - Oh oh.....Bogus Back Claims View Thread
Posted by Jackie on 12/06/06 at 20:07

At least you've got your eyes wide open. Good luck Shawn.

Posted on Wed, Dec. 06, 2006

Bogus back claims draw penalties

Chiropractors face fines for advertising treatment with questionable spinal-traction device

By VIRGINIA HENNESSEY

Herald Salinas Bureau

Local prosecutors have won injunctions and civil penalties against two Central Coast chiropractors and are asking anyone who was treated with a questionable spinal-traction device to notify their office.

Prosecutor John Hubanks said the chiropractors, Charles Strong and Tony Hoang, anonymously advertised in local newspapers offering a free report to consumers regarding the DRX-9000, an "FDA approved medical technology" that offered an "86 percent success rate for treating debilitating back pain without surgery."

The deceptive ads claimed the DRX-9000 was an effective treatment for multiple herniated disks and sciatica and was based on "an accidental NASA discovery" that outer space quickly and easily solved most back pain. In fact, Hubanks said, NASA has determined space travel has a detrimental impact on the spine.

Hubanks said the District Attorney's Consumer Protection Unit demanded substantiation of the claims from the chiropractors and the device's distributor, Axiom Worldwide Inc., but has received none. He said a multi-agency task force is investigating avenues of possible civil and criminal actions against the company.

Strong, a Watsonville chiropractor, was fined $25,000 for violating false-advertising laws.

Hoang of Monterey was also fined $25,000, but $17,000 of his fine was suspended, Hubanks said, because of his cooperation with prosecutors.

"He was great. He worked with us immediately when he realized the advertising couldn't be substantiated," said Hubanks. "My understanding is a media kit was provided at the time of sale of these devices."

Hubanks said he was particularly worried about the elderly and those without health insurance paying exorbitant fees for the treatment, which may aggravate their painful conditions.

Anyone who has been treated with the DRX-9000 by any health-care provider can reach the Consumer Protection Unit at 647-7705.

herald.com.

Result number: 78

Message Number 216214

NBC Saids Iraq In The Midst of "Civil War" View Thread
Posted by marie on 11/27/06 at 16:24

http://www.msnbc.msn.com/id/15921476/

Myself and many others here called this one before the 2004 election but I guess it took 2 years for reality to finally hit home.
NBC News Monday branded the Iraq conflict a civil war — a decision that put it at odds with the White House and that analysts said would increase public disillusionment with the U.S. troop presence there.
Fareed Zakria described the bind our troops are in best in his recent newsweek article The Next Step? Think Vietnam.
On Thursday, just hours before a series of car bombs killed more than 200 people in the Shia stronghold of Sadr City, Sunni militants attacked the Ministry of Health, which is run by one of Moqtada al-Sadr's followers. Within a couple of hours, American units arrived at the scene and chased off the attackers. The next day, Sadr's men began reprisals against Sunnis, firing RPGs at several mosques. When U.S. forces tried to stop the carnage and restore order, goons from Sadr's Mahdi Army began firing on American helicopters. In other words, one day the U.S. Army was defending Sadr's militia and, the next day, was attacked by it. We're in the middle of a civil war and are being shot at by both sides.
That pretty much saids it all to me. How can we be effective when we have both sides shooting at us? How can the Iraqi people inspire change when they themselves have lost faith in their govenrment? Two blogging Iraqi brothers, Omar & Mohammed, an upbeat pro Bush blogging pair at Iraq The Model have changed the tone of their blog posts. Fear and frustration have replaced their once upbeat blog posts.
Now, our real problem in Iraq is that we do not have leaderships with patriotic agendas and like we said many times in previous postings; these leaderships that work according to partisan and regional-foreign agendas are the main cause of trouble because they are in power and they would not easily abandon the agendas of their masters and regional supporters and they will remain an obstacle in the face of building the state.

The bitter fact is; it was us who brought them to power and gave them legitimacy through elections. But…regret is useless now.

I believe that America would like to see Iraq emerge as a model for the region and is working hard to find a way to solve the current crisis. But that cannot be done without having a cooperative Iraqi partner on the ground who shares similar views for Iraq and the middle east. And that's the point; that partner does not exist, at least not in the government.
Our elected leadership shares their frustration today with the Iraqi government and the Bush administration.

Senator Dick Durbin: “It is time to tell the Iraqis that unless they’re willing to disband the militias and the death squads, unless they’re willing to stand up and govern their country in a responsible fashion, America is not going to stay there indefinitely,” & “The fact is 150,000 of our best and bravest American soldiers are caught smack dab in the middle of a civil war in Iraq. That isn’t what we bargained the for.”

Senator Chuck Hagel:
"There will be no victory or defeat for the United States in Iraq." & "If the president fails to build a bipartisan foundation for an exit strategy, America will pay a high price for this blunder -- one that we will have difficulty recovering from in the years ahead."

Incoming House Majority Leader Steny Hoyer: "In the days ahead, the Iraqis must make the tough decisions and accept responsibility for their future." & "And the Iraqis must know: Our commitment, while great, is not unending."

Result number: 79

Message Number 212921

Re: Question for Scotty R. View Thread
Posted by R. Parker on 10/10/06 at 19:38

I really don't think it is that there is such pressing need for questions by the patient regarding other diagnoses and tests, as any good diagnostician digests the information which you tell him/her about your problem, and along with his/her general history queries and initial examination forms what is know as the differential diagnosis. These are all the conditions which come to mind which may fit the general description and impression which he/she has already formed. Then the process of elimination is begun, in which the doctor poses targeted and specific questions to the patient, and makes tests and assessments which are intended to separate the possibles from the impossibles, then the like-lies from the unlike-lies. And finally, the diagnosis which survives this "test by fire" will hopefully be the real diagnosis on which effective treatment can then be based.

The weakest link in this whole process is often the patient, especially those who come to the doctor with a predetermined judgment, which may have been supplied by another doctor. But your current doctor needs to know what was the thinking and treatment approach of your previous doctor, as it may not only help the diagnostic process, but will also make him/her aware of what has been tried and has failed.

The patient's job is to come prepared to offer a clear description and discussion of the problem as it effects him/her . . . (who would know better), and one precise enough so that he/she need not retract or materially alter it somewhere down the line. Finally the patient needs the ability to target responses directly to the crux and essence of the doctor's questions not simply take it as an opportunity to ramble on disjointedly.

You don't know how very painful it can be to have a new patient unprepared to discuss the problem for which he/she came to the doctor. After all . . this problem has certainly been on that patient's mind for some time, else he/she would not be willing to pay to have it resolved. Yet, many sit there and expect the doctor to pull the story from them. Then there are those who go into such tedious detail regarding unassociated and unimportant events having really absolutely to do with the condition . . who they were visiting, where they were going, what the weather was like, etc. that it tends to derail the diagnostic thought process. It is certainly the job of the doctor to teach the patient what is needed in terms of his/her cooperation, and channel the patient in that direction, but time with your doctor may not be easy to come by. Therefore, it is often wise to make the most of it by planning ahead, bringing in notes and practicing your story.

Result number: 80

Message Number 212599

Re: Republican State Senator Wants Teachers to Carry Guns View Thread
Posted by marie on 10/07/06 at 19:45

Terrible crimes happen in public places all over our nation. Should store clerks carry guns? should bank tellers carry guns? The fact of the matter is that there is no ONE single silver bullet on school violence. It takes multiple strategies. The first one comes at home. Telling your kids to take lock down practise seriously is a start. Talk to them about being quiet so a teacher's instructions can be heard. This is probably the worst failure. Kids simply do not take it seriously. They don't cooperate with teachers and that may be the thing that costs them their lives or someone elses.

The amish school was chosen because of the lack of security. Public schools usually only have one or two entrances unlocked. Most have a cop in the building but a larger school should have several. Teachers are better trained to handle a lockdown........what is that? It moves very quickly but all classroom doors are kept locked so all they have to be is shut. Several have inside storage rooms that can also be locked quickly. Phones are being placed in each classroom. In fact all classrooms should be equipped with phones. Teachers and students have cell phones (the kids aren't suppose to have them but they do). it all helps. But in the end a nut will do about anything if determined.

Result number: 81

Message Number 212391

Re: Best Doc in USA to Perform Surgery? View Thread
Posted by R. Parker, DPM on 10/05/06 at 21:04

I may have to frame your post for my office wall.

I'll be happy to tune in and see if I can add to the conversation. I don't often go on the TTS Message Board here because, although I see and treat TTS from time to time, generally with reasonable success, it is not one of the areas about which I feel most qualified to comment upon. As you may have noted from my posts, I like to, as they say in sports, "play within myself" rather than shooting from the hip and/or extending myself beyond my real competence. I'd much rather say "I don't know." when I don't know, than fake it, even in a forum venue. That became increasingly easier to voice as time in practice passed and experience grew, as, when you know much of what you need to know and have seen much of what you are expected to have seen, it should not longer be considered a pejorative to freely admit not knowing everything. Fortunately for me, I practice in a hospital environment, and I have become use to a cooperative team-approach to diagnosis and treatment, in which we tend to lean on each others best assets and expertise rather than going it alone. This has decided advantages for the patient, and the doctors do not have to be expert Jacks of all Trades. One of the problems in treating TTS is that the diagnosis is often a judgment call based on the concomitant presence of multiple signs and often vague symptoms, and both the conservative treatments and the surgical treatments are often basically empiric in nature. It takes a certain amount of guts to take a patient to surgery for an elective procedure with the lack of complete certainty inherent in such a diagnosis.

Result number: 82

Message Number 210502

Re: Maybe someone here can explain to me why people try to keep running..... View Thread
Posted by R. Parker, DPM on 9/17/06 at 11:33

The object of treatment by a doctor should be to rid the patient of complaints as quickly, as effectively and as permanently as possible, and simple common sense should dictate that if a part of the body hurts that only slightly abusing it not the most prudent way of fostering that goal. The issue is not whether some sort of treatment can be afforded even without the complete cooperation of the patient, but that, in the main, folks who post problems here regarding the ineffectiveness of their podiatric care for PF are probably the worst-case examples, as the vast majority of PF can be effectively treated effectively by conservative care and the dedicated acknowledgment by the patient that the treatment affords control and not generally cure. So for those who post here, complaining of or being disappointed by their lack progress, but still entertain the thought that perhaps they will neither have to either change their lifestyles nor tolerate the consequences is tantamount to wishing to have one's cake and eat it too.

Result number: 83

Message Number 210130

Re: Is there a treaty between the U.S. and Israel? View Thread
Posted by Dr. Ed on 9/12/06 at 14:27

John:

Despite the lack of a formal treaty the relationship between the US and Israel has been one of cooperation and friendship. Sometime formal treaties do not amount to much. Remember SEATO? I still remember a teacher in high school telling the class, tongue in cheek, that the Southeast Asia Treaty Organization means that the Republic of Vietnam would come to the aid of the US if attacked.

Your assessment of the lack of the doctrine of Mutually Assured Destruction makes this era even more dangerous than the Cold War. I am not sure that I am convinced that the mullahs really want to see the region come to an apocalyptic end. They and the leaders they are in cahoots with seem happy to send young Arab males to their deaths in suicide bombings. Would they be willing to strap on suicide belts?

Another issue relates to the demographics of Israel. Most of the population is concentrated around Tel Aviv. It would take the penetration of only one or two nuclear weapons aimed at Tel Aviv to destroy the country. It then comes down to a cost-benefit analysis to Iranian leaders. They may be willing to attempt a first strike banking on the ability for one or two nuclear weapons to penetrate the Israeli defense shield (Arrow, Patriot-Pac3). Provided that Israel could survive a first strike, their ability to deliver nuclear weapons in retaliation may be limited. That probably is why the Israelis have bought several subs from Germany. The leaders of Iran may be willing to sacrifice a portion of their population to achieve their goals.

Result number: 84
Searching file 20

Message Number 207098

It's Parrothhead Time! View Thread
Posted by Kathy G on 8/12/06 at 10:13


Well, we had decided that we didn't want to go to the Jimmy Buffett concert this year because we kind of felt like he "phoned it in" last year. Then we got a call from a friend who used to own Great Woods and is now a consultant to the Tweeter Center. He was given two complimentary VIP tickets and wondered if we wanted them!

So, it's off to Margaritaville! The weather this weekend is just like the weather that we usually have on Labor Day which is when Buffett usually comes to Great Woods so everything has cooperated.

I'm looking forward to going inside the VIP tent to see how the "other half" lives and while we are two of the most unlikely Parrotheads anyone has every seen, this is the fifteenth concert we've attended. I've never liked costumes and my idea of dressing up for this is to wear a lei for as long as I can stand it irritating my neck. My husband is even worse! And neither of us drinks but we have a ball, talking to the other Parrotheads and walking around the parking lot.

So, when I get back, I'll let you know if Jimmy is still phoning in his concerts or if his voice lessons were a success. And last night, in honor of the event, we had cheeseburgers for dinner!

Result number: 85

Message Number 206707

photosynthesis in animals - details explained View Thread
Posted by scott r on 8/08/06 at 13:25

This traces the energy, electrons, and photons when light reverses the respiratory action and act as a fuel cell to generate 4H+ and O2 from H20 to slow the krebs cycle when animals are in bright sunlight.

Normal operation of 3rd pump (CcO): electrons are brought in through the prior pumps that received e- energy from the krebs cycle. At the active pumping site of CcO, 2e- are bought in to attract 2H+ in tunnel A and 2H+ in tunnel B. O2 is spread apart in the iron-based active site so that the 2e- and 2H+ of tunnel B react with one oxygen to form H20. This releases energy that boots the 2H+ in tunnel A on up the gradient to the outside of the membrane. Since the 2e- that were being used to hold the 2H+ in place are now inside the H2O, there is nothing holding 2H+ in the active area. The exact mechanism of this second step of booting up the gradient is not known. Another 2e- are waiting in the wings (a 2 copper site) to react with the other oxygen in the same manner with the same result (H2O and a booting of another 2H+ upwards). Summary: O2+4e+8H => H2O + H2O + 4H+ where 4H+ is the energy gradient increase.

Instead of forming H2O to use electrons and release energy, let's run it in reverse and let light energy breaks apart H2O to release electrons. There are 5 metal atoms in this protien that do everything. 3 are at the active site, 2 irons and a copper. Two more coopers are at a "staging" area for bringing electrons in from the "electron food chain". Only the coppers absorb light strongly in the near-infrared, which can penetrate blood and water. In fact, it appears hemoglobin evolved to specifically allow these frequencies through since they were already being used for energy in bacteria. The copper at the 2-iron main reaction (pumping) site absorbs strongest at 670 nm (red) which is a higher energy level than what the other two coppers absorb at near-infrared). 1/4 or so of the red photon energy is absorbed and splits H2O (fuel cell!) to generate the 2e- that are needed at the reaction site to pull in 2H+ up tunnel A. This creates 2H+ in tunnel "B" from the H2O and the split oxygen is being held in one of the irons. Then the 2e- combine with the 2H+ in tunnel B and the oxygen held in the iron to recreate the H20 which releases the rest of the light energy the system had temporarily stored which boots the tunnel A 2H+ on up the gradient. So no electrons or ANYTHING ELSE comes in or out of the system, but 4H+ are delivered up the gradient thanks to light energy. The other 2 coppers that are outside of the 2 active iron site may also get into the act by absorbing light to push 2 more temporary electrons against an H+ gradient to bring them to the active site, but i don't know if it's necessary for the light-pumping. These wold also be cycled back and forth without using anything but light energy.

Therefore this cyctochrome c oxidase is not merely a respiration-based pump. Its organization and use of copper is not merely an evolutionary left over from bacteria that used light. It is an active photoreceptor providing possibly up to 20% of the energy to people laying out in the sun. Smaller animals with little hair will see the greatest benefit since the light only penetrate a few centimeters in the windo between the absorption of blood and water.

But the story isn't finished:
When light has pushed a lot of H+ outside the mitochondrial membrane, the H+ gradient is stronger and there is an increased pull towards the 2 staging coppers to pull e- out of the reaction site. This prevents the 2e- from absorbing back into the H2O which leaves 2H+ in tunnel B. O2 is created if it occurs twice (2H2O + 2 red photons => 4H+, 4e-, and O2). The 2e- in the 2-copper staging area absorbs light energy which might be used to jolt e- back into cytochrome c to be used for the previous pumps to act in reverse, as they are known to do. As the H+ gradient increases, the first 2 pumps that provided e- to our 3rd pump (under food conditions) start wanting to act in reverse (they are basically "passive" pumps known to act equally well in reverse). By providing the 2e- necessary, these pumps will recreate NADH and FADH food energy and deplete some of the H+ gradient and recreate NADH or FADH. The other two pumps do not absorb light energy. CcO is blue in color like some bacteria as a result of the coppers that are absorbing blue's opposing color, red (and infrared).

The increased H+ gradient creates more ATP, and the reversed pumps create more NADH and FADH. This halts the krebs cycle which increases the available pyruvate and therefore glucose so that energy stores are increased for time periods longer than ATP.

Only in recent years has the functioning of CcO been understood well enough to show how it could be run in reverse.

Result number: 86

Message Number 206119

cytochrome c oxidase - best explanation for LED benefits View Thread
Posted by scott r on 8/02/06 at 21:11

In reviewing research on how the near-infrared works, the most quoted researcher mentions severals times that a large percentage of the light is absorbed by cytochrome c oxidase. I knew cytochrome c has something to do with ATP (energy production) in the cell, so it caught my eye. This is a serious contender for how this stuff works.

The wikipedia article below mentions that "CCO" (let's call it) helps convert O2 and 4H+ to water (which is a necessary step in many forms of energy production). In creating the water in the cell, energy is released (as in fuel cells) and it creates a potential energy gradient across the mitochondrial membrane that is then used to create ATP.

In our case, i propose that the near-infrared is helping CCO take O2 to create the potential energy in the mitochondrial membrane which is then used to create ATP. Our light energy is converted to potential energy in the membrane, which can be depleted slowly as the ATP is created over the course of hours following treatment. The additional source of ATP should help the cell maintain it's functions and have more energy to repair itself. A previously mentioned theory said the light is helping to remove H+ from the cell which helps create the ATP. This CCO activity may have been what they were talking about. The H+ is not actually removed from the cell, but it and O2 are used to make water (and i wonder if the extra water pressure reduces inflammation).

The are two theories that propose O2 is made more available for energy production. One proposes N2O is released which dialates blood vessels and the other proposes oxygenated hemoglobin is persuaded to release more O2. This CCO theory proposes instead that O2 is actually used up which may persuade hemoglobin to release more O2. Indeed, hemoglobin exhibits "cooperative binding" which means the less O2 in its surroundings, the more O2 it will release. The light may also directly initiate both activities: increased use of O2 and increased releas of O2. An article i found indicates most of the light energy is absorbed by CCO, oxygenated hemoglobin, and myoglobin. I do not have a theory as to how the myoglobin in muscle could be persuaded by the light to increase healing. Increased and lasting gene expression for collagen synthesis and antioxidant activity have all been observed at the cellular following a single short term dose of light. My theory is that the light increases the potential energy in the mitochondrial membrane that is slowly used by the cell over time. The effect should be directly proportional to the energy/cm^2 of light applied until the mitochondrial membrane has reached the maximum amount of potential energy it can store. The next light treatment should occur when the the potential energy has been somewhat depleted by the cell as the energy is used in gene expression to create new cells and collagen to hold the new cells together. Increased diet of protien (including lysine) and vitamin C should help encourage the cell and collagen (vitamin C and lysine are often the limiting ingredients in collagen if there is not a copper deficiency).

Note that Cyanide and CO are deadly because they block CCO's ability to use O2 to create H2O and the energy potential that produces ATP. Therefore it should be no surprise that light increasing the activity of CCO should increase the use of O2 to create ATP.

http://en.wikipedia.org/wiki/Cytochrome_c_oxidase

The following quote is key to several ideas. Note that the weak energy intensities are for the retina where cells are directly exposed to the light so that much higher intensities are neeeded for deep wounds (the strength of the light is greatly reduce as it travels into the tissue). Also not that there are several "optimum" wavelengths mentioned but the worst wavelength in the near infrared was only 20% less beneficial than the best wavelength indicating that full spectrum is perfectly valid and useful for ATP production from CCO.
================
"With respect to energy density, we are confident that treatment
at an energy density of 4 J/cm2 is within the optimal range. This confidence is based on a large body of evidence
from our studies and those of other investigators which documents that exposure to near-infrared light at energy
densities (fluence) between 2 – 10 J/cm2 promotes mitochondrial energy metabolism, cell division, wound
healing, protects against retinal damage and improves the recovery of retinal function in following retinal
damage by a mitochondrial poison and promotes retinal healing and improved visual function following high
intensity laser-induced retinal injury. With respect to LED wavelength, the majority of our studies have been
conducted using 670 nm LED light and we have substantial evidence that NIR-LED treatment at 670 nm is
beneficial both in vitro and in vivo. In studies investigating additional NIR wavelengths, we have shown that
the recovery of neuronal cytochrome oxidase activity and cellular ATP content correlates with the cytochrome
oxidase absorption spectrum (Figure 1). "

http://www.warp-heals.com/pdf/DARPA_Soldier_Self_Care.pdf

"Exposure to LED irradiation accelerated
the growth rate of fibroblasts and osteoblasts in culture for 2–3
days (growing phase), but showed no significant change in
growth rate for cells in culture at 4 days (stationary phase).
These data are important demonstrations of cell-to-cell contact
inhibition, which occurs in vitro once cell cultures approach
confluence. This is analogous, in vivo, to a healthy organism,
which will regenerate healing tissue, but stop further growth
when healing is complete. It is important to note that LED treatment
accelerates normal healing and tissue regeneration without
producing overgrowth or neoplastic transformation.
A series of experiments has recently been completed"

http://www.warp-heals.com/pdf/WoundHealing_JCLMS.pdf

Result number: 87

Message Number 205518

Re: surgery fo plantar fasciitis View Thread
Posted by Kathy G on 7/27/06 at 16:36


I have no experience, Megan, and I hope others do but I am troubled by what appears to be inadequate direction from your doctor. Have you thought of going for a second opinion? Of course, since insurance companies seem to run the world, you'll have to check if they'll cover it but it seems like it might be a good job.

I had surgery joint replacement done on my hand almost six weeks ago and my doctor has been with me every step of the way. You should have answers from your doctor.

If it is uncooperative nurses who won't let you through to talk to the doctor, just tell them you want to make an appointment and be firm about it. Sometimes, the nurses prevent patients from seeing the doctor when it's necessary. Most nurses are great but once in a while, you run into one who needs a little nudge.

I hope you get some better advice. Maybe try posting your question on the Doctors' Board?

I hope you're soon dancing!

Result number: 88

Message Number 204975

Re: MRI doesn't show PF, but Dr. doing surgery-3mo. follow-up View Thread
Posted by Gaylyn D. on 7/21/06 at 17:25

Recooperation went good. Once out of walking cast and stitches out I went into sandals. Now I don't know if I will be able to wear sandals or if there is something else wrong. The top of my foot (over my arch), outside of foot and arch area are very painful. Like bone pain. Maybe pain associated with something broken. I have never had anything broken, so really can't compare it to that. Just pain when I walk, especially after I have been sitting or standing a while. Also my arch feels swollen. Sounds crazy to me! Can anyone feel my pain?????? Thanks, Dimples

Result number: 89

Message Number 204439

Dems taking funds from questionable donors View Thread
Posted by larry m on 7/17/06 at 17:07

A New Alliance Of Democrats Spreads Funding
But Some in Party Bristle At Secrecy and Liberal Tilt

By Jim VandeHei and Chris Cillizza
Washington Post Staff Writers
Monday, July 17, 2006; A01



An alliance of nearly a hundred of the nation's wealthiest donors is roiling Democratic political circles, directing more than $50 million in the past nine months to liberal think tanks and advocacy groups in what organizers say is the first installment of a long-term campaign to compete more aggressively against conservatives.

A year after its founding, Democracy Alliance has followed up on its pledge to become a major power in the liberal movement. It has lavished millions on groups that have been willing to submit to its extensive screening process and its demands for secrecy.

These include the Center for American Progress, a think tank with an unabashed partisan edge, as well as Media Matters for America, which tracks what it sees as conservative bias in the news media. Several alliance donors are negotiating a major investment in Air America, a liberal talk-radio network.

But the large checks and demanding style wielded by Democracy Alliance organizers in recent months have caused unease among Washington's community of Democratic-linked organizations. The alliance has required organizations that receive its endorsement to sign agreements shielding the identity of donors. Public interest groups said the alliance represents a large source of undisclosed and unaccountable political influence.

Democracy Alliance also has left some Washington political activists concerned about what they perceive as a distinctly liberal tilt to the group's funding decisions. Some activists said they worry that the alliance's new clout may lead to groups with a more centrist ideology becoming starved for resources.

Democracy Alliance was formed last year with major backing from billionaires such as financier George Soros and Colorado software entrepreneur Tim Gill. The inspiration, according to founders, was a belief that Democrats became the minority party in part because liberals do not have a well-funded network of policy shops, watchdog groups and training centers for activists equivalent to what has existed for years on the right.

But the alliance's early months have been marked by occasional turmoil, according to several people who are now or have recently been affiliated with the group. Made up of billionaires and millionaires who are accustomed to calling the shots, the group at times has gotten bogged down in disputes about its funding priorities and mission, participants said.

Democracy Alliance organizers say early disagreements are first-year growing pains for an organization that has decades-long goals. Judy Wade, managing director of the alliance, said fewer than 10 percent of its initial donors have left, a figure she called lower than would be expected for a new venture. And she said the group's funding priorities are a work in progress, as organizers try to determine what will have the most influence in revitalizing what she called the "center-left" movement.

"Everything we invest in should have not just short-term impact but long-term impact and sustainability," she said. The group requires nondisclosure agreements because many donors prefer anonymity, Wade added. Some donors expressed concern about being attacked on the Web or elsewhere for their political stance; others did not want to be targeted by fundraisers.

"Like a lot of elite groups, we fly beneath the radar," said Guy Saperstein, an Oakland lawyer and alliance donor. But "we are not so stupid though," he said, to think "we can deny our existence."

This article is based on interviews with more than two dozen Democrats who are members of the alliance, recipients of their money or familiar with the group's operations. None would speak on the record about financial details, but all such details were confirmed by multiple sources.

Democracy Alliance works essentially as a cooperative for donors, allowing them to coordinate their giving so that it has more influence.

To become a "partner," as the members are referred to internally, requires a $25,000 entry fee and annual dues of $30,000 to cover alliance operations as well as some of its contributions to start-up liberal groups. Beyond this, partners also agree to spend at least $200,000 annually on organizations that have been endorsed by the alliance. Essentially, the alliance serves as an accreditation agency for political advocacy groups.

This accreditation process is the root of Democracy Alliance's influence. If a group does not receive the alliance's blessing, dozens of the nation's wealthiest political contributors as a practical matter become off-limits for fundraising purposes.

Many of these contributors give away far more than the $200,000 requirement. Soros, Gill and insurance magnate Peter Lewis are among the biggest contributors, but 45 percent of the 95 partners gave $300,000 or better in the initial round of grants last October, according to a source familiar with the organization.

Democracy Alliance organizers say they are trying to bring principles of accountability and capital investment that are common in business to the world of political advocacy, where they believe such principles have often been missing.

Wade declined to discuss the donors or the groups they fund. But, in an interview, she described how the groups were chosen. Alliance officials initially reviewed about 600 liberal and Democratic-leaning organizations. Then, about 40 of those groups were invited to apply for an endorsement -- with a requirement that they submit detailed business plans and internal financial information. Those groups were then screened by a panel of alliance staff members, donors and outside experts, including some with expertise in philanthropy rather than politics. So far, according to people familiar with the alliance, 25 groups have received its blessing.

The goal was to invest in groups that could be influential in building what activists call "political infrastructure" -- institutions that can support Democratic causes not simply in the next election but for years to come.

Those who make the cut have prospered. The Center for American Progress (CAP), which is led by former Clinton White House chief of staff John Podesta, received $5 million in the first round because it was seen as a liberal version of the Heritage Foundation, which blossomed as a conservative idea shop in the Reagan years, said one person closely familiar with alliance operations. CAP officials declined to comment.

Likewise, a Democracy Alliance blessing effectively jump-started Citizens for Responsibility and Ethics in Washington (CREW). It bills itself as a nonpartisan watchdog group committed to targeting "government officials who sacrifice the common good to special interests." Alliance officials see CREW as a possible counterweight to conservative-leaning Judicial Watch, which filed numerous lawsuits against Clinton administration officials in the 1990s. A CREW spokesman declined to comment.

The Center for Progressive Leadership and its president, Peter Murray, are getting funding from the alliance and are seen by some as a potential leader in training young activists on the left. While the center is still dwarfed by conservative groups such as the Leadership Institute, alliance donors have helped increase Murray's budget to $2.3 million, compared with $1 million one year ago, he said.

But Democracy Alliance's decisions not to back some prominent groups have stirred resentment. Among the groups that did not receive backing in early rounds were such well-known centrist groups as the Democratic Leadership Council and the Truman National Security Project.

Funding for these groups was "rejected purely because of their ideologies," said one Democrat familiar with internal Democracy Alliance funding discussions.

Officials with numerous policy and political groups in Washington said they have reservations about the group's influence. Several declined to talk on the record for fear of alienating a funding source.

But Matt Bennett, a vice president at Third Way, a centrist group that did not receive funding in the first wave of endorsements, said he believes that Democracy Alliance has merit. "It will enable progressives, for the first time ever, to build a permanent infrastructure to beat the conservative machine," he said.

Philanthropist David Friedman, an alliance partner and self-described centrist, said that "as our portfolio grows, we will fund a broader range of groups."

But some consider Democracy Alliance's hidden influence troubling, regardless of its ideological orientation. Unlike election campaigns, which must detail contributions and spending, most of the think tanks and not-for-profit groups funded by the alliance are exempt from public disclosure laws.

"It is a huge problem," said Sheila Krumholz, the acting executive director of the nonpartisan Center for Responsive Politics. She noted that for decades "all kinds of Democrats and liberals were complaining that corporations and individuals were carrying on these stealth campaigns to fund right-wing think tanks and advocacy groups. Just as it was then, it is a problem today."

The exclusive donor club includes millionaires such as Susie Tompkins Buell and her husband, Mark Buell, major backers of Sen. Hillary Rodham Clinton (D-N.Y.), and Chris Gabrieli, an investment banker running for the Democratic gubernatorial nomination in Massachusetts this September. Mark Buell estimated that about 70 percent of alliance partners built their own wealth, while 30 percent became wealthy through inheritances.

Bernard L. Schwartz, retired chief executive of Loral Space & Communications Inc. and an alliance donor, said the group offers partners "an array of opportunities that have passed their smell test." This is most helpful, he said, for big donors who lack the time to closely examine their political investment options.

Trial lawyer Fred Baron, a member of the alliance and longtime Democratic donor, agreed: "The piece that has always been lacking in our giving is long-term infrastructure investments."

There also are a few "institutional investors" such as the Service Employees International Union (SEIU) that pay a $50,000 annual fee and agree to spend $1 million on alliance-backed efforts.

Some Democratic political consultants privately fear that the sums being spent by alliance donors will mean less money spent on winning elections in 2006 and 2008.

But Rob Stein, co-founder of Democracy Alliance, said the party will become ascendant only if it thinks beyond the next election cycle.

Stein has closely studied the conservative movement -- often with envy. Armed with a PowerPoint presentation for potential donors, he argues that Republicans dominate the federal and many state governments because they methodically made investments in groups that could generate new ideas, shape public opinion, train conservative activists and elected officials, and boost voter turnout among conservatives -- aware that there was no near-term payoff. Liberals have done nothing comparable, he said.

"It is not possible in the 21st century to promote a coherent belief system and maintain political influence without a robust, enduring local, state and national institutional infrastructure," Stein said. "Currently, the center-left is comparatively less strategic, coordinated and well financed than the conservative-right. These comparative disadvantages are debilitating."

Result number: 90

Message Number 203402

How Bush Lied his way into Iraq and killed 2,500 americans View Thread
Posted by Scott R on 7/08/06 at 18:34

http://www.pbs.org/wgbh/pages/frontline/darkside/interviews/clarke.html

I think we knew prior to 9/11 that there was serious interest in having something happen with Iraq. People would joke around the water cooler in the West Wing Situation Room, that "We're flying all these planes over Iraq every day, blowing up their radar sites. Maybe ... they'll shoot one down, and that will give us the provocation we need to do war."

Beginning on the night of 9/11, we have the secretary of defense and others talking about going to war with Iraq. I think we knew pretty much that week that the probability of finding a justification for going to war with Iraq was high on their agenda.

The president, in fact, talks to you about it.

Well, the president wandered into the Situation Room, totally unscheduled, just to say, "Hi. Keep it up! Good work!"-- raise everybody's morale. [He] saw me and dragged me and a few others into the conference room and started talking about Iraq, and having me go through all the evidence that we had piled up from the weeks and months before to see if there was a connection between what had happened on 9/11 and Iraq.

And he said: "Saddam! Saddam! See if there's a connection to Saddam!" And this wasn't "See if there's a connection with Iran, and while you're at it, do Iraq, and while you're at it, do the Palestinian Islamic group." It wasn't "Do due diligence." It wasn't "Have an exhaustive review." It was "Saddam, Saddam." I read that pretty clearly, that that was the answer he wanted.

I said to him, "We have already done that research prior to the attack" -- in fact, we'd done it a couple of times -- "and there's nothing there." And the facial expression back was, "That wasn't the right answer."

So I said, "Well, but we will do it again." And we asked CIA to do it again. CIA did it again, came up with the same answer. That answer was written up and handed to the president by George Tenet in one of his morning meetings, and it said, "For the third or fourth time, we've gone back to look at the relationship between Al Qaeda and Iraq, and there is no real cooperation between those two."

Result number: 91

Message Number 203401

Re: intelligence and judgement View Thread
Posted by Scott R on 7/08/06 at 18:33

My statement about bush pushing the war and twisting intelligence to suit his needs is based on known facts, not emotion or hating bush. Maybe if you'd watch something other than FOX news, you'd know something about it. Just do a few internet searches. See the end of this post for an example. Now say you're sorry for doubting me and believing that Bush didn't make the Iraq connection up, or I might start calling you "larry, the hater of truth, justice, and the american way" unless you think lying your way into a war is the american way (uh...oops....i think that's what we just did).

Not that i "hate" fox news (lord knows people here seem to like making ASSUMPTIONS about me), honest to God it's my favorite channel. Everytime I turn there for more than a few seconds I can't stop laughing. They're entertaining, exciting, passionate, perpetually ignorant in their thought processes, and hilariously biased in their selection and treatment of 'guests'. Maybe it's the ego boost I get out of watching them bleat like goats gorging on emotion and patriotism. What more could you ask for in entertainment? They appeal to all sides for different reasons.

From Frontline, Wesley Clarke, Bush's own man:

=====================
I think we knew prior to 9/11 that there was serious interest in having something happen with Iraq. People would joke around the water cooler in the West Wing Situation Room, that "We're flying all these planes over Iraq every day, blowing up their radar sites. Maybe ... they'll shoot one down, and that will give us the provocation we need to do war."

Beginning on the night of 9/11, we have the secretary of defense and others talking about going to war with Iraq. I think we knew pretty much that week that the probability of finding a justification for going to war with Iraq was high on their agenda.

The president, in fact, talks to you about it.

Well, the president wandered into the Situation Room, totally unscheduled, just to say, "Hi. Keep it up! Good work!"-- raise everybody's morale. [He] saw me and dragged me and a few others into the conference room and started talking about Iraq, and having me go through all the evidence that we had piled up from the weeks and months before to see if there was a connection between what had happened on 9/11 and Iraq.

And he said: "Saddam! Saddam! See if there's a connection to Saddam!" And this wasn't "See if there's a connection with Iran, and while you're at it, do Iraq, and while you're at it, do the Palestinian Islamic group." It wasn't "Do due diligence." It wasn't "Have an exhaustive review." It was "Saddam, Saddam." I read that pretty clearly, that that was the answer he wanted.

I said to him, "We have already done that research prior to the attack" -- in fact, we'd done it a couple of times -- "and there's nothing there." And the facial expression back was, "That wasn't the right answer."

So I said, "Well, but we will do it again." And we asked CIA to do it again. CIA did it again, came up with the same answer. That answer was written up and handed to the president by George Tenet in one of his morning meetings, and it said, "For the third or fourth time, we've gone back to look at the relationship between Al Qaeda and Iraq, and there is no real cooperation between those two."

http://www.pbs.org/wgbh/pages/frontline/darkside/interviews/clarke.html

Result number: 92

Message Number 202908

Re: Why are Americans so angry? View Thread
Posted by marie on 7/03/06 at 19:57

Can't say i disagree with you one bit. People are just plain angry and they have reason to be.

HON. RON PAUL OF TEXAS
Before the U.S. House of Representatives

June 29, 2006

Why Are Americans So Angry?

I have been involved in politics for over 30 years and have never seen the American people so angry. It’s not unusual to sense a modest amount of outrage, but it seems the anger today is unusually intense and quite possibly worse than ever. It’s not easily explained, but I have some thoughts on this matter. Generally, anger and frustration among people are related to economic conditions; bread and butter issues. Yet today, according to government statistics, things are going well. We have low unemployment, low inflation, more homeowners than ever before, and abundant leisure with abundant luxuries. Even the poor have cell phones, televisions, and computers. Public school is free, and anyone can get free medical care at any emergency room in the country. Almost all taxes are paid by the top 50% of income earners. The lower 50% pay essentially no income taxes, yet general dissatisfaction and anger are commonplace. The old slogan “It’s the economy, stupid,” just doesn’t seem to explain things

Some say it’s the war, yet we’ve lived with war throughout the 20th century. The bigger they were the more we pulled together. And the current war, by comparison, has fewer American casualties than the rest. So it can’t just be the war itself.

People complain about corruption, but what’s new about government corruption? In the 19th century we had railroad scandals; in the 20th century we endured the Teapot Dome scandal, Watergate, Koreagate, and many others without too much anger and resentment. Yet today it seems anger is pervasive and worse than we’ve experienced in the past.

Could it be that war, vague yet persistent economic uncertainty, corruption, and the immigration problem all contribute to the anger we feel in America? Perhaps, but it’s almost as though people aren’t exactly sure why they are so uneasy. They only know that they’ve had it and aren’t going to put up with it anymore.

High gasoline prices make a lot of people angry, though there is little understanding of how deficits, inflation, and war in the Middle East all contribute to these higher prices.

Generally speaking, there are two controlling forces that determine the nature of government: the people’s concern for their economic self interests; and the philosophy of those who hold positions of power and influence in any particular government. Under Soviet Communism the workers believed their economic best interests were being served, while a few dedicated theoreticians placed themselves in positions of power. Likewise, the intellectual leaders of the American Revolution were few, but rallied the colonists to risk all to overthrow a tyrannical king.

Since there’s never a perfect understanding between these two forces, the people and the philosophical leaders, and because the motivations of the intellectual leaders vary greatly, any transition from one system of government to another is unpredictable. The communist takeover by Lenin was violent and costly; the demise of communism and the acceptance of a relatively open system in the former Soviet Union occurred in a miraculous manner. Both systems had intellectual underpinnings.

In the United States over the last century we have witnessed the coming and going of various intellectual influences by proponents of the free market, Keynesian welfarism, varieties of socialism, and supply-side economics. In foreign policy we’ve seen a transition from the founder’s vision of non-intervention in the affairs of others to internationalism, unilateral nation building, and policing the world. We now have in place a policy, driven by determined neo-conservatives, to promote American “goodness” and democracy throughout the world by military force-- with particular emphasis on remaking the Middle East.

We all know that ideas do have consequences. Bad ideas, even when supported naively by the people, will have bad results. Could it be the people sense, in a profound way, that the policies of recent decades are unworkable-- and thus they have instinctively lost confidence in their government leaders? This certainly happened in the final years of the Soviet system. Though not fully understood, this sense of frustration may well be the source of anger we hear expressed on a daily basis by so many.

No matter how noble the motivations of political leaders are, when they achieve positions of power the power itself inevitably becomes their driving force. Government officials too often yield to the temptations and corrupting influences of power.

But there are many others who are not bashful about using government power to do “good.” They truly believe they can make the economy fair through a redistributive tax and spending system; make the people moral by regulating personal behavior and choices; and remake the world in our image using armies. They argue that the use of force to achieve good is legitimate and proper for government-- always speaking of the noble goals while ignoring the inevitable failures and evils caused by coercion.

Not only do they justify government force, they believe they have a moral obligation to do so.

Once we concede government has this “legitimate” function and can be manipulated by a majority vote, the various special interests move in quickly. They gain control to direct government largesse for their own benefit. Too often it is corporate interests who learn how to manipulate every contract, regulation and tax policy. Likewise, promoters of the “progressive” agenda, always hostile to property rights, compete for government power through safety, health, and environmental initiatives. Both groups resort to using government power-- and abuse this power-- in an effort to serve their narrow interests. In the meantime, constitutional limits on power and its mandate to protect liberty are totally forgotten.

Since the use of power to achieve political ends is accepted, pervasive, and ever expanding, popular support for various programs is achieved by creating fear. Sometimes the fear is concocted out of thin air, but usually it’s created by wildly exaggerating a problem or incident that does not warrant the proposed government “solution.” Often government caused the problem in the first place. The irony, of course, is that government action rarely solves any problem, but rather worsens existing problems or creates altogether new ones.

Fear is generated to garner popular support for the proposed government action, even when some liberty has to be sacrificed. This leads to a society that is systemically driven toward fear-- fear that gives the monstrous government more and more authority and control over our lives and property.

Fear is constantly generated by politicians to rally the support of the people.

Environmentalists go back and forth, from warning about a coming ice age to arguing the grave dangers of global warming.

It is said that without an economic safety net-- for everyone, from cradle to grave-- people would starve and many would become homeless.

It is said that without government health care, the poor would not receive treatment. Medical care would be available only to the rich.

Without government insuring pensions, all private pensions would be threatened.

Without federal assistance, there would be no funds for public education, and the quality of our public schools would diminish-- ignoring recent history to the contrary.

It is argued that without government surveillance of every American, even without search warrants, security cannot be achieved. The sacrifice of some liberty is required for security of our citizens, they claim.

We are constantly told that the next terrorist attack could come at any moment. Rather than questioning why we might be attacked, this atmosphere of fear instead prompts giving up liberty and privacy. 9/11 has been conveniently used to generate the fear necessary to expand both our foreign intervention and domestic surveillance.

Fear of nuclear power is used to assure shortages and highly expensive energy.

In all instances where fear is generated and used to expand government control, it’s safe to say the problems behind the fears were not caused by the free market economy, or too much privacy, or excessive liberty.

It’s easy to generate fear, fear that too often becomes excessive, unrealistic, and difficult to curb. This is important: It leads to even more demands for government action than the perpetrators of the fear actually anticipated.

Once people look to government to alleviate their fears and make them safe, expectations exceed reality. FEMA originally had a small role, but its current mission is to centrally manage every natural disaster that befalls us. This mission was exposed as a fraud during last year’s hurricanes; incompetence and corruption are now FEMA’s legacy. This generates anger among those who have to pay the bills, and among those who didn’t receive the handouts promised to them quickly enough.

Generating exaggerated fear to justify and promote attacks on private property is commonplace. It serves to inflame resentment between the producers in society and the so-called victims, whose demands grow exponentially.

The economic impossibility of this system guarantees that the harder government tries to satisfy the unlimited demands, the worse the problems become. We won’t be able to pay the bills forever, and eventually our ability to borrow and print new money must end. This dependency on government will guarantee anger when the money runs out. Today we’re still able to borrow and inflate, but budgets are getting tighter and people sense serious problems lurking in the future. This fear is legitimate. No easy solution to our fiscal problems is readily apparent, and this ignites anger and apprehension.

Disenchantment is directed at the politicians and their false promises, made in order to secure reelection and exert power that so many of them enjoy.

It is, however, in foreign affairs that governments have most abused fear to generate support for an agenda that under normal circumstances would have been rejected. For decades our administrations have targeted one supposed “Hitler” after another to gain support for military action against a particular country. Today we have three choices termed the axis of evil: Iran, Iraq or North Korea.

We recently witnessed how unfounded fear was generated concerning Saddam Hussein’s weapons of mass destruction to justify our first ever pre-emptive war. It is now universally known the fear was based on falsehoods. And yet the war goes on; the death and destruction continue.

This is not a new phenomenon. General Douglas MacArthur understood the political use of fear when he made this famous statement:

“Always there has been some terrible evil at home or some monstrous foreign power that was going to gobble us up if we did not blindly rally behind it.”

We should be ever vigilant when we hear the fear mongers preparing us for the next military conflict our young men and women will be expected to fight. We’re being told of the great danger posed by Almadinejad in Iran and Kim Jung Il in North Korea. Even Russia and China bashing is in vogue again. And we’re still not able to trade with or travel to Cuba. A constant enemy is required to expand the state. More and more news stories blame Iran for the bad results in Iraq. Does this mean Iran is next on the hit list?

The world is much too dangerous, we’re told, and therefore we must be prepared to fight at a moment’s notice, regardless of the cost. If the public could not be manipulated by politicians’ efforts to instill needless fear, fewer wars would be fought and far fewer lives would be lost.



Fear and Anger over Iraq

Though the American people are fed up for a lot of legitimate reasons, almost all polls show the mess in Iraq leads the list of why the anger is so intense.

Short wars, with well-defined victories, are tolerated by the American people even when they are misled as to the reasons for the war. Wars entered into without a proper declaration tend to be politically motivated and not for national security reasons. These wars, by their very nature, are prolonged, costly, and usually require a new administration to finally end them. This certainly was true with the Korean and Vietnam wars. The lack of a quick military success, the loss of life and limb, and the huge economic costs of lengthy wars precipitate anger. This is overwhelmingly true when the war propaganda that stirred up illegitimate fears is exposed as a fraud. Most soon come to realize the promise of guns and butter is an illusion. They come to understand that inflation, a weak economy, and a prolonged war without real success are the reality.

The anger over the Iraq war is multifaceted. Some are angry believing they were lied to in order to gain their support at the beginning. Others are angry that the forty billion dollars we spend every year on intelligence gathering failed to provide good information. Proponents of the war too often are unable to admit the truth. They become frustrated with the progress of the war and then turn on those wanting to change course, angrily denouncing them as unpatriotic and un-American.

Those accused are quick to respond to the insulting charges made by those who want to fight on forever without regard to casualties. Proponents of the war do not hesitate to challenge the manhood of war critics, accusing them of wanting to cut and run. Some war supporters ducked military service themselves while others fought and died, only adding to the anger of those who have seen battle up close and now question our campaign in Iraq.

When people see a $600 million embassy being built in Baghdad, while funding for services here in the United States is hard to obtain, they become angry. They can’t understand why the money is being spent, especially when they are told by our government that we have no intention of remaining permanently in Iraq.

The bickering and anger will not subside soon, since victory in Iraq is not on the horizon and a change in policy is not likely either.

The neoconservative instigators of the war are angry at everyone: at the people who want to get out of Iraq; and especially at those prosecuting the war for not bombing more aggressively, sending in more troops, and expanding the war into Iran.

As our country becomes poorer due to the cost of the war, anger surely will escalate. Much of it will be justified.

It seems bizarre that it’s so unthinkable to change course if the current policy is failing. Our leaders are like a physician who makes a wrong diagnosis and prescribes the wrong medicine, but because of his ego can’t tell the patient he made a mistake. Instead he hopes the patient will get better on his own. But instead of improving, the patient gets worse from the medication wrongly prescribed. This would be abhorrent behavior in medicine, but tragically it is commonplace in politics.

If the truth is admitted, it would appear that the lives lost and the money spent have been in vain. Instead, more casualties must be sustained to prove a false premise. What a tragedy! If the truth is admitted, imagine the anger of all the families that already have suffered such a burden. That burden is softened when the families and the wounded are told their great sacrifice was worthy, and required to preserve our freedoms and our Constitution.

But no one is allowed to ask the obvious. How have the 2,500 plus deaths, and the 18,500 wounded, made us more free? What in the world does Iraq have to do with protecting our civil liberties here at home? What national security threat prompted America’s first pre-emptive war? How does our unilateral enforcement of UN resolutions enhance our freedoms?

These questions aren’t permitted. They are not politically correct. I agree that the truth hurts, and these questions are terribly hurtful to the families that have suffered so much. What a horrible thought it would be to find out the cause for which we fight is not quite so noble.

I don’t believe those who hide from the truth and refuse to face the reality of the war do so deliberately. The pain is too great. Deep down, psychologically, many are incapable of admitting such a costly and emotionally damaging error. They instead become even greater and more determined supporters of the failed policy.

I would concede that there are some-- especially the die-hard neoconservatives, who believe it is our moral duty to spread American goodness through force and remake the Middle East-- who neither suffer regrets nor are bothered by the casualties. They continue to argue for more war without remorse, as long as they themselves do not have to fight. Criticism is reserved for the wimps who want to “cut and run.”

Due to the psychological need to persist with the failed policy, the war proponents must remain in denial of many facts staring them in the face.

They refuse to accept that the real reason for our invasion and occupation of Iraq was not related to terrorism.

They deny that our military is weaker as a consequence of this war.

They won’t admit that our invasion has served the interests of Osama Bin Laden. They continue to blame our image problems around the world on a few bad apples.

They won’t admit that our invasion has served the interests of Iran’s radical regime.

The cost in lives lost and dollars spent is glossed over, and the deficit spirals up without concern.

They ridicule those who point out that our relationships with our allies have been significantly damaged.

We have provided a tremendous incentive for Russia and China, and others like Iran, to organize through the Shanghai Cooperation Organization. They entertain future challenges to our plans to dominate South East Asia, the Middle East, and all its oil.

Radicalizing the Middle East will in the long term jeopardize Israel’s security, and increase the odds of this war spreading.

War supporters cannot see that for every Iraqi killed, another family turns on us-- regardless of who did the killing. We are and will continue to be blamed for every wrong done in Iraq: all deaths, illness, water problems, food shortages, and electricity outages.

As long as our political leaders persist in these denials, the war won’t end. The problem is that this is the source of the anger, because the American people are not in denial and want a change in policy.

Policy changes in wartime are difficult, for it is almost impossible for the administration to change course since so much emotional energy has been invested in the effort. That’s why Eisenhower ended the Korean War, and not Truman. That’s why Nixon ended the Vietnam War, and not LBJ. Even in the case of Vietnam the end was too slow and costly, as more then 30,000 military deaths came after Nixon’s election in 1968. It makes a lot more sense to avoid unnecessary wars than to overcome the politics involved in stopping them once started. I personally am convinced that many of our wars could be prevented by paying stricter attention to the method whereby our troops are committed to battle. I also am convinced that when Congress does not declare war, victory is unlikely.

The most important thing Congress can do to prevent needless and foolish wars is for every member to take seriously his or her oath to obey the Constitution. Wars should be entered into only after great deliberation and caution. Wars that are declared by Congress should reflect the support of the people, and the goal should be a quick and successful resolution.

Our undeclared wars over the past 65 years have dragged on without precise victories. We fight to spread American values, to enforce UN resolutions, and to slay supposed Hitlers. We forget that we once spread American values by persuasion and setting an example-- not by bombs and preemptive invasions. Nowhere in the Constitution are we permitted to go to war on behalf of the United Nations at the sacrifice of our national sovereignty. We repeatedly use military force against former allies, thugs we helped empower—like Saddam Hussein and Osama bin Laden—even when they pose no danger to us.

The 2002 resolution allowing the president to decide when and if to invade Iraq is an embarrassment. The Constitution authorizes only Congress to declare war. Our refusal to declare war transferred power to the president illegally, without a constitutional amendment. Congress did this with a simple resolution, passed by majority vote. This means Congress reneged on its responsibility as a separate branch of government, and should be held accountable for the bad policy in Iraq that the majority of Americans are now upset about. Congress is every bit as much at fault as the president.

Constitutional questions aside, the American people should have demanded more answers from their government before they supported the invasion and occupation of a foreign country.

Some of the strongest supporters of the war declare that we are a Christian nation, yet use their religious beliefs to justify the war. They claim it is our Christian duty to remake the Middle East and attack the Muslim infidels. Evidently I have been reading from a different Bible. I remember something about “Blessed are the peacemakers.”

My beliefs aside, Christian teaching of nearly a thousand years reinforces the concept of “The Just War Theory.” This Christian theory emphasizes six criteria needed to justify Christian participation in war. Briefly the six points are as follows:

1. War should be fought only in self defense;
2. War should be undertaken only as a last resort;
3. A decision to enter war should be made only by a legitimate authority;
4. All military responses must be proportional to the threat;
5. There must be a reasonable chance of success; and
6. A public declaration notifying all parties concerned is required.

The war in Iraq fails to meet almost all of these requirements. This discrepancy has generated anger and division within the Christian community.

Some are angry because the war is being fought out of Christian duty, yet does not have uniform support from all Christians. Others are angry because they see Christianity as a religion as peace and forgiveness, not war and annihilation of enemies.

Constitutional and moral restraints on war should be strictly followed. It is understandable when kings, dictators, and tyrants take their people into war, since it serves their selfish interests-- and those sent to fight have no say in the matter. It is more difficult to understand why democracies and democratic legislative bodies, which have a say over the issue of war, so readily submit to the executive branch of government. The determined effort of the authors of our Constitution to firmly place the power to declare war in the legislative branch has been ignored in the decades following WWII.

Many members have confided in me that they are quite comfortable with this arrangement. They flatly do not expect, in this modern age, to formally declare war ever again. Yet no one predicts there will be fewer wars fought. It is instead assumed they will be ordered by the executive branch or the United Nations-- a rather sad commentary.

What about the practical arguments against war, since no one seems interested in exerting constitutional or moral restraints? Why do we continue to fight prolonged, political wars when the practical results are so bad? Our undeclared wars since 1945 have been very costly, to put it mildly. We have suffered over one hundred thousand military deaths, and even more serious casualties. Tens of thousands have suffered from serious war-related illnesses. Sadly, we as a nation express essentially no concern for the millions of civilian casualties in the countries where we fought.

The cost of war since 1945, and our military presence in over 100 countries, exceeds two trillion dollars in today’s dollars. The cost in higher taxes, debt, and persistent inflation is immeasurable. Likewise, the economic opportunities lost by diverting trillions of dollars into war is impossible to measure, but it is huge. Yet our presidents persist in picking fights with countries that pose no threat to us, refusing to participate in true diplomacy to resolve differences. Congress over the decades has never resisted the political pressures to send our troops abroad on missions that defy imagination.

When the people object to a new adventure, the propaganda machine goes into action to make sure critics are seen as unpatriotic Americans or even traitors.

The military-industrial complex we were warned about has been transformed into a military-media-industrial-government complex that is capable of silencing the dissenters and cheerleading for war. It’s only after years of failure that people are able to overcome the propaganda for war and pressure their representatives in Congress to stop the needless killing. Many times the economic costs of war stir people to demand an end. This time around the war might be brought to a halt by our actual inability to pay the bills due to a dollar crisis. A dollar crisis will make borrowing 2.5 billion dollars per day from foreign powers like China and Japan virtually impossible, at least at affordable interest rates.

That’s when we will be forced to reassess the spending spree, both at home and abroad.

The solution to this mess is not complicated; but the changes needed are nearly impossible for political reasons. Sound free market economics, sound money, and a sensible foreign policy would all result from strict adherence to the Constitution. If the people desired it, and Congress was filled with responsible members, a smooth although challenging transition could be achieved. Since this is unlikely, we can only hope that the rule of law and the goal of liberty can be reestablished without chaos.

We must move quickly toward a more traditional American foreign policy of peace, friendship, and trade with all nations; entangling alliances with none. We must reject the notion that we can or should make the world safe for democracy. We must forget about being the world’s policeman. We should disengage from the unworkable and unforgiving task of nation building. We must reject the notion that our military should be used to protect natural resources, private investments, or serve the interest of any foreign government or the United Nations. Our military should be designed for one purpose: defending our national security. It’s time to come home now, before financial conditions or military weakness dictates it.

The major obstacle to a sensible foreign policy is the fiction about what patriotism means. Today patriotism has come to mean blind support for the government and its policies. In earlier times patriotism meant having the willingness and courage to challenge government policies regardless of popular perceptions.

Today we constantly hear innuendos and direct insults aimed at those who dare to challenge current foreign policy, no matter how flawed that policy may be. I would suggest it takes more courage to admit the truth, to admit mistakes, than to attack others as unpatriotic for disagreeing with the war in Iraq.

Remember, the original American patriots challenged the abuses of King George, and wrote and carried out the Declaration of Independence.

Yes Mr. Speaker, there is a lot of anger in this country. Much of it is justified; some of it is totally unnecessary and misdirected. The only thing that can lessen this anger is an informed public, a better understanding of economic principles, a rejection of foreign intervention, and a strict adherence to the constitutional rule of law. This will be difficult to achieve, but it’s not impossible and well worth the effort.

Result number: 93

Message Number 202898

Rep. Ron Paul (R) Texas Why are Americans So Angry? View Thread
Posted by marie on 7/03/06 at 18:44

It's fine. Scott is expressing a viewpoint that differs from many posters here. On oil from a Texan and a Republican at that.

http://www.house.gov/paul/congrec/congrec2006/cr021506.htm

HON. RON PAUL OF TEXAS
Before the U.S. House of Representatives

February 15, 2006


The End of Dollar Hegemony

A hundred years ago it was called “dollar diplomacy.” After World War II, and especially after the fall of the Soviet Union in 1989, that policy evolved into “dollar hegemony.” But after all these many years of great success, our dollar dominance is coming to an end.

It has been said, rightly, that he who holds the gold makes the rules. In earlier times it was readily accepted that fair and honest trade required an exchange for something of real value.

First it was simply barter of goods. Then it was discovered that gold held a universal attraction, and was a convenient substitute for more cumbersome barter transactions. Not only did gold facilitate exchange of goods and services, it served as a store of value for those who wanted to save for a rainy day.

Though money developed naturally in the marketplace, as governments grew in power they assumed monopoly control over money. Sometimes governments succeeded in guaranteeing the quality and purity of gold, but in time governments learned to outspend their revenues. New or higher taxes always incurred the disapproval of the people, so it wasn’t long before Kings and Caesars learned how to inflate their currencies by reducing the amount of gold in each coin-- always hoping their subjects wouldn’t discover the fraud. But the people always did, and they strenuously objected.

This helped pressure leaders to seek more gold by conquering other nations. The people became accustomed to living beyond their means, and enjoyed the circuses and bread. Financing extravagances by conquering foreign lands seemed a logical alternative to working harder and producing more. Besides, conquering nations not only brought home gold, they brought home slaves as well. Taxing the people in conquered territories also provided an incentive to build empires. This system of government worked well for a while, but the moral decline of the people led to an unwillingness to produce for themselves. There was a limit to the number of countries that could be sacked for their wealth, and this always brought empires to an end. When gold no longer could be obtained, their military might crumbled. In those days those who held the gold truly wrote the rules and lived well.

That general rule has held fast throughout the ages. When gold was used, and the rules protected honest commerce, productive nations thrived. Whenever wealthy nations-- those with powerful armies and gold-- strived only for empire and easy fortunes to support welfare at home, those nations failed.

Today the principles are the same, but the process is quite different. Gold no longer is the currency of the realm; paper is. The truth now is: “He who prints the money makes the rules”-- at least for the time being. Although gold is not used, the goals are the same: compel foreign countries to produce and subsidize the country with military superiority and control over the monetary printing presses.

Since printing paper money is nothing short of counterfeiting, the issuer of the international currency must always be the country with the military might to guarantee control over the system. This magnificent scheme seems the perfect system for obtaining perpetual wealth for the country that issues the de facto world currency. The one problem, however, is that such a system destroys the character of the counterfeiting nation’s people-- just as was the case when gold was the currency and it was obtained by conquering other nations. And this destroys the incentive to save and produce, while encouraging debt and runaway welfare.

The pressure at home to inflate the currency comes from the corporate welfare recipients, as well as those who demand handouts as compensation for their needs and perceived injuries by others. In both cases personal responsibility for one’s actions is rejected.

When paper money is rejected, or when gold runs out, wealth and political stability are lost. The country then must go from living beyond its means to living beneath its means, until the economic and political systems adjust to the new rules-- rules no longer written by those who ran the now defunct printing press.

“Dollar Diplomacy,” a policy instituted by William Howard Taft and his Secretary of State Philander C. Knox, was designed to enhance U.S. commercial investments in Latin America and the Far East. McKinley concocted a war against Spain in 1898, and (Teddy) Roosevelt’s corollary to the Monroe Doctrine preceded Taft’s aggressive approach to using the U.S. dollar and diplomatic influence to secure U.S. investments abroad. This earned the popular title of “Dollar Diplomacy.” The significance of Roosevelt’s change was that our intervention now could be justified by the mere “appearance” that a country of interest to us was politically or fiscally vulnerable to European control. Not only did we claim a right, but even an official U.S. government “obligation” to protect our commercial interests from Europeans.

This new policy came on the heels of the “gunboat” diplomacy of the late 19th century, and it meant we could buy influence before resorting to the threat of force. By the time the “dollar diplomacy” of William Howard Taft was clearly articulated, the seeds of American empire were planted. And they were destined to grow in the fertile political soil of a country that lost its love and respect for the republic bequeathed to us by the authors of the Constitution. And indeed they did. It wasn’t too long before dollar “diplomacy” became dollar “hegemony” in the second half of the 20th century.

This transition only could have occurred with a dramatic change in monetary policy and the nature of the dollar itself.

Congress created the Federal Reserve System in 1913. Between then and 1971 the principle of sound money was systematically undermined. Between 1913 and 1971, the Federal Reserve found it much easier to expand the money supply at will for financing war or manipulating the economy with little resistance from Congress-- while benefiting the special interests that influence government.

Dollar dominance got a huge boost after World War II. We were spared the destruction that so many other nations suffered, and our coffers were filled with the world’s gold. But the world chose not to return to the discipline of the gold standard, and the politicians applauded. Printing money to pay the bills was a lot more popular than taxing or restraining unnecessary spending. In spite of the short-term benefits, imbalances were institutionalized for decades to come.

The 1944 Bretton Woods agreement solidified the dollar as the preeminent world reserve currency, replacing the British pound. Due to our political and military muscle, and because we had a huge amount of physical gold, the world readily accepted our dollar (defined as 1/35th of an ounce of gold) as the world’s reserve currency. The dollar was said to be “as good as gold,” and convertible to all foreign central banks at that rate. For American citizens, however, it remained illegal to own. This was a gold-exchange standard that from inception was doomed to fail.

The U.S. did exactly what many predicted she would do. She printed more dollars for which there was no gold backing. But the world was content to accept those dollars for more than 25 years with little question-- until the French and others in the late 1960s demanded we fulfill our promise to pay one ounce of gold for each $35 they delivered to the U.S. Treasury. This resulted in a huge gold drain that brought an end to a very poorly devised pseudo-gold standard.

It all ended on August 15, 1971, when Nixon closed the gold window and refused to pay out any of our remaining 280 million ounces of gold. In essence, we declared our insolvency and everyone recognized some other monetary system had to be devised in order to bring stability to the markets.

Amazingly, a new system was devised which allowed the U.S. to operate the printing presses for the world reserve currency with no restraints placed on it-- not even a pretense of gold convertibility, none whatsoever! Though the new policy was even more deeply flawed, it nevertheless opened the door for dollar hegemony to spread.

Realizing the world was embarking on something new and mind boggling, elite money managers, with especially strong support from U.S. authorities, struck an agreement with OPEC to price oil in U.S. dollars exclusively for all worldwide transactions. This gave the dollar a special place among world currencies and in essence “backed” the dollar with oil. In return, the U.S. promised to protect the various oil-rich kingdoms in the Persian Gulf against threat of invasion or domestic coup. This arrangement helped ignite the radical Islamic movement among those who resented our influence in the region. The arrangement gave the dollar artificial strength, with tremendous financial benefits for the United States. It allowed us to export our monetary inflation by buying oil and other goods at a great discount as dollar influence flourished.

This post-Bretton Woods system was much more fragile than the system that existed between 1945 and 1971. Though the dollar/oil arrangement was helpful, it was not nearly as stable as the pseudo gold standard under Bretton Woods. It certainly was less stable than the gold standard of the late 19th century.

During the 1970s the dollar nearly collapsed, as oil prices surged and gold skyrocketed to $800 an ounce. By 1979 interest rates of 21% were required to rescue the system. The pressure on the dollar in the 1970s, in spite of the benefits accrued to it, reflected reckless budget deficits and monetary inflation during the 1960s. The markets were not fooled by LBJ’s claim that we could afford both “guns and butter.”

Once again the dollar was rescued, and this ushered in the age of true dollar hegemony lasting from the early 1980s to the present. With tremendous cooperation coming from the central banks and international commercial banks, the dollar was accepted as if it were gold.

Fed Chair Alan Greenspan, on several occasions before the House Banking Committee, answered my challenges to him about his previously held favorable views on gold by claiming that he and other central bankers had gotten paper money-- i.e. the dollar system-- to respond as if it were gold. Each time I strongly disagreed, and pointed out that if they had achieved such a feat they would have defied centuries of economic history regarding the need for money to be something of real value. He smugly and confidently concurred with this.

In recent years central banks and various financial institutions, all with vested interests in maintaining a workable fiat dollar standard, were not secretive about selling and loaning large amounts of gold to the market even while decreasing gold prices raised serious questions about the wisdom of such a policy. They never admitted to gold price fixing, but the evidence is abundant that they believed if the gold price fell it would convey a sense of confidence to the market, confidence that they indeed had achieved amazing success in turning paper into gold.

Increasing gold prices historically are viewed as an indicator of distrust in paper currency. This recent effort was not a whole lot different than the U.S. Treasury selling gold at $35 an ounce in the 1960s, in an attempt to convince the world the dollar was sound and as good as gold. Even during the Depression, one of Roosevelt’s first acts was to remove free market gold pricing as an indication of a flawed monetary system by making it illegal for American citizens to own gold. Economic law eventually limited that effort, as it did in the early 1970s when our Treasury and the IMF tried to fix the price of gold by dumping tons into the market to dampen the enthusiasm of those seeking a safe haven for a falling dollar after gold ownership was re-legalized.

Once again the effort between 1980 and 2000 to fool the market as to the true value of the dollar proved unsuccessful. In the past 5 years the dollar has been devalued in terms of gold by more than 50%. You just can’t fool all the people all the time, even with the power of the mighty printing press and money creating system of the Federal Reserve.

Even with all the shortcomings of the fiat monetary system, dollar influence thrived. The results seemed beneficial, but gross distortions built into the system remained. And true to form, Washington politicians are only too anxious to solve the problems cropping up with window dressing, while failing to understand and deal with the underlying flawed policy. Protectionism, fixing exchange rates, punitive tariffs, politically motivated sanctions, corporate subsidies, international trade management, price controls, interest rate and wage controls, super-nationalist sentiments, threats of force, and even war are resorted to—all to solve the problems artificially created by deeply flawed monetary and economic systems.

In the short run, the issuer of a fiat reserve currency can accrue great economic benefits. In the long run, it poses a threat to the country issuing the world currency. In this case that’s the United States. As long as foreign countries take our dollars in return for real goods, we come out ahead. This is a benefit many in Congress fail to recognize, as they bash China for maintaining a positive trade balance with us. But this leads to a loss of manufacturing jobs to overseas markets, as we become more dependent on others and less self-sufficient. Foreign countries accumulate our dollars due to their high savings rates, and graciously loan them back to us at low interest rates to finance our excessive consumption.

It sounds like a great deal for everyone, except the time will come when our dollars-- due to their depreciation-- will be received less enthusiastically or even be rejected by foreign countries. That could create a whole new ballgame and force us to pay a price for living beyond our means and our production. The shift in sentiment regarding the dollar has already started, but the worst is yet to come.

The agreement with OPEC in the 1970s to price oil in dollars has provided tremendous artificial strength to the dollar as the preeminent reserve currency. This has created a universal demand for the dollar, and soaks up the huge number of new dollars generated each year. Last year alone M3 increased over $700 billion.

The artificial demand for our dollar, along with our military might, places us in the unique position to “rule” the world without productive work or savings, and without limits on consumer spending or deficits. The problem is, it can’t last.

Price inflation is raising its ugly head, and the NASDAQ bubble-- generated by easy money-- has burst. The housing bubble likewise created is deflating. Gold prices have doubled, and federal spending is out of sight with zero political will to rein it in. The trade deficit last year was over $728 billion. A $2 trillion war is raging, and plans are being laid to expand the war into Iran and possibly Syria. The only restraining force will be the world’s rejection of the dollar. It’s bound to come and create conditions worse than 1979-1980, which required 21% interest rates to correct. But everything possible will be done to protect the dollar in the meantime. We have a shared interest with those who hold our dollars to keep the whole charade going.

Greenspan, in his first speech after leaving the Fed, said that gold prices were up because of concern about terrorism, and not because of monetary concerns or because he created too many dollars during his tenure. Gold has to be discredited and the dollar propped up. Even when the dollar comes under serious attack by market forces, the central banks and the IMF surely will do everything conceivable to soak up the dollars in hope of restoring stability. Eventually they will fail.

Most importantly, the dollar/oil relationship has to be maintained to keep the dollar as a preeminent currency. Any attack on this relationship will be forcefully challenged—as it already has been.

In November 2000 Saddam Hussein demanded Euros for his oil. His arrogance was a threat to the dollar; his lack of any military might was never a threat. At the first cabinet meeting with the new administration in 2001, as reported by Treasury Secretary Paul O’Neill, the major topic was how we would get rid of Saddam Hussein-- though there was no evidence whatsoever he posed a threat to us. This deep concern for Saddam Hussein surprised and shocked O’Neill.

It now is common knowledge that the immediate reaction of the administration after 9/11 revolved around how they could connect Saddam Hussein to the attacks, to justify an invasion and overthrow of his government. Even with no evidence of any connection to 9/11, or evidence of weapons of mass destruction, public and congressional support was generated through distortions and flat out misrepresentation of the facts to justify overthrowing Saddam Hussein.

There was no public talk of removing Saddam Hussein because of his attack on the integrity of the dollar as a reserve currency by selling oil in Euros. Many believe this was the real reason for our obsession with Iraq. I doubt it was the only reason, but it may well have played a significant role in our motivation to wage war. Within a very short period after the military victory, all Iraqi oil sales were carried out in dollars. The Euro was abandoned.

In 2001, Venezuela’s ambassador to Russia spoke of Venezuela switching to the Euro for all their oil sales. Within a year there was a coup attempt against Chavez, reportedly with assistance from our CIA.

After these attempts to nudge the Euro toward replacing the dollar as the world’s reserve currency were met with resistance, the sharp fall of the dollar against the Euro was reversed. These events may well have played a significant role in maintaining dollar dominance.

It’s become clear the U.S. administration was sympathetic to those who plotted the overthrow of Chavez, and was embarrassed by its failure. The fact that Chavez was democratically elected had little influence on which side we supported.

Now, a new attempt is being made against the petrodollar system. Iran, another member of the “axis of evil,” has announced her plans to initiate an oil bourse in March of this year. Guess what, the oil sales will be priced Euros, not dollars.

Most Americans forget how our policies have systematically and needlessly antagonized the Iranians over the years. In 1953 the CIA helped overthrow a democratically elected president, Mohammed Mossadeqh, and install the authoritarian Shah, who was friendly to the U.S. The Iranians were still fuming over this when the hostages were seized in 1979. Our alliance with Saddam Hussein in his invasion of Iran in the early 1980s did not help matters, and obviously did not do much for our relationship with Saddam Hussein. The administration announcement in 2001 that Iran was part of the axis of evil didn’t do much to improve the diplomatic relationship between our two countries. Recent threats over nuclear power, while ignoring the fact that they are surrounded by countries with nuclear weapons, doesn’t seem to register with those who continue to provoke Iran. With what most Muslims perceive as our war against Islam, and this recent history, there’s little wonder why Iran might choose to harm America by undermining the dollar. Iran, like Iraq, has zero capability to attack us. But that didn’t stop us from turning Saddam Hussein into a modern day Hitler ready to take over the world. Now Iran, especially since she’s made plans for pricing oil in Euros, has been on the receiving end of a propaganda war not unlike that waged against Iraq before our invasion.

It’s not likely that maintaining dollar supremacy was the only motivating factor for the war against Iraq, nor for agitating against Iran. Though the real reasons for going to war are complex, we now know the reasons given before the war started, like the presence of weapons of mass destruction and Saddam Hussein’s connection to 9/11, were false. The dollar’s importance is obvious, but this does not diminish the influence of the distinct plans laid out years ago by the neo-conservatives to remake the Middle East. Israel’s influence, as well as that of the Christian Zionists, likewise played a role in prosecuting this war. Protecting “our” oil supplies has influenced our Middle East policy for decades.

But the truth is that paying the bills for this aggressive intervention is impossible the old fashioned way, with more taxes, more savings, and more production by the American people. Much of the expense of the Persian Gulf War in 1991 was shouldered by many of our willing allies. That’s not so today. Now, more than ever, the dollar hegemony-- it’s dominance as the world reserve currency-- is required to finance our huge war expenditures. This $2 trillion never-ending war must be paid for, one way or another. Dollar hegemony provides the vehicle to do just that.

For the most part the true victims aren’t aware of how they pay the bills. The license to create money out of thin air allows the bills to be paid through price inflation. American citizens, as well as average citizens of Japan, China, and other countries suffer from price inflation, which represents the “tax” that pays the bills for our military adventures. That is until the fraud is discovered, and the foreign producers decide not to take dollars nor hold them very long in payment for their goods. Everything possible is done to prevent the fraud of the monetary system from being exposed to the masses who suffer from it. If oil markets replace dollars with Euros, it would in time curtail our ability to continue to print, without restraint, the world’s reserve currency.

It is an unbelievable benefit to us to import valuable goods and export depreciating dollars. The exporting countries have become addicted to our purchases for their economic growth. This dependency makes them allies in continuing the fraud, and their participation keeps the dollar’s value artificially high. If this system were workable long term, American citizens would never have to work again. We too could enjoy “bread and circuses” just as the Romans did, but their gold finally ran out and the inability of Rome to continue to plunder conquered nations brought an end to her empire.

The same thing will happen to us if we don’t change our ways. Though we don’t occupy foreign countries to directly plunder, we nevertheless have spread our troops across 130 nations of the world. Our intense effort to spread our power in the oil-rich Middle East is not a coincidence. But unlike the old days, we don’t declare direct ownership of the natural resources-- we just insist that we can buy what we want and pay for it with our paper money. Any country that challenges our authority does so at great risk.

Once again Congress has bought into the war propaganda against Iran, just as it did against Iraq. Arguments are now made for attacking Iran economically, and militarily if necessary. These arguments are all based on the same false reasons given for the ill-fated and costly occupation of Iraq.

Our whole economic system depends on continuing the current monetary arrangement, which means recycling the dollar is crucial. Currently, we borrow over $700 billion every year from our gracious benefactors, who work hard and take our paper for their goods. Then we borrow all the money we need to secure the empire (DOD budget $450 billion) plus more. The military might we enjoy becomes the “backing” of our currency. There are no other countries that can challenge our military superiority, and therefore they have little choice but to accept the dollars we declare are today’s “gold.” This is why countries that challenge the system-- like Iraq, Iran and Venezuela-- become targets of our plans for regime change.

Ironically, dollar superiority depends on our strong military, and our strong military depends on the dollar. As long as foreign recipients take our dollars for real goods and are willing to finance our extravagant consumption and militarism, the status quo will continue regardless of how huge our foreign debt and current account deficit become.

But real threats come from our political adversaries who are incapable of confronting us militarily, yet are not bashful about confronting us economically. That’s why we see the new challenge from Iran being taken so seriously. The urgent arguments about Iran posing a military threat to the security of the United States are no more plausible than the false charges levied against Iraq. Yet there is no effort to resist this march to confrontation by those who grandstand for political reasons against the Iraq war.

It seems that the people and Congress are easily persuaded by the jingoism of the preemptive war promoters. It’s only after the cost in human life and dollars are tallied up that the people object to unwise militarism.

The strange thing is that the failure in Iraq is now apparent to a large majority of American people, yet they and Congress are acquiescing to the call for a needless and dangerous confrontation with Iran.

But then again, our failure to find Osama bin Laden and destroy his network did not dissuade us from taking on the Iraqis in a war totally unrelated to 9/11.

Concern for pricing oil only in dollars helps explain our willingness to drop everything and teach Saddam Hussein a lesson for his defiance in demanding Euros for oil.

And once again there’s this urgent call for sanctions and threats of force against Iran at the precise time Iran is opening a new oil exchange with all transactions in Euros.

Using force to compel people to accept money without real value can only work in the short run. It ultimately leads to economic dislocation, both domestic and international, and always ends with a price to be paid.

The economic law that honest exchange demands only things of real value as currency cannot be repealed. The chaos that one day will ensue from our 35-year experiment with worldwide fiat money will require a return to money of real value. We will know that day is approaching when oil-producing countries demand gold, or its equivalent, for their oil rather than dollars or Euros. The sooner the better.

http://www.house.gov/paul/index.shtml

Result number: 94

Message Number 202243

Re: short term disabilty View Thread
Posted by SYED S on 6/26/06 at 23:49

TODAY I REALIZE HOW WIDE SPREAD THIS CONDITION IS.DEBBIE DEAR I CAN RELATE TO YOUR SUFFERING BECAUSE I HAVE BEEN AND AM IN THE EXACT SITUATION.THE EVENTS ARE SO SIMILLER I AM AMAZED.
I HOPE I GET A LOT OF MONEY SOMEDAY AND CREATE SOMRE TIME OF FOUNDATION FOR TTS.SAY FOLKS WARREN B JUST SET ASIDE SOME MONEY FOR DESERVING FOUDATIONS.MAYBE IT IS A GOOD IDEA THAT WE COLLECTIVELY EMAIL OR WRITE OR CALL THE BILL GATES AND MALINDA GATES FOUNDATION AND REQUEST THEIR COOPERATION.
THE SYSYTEM IS SO SLOW TO ASSIST THIS VERY PAINFULL CONDITION IT IS DISGUSTING AND WHEN THEY SUSPECT YOU FOR A PHONEY .IT DRIVES ONE SO ANGERY.
I HAVE HAD TO GET PRESCRIBTION STRENGHT PAINKILLERS AND ONLY THEN I COULD SLEEP.THE DOCTERS WILL GENERALLY TELL ME TO JUST TAKE MOTRINE.I CANT UNDERSTAND HOW THESE PROFFESIONALS ARE SO NEGLECTFULL OF THE PAIN ASSOCIATTED WITH THIS CONDITION.
BY THE WAY I AM A MALE 45-YRS.HAD A VERY ACTIVE LIFESTYLE,NO DIABETES.SMOKING YES.BLOOD PRESSURE HIGH.SOME SAY THIS CONDITION CAN ALSO BE THE RESULT OF A MINOR STROKE IN WHICH CASE THE CLOT LUCKILY GOES TOWARDS THE FOOT NOT THE HEART AND GETS STUCK AROUND THE ANKLE JOINT.WHEN THE CLOT OBSTRUCTS THE FLOW OF BLOOD THE PRESSURE WILL ALLOW THE VIEN /ARTERY TO SWELL THUS COMPRESSING THE MAIN NERVE WHICH SPLITS INTO MORE BRANCHES LEADING TO THE TOE AND FRONT OF THE FOOT.DUE TO THE DISRUPTION OF THE NERVE CURRENT THE SHOCK WAVES REACH THE ENDS OF THE FOOT.
BUT THE WORSE STAGE OF THIS CONDITION IS SURELY THE FIRST THREE WEEKS.
I AM SCHEDULED FOR AN AAG NEXT WEEK .I DONT KNOW HOW THAT WILL HELP BUT HOPE IT PIN POINTS THE PROBLEM.
IN THE MEANTIME THE SSI WANTS DIAGNOSES AND PROGNOSES AND THE DOCTERS HAVE REFUSED ME THOSE UNTILL THEY HAVE CONDUCTED ALL TESTS.SEEMS LIKE ONE IS STUCK BETWEEN THE ROCK(SSI)AND THE HARD PLACE(HOSPITAL).
FOR HEAVENS SAKE STOP THINKING YOU ARE PAYING FOR YOUR SINS IT IS JUST A MEDICAL SITUATION.DONT BE IN A HURRY TO PAY FOR YOUR SINS YOU LL STILL HAVE THE CHANCE TO DO SO IN THE AFTER LIFE.

CHIN-UP DONT FORGET TO COUNT YOUR BLESSINGS AND DONT YOU DARE LOOSE YOUR SENSE OF HUMOR.BELIEVE IN MIRACLES.

I LOVE YOU ALL.

Result number: 95
Searching file 19

Message Number 198756

Re: anyone have successful cryosurgery for PF? View Thread
Posted by Jen R on 5/08/06 at 18:39

Hi Dr. Wander...
I do understand that everyone is different...especially when it comes to feet. My intent is to see Dr. Wishnie sometime in the next few months for cryosurgery. I have spoken to him on the phone and I am confident that he will only do cryosurgery if he feels that it's something that can help me.
But you should understand that I've seen many doctors, physical therapists, chiropractors, pedorthists, and other medical providers...all who said that what they do would help me...and after 8 years I've had absolutely no relief. With that said, I also believe that each of those providers fully believed in what they said...and that each one of them was very good in what they do...but for some reason, my feet just didn't want to cooperate. For that reason, I try to do as much homework as I can before I jump into something. I had ESWT back in 1999...before most people even knew what it was...but even then, I did as much research as I could. With cryosurgery being a relatively new treatment for PF...it would just be nice to know that there is some data that can support that it has a fairly good success rate for PF. If that's not the case...I am functional enough to wait until such a time that technology has improved enough that it is getting better results.
I work a desk job in a casual atmosphere...exercise as much as I can in a non-impacting way...and to look at me no one would know that I am in pain. My worst fear is that I would do something to make it worse.
In any event, I appreciate your thoughts and I will try to keep them in mind.
Jen R

Result number: 96

Message Number 197259

A little giggle View Thread
Posted by Mary on 4/10/06 at 17:35

Thought this little funny would take your minds off this deradful PF

Hope it's okay to post this. If not moderator, please delete.

WAL-MART APPLICATION



This is an actual job application that a 75 year old senior citizen submitted to Walmart in Arkansas.

They hired him because he was so funny.....


NAME: Kenneth Way (Grumpy Bastard)

SEX: Not lately, but I am looking for the right woman (or at least one who will cooperate)

DESIRED POSITION: Company's President or Vice President. But seriously, whatever's available. If I was in a position to be picky, I wouldn't be applying here in the first place ?

DES! IRED SALARY: $185,000 a year plus stock options and a Michael Ovitz style severance package. If that's not possible, make an offer and we can haggle.

EDUCATION: Yes.

LAST POSITION HELD: Target for middle management hostility.

PREVIOUS SALARY: A lot less than I'm worth.

MOST NOTABLE ACHIEVEMENT: My incredible collection of stolen pens and post-it notes.

REASON FOR LEAVING: It sucked.

HOURS AVAILABLE TO WORK: Any.

PREFERRED HOURS: 1:30-3:30 p.m. Monday, Tuesday, and Thursday.

DO YOU HAVE ANY SPECIAL SKILLS?: Yes, but they're better suited to a more intimate environment.

MAY WE CONTACT YOUR CURRENT EMPLOYER?: If I had one, would I be here?

DO YOU HAVE ANY PHYSICAL CONDITIONS THAT WOULD PROHIBIT YOU FROM LIFTING UP TO 50 lbs.?: Of what?

DO YOU HAVE A CAR?: I think the more appropriate question here would be "Do you have a car that runs?"

HAVE YOU RECEIVED ANY SPECIAL AWARDS OR RECOGNITION?: I may already be a winner of the Publishers Clearing House Sweepstakes, so they tell me.

DO YOU SMOKE?: On the job - no!
On my breaks - yes!

WHAT WOULD YOU LIKE TO BE DOING IN FIVE YEARS?: Living in the Bahamas with a fabulously wealthy dumb sexy blonde supermodel who thinks I'm the greatest thing since sliced bread. Actually, I'd like to be doing that now.

NEAREST RELATIVE....7 miles

DO YOU CERTIFY THAT THE ABOVE IS TRUE AND COMPLETE TO THE BEST OF YOUR
KNOWLEDGE?: Oh yes, absolutely.

Result number: 97

Message Number 194855

Re: Relief in finding a Shoe Stores with Fit Experts View Thread
Posted by Dorothy on 3/04/06 at 19:50

Suzy D - You asked Ted, but since I've mentioned REI here for several years, I'll just jump in and Ted can jump in, too. REI is a cooperative business (a co-op)and is often ranked as one of the best companies to work for. It is based in the northwest U.S. and is just a decent, reputable place to do business with good products and nice folks. The following is taken from their website which you can peruse (www.rei.com):
In 1938, mountain climbers Lloyd and Mary Anderson joined with 21 fellow Northwest climbers to found Recreational Equipment, Inc. (REI). The group structured REI as a consumer cooperative to purchase high-quality ice axes and climbing equipment from Europe because such gear could not be purchased locally. The word quickly spread, and soon many other outdoors people joined the co-op. As REI grew, so too did the range of outdoor gear available to the co-op members.

During the past six decades, REI has grown into a renowned supplier of specialty outdoor gear and clothing. We serve the needs of outdoors people through 78 retail stores in the U.S. and by direct sales via the Internet (REI.com and REI-OUTLET.com), telephone and mail. Today, REI is the nation’s largest consumer cooperative with more than 2 million members.

Result number: 98

Message Number 193704

Re: Tarsal Tunnel Surgery View Thread
Posted by Pam on 2/17/06 at 18:35

D, The doctor does not know why I have TTS in both feet. I have never had any type of injury to either foot and I have it in both. Fortunately the right foot has NO symptoms. But if it ever does I'm glad to know where to go and what too expect to get it corrected. That is if the right foot will cooperate. But hopefully we will never have to find that out. But my doc did test both feet and found that I did have TT in both feet. The only thing we could even possibly narrow the problem down to was all the years I worked standing on my feet for hours on end working but there was never an injury of any type that we could pin point it too.

Result number: 99

Message Number 190388

Re: navicular-cuneiform arthrodesis with kidner procedure for navicular spur; Evan's calcaneal osteotomy and bone graft; gastrocnemius recession View Thread
Posted by Dr. David S. Wander on 12/28/05 at 19:38

Pat, the procedures that your surgeon has mentioned have nothing to do with plantar fasciitis. These procedures are reconstructive procedures for a severe flatfoot deformity. This site is a great site for offering advice for patients that may be looking for help regarding potential treatment options or to help define some problems they may be having. I strongly suggest that you do not continue your search on the internet to learn more about these proposed procedures, and that you do not look for advice on this site for information regarding these procedures UNTIL you have sat down and had a lengthy discussion with YOUR surgeon for him/her to discuss the procedures. It is the OBLIGATION of your surgeon for him/her to discuss the details of each and every procedure that has been recommended in order for you to be able to make an educated decision regarding whether or not to have that procedure performed. You should not have to seek that information from an outside source, that information should be made available by YOUR SURGEON. If you are not comfortable asking your surgeon these questions, then you should find another surgeon. It is my personal feelings that you should not even have to ask, and it is the surgeons responsibility and DUTY to explain each of these procedures to you without you having to ask. Remember, you have to have an excellent relationship and confidence in your surgeon and you have to be able to communicate with your surgeon and have the confidence that if you have a problem or question AFTER the surgery than he/she will be available to answer your questions and solve your problems. If he/she is not cooperative and will not explain procedures before surgery, then it will be worse after surgery.

Your absolute best resource to answer ALL your questions is your surgeon since he/she knows your case better than anyone and knows the details of all the proposed procedures. Asking advice on the internet may end up making you more confused or frustrated. If your doctor is not willing to answer your questions, it is indicative of his/her attitude of how you will be treated post operatively and I would suggest finding another surgeon.

Result number: 100
Searching file 18

Message Number 186198

Re: antibiotic (quinolone) and tendons View Thread
Posted by d fuller on 10/30/05 at 01:19

This is a list of citations begining in 1965 to date that deal with this "rare" adverse event. I present this not as an argumentative rebuttal but as proofs regarding my previous post. One would think if indeed this was a rare occurence we would not read medical journal articles concerning it each and every year for forty years. Nor does this list inlcude all such citations, only those readily available to the average person. Of special interest is the statements made at the 62 Meeting of the Anti-Infective Drugs Advisory Committee (circa 1994)where quinolone induced joint destruction (requiring complete joint replacement) is discussed as well as irreversible tendon and ligament damage. You will find that towards the end of this response. We find the same documentation when it comes to peripherial neuropathy as well which was first reported in association with Nalidixic Acid in the mid sixties.

1965

1. DE VRIES AC.
[SPONTANEOUS RUPTURE OF THE ACHILLES TENDON]
Ned Tijdschr Geneeskd. 1965 Jan 2;109:59-60. Dutch. No abstract available.
PMID: 14284979 [PubMed - OLDMEDLINE for Pre1966]

2. CROZZOLI NR, MANCA M.
[SUBCUTANEOUS RUPTURE OF THE ACHILLES TENDON. CONSIDERATIONS ON OUR CASE
HISTORIES]
Minerva Ortop. 1965 Jan-Feb;16:21-9. Italian. No abstract available.
PMID: 14303636 [PubMed - OLDMEDLINE for Pre1966]

3. VON GRAFFENRIED, ENGELER V, HEIM U.
[SUBCUTANEOUS RUPTURE OF THE ACHILLES TENDON]
Helv Chir Acta. 1965 Jan;32:253-6. German. No abstract available.
PMID: 14290218 [PubMed - OLDMEDLINE for Pre1966]


1969

1. Rosolleck H.
[Subcutaneous achilles tendon rupture]
Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed. 1969 Dec;72(12):544-7.
German. No abstract available.
PMID: 4248859 [PubMed - indexed for MEDLINE]


1971

1. Auquier L, Siaud JR.
[Nodular tendinitis of the Achilles tendon]
Rev Rhum Mal Osteoartic. 1971 May;38(5):373-81. French. No abstract available.
PMID: 5092370 [PubMed - indexed for MEDLINE]

2. Krahl H, Langhoff J.
[Degenerative tendon changes following local application of corticoids]
Z Orthop Ihre Grenzgeb. 1971 Jul;109(3):501-11. German. No abstract available.
PMID: 4254811 [PubMed - indexed for MEDLINE]


1972

1. Nalidixic Acid arthralgia
Bailey et al (CMA Journal 1972; 107 601-605)

2. Dupuis PR, Uhthoff HK.
In vivo study of the effects of a synthetic steroid, betamethasone (16B methyl-9X fluoroprednisolone) on the calcaneal tendon in rabbits Union Med Can. 1972 Sep;101(9):1763-7. French. No abstract available.
PMID: 5075006 [PubMed - indexed for MEDLINE]


1976

1. Jouirland JP Les ruptures tendineusues. Le tendon normal et patholoqique
Seminar de Monte Carlo 13-14 February 1976


1980

1. Mason JO, Meagher DJ, Sheehan B, O'Doherty CK.
The management of supraspinatus tendinitis in general practice.
Ir Med J. 1980 Jan;73(1):23-40. No abstract available.
PMID: 7380640 [PubMed - indexed for MEDLINE]


1981

1. Jensen KE.
[Bilateral rupture of the Achilles tendon]
Ugeskr Laeger. 1981 Jul 6;143(28):1768. Danish. No abstract available.
PMID: 7292758 [PubMed - indexed for MEDLINE]


1982

1. Fink RJ, Corn RC.
Fracture of an ossified Achilles tendon.
Clin Orthop. 1982 Sep;(169):148-50. No abstract available.
PMID: 6809391 [PubMed - indexed for MEDLINE]

2. Cetti R, Christensen SE.
[Rupture of the Achilles tendon after local steroid injection]
Ugeskr Laeger. 1982 May 10;144(19):1392. Danish. No abstract available.
PMID: 7135524 [PubMed - indexed for MEDLINE]

3. Chechick A, Amit Y, Israeli A, Horoszowski H.
Recurrent rupture of the achilles tendon induced by corticosteroid injection.
Br J Sports Med. 1982 Jun;16(2):89-90. No abstract available.
PMID: 7104562 [PubMed - indexed for MEDLINE]

4. Newmark H 3rd, Olken SM, Mellon WS Jr, Malhotra AK, Halls J
A new finding in the radiographic diagnosis of achilles tendon rupture.
Skeletal Radiol. 1982;8(3):223-4. No abstract available.
PMID: 7112151 [PubMed - indexed for MEDLINE]


1983

1. Norfloxacin induced rheumatic disease
Bailey et al (NZ Med J 1983; 96; 590)

2. Kleinman M, Gross AE.
Achilles tendon rupture following steroid injection. Report of three cases.
J Bone Joint Surg Am. 1983 Dec;65(9):1345-7. No abstract available.
PMID: 6197416 [PubMed - indexed for MEDLINE]


1984

1. Chamot AM, Gobelet C.
[Achilles tendinitis: a pathology of confines]
Rev Med Suisse Romande. 1984 Oct;104(10):783-7. French. No abstract available.
PMID: 6515224 [PubMed - indexed for MEDLINE]


1985

1. Between 1985 and July 1992 100 cases of tendon disorders had been identified in France
Kessler et al (HRG Publication 1399, August 1. 1996)

2. Jones JG.
Achilles tendon rupture following steroid injection.
J Bone Joint Surg Am. 1985 Jan;67(1):170. No abstract available.
PMID: 3968099 [PubMed - indexed for MEDLINE]

3. 100 reported tendinopathies 1985-1992 France
In France, between 1985 and 1992, 100 patients who were being managed with fluoroquinolones had tendon disorders, which included thirty-one ruptures (Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of tendon disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)
http://www.studiomedico.it/allegati/achille.pdf


1987

1. Ciprofloxacin an update on clinical experience
Areieri et al (Am J of Med 1987 82 381-386)

2. 93 ruptures, 103 tendinopathies, 20 tenasynovitis, 1987-1997
Source: http://www.sma.org/smj1999/junesmj99/harrell.pdf


1988

1. McEwan SR, Davey PG. Ciprofloxacin and tenosynovitis. Lancet 1988; 2: 900.

2. Adverse effects of fluoroquinolones
Halkin et al (Rev Infect Dis 1988 10 258-261)

3. Ciprofloxacin and tenosynovitis
McEwan et al ( Lancet 1988 15 900)

4. Tendon disorders attributed to fluoroquinolones; a study on 42 spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care and Research 45; 2001 pages


1989

1. Adverse reactions during clinical trials and post marketing surveillance
Janknegt et al (Pharm Weekbl Sci 1989 11(4) 124-127)

2. Arthritis induced by norfloxacin
Jeandel et al (J Rheumatol 1989 16 560-561)

3. Schumacher HR Jr, Michaels R.
Recurrent tendinitis and achilles tendon nodule with positively birefringent crystals in a patient with hyperlipoproteinemia.
J Rheumatol. 1989 Oct;16(10):1387-9.
PMID: 2810266 [PubMed - indexed for MEDLINE]


1990

1. Histologic and Histochemical Changes in Articular Cartilages of Immature Beagle Dogs Dosed with Difloxacin, a Fluoroquinolone
J.E. Kurkhardt et al (Vet Pathol 27;162-170, 1990)


1991

1. Rheumatolgical side effects of quinolones
Ribard et al (Baillere’s Clin Rheumatol 1991 5 175-191)

2. Perrot S, Ziza JM, De Bourran-Cauet G, Desplaces N, Lachand AT.
[A new complication related to quinolones: rupture of Achilles tendon]
Presse Med. 1991 Jul 6-13;20(26):1234. French. No abstract available.
PMID: 1831902 [PubMed - indexed for MEDLINE]


1992

1. Seven Achilles tendinitis including three complicated by rupture during fluoroquinolone therapy
Ribard et al (J Rheumatol 1992; 19; 1479-1481)

2. 704 achilles tendinitis, 38 ruptures 1992-1998 Netherlands
Fluoroquinolone use and the change in incidence of tendon rupture in the Netherlands
Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg 89-92)
The cohort included 46 776 users of fluoroquinolones between 1 July 1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38 had Achilles tendon rupture
source: http://bmj.com/cgi/content/full/324/7349/1306

3. 100 reported tendinopathies 1985-1992 France
In France, between 1985 and 1992, 100 patients who were being managed with fluoroquinolones had tendon disorders, which included thirty-one ruptures (Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of tendon disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)
http://www.studiomedico.it/allegati/achille.pdf

4. Ribard P, Audisio F, Kahn MF, De Bandt M, Jorgensen C, Hayem G, Meyer O, Palazzo E.
Seven Achilles tendinitis including 3 complicated by rupture during fluoroquinolone therapy.
J Rheumatol. 1992 Sep;19(9):1479-81.
PMID: 1433021 [PubMed - indexed for MEDLINE]

5. Perrot S, Kaplan G, Ziza JM.
[3 cases of Achilles tendinitis caused by pefloxacin, 2 of them with tendon rupture]
Rev Rhum Mal Osteoartic. 1992 Feb;59(2):162. French. No abstract available.
PMID: 1604233 [PubMed - indexed for MEDLINE]

6. Lee WT, Collins JF.
Ciprofloxacin associated bilateral achilles tendon rupture.
Aust N Z J Med. 1992 Oct;22(5):500. No abstract available.
PMID: 1445042 [PubMed - indexed for MEDLINE]

7. Blanche P, Sereni D, Sicard D, Christoforov B.
[Achilles tendinitis induced by pefloxacin. Apropos of 2 cases]
Ann Med Interne (Paris). 1992;143(5):348. French. No abstract available.
PMID: 1482040 [PubMed - indexed for MEDLINE]

8. Olivieri I, Padula A, Lisanti ME, Braccini G.
Longstanding HLA-B27 associated Achilles tendinitis.
Ann Rheum Dis. 1992 Nov;51(11):1265. No abstract available.
PMID: 1466609 [PubMed - indexed for MEDLINE]


1993

1. Spontaneous bilateral rupture of the Achille’s tendon in a renal transplant recipient
Mainard et al (Nephron 1993;65- 491-492)

2. Boulay I, Farge D, Haddad A, Bourrier P, Chanu B, Rouffy J
[Tendinopathy caused by ciprofloxacin with possible partial rupture of Achilles tendon]
Ann Med Interne (Paris). 1993;144(7):493-4. French. No abstract available.
PMID: 8141519 [PubMed - indexed for MEDLINE]


1994

1. Royer RJ, Pierfitte C, Netter P.
Features of tendon disorders with fluoroquinolones.
Therapie. 1994 Jan-Feb;49(1):75-6. No abstract available.
PMID: 8091374 [PubMed - indexed for MEDLINE]

2. Armengol S, Moreno JA, Xirgu J, Torrabadella P, Tomas R.
[Ciprofloxacin as a cause of a behavior disorder in a patient admitted into intensive care]
Enferm Infecc Microbiol Clin. 1994 May;12(5):271-2. Spanish. No abstract available.
PMID: 8049295 [PubMed - indexed for MEDLINE]

3. Donck JB, Segaert MF, Vanrenterghem YF.
Fluoroquinolones and Achilles tendinopathy in renal transplant recipients.
Transplantation. 1994 Sep 27;58(6):736-7. No abstract available.
PMID: 7940700 [PubMed - indexed for MEDLINE]

4. Onieal ME.
Achilles injuries.
J Am Acad Nurse Pract. 1994 Mar;6(3):125-6. No abstract available.
PMID: 8003362 [PubMed - indexed for MEDLINE]

5. Scioli MW.
Achilles tendinitis.
Orthop Clin North Am. 1994 Jan;25(1):177-82. Review.
PMID: 8290227 [PubMed - indexed for MEDLINE]

6. Hernandez MV, Peris P, Sierra J, Collado A, Munoz-Gomez J.
[Tendinitis due to fluoroquinolones. Description of 2 cases]
Med Clin (Barc). 1994 Sep 10;103(7):264-6. Review. Spanish.
PMID: 7934295 [PubMed - indexed for MEDLINE]

7. Achilles tenditinis and tendon rupture due to fluoroquinolone therapy
Huston et al (New England Journal of Medicene 1994 331 748)

8. Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of tendon disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)

9. Dekens-Konter JA, Knol A, Olsson S, Meyboom RH, de Koning GH.
[Tendinitis of the Achilles tendon caused by pefloxacin and other
fluoroquinolone derivatives]
Ned Tijdschr Geneeskd. 1994 Mar 5;138(10):528-31. Dutch.
PMID: 8139714 [PubMed - indexed for MEDLINE]

10. Prantera C, Kohn A, Zannoni F, Spimpolo N, Bonfa M.
Metronidazole plus ciprofloxacin in the treatment of active, refractory Crohn's disease: results of an open study.
J Clin Gastroenterol. 1994 Jul;19(1):79-80. No abstract available.
PMID: 7930441 [PubMed - indexed for MEDLINE]

11. Van Linthoudt D, D'Oro A, Ott H.
[What is your diagnosis? Bilateral Achilles tendinitis associated with
quinolone treatment]
Schweiz Rundsch Med Prax. 1994 Feb 22;83(8):201-2. German. No abstract available.
PMID: 8134743 [PubMed - indexed for MEDLINE]

12. Kawada A, Hiruma M, Morimoto K, Ishibashi A, Banba H.
Fixed drug eruption induced by ciprofloxacin followed by ofloxacin.
Contact Dermatitis. 1994 Sep;31(3):182-3. No abstract available.
PMID: 7821014 [PubMed - indexed for MEDLINE]

13. Guharoy SR.
Serum sickness secondary to ciprofloxacin use.
Vet Hum Toxicol. 1994 Dec;36(6):540-1.
PMID: 7900274 [PubMed - indexed for MEDLINE]


1995

1. Hernandez Rodriguez I, Allegue F.
Achilles and suprapatellar tendinitis due to isotretinoin.
J Rheumatol. 1995 Oct;22(10):2009-10. No abstract available.
PMID: 8992016 [PubMed - indexed for MEDLINE]

2. Szarfman A, Chen M, Blum MD. More on fluoroquinolone antibiotics and tendon rupture. N Engl J Med 1995; 332: 193[Free Full Text].

3. Magnesium Deficiency Induces Joint Cartilage Lesions in Juvenile Rats which are Identical to Quinolone Induced Arthropathy
Stahlmann et al (Antimicrobial Agents and Chemotherapy, Sept., 1995 pg 2013-2018)

4. Crowder SW, Jaffey LH.
Sarcoidosis presenting as Achilles tendinitis.
J R Soc Med. 1995 Jun;88(6):335-6.
PMID: 7629765 [PubMed - indexed for MEDLINE]

5. Pierfitte C, Gillet P, Royer RJ
More on fluoroquinolone antibiotics and tendon rupture.
N Engl J Med. 1995 Jan 19;332(3):193. No abstract available.
PMID: 7800022 [PubMed - indexed for MEDLINE]

6. Szarfman A, Chen M, Blum MD.
More on fluoroquinolone antibiotics and tendon rupture.
N Engl J Med. 1995 Jan 19;332(3):193. No abstract available.
PMID: 7800023 [PubMed - indexed for MEDLINE]

7. Norfloxacin induced arthalgia
Terry et al ( J Rheumatol 1995 22 793-794)

8. Fluoroquinolone Induced Tenosynovitis of the Wrist mimicking de Quervain’s Disease
Gillet et al (British Journal of Rheumatology vol 34 no 6 pg 583-584, Feb 1995)

9. Mirovsky Y, Pollack L, Arlazoroff A, Halperin N.
[Ciprofloxacin-associated bilateral acute achilles tendinitis]
Harefuah. 1995 Dec 1;129(11):470-2, 535. Hebrew.
PMID: 8846955 [PubMed - indexed for MEDLINE]



1996

1. McGarvey WC, Singh D, Trevino SG. Partial Achilles tendon ruptures associated with fluoroquinolone antibiotics: a case report and literature review. Foot Ankle Int 1996; 17: 496-498[ISI][Medline].

2. Pierfitte C, Royer RJ.
Tendon disorders with fluoroquinolones.
Therapie. 1996 Jul-Aug;51(4):419-20. No abstract available.
PMID: 8953821 [PubMed - indexed for MEDLINE]

3. Hugo-Persson M.
[Rupture of the Achilles tendon after ciproxine therapy]
Lakartidningen. 1996 Apr 17;93(16):1520. Swedish. No abstract available.
PMID: 8667750 [PubMed - indexed for MEDLINE]

4. Therapie 1996; 51: 419-420 Tendon disorders with fluoroquinolones 421 cases have been collected by the Centre de Pharmacovigilance, 340 of tendinitis and 81 cases of tendon rupture.

5. McGarvey WC, Singh D, Trevino SG.
Partial Achilles tendon ruptures associated with fluoroquinolone antibiotics: a
case report and literature review.
Foot Ankle Int. 1996 Aug;17(8):496-8. Review.
PMID: 8863030 [PubMed - indexed for MEDLINE]

6. Skovgaard D, Feldt-Rasmussen BF, Nimb L, Hede A, Kjaer M.
[Bilateral Achilles tendon rupture in individuals with renal transplantation]
Ugeskr Laeger. 1996 Dec 30;159(1):57-8. Danish.
PMID: 9012076 [PubMed - indexed for MEDLINE]

7. Jagose JT, McGregor DR, Nind GR, Bailey RR.
Achilles tendon rupture due to ciprofloxacin.
N Z Med J. 1996 Dec 13;109(1035):471-2. No abstract available.
PMID: 9006634 [PubMed - indexed for MEDLINE]

8, Ottosson L.
[An unexpected verdict by the HSAN in a case of Achilles tendon rupture]
Lakartidningen. 1996 Dec 18;93(51-52):4712, 4715. Swedish. No abstract available.
PMID: 9011717 [PubMed - indexed for MEDLINE]

9. Castagnola C, Suhler A.
[Tendinopathy and fluoroquinolones]
Ann Urol (Paris). 1996;30(3):129-30. French.
PMID: 8766149 [PubMed - indexed for MEDLINE]

10. Foot Ankle Int. 1996 Aug;17(8):496-8.
Partial Achilles tendon ruptures associated with fluoroquinolone antibiotics: a case report and literature review.

11. Fluoroquinolone induced arthralgia and Magnetic Resonance Imaging
Loeuille et al (The Journal of Rheumatology volume 23 no 7 , July 1996)

12. Fluoroquinolone Induced Tendinopathy; Report of Six Cases
Zabraniedkl et al (The Journal of Rhuematology 1996; 23; 3)

13. Quinolone induced cartilage lesions are not reversible in rats
Forster et al (Arch Toxicol (1996) 70; 474-481)

14. Maki T, Heinasmaki T, Riutta J, Tikkanen T, Laasonen L, Eklund K.
[Bilateral Achilles tendon rupture caused by oral fluoroquinolones]
Duodecim. 1996;112(19):1818-20. Finnish. No abstract available.
PMID: 10596182 [PubMed - indexed for MEDLINE

15. ENGLAND
130 reported tendon inflammation or rupture (England, France and Belgium, 1996)
The group cited 130 reports of tendon inflammation or rupture in people who used the prescription drug in England, France and Belgium. The FDA has received at least 52 reports of patients in the U.S. who have suffered tendon damage
(from public citizens 1996 petition)
Szarfman et al. recommended that the labeling on packaging for fluoroquinolone be up-dated to include a warning about the possibility of tendon rupture. In its recommendations on the use of
this class of antibiotics, the British National Formulary
suggested that "at the first sign of pain or inflammation, patients should discontinue the treatment and rest the affected limb until the tendon symptoms have resolved."
British National Formulary. No. 32, p. 259. London, British Medical Association, Royal Pharmaceutical Society of Great Britain, 1996.
{Notice how this labeling change has not be altered since 1996 and appears to have been copied word for word in every monograph.}

16. FRANCE
921 reported tendon disorders France
340 reported tendonitis, 81 tendon ruptures 1996, WHO
Adverse drug reactions with fluoroquinolones The French system of drug surveillance has analyzed the reports of adverse drug reactions (ADRs) to fluoroquinolones since they were launched. The frequency of reactions ranges from 1/15000 to 1/208000 case per days of treatment. Cutaneous disorders and tendon disorders dominate in France, whereas cutaneous effects and neuropsychiatric disorders are predominant in the UK; tendon disorders take up only the 5th position. Among the most unexpected ADRs are the following: 1- Shock 2- Acure renal failure Tendon ruptures represent 81 cases for 921 reports of tendon disorders which are related in decreasing order to pefloxacin 1/23130 case per days of treatment, ofloxin, norfloxacin and ciprofloxacin 1/779600 case per days of treatment. Age and corticosteroids increase the risk of tendon rupture. Therapie 1996; 51; 419-420 Tendon disorders with fluoroquinolones 421 cases have been collected by the Centre de Pharmacovigilance: 340 of tendinitis and 81 of tendon rupture. These cases were attributed to Peflacine, Oflocet, Noroxine, Ciflox. Tendinitis was characterized by a bilateral malleolar oedema associated with a sudden pain. Sometimes this oedema evoked phlebitis. The tendon rupture was generally preceded by a tendinitis but in half of the cases it occurred without warning.
Source: http://www.who-umc.org/newsletter/newsltr97_1.html (sic)


1997

1. Australia. The Adverse Drug Reactions Advisory Committee first reported tendinitis in association with fluoroquinolone antibiotics in 1997. The Committee has continued to monitor this adverse reaction, and has now received 60 reports of tendinitis, tensosynovitis and/or tendon rupture in association with these drugs. Ciprofloxacin was most frequently cited (55 reports), as well as norfloxacin (4) and enoxacin (1).
Forty-five reports described tendinitis alone, one report described tensosynovitis, and 14 reports documented tendon tear or rupture. Fifty-five of the 60 reports specified the Achilles tendon, including 20 which described bilateral Achilles tendon damage. All 14 reports of tendon rupture involved the Achilles tendon. The 58 patients ranged in age from 38 to 91 years (median: 69), with no significant difference between those with tendinitis and those with tendon rupture.
The daily doses of ciprofloxacin ranged from 500 mg to 2250 mg, with 46% of patients taking 1500 mg and 46% of patients taking 1000 mg daily. For those who developed tendon rupture, 57% were taking 1500 mg daily. Time to onset varied from within 24 hours after the drug was commenced to 3 months after starting, but the majority of cases of tendinitis occurred within the first week. Time to rupture was longer with a median time of 2-3 weeks. Known risk factors for these reactions include old age, renal dysfunction and concomitant corticosteroid therapy. In the cases reported to the ADRAC, 29 reports documented concomitant corticosteroid use, and in 21 of the other 31 reports the patients were aged 69 years or older. In the reports of tendon rupture, 12 of the 14 described either concomitant steroid use (9) or old age (9).
Prescribers are reminded to be alert for this reaction and to withdraw the fluoroquinolone immediately when symptoms of tendinitis appear in order to reduce the risk of tendon rupture.
[See also Pharmaceuticals Newsletter Nos. 7&8, July&August 1997.]
Tendinitis associated with Fluoroquinolone therapy
(Pharmaceuticals Newsletters Nos 7&8 July & August 1997)
Australia

2. 93 ruptures, 103 tendinopathies, 20 tenasynovitis, 1987-1997
Source: http://www.sma.org/smj1999/junesmj99/harrell.pdf

3. Danesh-Meyer MJ.
Complicated management of a patient with rapidly progressive periodontitis: a case report.
J N Z Soc Periodontol. 1997;(82):25-9. No abstract available.
PMID: 10483437 [PubMed - indexed for MEDLINE]

4. Poon CC, Sundaram NA.
Spontaneous bilateral Achilles tendon rupture associated with ciprofloxacin.
Med J Aust. 1997 Jun 16;166(12):665. No abstract available.
PMID: 9216589 [PubMed - indexed for MEDLINE]

5. Shinohara YT, Tasker SA, Wallace MR, Couch KE, Olson PE.
What is the risk of Achilles tendon rupture with ciprofloxacin?
J Rheumatol. 1997 Jan;24(1):238-9. No abstract available.
PMID: 9002057 [PubMed - indexed for MEDLINE]

6. Movin T, Gad A, Guntner P, Foldhazy Z, Rolf C.
Pathology of the Achilles tendon in association with ciprofloxacin treatment.
Foot Ankle Int. 1997 May;18(5):297-9.
PMID: 9167931 [PubMed - indexed for MEDLINE]

7. Tendons and Fluoroquinolones; Unresolved issues
Kahn et al (Rev Rhum [Engl. Ed.] 1997 64(7-9) 437-439)
(Rev Rhum [Ed. Fr.] 1997 64(7-9) 511-513

8. Fluoroquinolones tendinitis update Australia
Tendinitis associated with Fluoroquinolone therapy
(Pharmaceuticals Newsletters Nos 7&8 July & August 1997)

9. Toxic effects of quinolone antibacterial agents on the musculoskeletal system in juvenile rats
Yoko Kashida et al (Toxicologic Pathology vol 25 number 6 pages 635-643 1997)

10. Tendinitis and tendon rupture with fluoroquinolones
ADRAC (The Achilles heel of fluoroquinolones Aust Adv Drug React Bull 1997;16;7, Szarfman et al)

11. Effects of Ciprofloxacin and Ofloxacin on adult human cartilage in vitro
(Antimicrob Agents Chemother 1997, Vol 41; issue 11; pages 2562-2565)

12. Repeated rupture of the extensor tendons of the hand due to fluoroquinolones, Apropos of a case
Levadoux et al (Ann Chir Main Memb Super 1997, vol 16, issue 2, pgs 130-133)

13. Benizeau I, Cambon-Michot C, Daragon A, Voisin L, Mejjad O, Thomine JM, Le Loet X.
Tendinitis of the tibialis anterior with histologic documentation in a patient under fluoroquinolone therapy.
Rev Rhum Engl Ed. 1997 Jun;64(6):432-3. No abstract available.
PMID: 9513620 [PubMed - indexed for MEDLINE]


1998

1. Khan KM, Cook JL, Bonar SF, Harcourt PR.
Subcutaneous rupture of the Achilles tendon.
Br J Sports Med. 1998 Jun;32(2):184-5. No abstract available.
PMID: 9631234 [PubMed - indexed for MEDLINE]

2. Stafford L, Bertouch J.
Reactive arthritis and ruptured Achilles tendon.
Ann Rheum Dis. 1998 Jan;57(1):61. No abstract available.
PMID: 9536827 [PubMed - indexed for MEDLINE]

3. Kahn MF.
Achilles tendinitis and ruptures.
Br J Sports Med. 1998 Sep;32(3):266. No abstract available.
PMID: 9773187 [PubMed - indexed for MEDLINE]

4. van der Linden PD, van Puijenbroek EP, Feenstra J, Veld BA, Sturkenboom MC, Herings RM, Leufkens HG, Stricker BH.
Tendon disorders attributed to fluoroquinolones: a study on 42 spontaneous reports in the period 1988 to 1998. Arthritis Rheum. 2001 Jun;45(3):235-9.
PMID: 11409663 [PubMed - indexed for MEDLINE]

5. Blanco Andres C, Bravo Toledo R.
[Bilateral tendinitis caused by ciprofloxacin]
Aten Primaria. 1998 Feb 28;21(3):184-5. Spanish. No abstract available.
PMID: 9607242 [PubMed - indexed for MEDLINE]

6. Tendon disorders attributed to fluoroquinolones; a study on 42 spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care and Research 45; 2001 pages 235-239)

7. Petersen W, Laprell H
[Insidious rupture of the Achilles tendon after ciprofloxacin-induced tendopathy. A case report]
Unfallchirurg. 1998 Sep;101(9):731-4. German.
PMID: 9816984 [PubMed - indexed for MEDLINE]

8. Voorn R.
Case report: can sacroiliac joint dysfunction cause chronic Achilles
tendinitis?
J Orthop Sports Phys Ther. 1998 Jun;27(6):436-43.
PMID: 9617730 [PubMed - indexed for MEDLINE]

9. West MB, Gow P.
Ciprofloxacin, bilateral Achilles tendonitis and unilateral tendon rupture--a case report.
N Z Med J. 1998 Jan 23;111(1058):18-9. No abstract available.
PMID: 9484431 [PubMed - indexed for MEDLINE]

10. Gabutti L, Stoller R, Marti HP.
[Fluoroquinolones as etiology of tendinopathy]
Ther Umsch. 1998 Sep;55(9):558-61. German.
PMID: 9789471 [PubMed - indexed for MEDLINE]

11. NETHERLANDS
704 achilles tendinitis, 38 ruptures 1992-1998 Netherlands
Fluoroquinolone use and the change in incidence of tendon rupture in the Netherlands
Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg 89-92)
The cohort included 46 776 users of fluoroquinolones between 1 July 1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38 had Achilles tendon rupture
source: http://bmj.com/cgi/content/full/324/7349/1306

12. 42 spontaneous reports 1988-1998
Tendon disorders attributed to fluoroquinolones; a study on 42 spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care and Research 45; 2001 pages 235-239) June 2001
http://www.rheumatology.org/arhp/acnr/2001/0106.html


1999

1. Eriksson E.
In vivo microdialysis of painful achilles tendinosis.
Knee Surg Sports Traumatol Arthrosc. 1999;7(6):339. No abstract available.
PMID: 10639649 [PubMed - indexed for MEDLINE]

2. Mousa A, Jones S, Toft A, Perros P.
Spontaneous rupture of Achilles tendon: missed presentation of Cushing's syndrome.
BMJ. 1999 Aug 28;319(7209):560-1. No abstract available.
PMID: 10463901 [PubMed - indexed for MEDLINE]

3. Harrell RM.
Fluoroquinolone-induced tendinopathy: what do we know?
South Med J. 1999 Jun;92(6):622-5. Review.
PMID: 10372859 [PubMed - indexed for MEDLINE]

4. Gibbon WW, Cooper JR, Radcliffe GS.
Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis.
Br J Sports Med. 1999 Apr;33(2):129-30.
PMID: 10205697 [PubMed - indexed for MEDLINE]

5. Lewis JR, Gums JG, Dickensheets DL.
Levofloxacin-induced bilateral Achilles tendonitis.
Ann Pharmacother. 1999 Jul-Aug;33(7-8):792-5.
PMID: 10466906 [PubMed - indexed for MEDLINE]

6. Zambanini A, Padley S, Cox A, Feher M.
Achilles tendonitis: an unusual complication of amlodipine therapy.
J Hum Hypertens. 1999 Aug;13(8):565-6. No abstract available.
PMID: 10455480 [PubMed - indexed for MEDLINE]

7. van der Linden PD, van de Lei J, Nab HW, Knol A, Stricker BH.
Achilles tendinitis associated with fluoroquinolones.
Br J Clin Pharmacol. 1999 Sep;48(3):433-7.
PMID: 10510157 [PubMed - indexed for MEDLINE]

8. Van der Linden PD, van de Lei J, Nab HW, Knol A, Stricker BHCh. Achilles tendinitis associated with fluoroquinolones. Br J Clin Pharmacol 1999; 48: 433-437[CrossRef][ISI][Medline].

9. 60 reported tendonitis August 1999
Fluoroquinolones tendinitis update Australia
Tendinitis associated with Fluoroquinolone therapy
(Pharmaceuticals Newsletters Nos 7&8 July & August 1997)
Australia
ADRAC Bulletin, vol 18, No 3, August 1999
Tendinitis and tendon rupture with
fluoroquinolones
The Adverse Drug Reactions Advisory Committee (ADRAC) first reported tendinitis in association with the fluoroquinolone antibiotics in 1997. The Committee has continued to monitor this adverse
reaction, and has now received 60 reports of tendinitis, tenosynovitis and/or tendon rupture in association with these drugs. Most involved was ciprofloxacin (55), but there were also reports with norfloxacin (4) and enoxacin (1). Fortyfive reports described tendinitis alone, one report described tenosynovitis, and 14 reports documented tendon tear or rupture. Fifty five of the 60 reports specified the Achilles tendon, including 20 which described bilateral
Achilles tendon damage. All 14 reports of tendon rupture
involved the Achilles tendon.
Source: http://www.who.int/medicines/library/pnewslet/pndec99.html

10. 421 reported tendon disorders and 81 tendon ruptures 1999
Therapie 1996; 51: 419-420 Tendon disorders with fluoroquinolones 421 cases have been collected by the Centre de Pharmacovigilance, 340 of tendinitis and 81 cases of tendon rupture.

11. Rev Rhum Engl Ed. 1999 Jul-Sep;66(7-9):419-21.
Suspected role of ofloxacin in a case of arthalgia, myalgia, and multiple tendinopathy.

12. Levofloxacin-induced bilateral Achilles tendonitis
Lewis JR, JG Gums, and DL Dickensheets 1999

13. Inhibition of fibroblast metabolism by a fluoroquinolone antibiotic
Williams et al (American Academy of Orthopedic Surgeons, 1999 Annual meeting, paper number 118, Geb 5, 1999)

14. Levofloxacin induced bilateral achilles tendinitis
Lewis et al (The Annals of Pharmacotherapy 1999 July/August, volume 33 pages 792-795)

15. Fluoroquinolone induced tendinopathy; what do we know?
Harrell et al (South Med J 92(6) 622-625 1999)

16. Ann Pharmacother. 1999 Jul-Aug;33(7-8):792-5.
Levofloxacin-induced bilateral Achilles tendonitis.

17. Schwald N, Debray-Meignan S.
Suspected role of ofloxacin in a case of arthalgia, myalgia, and multiple tendinopathy.
Rev Rhum Engl Ed. 1999 Jul-Sep;66(7-9):419-21.
PMID: 10526383 [PubMed - indexed for MEDLINE]


2000

1. Fluoroquinolone induced tendinopathy; also occurring with levofloxacin
Fleisch et al (Infection 28 2000 no 4 pages 256-257)

2. Infection. 2000 Jul-Aug;28(4):256-7.
Fluoroquinolone-induced tendinopathy: also occurring with levofloxacin.

3. Quinolone and Tendon Ruptures
Casperian et al (Southern Medical Journal May 2000 vol 93 no 5 pages 488-491)

4. Evaluation of toxicokinetic variables and arthropathic changes in juvenile rabbits after oral administration of an ivestigational fluoroquinolone, pd 117596
Johnson et al (AJVR vol 61 no 11, pages, 1396-1402, November 2000)

5. Rupture of the patellar ligament one month after treatment with fluoroquinolone
Rev Chir Orthop Reparatrice Appar Mot. 2000 Sep;86(5):495-7.

6. FINLAND
42 reported tendinopathies 2000
Finland:
Register of adverse drug reactions in 2000

7. The majority of ADR reports received among antibacterials concerned levofloxacin, which is a fluoroquinolone antibiotic. Fourteen of the reports were on tendinitis or rupture of the Achilles tendon. Tendinitis caused by fluoroquinolones was discussed in TABU for the first time in 1996. Since then the ADR register has received a total of 42 reports on tendinopathies caused by
fluoroquinolones, over a third of which were ruptures of the tendon.
The use of fluoroquinolones has in-creased by about 75% since 1996. Levofloxacin is responsible for the major part of this increase. It has been marketed in Finland since mid 1998.
source: www.nam.fi/uploads/english/Publications/Tabu/tabu22001_eng.pdf

8. Casado Burgos E, Vinas Ponce G, Lauzurica Valdemoros R, Olive Marques A.
[Levofloxacin-induced tendinitis]
Med Clin (Barc). 2000 Mar 4;114(8):319. Spanish. No abstract available.
PMID: 10774524 [PubMed - indexed for MEDLINE]

9. Casparian JM, Luchi M, Moffat RE, Hinthorn D.
Quinolones and tendon ruptures.
South Med J. 2000 May;93(5):488-91. Review.
PMID: 10832946 [PubMed - indexed for MEDLINE]

10. Gravlee JR, Hatch RL, Galea AM.
Achilles tendon rupture: a challenging diagnosis.
J Am Board Fam Pract. 2000 Sep-Oct;13(5):371-3. No abstract available.
PMID: 11001009 [PubMed - indexed for MEDLINE]

11. Kouvalchouk JF, Hassan E
[Achilles tendon disorders]
Tunis Med. 2000 Jun-Jul;78(6-7):462-7. Review. French. No abstract available.
PMID: 11043038 [PubMed - indexed for MEDLINE]

12. Ortiz V, Holgado S, Olive A, Fite E.
Ach illes tendinitis as the presentation form of Lofgren's syndrome.
Clin Rheumatol. 2000;19(2):169-70.
PMID: 10791635 [PubMed - indexed for MEDLINE]

13. Vavra-Hadziahmetovic N, Hadziahmetovic Z, Smajlovic F.
Phy sical therapy in conservative (functional) treatment of acute achilles tendon rupture.
Med Arh. 2000;54(2):121-2.
PMID: 10934845 [PubMed - indexed for MEDLINE]

14. Martinelli B.
Rupture of the Achilles tendon.
J Bone Joint Surg Am. 2000 Dec;82-A(12):1804. No abstract available.
PMID: 11130653 [PubMed - indexed for MEDLINE]


2001

1. Rev Clin Esp. 2001 Sep;201(9):539-40.
Achilles pain and functional impotence in a patient with chronic obstructive pulmonary disease with pneumonia. Tendon rupture caused by levofloxacin

2. Pharm World Sci. 2001 Jun;23(3):89-92.
Fluoroquinolone use and the change in incidence of tendon ruptures in the Netherlands.
van der Linden PD, Nab HW, Simonian S, Stricker BH, Leufkens HG, Herings RM.

3. Mennecier D, Thiolet C, Bredin C, Potier V, Vergeau B, Farret O.
[Acute pancreatitis after treatment by levofloxacin and methylprednisolone]
Gastroenterol Clin Biol. 2001 Oct;25(10):921-2. French. No abstract available.
PMID: 11852403 [PubMed - indexed for MEDLINE]

4. Csizy M, Hintermann B.
[Rupture of the Achilles tendon after local steroid injection. Case reports and consequences for treatment]
Swiss Surg. 2001;7(4):184-9. German.
PMID: 11515194 [PubMed - indexed for MEDLINE]

5. Adverse reactions to fluoroquinolones an overview on mechanistic aspects
De Sarro et al (Current Medicinal Chemistry 2001, 8, 371-384)

6. Fluoroquinolone use and the change in incidence of tendon rupture in the Netherlands
Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg 89-92)

7. Tendon disorders attributed to fluoroquinolones; a study on 42 spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care and Research 45; 2001 pages 235-239)

8. 1847 reported tendinopathies December 2001
Tabelle 7
Pharmacovigilance: Meldungen von Tendinopathien im Vergleich zu allen gemeldeten unerwünschten Arzneimittelwirkungen (UAW), Stand 17. Dezember 2001.

9. Meldungen Schweiz (IKS-Datenbank) Welt (WHO-Datenbank)
Tendinopathie alle UAW Tendinopathie alle UAW
Ciprofloxacin 8 (5%) 155 649(2,2%) 29 090
Fleroxacin 9 (1,2 %) 754
Norfloxacin 1 (1%) 91 163 (2,1%) 7536
Ofloxacin 2 (6%) 34 432 (1,8%) 23 990
Levofloxacin 32 (41%) 79 576 (7,8%) 7432
Moxifloxacin 18 (4,5 %) 4030
Source: http://www.saez.ch/pdf/2003/2003-02/2003-02-694.PDF
http://www.saez.ch/pdf/2003/2003-02/2003-02-694.PDF

10. U.S. ARMED FORCES
Spontaneous Ruptures of the Achilles Tendon, US Armed Forces, 1998-2001
Methods. The Defense Medical Surveillance System was searched to identify all incident ambulatory visits of active duty servicemembers with a primary diagnosis of non-traumatic rupture of the achilles tendon (ICD-9- CM code 727.67) and other tendon ruptures (ICD-9- CM codes 727.60-727.66, 727.68-727.69) between January 1998 and May 2001.
The most striking finding of this analysis is the sudden and significant increase in rates of achilles tendon ruptures beginning in calendar year 2000. The increase was manifested across all Services and in most demographic subgroups (table 1). Rates
of non-traumatic ruptures of several other tendons also increased during the period; and increases in ruptures of the rotator cuff were comparable to those of the achilles tendon.
Source: http://amsa.army.mil/1Msmr/2002/v08_n01.pdf

11. Nuno Mateo FJ, Noval Menendez J, Suarez M, Guinea O.
[Achilles pain and functional impotence in a patient with chronic obstructive pulmonary disease with pneumonia. Tendon rupture caused by levofloxacin]
Rev Clin Esp. 2001 Sep;201(9):539-40. Spanish. No abstract available.
PMID: 11692412 [PubMed - indexed for MEDLINE]

12. Malaguti M, Triolo L, Biagini M.
Ciprofloxacin-associated Achilles tendon rupture in a hemodialysis patient.
J Nephrol. 2001 Sep-Oct;14(5):431-2. No abstract available.
PMID: 11730281 [PubMed - indexed for MEDLINE]

13. Butler MW, Griffin JF, Quinlan WR, McDonnell TJ.
Quinolone-associated tendonitis: a potential problem in COPD?
Ir J Med Sci. 2001 Jul-Sep;170(3):198-9.
PMID: 12120977 [PubMed - indexed for MEDLINE]

14. Bharani A, Kumar H.
Drug points: Diabetes inspidus induced by ofloxacin.
BMJ. 2001 Sep 8;323(7312):547. No abstract available.
PMID: 11546701 [PubMed - indexed for MEDLINE]

15. Toverud EL, Landaas S, Hellebostad M.
Repeated achilles tendinitis after high dose methotrexate.
Med Pediatr Oncol. 2001 Aug;37(2):156. No abstract available.
PMID: 11496361 [PubMed - indexed for MEDLINE]

16. Oatridge A, Herlihy AH, Thomas RW, Wallace AL, Curati WL, Hajnal JV, Bydder GM.
Magnetic resonance: magic angle imaging of the Achilles tendon.
Lancet. 2001 Nov 10;358(9293):1610-1.
PMID: 11716890 [PubMed - indexed for MEDLINE]

17. Fletcher MD, Warren PJ.
Sural nerve injury associated with neglected tendo Achilles ruptures.
Br J Sports Med. 2001 Apr;35(2):131-2.
PMID: 11273977 [PubMed - indexed for MEDLINE]

18. Humble RN, Nugent LL.
Achilles' tendonitis. An overview and reconditioning model.
Clin Podiatr Med Surg. 2001 Apr;18(2):233-54. Review.
PMID: 11417153 [PubMed - indexed for MEDLINE]

19. Eriksson E.
Achilles tendon surgery and wound healing.
Knee Surg Sports Traumatol Arthrosc. 2001 Jul;9(4):193. No abstract available.
PMID: 11522072 [PubMed - indexed for MEDLINE]

20. Speed CA.
Fortnightly review: Corticosteroid injections in tendon lesions.
BMJ. 2001 Aug 18;323(7309):382-6. No abstract available.
PMID: 11509432 [PubMed - indexed for MEDLINE]

21. Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg 89-92)
The cohort included 46 776 users of fluoroquinolones between 1 July 1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38 had Achilles tendon rupture
source: http://bmj.com/cgi/content/full/324/7349/1306


2002

1. Ulreich N, Kainberger F, Huber W, Nehrer S.
[Achilles tendon and sports]
Radiologe. 2002 Oct;42(10):811-7. German.
PMID: 12402109 [PubMed - indexed for MEDLINE]

2. Doral MN, Tetik O, Atay OA, Leblebicioglu G, Oznur A.
[Achilles tendon diseases and its management]
Acta Orthop Traumatol Turc. 2002;36 Suppl 1:42-6. Review. Turkish. No abstract available.
PMID: 12510123 [PubMed - indexed for MEDLINE]

3. Hersh BL, Heath NS.
Achilles tendon rupture as a result of oral steroid therapy.
J Am Podiatr Med Assoc. 2002 Jun;92(6):355-8.
PMID: 12070236 [PubMed - indexed for MEDLINE]

4. [No authors listed]
Side effects of levofloxacin.
Prescrire Int. 2002 Aug;11(60):116-7. No abstract available.
PMID: 12199267 [PubMed - indexed for MEDLINE]

5. Hatori M, Matsuda M, Kokubun S.
Ossification of Achilles tendon--report of three cases.
Arch Orthop Trauma Surg. 2002 Sep;122(7):414-7. Epub 2002 May 03.
PMID: 12228804 [PubMed - indexed for MEDLINE]

6. Pouzaud F, Rat P, Cambourieu C, Nourry H, Warnet JM.
[Tenotoxic potential of fluoroquinolones in the choice of surgical antibiotic prophylaxis in ophthalmology]
J Fr Ophtalmol. 2002 Nov;25(9):921-6. French.
PMID: 12515937 [PubMed - indexed for MEDLINE]

7. Sobel E, Giorgini R, Hilfer J, Rostkowski T.
Ossification of a ruptured achilles tendon: a case report in a diabetic patient.
J Foot Ankle Surg. 2002 Sep-Oct;41(5):330-4.
PMID: 12400718 [PubMed - indexed for MEDLINE]

8. Lohrer H, Scholl J, Arentz S.
[Achilles tendinopathy and patellar tendinopathy. Results of radial shockwave therapy in patients with unsuccessfully treated tendinoses] Sportverletz Sportschaden. 2002 Sep;16(3):108-14. German. No abstract available.
PMID: 12382183 [PubMed - indexed for MEDLINE]

9. Eriksen HA, Pajala A, Leppilahti J, Risteli J.
Increased content of type III collagen at the rupture site of human Achilles tendon.
J Orthop Res. 2002 Nov;20(6):1352-7.
PMID: 12472252 [PubMed - indexed for MEDLINE]

10. Kannus P, Paavola M, Paakkala T, Parkkari J, Jarvinen T, Jarvinen M.
[Pathophysiology of overuse tendon injury]
Radiologe. 2002 Oct;42(10):766-70. German.
PMID: 12402104 [PubMed - indexed for MEDLINE]

11. Summers JB.
Importance of an accurate diagnosis for Achilles rupture.
Am Fam Physician. 2002 Nov 15;66(10):1836. No abstract available.
PMID: 12469956 [PubMed - indexed for MEDLINE]

12. Ulreich N, Huber W, Nehrer S, Kainberger F.
[High resolution magnetic resonance tomography and ultrasound imaging of the Achilles tendon]
Wien Med Wochenschr Suppl. 2002;(113):39-40. German.
PMID: 12621837 [PubMed - indexed for MEDLINE]

13. Dwornik L, Lomasney LM, Demos TC, Lavery LA.
Radiologic case study. Acute Achilles tendon rupture.
Orthopedics. 2002 Nov;25(11):1239, 1318-20. No abstract available.
PMID: 12452339 [PubMed - indexed for MEDLINE]

14. Wood ML, Schlessinger S.
Levaquin induced acute tubulointerstitial nephritis--two case reports.
J Miss State Med Assoc. 2002 Apr;43(4):116-7. No abstract available.
PMID: 11989200 [PubMed - indexed for MEDLINE]

15. McClelland D, Maffulli N.
Percutaneous repair of ruptured Achilles tendon.
J R Coll Surg Edinb. 2002 Aug;47(4):613-8. Review.
PMID: 12363186 [PubMed - indexed for MEDLINE]

16. Eriksson E.
Tendinosis of the patellar and achilles tendon.
Knee Surg Sports Traumatol Arthrosc. 2002 Jan;10(1):1. Epub 2001 Dec 18. No abstract available.
PMID: 11819012 [PubMed - indexed for MEDLINE]

17. Bleakney RR, Tallon C, Wong JK, Lim KP, Maffulli N.
Long-term ultrasonographic features of the Achilles tendon after rupture.
Clin J Sport Med. 2002 Sep;12(5):273-8.
PMID: 12394198 [PubMed - indexed for MEDLINE]

18. Majewski M, Widmer KH, Steinbruck K.
[Achilles tendon ruptures: 25 year's experience in sport-orthopedic treatment]
Sportverletz Sportschaden. 2002 Dec;16(4):167-73. German.
PMID: 12563559 [PubMed - indexed for MEDLINE]

19. Cook JL, Khan KM, Purdam C.
Achilles tendinopathy.
Man Ther. 2002 Aug;7(3):121-30. Review.
PMID: 12372309 [PubMed - indexed for MEDLINE]

20. Shukla DD.
Bilateral spontaneous rupture of achilles tendon secondary to limb ischemia: a case report.
J Foot Ankle Surg. 2002 Sep-Oct;41(5):328-9.
PMID: 12400717 [PubMed - indexed for MEDLINE]

21. Grechenig W, Clement H, Bratschitsch G, Fankhauser F, Peicha G.
[Ultrasound diagnosis of the Achilles tendon]
Orthopade. 2002 Mar;31(3):319-25. German.
PMID: 12017866 [PubMed - indexed for MEDLINE]

22. Mazzone MF, McCue T.
Common conditions of the achilles tendon.
Am Fam Physician. 2002 May 1;65(9):1805-10. Review.
PMID: 12018803 [PubMed - indexed for MEDLINE]

23. Schepsis AA, Jones H, Haas AL.
Achilles tendon disorders in athletes.
Am J Sports Med. 2002 Mar-Apr;30(2):287-305. Review.
PMID: 11912103 [PubMed - indexed for MEDLINE]

24. Fluoroquinolones and risk of Achilles tendon disorders: case-control study BMJ 2002;324:1306-1307 ( 1 June ) P D van der Linden, researcher a, M C J M Sturkenboom, assistant professor a, R M C Herings, associate professor b, H G M Leufkens, professor b, B H Ch Stricker, professor a.
a Pharmaco-epidemiology Unit, Department of Epidemiology & Biostatistics and Internal Medicine, Erasmus Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands, b Department of Pharmaco-epidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands

25. Pai VS, Patel N.
Atypical coronal or sagittal Z ruptures of the achilles tendon: a report of four cases.
J Foot Ankle Surg. 2002 May-Jun;41(3):183-5.
PMID: 12075907 [PubMed - indexed for MEDLINE]

26. van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HG, Stricker BH.
Fluoroquinolones and risk of Achilles tendon disorders: case-control study.
BMJ. 2002 Jun 1;324(7349):1306-7. No abstract available.
PMID: 12039823 [PubMed - indexed for MEDLINE]

27. Tiling T.
[Is an Achilles tendon rupture without degeneration possible?]
Dtsch Med Wochenschr. 2002 Jun 21;127(25-26):1401. German. No abstract available.
PMID: 12075502 [PubMed - indexed for MEDLINE]

28. Med Clin (Barc). 2003 Jan 25;120(2):78-9.
Comment on: Med Clin (Barc). 2002 Jun 8;119(1):38-9.
Levofloxacin and bilateral spontaneous Achilles tendon rupture

29. 4 cases of levaquin induced tendintis (orign spansih)
Mica magazine of Chile Issn0034-9887 versi printed
Rev. m. Chilev.130n.11Santiagonov.2002
Rev Méd Chile 2002; 130: 1277-1281
Associated aquiliana Tendinitis to the levofloxacino use:
communication of four cases
Claudius Hoops And, Claudius Flowers W, Sergio Mezzano A.
Levofloxacin associated Achilles

29. Pedros A, Emilio Gomez J, Angel Navarro L, Tomas A.
[Levofloxacin and acute confusional syndrome]
Med Clin (Barc). 2002 Jun 8;119(1):38-9. Spanish. No abstract available.
PMID: 12062009 [PubMed - indexed for MEDLINE]

30. Maffulli N, Kader D.
Tendinopathy of tendo achillis.
J Bone Joint Surg Br. 2002 Jan;84(1):1-8. Review. No abstract available.
PMID: 11837811 [PubMed - indexed for MEDLINE]

31. Sidorenko SV, Krivitskaia NS
[Use of ciprofloxacin in sequential antibiotic therapy]
Antibiot Khimioter. 2002;47(7):25-30. Review. Russian. No abstract available.
PMID: 12516193 [PubMed - indexed for MEDLINE]

32. Paavola M, Kannus P, Jarvinen TA, Khan K, Jozsa L, Jarvinen M.
Achilles tendinopathy.
J Bone Joint Surg Am. 2002 Nov;84-A(11):2062-76. Review. No abstract available.
PMID: 12429771 [PubMed - indexed for MEDLINE]

33. Roberts C, Deliss L.:
Acute rupture of tendo Achillis.
J Bone Joint Surg Br. 2002 May;84(4):620; author reply 620. No abstract available.
PMID: 12043793 [PubMed - indexed for MEDLINE]

34. Tumia N, Kader D, Arena B, Maffulli N
Achilles tendinopathy during pregnancy.
Clin J Sport Med. 2002 Jan;12(1):43-5. No abstract available.
PMID: 11854590 [PubMed - indexed for MEDLINE]

35. Paffey MD, Faraj AA.
Acute rupture of tendo Achillis.
J Bone Joint Surg Br. 2002 May;84(4):620-1; author reply 621. No abstract available.
PMID: 12043792 [PubMed - indexed for MEDLINE]

36. Chhajed PN, Plit ML, Hopkins PM, Malouf MA, Glanville AR.
Achilles tendon disease in lung transplant recipients: association with ciprofloxacin.
Eur Respir J. 2002 Mar;19(3):469-71.
PMID: 11936524 [PubMed - indexed for MEDLINE]

37. Greene BL.Physical therapist management of fluoroquinolone-induced Achilles tendinopathy.
Phys Ther. 2002 Dec;82(12):1224-31.
PMID: 12444881 [PubMed - indexed for MEDLINE]

38. Breck RW.
"Ciprofloxacin: a warning for clinicians".
Conn Med. 2002 Oct;66(10):635. No abstract available.
PMID: 12448217 [PubMed - indexed for MEDLINE]

39. Hufner T, Wohifarth K, Fink M, Thermann H, Rollnik JD.
EMG monitoring during functional non-surgical therapy of Achilles tendon rupture.
Foot Ankle Int. 2002 Jul;23(7):614-8.
PMID: 12146771 [PubMed - indexed for MEDLINE]

40. Khurana R, Torzillo PJ, Horsley M, Mahoney J.
Spontaneous bilateral rupture of the Achilles tendon in a patient with chronic obstructive pulmonary disease.
Respirology. 2002 Jun;7(2):161-3.
PMID: 11985741 [PubMed - indexed for MEDLINE]

41. Mert G.
Rupture of the Achilles tendon in athletes: do synthetic grass fields play a part?
J Bone Joint Surg Am. 2002 Feb;84-A(2):320-1. No abstract available.
PMID: 11861742 [PubMed - indexed for MEDLINE]

42. Lynch RM
Management of Achilles tendon ruptures.
Am J Sports Med. 2002 Nov-Dec;30(6):917; author reply 917-8. No abstract
available.
PMID: 12435663 [PubMed - indexed for MEDLINE]

43. Amendola N.
Surgical treatment of acute rupture of the tendo Achillis led to fewer
reruptures and better patient-generated ratings than did nonsurgical treatment.
J Bone Joint Surg Am. 2002 Feb;84-A(2):324. No abstract available.
PMID: 11861747 [PubMed - indexed for MEDLINE]

44. Zwar RB.
Utility of musculoskeletal ultrasound.
Aust Fam Physician. 2002 Jun;31(6):559, 561.
PMID: 12154604 [PubMed - indexed for MEDLINE]

45. Cottrell WC, Pearsall AW 4th, Hollis MJ.
Simultaneous tears of the Achilles tendon and medial head of the gastrocnemius muscle.
Orthopedics. 2002 Jun;25(6):685-7. No abstract available.
PMID: 12083581 [PubMed - indexed for MEDLINE]


2003

1. Journal of Antimicrobial Chemotherapy (2003) 51, 747–748
DOI: 10.1093/jac/dkg081
Advance Access publication 28 January 2003
Correspondence
Spontaneous Achilles tendon rupture in patients
treated with levofloxacin
L. J. Haddow, M. Chandra Sekhar, V. Hajela and
G. Gopal Rao

2. Manoj Kumar RV, Rajasekaran S.
Spontaneous tendon ruptures in alkaptonuria.
J Bone Joint Surg Br. 2003 Aug;85(6):883-6.
PMID: 12931812 [PubMed - indexed for MEDLINE]

3. Harris RD, Nindl G, Balcavage WX, Weiner W, Johnson MT.
Use of proteomics methodology to evaluate inflammatory protein expression in tendinitis.
Biomed Sci Instrum. 2003;39:493-9.
PMID: 12724941 [PubMed - indexed for MEDLINE]

4. Milgrom C, Finestone A, Zin D, Mandel D, Novack V.
Cold weather training: a risk factor for Achilles paratendinitis among
recruits.
Foot Ankle Int. 2003 May;24(5):398-401.
PMID: 12801195 [PubMed - indexed for MEDLINE]

5. Schwalm JD, Lee CH.
Acute hepatitis associated with oral levofloxacin therapy in a hemodialysis patient.
CMAJ. 2003 Apr 1;168(7):847-8.
PMID: 12668542 [PubMed - indexed for MEDLINE]

6. Oh YR, Carr-Lopez SM, Probasco JM, Crawley PG.
Levofloxacin-induced autoimmune hemolytic anemia.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1010-3.
PMID: 12841809 [PubMed - indexed for MEDLINE]

7. Bardin L.
Comments on 'Achilles tendinopathy'.
Man Ther. 2003 Aug;8(3):189; author reply 190-1. No abstract available.
PMID: 12909446 [PubMed - indexed for MEDLINE]

8. Ackermann PW, Li J, Lundeberg T, Kreicbergs A.
Neuronal plasticity in relation to nociception and healing of rat achilles tendon.
J Orthop Res. 2003 May;21(3):432-41.
PMID: 12706015 [PubMed - indexed for MEDLINE]

9. Gotoh M, Higuchi F, Suzuki R, Yamanaka K.
Progression from calcifying tendinitis to rotator cuff tear.
Skeletal Radiol. 2003 Feb;32(2):86-9. Epub 2002 Apr 05.
PMID: 12589487 [PubMed - indexed for MEDLINE]

10. Dalal RB, Zenios M.
The flexor hallucis longus tendon transfer for chronic tendo-achilles ruptures revisited. Ann R Coll Surg Engl. 2003 Jul;85(4):283. No abstract available.
PMID: 12908473 [PubMed - indexed for MEDLINE]

11. Joseph TA, Defranco MJ, Weiker GG.
Delayed repair of a pectoralis major tendon rupture with allograft: A case report.
J Shoulder Elbow Surg. 2003 Jan-Feb;12(1):101-4. No abstract available.
PMID: 12610495 [PubMed - indexed for MEDLINE]

12. [No authors listed]
Tendon abnormalities and hypersensitivity of levofloxacin.
Prescrire Int. 2003 Feb;12(63):20. No abstract available.
PMID: 12602391 [PubMed - indexed for MEDLINE]

13. Magnusson SP, Beyer N, Abrahamsen H, Aagaard P, Neergaard K, Kjaer M.
Increased cross-sectional area and reduced tensile stress of the Achilles tendon in elderly compared with young women.
J Gerontol A Biol Sci Med Sci. 2003 Feb;58(2):123-7.
PMID: 12586849 [PubMed - indexed for MEDLINE]

14. Khan KM, Forster BB, Robinson J, Cheong Y, Louis L, Maclean L, Taunton JE.
Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study.
Br J Sports Med. 2003 Apr;37(2):149-53.
PMID: 12663358 [PubMed - indexed for MEDLINE]

15. DY, Song JC, Wang CC.
Anaphylactoid reaction to ciprofloxacin.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1018-23.
PMID: 12841811 [PubMed - indexed for MEDLINE]

16. Ying M, Yeung E, Li B, Li W, Lui M, Tsoi CW.
Sonographic evaluation of the size of Achilles tendon: the effect of exercise and dominance of the ankle.
Ultrasound Med Biol. 2003 May;29(5):637-42.
PMID: 12754062 [PubMed - indexed for MEDLINE]

17. Cook J, Khan K.
The treatment of resistant, painful tendinopathies results in frustration for athletes and health professionals alike.
Am J Sports Med. 2003 Mar-Apr;31(2):327-8; author reply 328. No abstract available.
PMID: 12642274 [PubMed - indexed for MEDLINE]

18. [No authors listed]
Fluoroquinolones in ambulatory ENT and respiratory tract infections: rarely appropriate.
Prescrire Int. 2003 Feb;12(63):26-7.
PMID: 12602405 [PubMed - indexed for MEDLINE]

19. Matsumoto F, Trudel G, Uhthoff HK, Backman DS.
Mechanical effects of immobilization on the Achilles' tendon.
Arch Phys Med Rehabil. 2003 May;84(5):662-7.
PMID: 12736878 [PubMed - indexed for MEDLINE]

20. Maffulli N, Kenward MG, Testa V, Capasso G, Regine R, King JB.
Clinical diagnosis of Achilles tendinopathy with tendinosis.
Clin J Sport Med. 2003 Jan;13(1):11-5.
PMID: 12544158 [PubMed - indexed for MEDLINE]

21. Forslund C.
BMP treatment for improving tendon repair. Studies on rat and rabbit Achilles tendons.
Acta Orthop Scand Suppl. 2003 Feb;74(308):I, 1-30. No abstract available.
PMID: 12640969 [PubMed - indexed for MEDLINE]

22. Cetti R, Junge J, Vyberg M.
Spontaneous rupture of the Achilles tendon is preceded by widespread and bilateral tendon damage and ipsilateral inflammation: a clinical and histopathologic study of 60 patients.
Acta Orthop Scand. 2003 Feb;74(1):78-84.
PMID: 12635798 [PubMed - indexed for MEDLINE]

23. Mulvaney S.
Calf muscle therapy for Achilles tendinosis.
Am Fam Physician. 2003 Mar 1;67(5):939; author reply 939-40. No abstract available.
PMID: 12643353 [PubMed - indexed for MEDLINE]

24. Khaliq Y, Zhanel GG.
Fluoroquinolone-associated tendinopathy: a critical review of the literature.
Clin Infect Dis. 2003 Jun 1;36(11):1404-10. Epub 2003 May 20. Review.
PMID: 12766835 [PubMed - indexed for MEDLINE]

25. Prasad S, Lee A, Clarnette R, Faull R.
Spontaneous, bilateral patellar tendon rupture in a woman with previous Achilles tendon rupture and systemic lupus erythematosus.
Rheumatology (Oxford). 2003 Jul;42(7):905-6. No abstract available.
PMID: 12826711 [PubMed - indexed for MEDLINE]

26. Gold L, Igra H.
Levofloxacin-induced tendon rupture: a case report and review of the literature.
J Am Board Fam Pract. 2003 Sep-Oct;16(5):458-60. Review. No abstract available.
PMID: 14645337 [PubMed - indexed for MEDLINE]

27. Schindler C, Pittrow D, Kirch W.
Reoccurrence of levofloxacin-induced tendinitis by phenoxymethylpenicillin therapy after 6 months: a rare complication of fluoroquinolone therapy?
Chemotherapy. 2003 May;49(1-2):90-1. No abstract available.
PMID: 12756981 [PubMed - indexed for MEDLINE]

28. de La Red G, Mejia JC, Cervera R, Llado A, Mensa J, Font J.
Bilateral Achilles tendinitis with spontaneous rupture induced by levofloxacin in a patient with systemic sclerosis.
Clin Rheumatol. 2003 Oct;22(4-5):367-8. No abstract available.
PMID: 14579169 [PubMed - indexed for MEDLINE]

29. Tomas ME, Perez Carreras M, Morillasa JD, Castellano G, Solis JA.
[Rupture of the Achilles' tendon secondary to levofloxacin]
Gastroenterol Hepatol. 2003 Jan;26(1):53-4. Spanish. No abstract available.
PMID: 12525331 [PubMed - indexed for MEDLINE]

30. Mathis AS, Chan V, Gryszkiewicz M, Adamson RT, Friedman GS.
Levofloxacin-associated Achilles tendon rupture.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1014-7.
PMID: 12841810 [PubMed - indexed for MEDLINE]

31. Aros C, Flores C, Mezzano S.[Achilles tendinitis associated to levofloxacin: report of 4 cases]
Rev Med Chil. 2002 Nov;130(11):1277-81. Spanish.
PMID: 12587511 [PubMed - indexed for MEDLINE]

32. Shah P.[Do tendon lesions occur during quinolone administration?]
Dtsch Med Wochenschr. 2003 Oct 17;128(42):2214. German. No abstract available.
PMID: 14562223 [PubMed - indexed for MEDLINE]

33. Melhus A, Apelqvist J, Larsson J, Eneroth M.
Levofloxacin-associated Achilles tendon rupture and tendinopathy.
Scand J Infect Dis. 2003;35(10):768-70.
PMID: 14606622 [PubMed - indexed for MEDLINE]

34. Cebrian P, Manjon P, Caba P.
Ultrasonography of non-traumatic rupture of the Achilles tendon secondary to
levofloxacin.
Foot Ankle Int. 2003 Feb;24(2):122-4.
PMID: 12627618 [PubMed - indexed for MEDLINE]

35. Bernacer L, Artigues A, Serrano A.
[Levofloxacin and bilateral spontaneous Achilles tendon rupture]
Med Clin (Barc). 2003 Jan 25;120(2):78-9. Spanish. No abstract available.
PMID: 12570920 [PubMed - indexed for MEDLINE]

36. Haddow LJ, Chandra Sekhar M, Hajela V, Gopal Rao G.
Spontaneous Achilles tendon rupture in patients treated with levofloxacin.
J Antimicrob Chemother. 2003 Mar;51(3):747-8. No abstract available.
PMID: 12615887 [PubMed - indexed for MEDLINE]

37. Othmani S, Battikh R, Ben Abdallah N.
[The myo-tendinopathy caused by levofloxacin]
Therapie. 2003 Sep-Oct;58(5):463-5. French. No abstract available.
PMID: 14682197 [PubMed - indexed for MEDLINE]

38. Gutierrez E, Morales E, Garcia Rubiales MA, Valentin MO.
[Levofloxacin and Achilles tendon involvement in hemodialysis patients]
Nefrologia. 2003 Nov-Dec;23(6):558-9. Spanish. No abstract available.
PMID: 15002793 [PubMed - indexed for MEDLINE]

40. Spontaneous Achilles tendon rupture in patients treated with levofloxacin
L. J. Haddow, M. Chandra Sekhar, V. Hajela and G. Gopal Rao*
Department of Microbiology, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK 2003 The British Society for Antimicrobial Chemotherapy

41. Clinical Infectious Diseases 2003;36:1404-1410
2003 by the Infectious Diseases Society of America. All rights reserved.
Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature
Yasmin Khaliq1 and George G. Zhanel2

42. J Am Podiatr Med Assoc. 2003 Jul-Aug;93(4):333-5.
Fluoroquinolone therapy and Achilles tendon rupture.
Vanek D, Saxena A, Boggs JM.

43. Clin Rheumatol. 2003 Dec;22(6):500-1. Epub 2003 Oct 18.
Ciprofloxacin and Achilles' tendon rupture: a causal relationship.

44. Aten Primaria. 2003 Sep 15;32(4):256
Bilateral Achilles tendinitis as adverse reaction to levofloxacine.

45. Therapie. 2003 Sep-Oct;58(5):463-5.
The myo-tendinopathy caused by levofloxacin

46. Reumatismo. 2003 Oct-Dec;55(4):267-9.
Levofloxacin-induced bilateral rupture of the Achilles tendon: clinical and sonographic findings

47. Gastroenterol Hepatol. 2003 Jan;26(1):53-4.
Rupture of the Achilles' tendon secondary to levofloxacin

48. J Antimicrob Chemother. 2003 Mar;51(3):747-8.
Spontaneous Achilles tendon rupture in patients treated with levofloxacin.

49. Foot Ankle Int. 2003 Feb;24(2):122-4.
Ultrasonography of non-traumatic rupture of the Achilles tendon secondary to levofloxacin.

50. Chemotherapy. 2003 May;49(1-2):90-1.
Reoccurrence of levofloxacin-induced tendinitis by phenoxymethylpenicillin therapy after 6 months: a rare complication of fluoroquinolone therapy?

51. rupture of the Achilles tendon: clinical and sonographic findings]
Reumatismo. 2003 Oct-Dec;55(4):267-9. Italian.
PMID: 14872227 [PubMed - indexed for MEDLINE]

52. Ann Pharmacother. 2003 Jul-Aug;37(7-8):1014-7.
Levofloxacin-associated Achilles tendon rupture.

53. Clin Rheumatol. 2003 Oct;22(4-5):367-8.
Bilateral Achilles tendinitis with spontaneous rupture induced by levofloxacin in a patient with systemic sclerosis.

54. Scand J Infect Dis. 2003;35(10):768-70.
Levofloxacin-associated Achilles tendon rupture and tendinopathy.

55. Levofloxacin-associated Achilles tendon rupture and tendinopathy. Scand J Infect Dis 2003;35(10):768-70 (ISSN: 0036-5548) Melhus A; Apelqvist J; Larsson J; Eneroth M Department of Medical Microbiology, Malmo University Hospital, Malmo, Sweden. asa.melhus at mikrobiol.mas.lu.se.

56. Levofloxacin and trovafloxacin inhibition of experimental fracture-healing. Clin Orthop 2003 Sep;(414):95-100 (ISSN: 0009-921X) Perry AC; Prpa B; Rouse MS; Piper KE; Hanssen AD; Steckelberg JM; Patel R Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.

57. Levofloxacin-associated Achilles tendon rupture. Ann Pharmacother 2003 Jul-Aug;37(7-8):1014-7 (ISSN: 1060-0280) Mathis AS; Chan V; Gryszkiewicz M; Adamson RT; Friedman GS Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA. smathis at sbhcs.com.

58. Richardson LC, Reitman R, Wilson M.
Achilles tendon ruptures: functional outcome of surgical repair with a "pull-out" wire.
Foot Ankle Int. 2003 May;24(5):439-43.
PMID: 12801203 [PubMed - indexed for MEDLINE]

59. Ultrasonography of non-traumatic rupture of the Achilles tendon secondary to levofloxacin. Foot Ankle Int 2003 Feb;24(2):122-4 (ISSN: 1071-1007) Cebrian P; Manjon P; Caba P Departamento de Radiodiagnostico, Hospital Universitario 12 de Octubre, Madrid, Spain. pcvbb at yahoo.es.

60. J Am Board Fam Pract. 2003 Sep-Oct;16(5):458-60.
Levofloxacin-induced tendon rupture: a case report and review of the literature.


2004

1. Mehra A, Maheshwari R, Case R, Croucher C.
Bilateral simultaneous spontaneous rupture of the Achilles tendon.
Hosp Med. 2004 May;65(5):308-9. No abstract available.
PMID: 15176150 [PubMed - indexed for MEDLINE]

2. Vergara Fernandez I.
[Muscle and tendon problems as a side-effect of levofloxacine: review of a case]
Aten Primaria. 2004 Mar 15;33(4):214. Spanish. No abstract available.
PMID: 15023326 [PubMed - indexed for MEDLINE]

3. McKinley BT, Oglesby RJ.
A 57-year-old male retired colonel with acute ankle swelling.
Mil Med. 2004 Mar;169(3):254-6. No abstract available.
PMID: 15080249 [PubMed - indexed for MEDLINE]

4. Fama U, Irace S, Frati R, de Gado F, Scuderi N.
Is it a real risk to take ciprofloxacin?
Plast Reconstr Surg. 2004 Jul;114(1):267. No abstract available.
PMID: 15220615 [PubMed - indexed for MEDLINE]

5. Kahn F, Christensson B.
[A rapid development of Achilles tendon rupture following quinolone treatment]
Lakartidningen. 2004 Jan 15;101(3):190-1. Swedish. No abstract available.
PMID: 14763088 [PubMed - indexed for MEDLINE]

6. Long term outcome after Fluoroquinolones tendinopathies
13/01/2004 14:11:07 P-0077
C Guy (1); Y Murat (1); MN Beyens (1); M Ratrema (1); G Mounier (1); M Ollagnier (1); (1) Centre de Pharmacovigilance, Hôpital Bellevue - CHU St-Etienne, Sant-Etienne

7. Levofloxacin-induced bilateral Achilles tendon rupture: a case report and review of the literature. J Orthop Sci 2004;9(2):186-90 (ISSN: 0949-2658) Kowatari K; Nakashima K; Ono A; Yoshihara M; Amano M; Toh S Department of Orthopaedic Surgery, Aomori Rosai Hospital, 1 Minamigaoka, Shirogane-machi, Hachinohe 031-8551, Japan.

8. Pharmacol Exp Ther. 2004 Jan;308(1):394-402. Epub 2003 Oct 20. In vitro discrimination of fluoroquinolones toxicity on tendon cells: involvement of oxidative stress.

9. Hosp Med. 2004 May;65(5):308-9.
Bilateral simultaneous spontaneous rupture of the Achilles tendon.
Mehra A, Maheshwari R, Case R, Croucher C.

10. Therapie. 2004 Nov-Dec;59(6):653-5.
Ofloxacin-induced achilles tendinitis in the absence of a predisposition

11. An Med Interna. 2004 Mar;21(3):154.
Achilles bilateral tendonitis and levofloxacin

12. J Orthop Sci. 2004;9(2):186-90.
Levofloxacin-induced bilateral Achilles tendon rupture: a case report and review of the literature.

13. Scand J Infect Dis. 2004;36(4):315-6.
Recurrent tendinitis after treatment with two different fluoroquinolones.

14. Joint Bone Spine. 2004 Nov;71(6):586-7. Related Articles, Links
Rupture of multiple tendons after levofloxacin therapy.
Braun D, Petitpain N, Cosserat F, Loeuille D, Bitar S, Gillet P, Trechot P.
Pneumology Department, Maillot Hospital, 54150 Briey, France.

15. Aten Primaria. 2004 Mar 15;33(4):214.
Muscle and tendon problems as a side-effect of levofloxacine: review of a case

16. Kowatari K, Nakashima K, Ono A, Yoshihara M, Amano M, Toh S.
Levofloxacin-induced bilateral Achilles tendon rupture: a case report and review of the literature.
J Orthop Sci. 2004;9(2):186-90. Review.
PMID: 15045551 [PubMed - indexed for MEDLINE]

17. Gomez Rodriguez N, Ibanez Ruan J, Gonzalez Perez M.
[Achilles bilateral tendonitis and levofloxacin]
An Med Interna. 2004 Mar;21(3):154. Spanish. No abstract available.
PMID: 15043504 [PubMed - indexed for MEDLINE]

18. Filippucci E, Farina A, Bartolucci F, Spallacci C, Busilacchi P, Grassi W.[Levofloxacin-induced bilateral

19. Burkhardt O, Kohnlein T, Pap T, Welte T.
Recurrent tendinitis after treatment with two different fluoroquinolones.
Scand J Infect Dis. 2004;36(4):315-6.
PMID: 15198194 [PubMed - indexed for MEDLINE]


2005

1. Toxicology. 2005 May 9
Fluoroquinolones cause changes in extracellular matrix, signalling proteins, metalloproteinases and caspase-3 in cultured human tendon cells.
Sendzik J, Shakibaei M, Schafer-Korting M, Stahlmann R.

2. Arch Orthop Trauma Surg. 2005 Mar;125(2):124-6. Epub 2005 Jan 12.
Missed Achilles tendon rupture due to oral levofloxacin: surgical treatment and result.

3. An Med Interna. 2005 Jan;22(1):28-30.
Partial bilateral rupture of the Achilles tendon associated to levofloxacin

4. Expert Opin Drug Saf. 2005 Mar;4(2):299-309.
Fluoroquinolones and tendon disorders.
Melhus A.

5. Toxicology. 2005 May 9
Fluoroquinolones cause changes in extracellular matrix, signalling proteins, metalloproteinases and caspase-3 in cultured human tendon cells.
Sendzik J, Shakibaei M, Schafer-Korting M, Stahlmann R.
Institute of Clinical Pharmacology and Toxicology, Department of Toxicology, Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Garystr. 5, 14195 Berlin, Germany; Institute of Anatomy, Department of Cell and Neurobiology, Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Konigin-Luise-Str. 15, 14195 Berlin, Germany; Musculoskeletal Research Group, Institute of Anatomy, Ludwig-Maximilian-Universitat Munich, Pettenkoferstr. 11, 80336 Munich, Germany.

Additional references:

AUSTRALIA
THE ACHILLES HEEL OF FLUOROQUINOLONES
One of the more unusual adverse reactions known to be associated with the fluoroquinolone antibiotics is the occurrence of tendinitis. This is a serious effect since it may progress to tendon rupture with many weeks of disability as a result. Over 200 cases have been reported in the literature with the majority from France. Most members of the class including ciprofloxacin, enoxacin, ofloxacin, and norfloxacin have been implicated. The Achilles tendon is most often involved.
In Australia, there have been 25 reports of tendinitis in association with fluoroquinolones. Most (22) have been with ciprofloxacin and the other three with norfloxacin. The majority of the patients involved were elderly, ranging in age from 46 to 91 (median 69) years and the sex distribution was equal. For ciprofloxacin, daily dosages ranged from 750 mg to 2250 mg although most (13) patients were taking 1000 mg daily. For norfloxacin, all three patients were taking the usual dose of 800 mg daily. Time to onset ranged from the same day that the drug was commenced (in two patients) to two months although in 13 of the 24 reports which provided the information, the reaction occurred within the first week. Almost all (23) of the reports specified the Achilles tendon as the site of the tendinitis. Tendinitis was described as bilateral in 11 cases. Only 8 patients had recovered at the time the report was submitted and the other patients were being treated with rest and/or physiotherapy. There have been no reports of tendon rupture in Australia although in one severe case, the patient required a plaster cast up to the mid thigh.
A number of risk factors have been identified with regard to this adverse reaction. These include old age, renal dysfunction, and concomitant corticosteroid therapy. Of the patients reported to ADRAC, 72% were older than 60 years. Nine of these patients were taking corticosteroids as were three of the younger patients.
Prescribers are reminded that tendinitis, especially involving the Achilles tendon, is a rare adverse effect of the fluoroquinolones. It is more likely to occur in association with the risk factors referred to above. The antibiotic should be withdrawn immediately to reduce the risk of tendon rupture.


DUTCH
Fluoroquinolones have been associated with tendon disorders, usually during the first month of treatment,1-5 but the epidemiological evidence is scanty. We did a nested case-control study among users of fluoroquinolones in a large UK general practice database to study the association with Achilles tendon disorders.

Participants, methods, and results

We obtained data from the IMS Health database (UK MediPlus), which contains data from general practice on consultations, morbidity, prescriptions, and other interventions in a source population of 1-2 million inhabitants. The base cohort consisted of all patients aged 18 years or over who had received a fluoroquinolone. We excluded people with a history of Achilles tendon disorders, cancer, AIDS, illicit drug use, or alcohol misuse. We identified potential cases by reviewing patient profiles and clinical data and excluded tendon disorders due to direct trauma. We randomly sampled a group of 10 000 control patients from the study cohort.

We defined four categories of exposure to fluoroquinolones: current use, recent use, past use, and no use. We defined current use as when the tendon disorder occurred in the period between the start of the fluoroquinolone treatment and the calculated end date plus 30 days, recent use as when the calculated end date was between 30 and 90 days before the occurrence of the disorder, and past use as when the calculated end date was more than 90 days before the occurrence of the disorder. We used unconditional logistic regression analysis to calculate adjusted relative risks and 95% confidence intervals for Achilles tendon disorders, using the no use group as the reference. We adjusted for age, sex, number of visits to the general practitioner, use of corticosteroid, calendar year, obesity, and history of musculoskeletal disorders.

The cohort included 46 776 users of fluoroquinolones between 1 July 1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38 had Achilles tendon rupture. Four hundred and fifty three (61%) of the cases were women, and the mean age was 56 years. Cases visited the general practitioner significantly more often than did controls (mean 20 v 17). Cases and controls were similar with respect to indications for use of fluoroquinolone. Age, number of visits to the general practitioner in the previous 18 months, gout, obesity, and use of corticosteroid were determinants of Achilles tendon disorders. The adjusted relative risk of Achilles tendon disorders with current use of fluoroquinolones was 1.9 (95% confidence interval 1.3 to 2.6). The risk for recent and past use was similar to that for no use. The relative risk with current use was 3.2 (2.1 to 4.9) among patients aged 60 and over and 0.9 (0.5 to 1.6) among patients aged under 60 (table). In patients aged 60 or over, concurrent use of corticosteroids and fluoroquinolones increased the risk to 6.2 (3.0 to 12.8).

Relative risk of Achilles tendon disorders associated with use of fluoroquinolones according to age
Current exposure to fluoroquinolones increases the risk of Achilles tendon disorders. This finding is in agreement with a smaller study, in which we found an association between tendinitis and fluoroquinolones.5 Our results indicate that this adverse effect is relatively rare, with an overall excess risk of 3.2 cases per 1000 patient years. The effect seems to be restricted to people aged 60 or over, and within this group concomitant use of corticosteroids increased the risk substantially. The proportion of Achilles tendon disorders among patients with both risk factors that is attributable to their interaction was 87%. Although the mechanism is unknown, the sudden onset of some tendinopathies, occasionally after a single dose of a fluoroquinolone, suggests a direct toxic effect on collagen fibres. Prescribers should be aware of this risk, especially in elderly people taking corticosteroids.

Acknowledgments
We acknowledge the cooperation of IMS Health United Kingdom.
Contributors: PDvdL, MCJMS, and BHChS formulated the design of the study. PDvdL carried out the analyses. PDvdL, MCJMS, and BHChS wrote the paper, and RMCH and HGML edited it. BHChS and HGML are guarantors for the paper.

Funding:
Dutch Inspectorate for Health Care.

Competing interests:
MCJMS is a consultant for Lundbeck (France) and Beaufour (UK) and has previously been a consultant for Pfizer (USA), Roche (Switzerland), and Novartis Consumerhealth (Switzerland). MCJMS is responsible for research conducted with the integrated primary care information database in the Netherlands, which is supported by project specific grants from GlaxoSmithKline, AstraZeneca, Merck Sharp & Dohme, Pharmacia & Upjohn, Bristol-Myers Squibb, Eli Lilly, Wyeth, and Yamanouchi. MCJMS has conducted research projects on use of antibiotics for Merck & Co (USA) and Bayer (Italy).

This is far from being an all inclusive list of such medical journal entries and other such main stream documentation. Starting in 1965 and ending in 2005, almost forty years worth of such reports and the treating physician as well as the patient have no prior knowledge concerning such events. This defies logic but sadly enough this is the true state of affairs. In spite of the overwhelming evidence presented at that 62 Meeting of the Anti-Infective Drugs Advisory Committee that the fluoroquinolones cause irreversible joint damage in the pediatric population the FDA has recently added the use of Ciprofloxacin in the pediatric population, treating children as young as one years of age.

Numerous studies have indicated that such use in a pediatric patient runs the risk of crippling the child for life. Yet additional clinical trials continue aided and abetted by the FDA, for other drugs in this class other than Ciprofloxacin. A disaster that is detailed within the 62nd meeting of the Anti-Infective Drugs Advisory Committee where it was so eloquently stated:

"…when we talk about the issue of arthropathy that potentially includes a number of things, ranging from simple effusion, for instance, of a knee joint, which might rapidly resolve after the conclusion of therapy, to a more permanent disability. .." (sic)

"…in September of 1997 there is now a ciprofloxacin suspension which is available, and although it continues to have the same warning statements about arthropathy in juvenile animals and the potential concern in pediatric populations, obviously, the issue of off label use will extend over to pediatric populations in this formulation…."(sic)

"…An important safety question is, what adverse events should be monitored, and Doctor Goldberger alluded to this earlier. This is some of the examples I present. One is permanent lameness, reversible lameness, joint effusion, joint pain, and even latent articular disease or damage that may occur months or years following drug exposure, and there may be others…."(sic)

"…And, data submitted to the Agency, as well as data from the scientific literature, indicate that these lesions don't appear to be reversible…"(sic)

"…Doctor Stahlmann in Berlin is working on an idea that it may be an effect between the endocrines, the magnesium and the matrix and the quinolone. And that data is just coming out now. But as to the exact mechanism, I think you're right. I don't think we have a handle, as far as I know, on the exact mechanism. If there's anybody else that does, I'd sure like to hear it…"(sic)

"… Relating your personal experience, I was wondering about the potential for a delayed effect that in fact one might have a patient who had some histologic changes that would not be manifest clinically for many years. Is that a potential?" (sic)

"… I think it is a potential…"(sic)

"… In trying to assess toxicity with a very sensitive assay, obviously you've got tissue that you can look at in your animal models. There is some human data that were collected by Doctor Urs Schaad using MRI scanning in children and I'm wondering if you can correlate some of your histopathologic findings with MR in the animal model to give us an idea of how sensitive it would be sort of as a follow-up to Doctor Klein's question is the MR something that will be able to predict long-term outcomes, even if there are no clinical symptoms during therapy…."(sic)

"… That I don't know. I'll just be perfectly frank. I don't know. But on the slides I've seen from the animals from the chronic study, the repaired articular cartilage that is there is principally fibrocartilage yet it will provide the same joint margin and it has a calcified base and when we stain it with safrain O screen there's no proteoglycans there so it's going to make it an extremely chondromalaistic area and beyond the one year I can't tell you what the results will be…"(sic)

"…Anyway, it was by a group in Vienna where they looked at the articular cartilage of postmortem specimens of articular cartilage from kids with cystic fibrosis that had been on quinolones for a period of time and they found that there was damage in the chondrocytes…."(sic)

"…There were no deaths reported in U.S. pediatric zero to 18 year old cases where a flouroquinolone was reported as the suspect drug. However, there are eight deaths in the whole cohort of suspect and concomitant flouroquinolone drug reports in the system. Five of these deaths reported ciprofloxacin as a concomitant drug and not the suspect drug. These five were U.S. cases with ages ranging from seven months to six years. The remaining three deaths were all foreign, all 18 year old patients with either ofloxacin or norfloxacin reported as the suspect drug…."(sic)

"…There are 14 reports of arthropathy or arthralgia in the pediatric zero to 18 year old flouroquinolone reports. One report of a 14 year old girl had both ofloxacin and lomefloxacin as the suspect drug so there is an extra count because of the two flouroquinolones on this one report. This particular report indicates that a pediatric orthopedic surgeon diagnosed femoral anteversion as the cause for the girl's arthralgia, therefore you see it listed twice, and not the flouroquinolones. Most of the reports indicated that either an involved knee or elbow with or without other joints was involved…."(sic)

"…One interesting case which is not included on this slide for arthralgias was a 15 year old boy who received ofloxacin IV for an emergency appendectomy and had not grown more than his 70 inches in height over the last year. The 15th percentile for height for a 15 year old boy however is 66.5 inches and the expected growth rate is about two inches per year…"(sic)

"…Three patients had their seizure after the first dose of flouroquinolone, one on ciprofloxacin and the other two on ofloxacin, one of which had received ofloxacin several months earlier…"(sic)

"…The 15 psychiatric reports are a loose grouping of reports which include events ranging from euphoria to psychosis. The ages range from five to 18 years with the median at 15 years. There were two suicide attempts, one on ofloxacin and the other on norfloxacin, three reports of hallucination, one each on ciprofloxacin, ofloxacin and norfloxacin, and one report of aggressive behavior with confusion in a patient who had a psychiatric history and was on norfloxacin. The seven cases of photosensitivity were reported with lomefloxacin with one case on ciprofloxacin and two cases on ofloxacin. …"(sic)

"…I will mention that there were 152 U.S. cases aged zero to 18 years in the U.S. AERS system suspect flouroquinolones in the WHO line listing. The country with the most pediatric reports in the WHO foreign reports is the United Kingdom with 177 reports followed by Germany with 72 and France with 71. The rest of the countries had 20 or fewer reports…."(sic)

"…And with regards to muscular-skeletal events, 21 percent of the patients had an event in ciprofloxacin…"(sic)

"…We have focused our analysis on joint disorders and pefloxacin. 79 cases were reported and consist mainly of arthralgia. I don't know the pronunciation of hydrarthrosis -- 49 persons. It involved the knee in 52 cases, the wrist in 20 cases, the elbow in 20 cases, the shoulder in 6 cases, the ankle in 5 cases, and the hip once. It is associated with a functional discomfort in all cases, and when the duration of this discomfort is known, it can persist more than one month in 61 percent of these cases. But the outcome was favorable in 58 cases without discontinuation in two cases. …"(sic)

"…There have been sequelae in three cases with knee effusions persisting one year later in one case with discomfort following 8 months later in the second case. The third case is articular. It is a 17-year-old patient who experienced arthropathy and the drug was not suspected and the treatment was continued two following months. It leads to destructive arthropathy of the knees and the hip and prothesis was performed three years later. He was treated for a cerebral abscess. The outcome was unknown in 18 cases. In 9 cases, there was no follow-up. In the 9 last cases, we had a follow-up three months later and patients were not -- were still with disabilities and after we have no evolution…." (sic)

"… It is my understanding that one of the children had a joint replacement, is that correct?"

" Pardon me?"

" One of the children with the complications had an artificial joint replacement?"

"Yes."

"…If an irreversible cartilaginous lesion can occur, it is very likely that is going to cause problems down the line and we can't even anticipate what they are like…" (sic)


Again I state that this is for your reference & review and being made in support of my oppossing opinion that such occurences are not rare. I also take exception to the statement made that there is some kind of obligation to report such events. There is not. Such reports are done strictly on a voluntary basis and no law mandates that this be done by the treating physician. The medwatch program is voluntary and less that 3% of such events are ever reported to the FDA. A full 97% of such events never make it to the FDA. When reviewing the medwatch data base for the fluoroquinolones, joint, tendon and cartilage damage are all the top three events being reported, more so than any other adr.

In addition when a physician fails to recognize such an event it is doubtful that it would be reported. The NUMBER ONE complaint of those who have suffered such an event is the fact that the treating physician DENIES that it could possibly be the result of fluoroquinolone therapy. Any number of the tens of thousands of such victims I have discussed this issue with have reported that their physician REFUSED to make such a report, REFUSED to review the citations brought to them by their patients, and instructed their patients to stay off the internet. Even when such documentation was presented to the drug reps via pharmacafe those posting such information were ridiculed and harassed. This is not a situation I find condusive to accurate reporting of such events. It is a situation that results in false and misleading information being available to both the patient and the physician, while the true state of affairs is swept under the carpet.

Result number: 101

Message Number 184314

Re: Walkfit orthotics? View Thread
Posted by Melissa B. on 10/08/05 at 11:27

I ordered a pair for my husband from their website the first week in July. Walkfit debited my account the following day. I never received confirmation of the order, nor have I received the merchandise for which I paid! I cannot tell you how uncooperative the customer support people have been. Has anyone else suffered the same problem?

Result number: 102

Message Number 182668

Re: The Tale of Two Paramedics In NOLA Attending a conference. View Thread
Posted by marie on 9/11/05 at 15:32

The current link is dead but I saved the story. Two follow up links at the bottome. I wonder if they have any job openings in the sheriff's dept on the other side of Gretna. I think I know someone who'd fit right in.

Hurricane Katrina-Our Experiences
Hurricane Katrina-Our Experiences

Larry Bradshaw
Lorrie Beth Slonsky

Two days after Hurricane Katrina struck New Orleans, the Walgreen's store at
the corner of Royal and Iberville streets remained locked. The dairy display
case was clearly visible through the widows. It was now 48 hours without
electricity, running water, plumbing. The milk, yogurt, and cheeses were beginning
to spoil in the 90-degree heat. The owners and managers had locked up the
food, water, pampers, and prescriptions and fled the City. Outside Walgreen's
windows, residents and tourists grew increasingly thirsty and hungry.

The much-promised federal, state and local aid never materialized and the
windows at Walgreen's gave way to the looters. There was an alternative. The
cops could have broken one small window and distributed the nuts, fruit juices,
and bottle water in an organized and systematic manner. But they did not.
Instead they spent hours playing cat and mouse, temporarily chasing away the
looters.

We were finally airlifted out of New Orleans two days ago and arrived home
yesterday (Saturday). We have yet to see any of the TV coverage or look at a
newspaper. We are willing to guess that there were no video images or
front-page pictures of European or affluent white tourists looting the Walgreen's in
the French Quarter.

We also suspect the media will have been inundated with "hero" images of the
National Guard, the troops and the police struggling to help the "victims" of
the Hurricane. What you will not see, but what we witnessed,were the real
heroes and sheroes of the hurricane relief effort: the working class of New
Orleans. The maintenance workers who used a fork lift to carry the sick and
disabled. The engineers, who rigged, nurtured and kept the generators running. The
electricians who improvised thick extension cords stretching over blocks to
share the little electricity we had in order to free cars stuck on rooftop
parking lots. Nurses who took over for mechanical ventilators and spent many
hours on end manually forcing air into the lungs of unconscious patients to keep
them alive. Doormen who rescued folks stuck in elevators. Refinery workers
who broke into boat yards, "stealing" boats to rescue their neighbors clinging
to their roofs in flood waters. Mechanics who helped hot-wire any car that
could be found to ferry people out of the City. And the food service workers who
scoured the commercial kitchens improvising communal meals for hundreds of
those stranded.

Most of these workers had lost their homes, and had not heard from members of
their families, yet they stayed and provided the only infrastructure for the
20% of New Orleans that was not under water.

On Day 2, there were approximately 500 of us left in the hotels in the French
Quarter. We were a mix of foreign tourists, conference attendees like
ourselves, and locals who had checked into hotels for safety and shelter from
Katrina. Some of us had cell phone contact with family and friends outside of New
Orleans. We were repeatedly told that all sorts of resources including the
National Guard and scores of buses were pouring in to the City. The buses and the
other resources must have been invisible because none of us had seen them.

We decided we had to save ourselves. So we pooled our money and came up with
$25,000 to have ten buses come and take us out of the City. Those who did
not have the requisite $45.00 for a ticket were subsidized by those who did have
extra money. We waited for 48 hours for the buses, spending the last 12
hours standing outside, sharing the limited water, food, and clothes we had. We
created a priority boarding area for the sick, elderly and new born babies. We
waited late into the night for the "imminent" arrival of the buses. The
buses never arrived. We later learned that the minute the arrived to the City
limits, they were commandeered by the military.

By day 4 our hotels had run out of fuel and water. Sanitation was
dangerously abysmal. As the desperation and despair increased, street crime as well as
water levels began to rise. The hotels turned us out and locked their doors,
telling us that the "officials" told us to report to the convention center to
wait for more buses. As we entered the center of the City, we finally
encountered the National Guard.

The Guards told us we would not be allowed into the Superdome as the City's
primary shelter had been descended into a humanitarian and health hellhole.
The guards further told us that the City's only other shelter, the Convention
Center, was also descending into chaos and squalor and that the police were not
allowing anyone else in. Quite naturally, we asked, "If we can't go to the
only 2 shelters in the City, what was our alternative?" The guards told us that
that was our problem, and no they did not have extra water to give to us. This
would be the start of our numerous encounters with callous and hostile "law
enforcement".

We walked to the police command center at Harrah's on Canal Street and were
told the same thing, that we were on our own, and no they did not have water to
give us. We now numbered several hundred. We held a mass meeting to decide a
course of action. We agreed to camp outside the police command post. We
would be plainly visible to the media and would constitute a highly visible
embarrassment to the City officials. The police told us that we could not stay.
Regardless, we began to settle in and set up camp. In short order, the police
commander came across the street to address our group. He told us he had a
solution: we should walk to the Pontchartrain Expressway and cross the greater
New Orleans Bridge where the police had buses lined up to take us out of the
City. The crowed cheered and began to move. We called everyone back and
explained to the commander that there had been lots of misinformation and wrong
information and was he sure that there were buses waiting for us. The commander
turned to the crowd and stated emphatically, "I swear to you that the buses are
there."

We organized ourselves and the 200 of us set off for the bridge with great
excitement and hope. As we marched pasted the convention center, many locals
saw our determined and optimistic group and asked where we were headed. We told
them about the great news. Families immediately grabbed their few belongings
and quickly our numbers doubled and then doubled again. Babies in strollers
now joined us, people using crutches, elderly clasping walkers and others
people in wheelchairs. We marched the 2-3 miles to the freeway and up the steep
incline to the Bridge. It now began to pour down rain, but it did not dampen
our enthusiasm.

As we approached the bridge, armed Gretna sheriffs formed a line across the
foot of the bridge. Before we were close enough to speak, they began firing
their weapons over our heads. This sent the crowd fleeing in various
directions. As the crowd scattered and dissipated, a few of us inched forward and
managed to engage some of the sheriffs in conversation. We told them of our
conversation with the police commander and of the commander's assurances. The
sheriffs informed us there were no buses waiting. The commander had lied to us to
get us to move.

We questioned why we couldn't cross the bridge anyway, especially as there
was little traffic on the 6-lane highway. They responded that the West Bank was
not going to become New Orleans and there would be no Superdomes in their
City. These were code words for if you are poor and black, you are not crossing
the Mississippi River and you were not getting out of New Orleans.

Our small group retreated back down Highway 90 to seek shelter from the rain
under an overpass. We debated our options and in the end decided to build an
encampment in the middle of the Ponchartrain Expressway on the center divide,
between the O'Keefe and Tchoupitoulas exits. We reasoned we would be visible
to everyone, we would have some security being on an elevated freeway and we
could wait and watch for the arrival of the yet to be seen buses.

All day long, we saw other families, individuals and groups make the same
trip up the incline in an attempt to cross the bridge, only to be turned away.
Some chased away with gunfire, others simply told no, others to be verbally
berated and humiliated. Thousands of New Orleaners were prevented and prohibited
from self-evacuating the City on foot. Meanwhile, the only two City shelters
sank further into squalor and disrepair. The only way across the bridge was
by vehicle. We saw workers stealing trucks, buses, moving vans, semi-trucks
and any car that could be hotwired. All were packed with people trying to
escape the misery New Orleans had become.

Our little encampment began to blossom. Someone stole a water delivery truck
and brought it up to us. Let's hear it for looting! A mile or so down the
freeway, an army truck lost a couple of pallets of C-rations on a tight turn.
We ferried the food back to our camp in shopping carts. Now secure with the
two necessities, food and water; cooperation, community, and creativity
flowered. We organized a clean up and hung garbage bags from the rebar poles. We
made beds from wood pallets and cardboard. We designated a storm drain as the
bathroom and the kids built an elaborate enclosure for privacy out of plastic,
broken umbrellas, and other scraps. We even organized a food recycling system
where individuals could swap out parts of C-rations (applesauce for babies and
candies for kids!).

This was a process we saw repeatedly in the aftermath of Katrina. When
individuals had to fight to find food or water, it meant looking out for yourself
only. You had to do whatever it took to find water for your kids or food for
your parents. When these basic needs were met, people began to look out for
each other, working together and constructing a community.

If the relief organizations had saturated the City with food and water in the
first 2 or 3 days, the desperation, the frustration and the ugliness would
not have set in.

Flush with the necessities, we offered food and water to passing families and
individuals. Many decided to stay and join us. Our encampment grew to 80 or
90 people.

From a woman with a battery powered radio we learned that the media was
talking about us. Up in full view on the freeway, every relief and news
organizations saw us on their way into the City. Officials were being asked what they
were going to do about all those families living up on the freeway? The
officials responded they were going to take care of us. Some of us got a sinking
feeling. "Taking care of us" had an ominous tone to it.

Unfortunately, our sinking feeling (along with the sinking City) was correct.
Just as dusk set in, a Gretna Sheriff showed up, jumped out of his patrol
vehicle, aimed his gun at our faces, screaming, "Get off the fucking freeway".
A helicopter arrived and used the wind from its blades to blow away our flimsy
structures. As we retreated, the sheriff loaded up his truck with our food
and water.

Once again, at gunpoint, we were forced off the freeway. All the law
enforcement agencies appeared threatened when we congregated or congealed into groups
of 20 or more. In every congregation of "victims" they saw "mob" or "riot".
We felt safety in numbers. Our "we must stay together" was impossible because
the agencies would force us into small atomized groups.

In the pandemonium of having our camp raided and destroyed, we scattered once
again. Reduced to a small group of 8 people, in the dark, we sought refuge
in an abandoned school bus, under the freeway on Cilo Street. We were hiding
from possible criminal elements but equally and definitely, we were hiding from
the police and sheriffs with their martial law, curfew and shoot-to-kill
policies.

The next days, our group of 8 walked most of the day, made contact with New
Orleans Fire Department and were eventually airlifted out by an urban search
and rescue team. We were dropped off near the airport and managed to catch a
ride with the National Guard. The two young guardsmen apologized for the
limited response of the Louisiana guards. They explained that a large section of
their unit was in Iraq and that meant they were shorthanded and were unable to
complete all the tasks they were assigned.

We arrived at the airport on the day a massive airlift had begun. The
airport had become another Superdome. We 8 were caught in a press of humanity as
flights were delayed for several hours while George Bush landed briefly at the
airport for a photo op. After being evacuated on a coast guard cargo plane, we
arrived in San Antonio, Texas.

There the humiliation and dehumanization of the official relief effort
continued. We were placed on buses and driven to a large field where we were forced
to sit for hours and hours. Some of the buses did not have air-conditioners.
In the dark, hundreds if us were forced to share two filthy overflowing
porta-potties. Those who managed to make it out with any possessions (often a few
belongings in tattered plastic bags) we were subjected to two different
dog-sniffing searches.

Most of us had not eaten all day because our C-rations had been confiscated
at the airport because the rations set off the metal detectors. Yet, no food
had been provided to the men, women, children, elderly, disabled as they sat
for hours waiting to be "medically screened" to make sure we were not carrying
any communicable diseases.

This official treatment was in sharp contrast to the warm, heart-felt
reception given to us by the ordinary Texans. We saw one airline worker give her
shoes to someone who was barefoot. Strangers on the street offered us money and
toiletries with words of welcome.

Throughout, the official relief effort was callous, inept, and racist. There
was more suffering than need be. Lives were lost that did not need to be
lost.





http://www.emsnetwork.org/artman/publish/article_18443.shtml

http://www.cadenhead.org/workbench/news/2748

Result number: 103

Message Number 182592

Re: John's question View Thread
Posted by Dorothy on 9/10/05 at 14:34

John H/john h - Actually, contemporary Democrats and contemporary Republicans are much more alike than they are different - their backgrounds, their voting records, their funding sources, their resumes, their educational background, their class, their race, their sex, their incomes, and so on.
Republicans and Democrats do NOT need to sit down and "get to know each other" - they already know each other very well; they socialize together constantly - except for the Bushes; they don't do that. Republicans and Democrats need to actually stand for something clear and identifiable that gives American voters choices in philosophies, approaches, ideas. Clinton was a master at co-opting Republican "ideas" and the new Bush Republican clan saw his clever maneuvers and decided to do it even better - and so, now the Bush "Republicans" are masters at co-opting traditional Democrat territory. They are one and the same; they just keep trading dance partners but they're dancing to the same music and the partners look just like each other.
This common, but silly, idea that "being against things" is somehow obstructionist or is somehow antithetical to "finding solutions" is common, but wrong. People should not be "for" something just because to be against it makes some people uncomfortable. Conflict and contention is part and parcel of America's rich history; it allows those with opposing views and ideas and philosophies to carve out plans and the "solutions" you claim to want.
We don't need more "nice and cooperative" out of these people. What we need is choice and change - and a whole heck of a lot better! The BILLIONS and BILLIONS that disappear into their coffers SHOULD bother you, but it apparently does not as long as it's Republicans or Republican-like people mishandling them.
Tell me if you can, WHAT is "moderate" and WHY is "moderate" good, in your opinion?
Feel free to like, love, vote for - whatever you want - regarding Lieberman; I am not a fan of his. He is nice. He is not a leader.
His voice to my ears is like the proverbial chalk on the blackboard (you and I remember chalk and blackboards.)
Tell me, if you can, what do you think contemporary Republicans and contemporary Democrats stand for? represent? believe?

Result number: 104

Message Number 182119

Re: "Last December the US mobilised massive relief for a flood halfway around the world in two days, and after nearly a week those people just down in Louisiana still didn't have any water." View Thread
Posted by marie on 9/06/05 at 17:29

Senator Landrieu she's had a change of heart towards Bush. Anderson Cooper let her have it for being to politically correct here but a couple days later she let Bush have it. In the end of the video she tearfully pleaded for help.

Result number: 105

Message Number 181759

Re: THANK YOU FRANCE! View Thread
Posted by marie on 9/02/05 at 19:29

Dr. Ed......can't agree with you more.

Check my Wiki post below to follow the money. Lots of Republicans and conservatives are hopping mad too and I'm darn glad of it. Lott was on MSNBC tonight and I just wanted to strangle him. Our msm is beginning to step up to the plate. Anderson cooper unraveled him a bit. GO Anderson! And don't worry I'm not exactly happy with the silence by some of our Dems too.

Result number: 106

Message Number 180911

Re: Paying Drs to post via advertisements? View Thread
Posted by Dr. Z on 8/21/05 at 11:55

You have a very bad memory and are completely distorting the Dr. Castro visit to heelspurs.com. Dr. Z never put down Dr. Castro . I even asked him questions which he NEVER responded too. I still remember one specfic one . What do you think about the Endoscopic Gastronemis release vs the Open. Answer: No Response. Dr. Ed had many good points that Dr. Castro never wanted to answer. Dr. Castro even posted under two different names. IT waw Scott R who made Dr. Castro state who he was. There was some rumor from Dr. Ed. How can who be chief of a department when there is no one else in that department. Cooper Hospital has a large Podiatry department which Dr. Castro didn't or couldn't remember who was there. It wasn't his "beating" down it was Dr. Castro leaving after he started a fire and then refused too answer questions. The bottom line with Dr. Castro was he never responded to any qustions or helped any posters. So lets bring on mroe doctors like that.
I have no idea what you goal is with this entire thread but all it is is negative.

Result number: 107
Searching file 17

Message Number 179419

Re: are we being baited? ScottR View Thread
Posted by Ed Davis, DPM on 7/29/05 at 13:45

Scott:
How are medically untrained readers to know that Dr. Cooper has contradicted medical knowledge being taught to the vast majority of doctors in the US. That is why I am here -- to let readers know what the standard of care is and to answer mecically related questions. If I had come here, expecting to win approval from readers/posters, I would have at least made some attempt to back up my statements as opposed to telling people that I have a wonderful resume.
Ed

Result number: 108

Message Number 179387

Re: are we being baited? ScottR View Thread
Posted by Elyse B on 7/29/05 at 10:59

ED,
I just nominated this for the heelspurs.com newsletter. I will tell you that unless Cooper Hospital has completely changed and their web site is wrong there are other podiatrists on staff at Cooper Hospital.
The former chief of foot and ankle left with the entire orthopedic group and is doing ESWT with Excellence. Cooper is a very well know hospital in our community.
I am still laughting with this post !

Result number: 109

Message Number 179381

Re: are we being baited? ScottR View Thread
Posted by Elyse B on 7/29/05 at 10:26

http://www.cooperhealth.com/indirectory/search/member_view.asp?memID=347&char=&kwd=&elemParam=6:-:Surgery,%20Orthopaedic&zip=&dist=5&PageNum=&page_id=2&site_id=1&template=STANDARD

Scott this is truly unbelievable, a doctor comes on this board who is obviously legitimate as anyone can see by googling him, (see above) and looking up his CV. Yet Drs. Ed and Z absolutely refuse to believe that he is legitimate, dispute his post, professional opinions and even his credentials. Dr. Z. you said you were going to call him on a professional level let us know what you found out but you might want to talk to him before putting him down. Dr. Castro invited you to call him.

Yes we all wish he would come back and post but give him time. There ARE other points of view on PF and doctors do differ in their treatments, not all doctors accept Drs. Z. and Ed's points of view and treatment methods. To completely disregard and dispute what Dr. Castro posted is incredible and not fair to the readers of this board.

I almost can understand why Dr. Castro would choose not to post again.

Result number: 110

Message Number 179374

Re: are we being baited? ScottR View Thread
Posted by Dr. Zuckerman on 7/29/05 at 09:56

ED,
I just nominated this for the heelspurs.com newsletter. I will tell you that unless Cooper Hospital has completely changed and their web site is wrong there are other podiatrists on staff at Cooper Hospital.
The former chief of foot and ankle left with the entire orthopedic group and is doing ESWT with Excellence. Cooper is a very well know hospital in our community.
I am still laughting with this post !!!!

Result number: 111

Message Number 179370

Re: are we being baited? ScottR View Thread
Posted by Ed Davis, DPM on 7/29/05 at 08:36

Let me get this straight -- he is "Director" of the Foot and Science Inbstitute" at Cooper Hospital but there are no podiatrists there and no other orhtopods on staff under him? In order to be a chief, one must have "Indians" so what if I call myself Director of the Heelspurs.com Foot and Ankle Institute?
Ed

Result number: 112

Message Number 179365

Re: Here is his CV View Thread
Posted by Scott R on 7/29/05 at 07:51

Dr Z pointed out your credentials out just to show us that there was such a Dr at Cooper. I've done a spot-check on the IP address.

We're hoping for a reference or explanation of how the soleus can be the larger of the two. We're just kind of stuck on that point since it seems very basic. I'm sure one could be a wonderful doctor for many years without knowing the difference. But as far as heel pain is concerned, one needs to know that the gastroc is by far the most important of the two.

Result number: 113

Message Number 179359

Re: Deception View Thread
Posted by Ed Davis, DPM on 7/28/05 at 22:48

Sorry: corection, Dr. Castro, not Dr. Cooper.
Ed

Result number: 114

Message Number 179358

Re: Deception View Thread
Posted by Ed Davis, DPM on 7/28/05 at 22:47

A few comments. The gastrocnemius muscle is a much larger and stronger muscle than the soleus as can be seen from any anatomy book or dissection.

Anatomy books tend to focus on "open chain kinetic motion," that is, what do the two muscles do when the foot is off the ground. The anatomic answer is that they both cause flexion (plantarflexion) of the foot.

The foot, in reality, is planted on the ground much of the time and during that time we are looking at closed chain kinetic motion, in other words, what do the mucles do working from the bone they attach to working backwards (or upwards in this case) as we walk.

Once the heel bone hits the ground and the foot flattens out, we get ready to push off by the soleus pulling back on the leg bone, the tibia. In other words, the soleus pulls the leg bone back in order to straighten the knee. The knee must be straight in order to have push off power becasue the much larger gastrocnemius actually takes origin on the femur, the thigh bone. If the knee was not straight the gastrocnemius would be trying to make us push off on a bent knee which would make it very inefficient. So the soleus must fire first and quickly to get the knee straight but then the much larger gastrocnemius lifts our body weight up.
Could the soleus lift our body weight up? Not likely as that is not its function. The soleus may continue firing helping the gastrocnemius as it lifts our body weight up.

Both muscles act to plantarflex or flex the foot but they do so in sequence with the soleus acting first.

Considering the fact that the gastrocnemius is much bigger than the soleus and that the achilles is made up of a huge "roll up" of the fibers of the gastrocnemius aponeurosis, one would have to dissect the fibers and prove what percentage came from which muscle -- gastrocnemius or soleus. Gross anatomy classes teach us that the majority of fibers come from the gastrocnemius, then the soleus and finally a third and very samll muscle, the plantaris. There are so many fibers in the aponeurosis, that the gastrocnemius aponeurosis is often used to effect a repair of a torn achilles, never the fibers from the soleus.

So if Dr. Cooper has performed some research that goes against what most of us consider common knowledge, he needs to present that research.
Ed

Anatomically, one can see that the flattened part of the gastrocnemius, the aponeurosis of the gastrocnemius is huge but narrows down, actually twisting and comewhat circularizing to form the tendo achilles, the back of which the soleus inserts to.

Result number: 115

Message Number 179348

Re: Deception View Thread
Posted by Ed Davis, DPM on 7/28/05 at 21:05

Elyse:
We will have to await Dr. Cooper's explaination for his claims as he seems to be implying that almost all anatomy books are wrong. All studies that I know of, both podiatric and orthopedic seem to be in agreement with the anatomy books so I must assume Dr. Cooper has done some unique study on his own. I think when one contradicts what is considered to be common knowledge (eg. Gray's anatomy book -- used in most medical schools), that person must have some data or information to back that up.
Ed

Result number: 116

Message Number 179168

Here is his CV View Thread
Posted by Dr. Z on 7/26/05 at 16:47

I could get his picture. Nice looking gentlemen








Home / Find A Physician



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

Make An Appointment
Call 1-800-8-COOPER for more information

--------------------------------------------------------------------------------
<< Search Results
Michael D. Castro , D.O.

Title:
Director, Orthopaedic Foot & Ankle Reconstruction

Specialty:
Orthopaedics

Board Certification:
AOA Bd Orthopedic Surgery

Medical School:
Texas College of Osteopathic Medici

Internship:
Mount Clemens General Hospital

Residency:
Mount Clemens General Hospital

Fellowship:
Portland Orthopaedic Foot and Ankle Center

Notes:
Michael D. Castro, DO, received his degree of Doctor of Osteopathy from the University of North Texas in 1991 and his Orthopaedic residency training at Michigan State University. Dr. Castro received his Orthopaedic Fellowship training, specializing in foot and ankle surgery, from the Portland Foot and Ankle Center in Portland, Maine which was followed with an AO/ASIF Fellowship in Bellinzona, Switerland.

Most recently, Dr. Castro was an Assistant Professor, of Orthopaedic Surgery at the University of Minnesota School of Medicine and is board certified in Orthopaedic Surgery. He has provided numerous lectures and written various journal articles related to foot and ankle treatment and care as well as being active in national professional societies.

Location(s):
3740 West Chester Pike
Newtown Square PA - 19073
Phone: 856-342-3159

Bunker Hill Plaza, Two Plaza Drive
Chapel Hill / Hurffville-Crosskeys Rd.
Sewell NJ - 08080
Phone: 856-342-3159

6117 Main Street
Voorhees NJ

Result number: 117

Message Number 179136

Re: Deception View Thread
Posted by Dr. Michael Castro on 7/26/05 at 12:24

There is only one orthopaedic surgeon and no podiatrists.
You can contact me through the Cooper Bopne & Joint Institute.

Result number: 118

Message Number 179101

Re: Deception View Thread
Posted by Dr. Zuckerman on 7/26/05 at 08:37

Dr. Castro,
This is an interesting topic. Equinus is the killer for all feet to some degree. What is your opinion on the new Endoscopic procedures for Gastro equinus.?
I would love to read your presentation on this topic if you would be so kind to direct me to the publication and year etc.
I know many podiatrists and one orthpedic surgeon that are part of the foot and ankle service at Cooper. If you have any interest in learing more about ESWT and how it is very effective with the treatment of plantar fasciosis please e-mail at foot.care@verizon.net

Result number: 119

Message Number 179088

Deception View Thread
Posted by Dr. Michael Castro on 7/26/05 at 03:50

Mr. Roberts,

I am the director of the Foot&Ankle Service at Cooper Hospital in Camden, NJ. My undergraduate training is in exercise physiology and biomechanics. My graduate training is in biochemistry and biomechanics. After completing a residency in orthopaedic surgery I completed a fellowship in foot and ankle reconstruction, both in the US and Switzerland. I have presented and published re: foot & ankle biomechanics. No deception intended. Regarding gastrocnemius: "tight heel cord" and gastroc equinus are two very different things. In the vast majority of individuals the gastrocnemius is certainly not the larger of the two muscles inserting into the Achilles tendon. Knowledge of recruitment patterns and muscle fiber type adds to the understanding of the anatomy and pathoanatomy.
I would be happy to discuss this and any other related issues.

Result number: 120

Message Number 179087

Re: gastric recession View Thread
Posted by Dr. Michael Castro on 7/26/05 at 03:45

Mr. Roberts,

I am the director of the Foot&Ankle Service at Cooper Hospital in Camden, NJ. My undergraduate training is in exercise physiology and biomechanics. My graduate training is in biochemistry and biomechanics. After completing a residency in orthopaedic surgery I completed a fellowship in foot and ankle reconstruction, both in the US and Switzerland. I have presented and published re: foot & ankle biomechanics. No deception intended. Regarding gastrocnemius: "tight heel cord" and gastroc equinus are two very different things. In the vast majority of individuals the gastrocnemius is certainly not the larger of the two muscles inserting into the Achilles tendon. Knowledge of recruitment patterns and muscle fiber type adds to the understanding of the anatomy and pathoanatomy.
I would be happy to discuss this and any other related issues.

Result number: 121

Message Number 178328

Re: Complete list of ESWT research View Thread
Posted by Elyse B on 7/13/05 at 12:24

yes that is why I suggested that Sally have her brother post. I don't believe for a minute that her brother is a podiatrist. Yes it would be nice if that person Mike C and/or Cooper Ankle and Foot "came out of the closet" and posted like Drs. Ed and Z. Liboralis is very smart and knowledgeable.

Result number: 122

Message Number 178115

Re: gastric recession View Thread
Posted by Dr. Z on 7/09/05 at 21:03

Please send me reprints. The question is what is long term. One year, two years three years four years. I personaly have six year follow ups from ESWT plantar fasciosis treatment.
Not sure what materials I referred you too since there are pages and pages on medline
The gastro recession procedure does have a place as well as ESWT. One of the most consistant statments that here from doctors is that they won't use a procedure that insurace won't cover because they are afraid of rejection from their patient. The typical comment I hear is hey they won't pay for a co-pay so how am I going to get my pateints to pay for ESWT. The answer is to learn as much as you can and understand as much as you can so that you can give your patients a CHOICE
If you want to really send me the reprints
David Zuckerman DPM\
341 South Evergreen Ave
Woodbury, New Jersey -8-96

So are you located in Camden New Jersey??????????????????? The former Cooper Hospital Chief of Foot and Ankle Serices uses ESWT. His name is Dr. Fox

Result number: 123

Message Number 178114

Re: gastric recession View Thread
Posted by scott r - moderator on 7/09/05 at 20:50

Dear "Cooper Hospital",
Using the name "Cooper Hospital" implies Cooper hospital stands behind your posts. If the partners or administrators of Cooper Hospital do not support or are not aware of your posts, then the name you're using could be considered deceptive. So, please use a different but consistent ID like "Franklin" or "Visiting DPM".

From my knowledge, the gastroc certainly is the larger of the two muscles and is at least a major contributor to a "tight heel cord", no matter how "tight heel cord" is defined.

Scott Roberts, owner
heelspurs.com LLC

Result number: 124

Message Number 178087

Re: gastric recession View Thread
Posted by Cooper University Hospital FootAnkle on 7/09/05 at 05:13

We are in the process of data collection for both the clinical study and a biomechanical analysis. I will send you reprints.

I was merely sharing my experience with this menacing problem.

I rewiewed the published material you referred me to several months ago and found an editorial written the author you mentioned. He stated that long term studies were necessary to determine the efficacy or this treatment.

I have seen many patients who have had shock wave therapy and have not been helped. My point about gastrocnemius recession is that when indicated, 1) it addresses the cause of the problem and 2) insurance pays for it 3) the outcomes are consistently good.

Result number: 125

Message Number 177994

Re: gastric recession View Thread
Posted by Dr. Z on 7/07/05 at 08:16

We await your paper that shows that your specific treatment shows a long term improvement and the degree of improvement. In what journal is this article published by you.
I think that you better go to medline and review your statements about shockwave and it long term efficacy.
I bet that a gastroncenmius recession with all pre, post follow up in an ASC is alot of more expensive then ESWT but that isn't really the point is it.?
Interesting Cooper Hospital Foot and Ankle Service. Are you in Camden, New Jersey.?

Result number: 126

Message Number 177989

Re: gastric recession View Thread
Posted by Cooper Hospital FootAnkle Service on 7/07/05 at 06:03

Gentlemen, I was on this board several months ago discussing the etiology of plantar fasciitis.

The gastrocnemius muscle is not the larger of the two muscles inserting at the Achilles tendon.
The gastroc is not the culprit when the heel cord is tight. It is the culprit when there is a gastroc equinus contracture (99% of people with plantar fasciitis) that is when dorsiflexion of the ankle is restricted with knee extension and improves with knee flexion.

No functional deficit results from releasing the gastrocnemius as this muscle is rarely recruited, hence it's tightness.

In the over 1000 patients I have treated with plantar fasciitis less then a dozen have failed to improve with stretching and a night splint. In those patients a gastrocnemius recession eliminted there heel pain within 3 weeks of having the procedure.

Shock wave therapy is expensive and has no long term studies to support it's efficacy.

Result number: 127

Message Number 175648

Re: Sonorex in San Diego View Thread
Posted by Ed Davis, DPM on 5/24/05 at 17:53

Kat:
We all wish the insurers would cooperate. Keep in mind that while they may cover surgery, add your co-pay, deductible plus time loss from work to see what those costs really are. Your health insurance does not really care about your lost work as they are not paying for it.
ed

Result number: 128

Message Number 173406

Re: Achillies Tendon View Thread
Posted by Dr. Zuckerman on 4/19/05 at 11:28

Kathy,
Your lawyer should write to this office and request all of your medical records. Most states require a time period of 30 days. If there is no response by 30 days the State Board is contacted and the doctor has to face this regulatory board. The case would really look bad for this doctor if he doesn't cooperative with you or your lawyer. Great trial evidence for lack of caring.
So walking into the office and demanding won't help your case at all. They can refuse the medical records and have a period of time to mail them . The most important point is for you to write down a record of what is going on and to have you lawyer handle this
Footlaw.com is a service that Scott posts from time to time. I would recommend Dr. Larry Koback from this firm Honest, very smart and hard worker

Result number: 129

Message Number 171334

Aloha View Thread
Posted by Dorothy on 3/16/05 at 16:04

So many of you were so kind and encouraging about my planned trip to Hawaii about which I had so much fear and trepidation that I feel I owe you some feedback about the trip. We went and are just back and I’m still in a state of shock and jetlag! Believe me, your words and suggestions were with me and on my mind quite often and they helped tremendously. It was wonderful and while not trouble-free, it was overall a joy. I love the ocean so much and cannot get enough of it. We were on O’ahu and ohmygoodness, the ocean….magnificent. It rained some, winds blew hard sometimes, but mostly it was sunny. We walked a lot, stood and waited a lot, rode on some jostling conveyances, and of course had a very long airplane trip (~8 hours) – but swimming in that ocean compensated for anything else. Usually by the end of time away, we are ready and anxious to get back home – but in contrast, on our last day there, we were sad to be leaving. To the dear foot people here: Thank you so much for your encouragement and the information provided to me while I fretted and worried about what must have seemed to be very silly anxiety – especially to people facing real worries, like surgery or other issues. Your advice and suggestions were so very good. I thought I was being ultra-careful, but I still got a nasty sunburn and am shedding skin like a human snowstorm (yuck!!) but it’s a small price to pay to visit that ocean and feel that sunshine. We met many wonderful people – and just had a very sweet time. It’s already becoming a treasured memory – and I am happy to say: I did it! My feet and back and all parts cooperated fairly well – manageable complaints for the most part. My first beach there was one with lots of sharp rocks and coral and that was a big challenge. Other beaches were softer. The water was soft and warm with colors that one could just stare at for hours on end.Sunrises and sunsets: breathtaking. We saw the most beautiful rainbow in the mountains with the densest Roy G. Biv that I have ever seen in my life. That place – it really is a kind of paradise, isn’t it… I feel like a disoriented duck out of water now – from the warm Pacific to the cold and snow, all with an ugly sunburn that seems out of place and time. There were 30-35 foot faces on the surf on the north shore one day!

Upon returning and after getting some sleep, I checked in here and began catching up. I was dismayed to see that again there was Dorothy-animosity while I was gone. I think the fault must be in myself and not in the stars....and so will look to reform.

I just wanted to say thank you to all of you good Travel Agents and Adventure Counselors out there in Foot-land. I felt you with me in many ways – just as Carole C and Suzanne D said recently and so accurately. Your feet may be unpredictable, but your hearts are so good and your heads so wise. And “if I were a rich man…” I would buy an estate there and a big private plane and would send us all there for R & R whenever needed. I’m not a rich man so …. let’s all just open a can of Dole pineapple and imagine….

Mahola (thank you) and aloha (hello, goodbye, love, best wishes….)

Result number: 130
Searching file 16

Message Number 169295

Re: FRUSTRATED View Thread
Posted by Ed Davis, DPM on 2/18/05 at 00:28

Ralph:

I can give you a 100% guarantee that I can make orthotics that you will find comfortable and wear. What I cannot do is give you any promises as to their therapeutic effect. Therin, lies the "rub," as we are creating a prescription device specifically designed to have a specific therapeutic effect and must balance effectiveness with comfort and patient tolerance. The key factor is that orthotic therapy is a PROCESS, not simply a device and involves cooperation between physician and patient including the investment of time to make the necessary changes in the device, shoegear, dealing with problems of tight heel cords (creates orthotic intolerance) and so on...
Ed

Result number: 131

Message Number 168999

Re: Need some advice from my foot friends View Thread
Posted by wendyn on 2/13/05 at 17:10

Thank you all so much! Holy cow, I didn't expect that many answers waiting for me this afternoon!

Ralph, I have had an MRI on my ankles. I think a tall person's head would have poked out the top of the tube, but mine is mostly in (I'm just under 5 foot 2). I'm not claustrophobic. I didn't like being in the tube, but it was more of an annoyance than anything, and it was very hard to lay still for so long (I'm a pretty fidgety person).

When I last spoke with my rheumatologist in November, she suggested the MRI, more xrays, and then a biopsy simply to see if they show anything at all that will help pinpoint a problem. She's really at a loss to explain what's happening to me. When we spoke, we even agreed that since there was no risk - there was no reason NOT to do it (of course, other than the cost to the health care system, but we both felt that after this many years - the cost is justified).

From my conversation with the nurse today (yes the MRI is done at the hospital) the referral for the test goes to a radiologist, and the radiologist determines what type of test to order. So, it's not my doctor asking for the dye - it's the radiologist (who I've never met).

The appointment is tomorrow, and I agreed to go up and talk to the radiologist. I guess what I need to understand is what the test will show with the dye versus what it will show without. If there is something super important that we may overlook withouth the dye, then I may have reason to reconsider. If not, and if it's more all being done out of curiousity - then forget it. Any risk to my health (however small) is just not worth it if it's not going to lead to real answers and possibly treatment.

For many years, I really wanted a name for what's wrong with me. I guess I'm just at the point now where it seems far more important to my doctors than it does to me. I realize that the dye itself may not be that risky, but one injection needs to be seen in conjunction with all of the xrays, the bone scan injections, and all of the other things that are being done to me. Thus far, none of those tests have provided any valuable information at all, and perhaps - it's time to say "enough".

My doctors haven't labelled me as uncooperative (at least not yet!), it's more me questioning my own motives and whether or not I'm thinking clearly.

If I agree to have the one foot done with the dye tomorrow, I have to go back and have the other foot done in a few days (with another dye injection). My doctor would also like a lower back MRI, which I'm guessing may mean more dye. Then I have the biopsies to decide on. Do I do them or not? When I spoke to the rheumatologist about whether or not it's really worth it - even she had a hard time believing that it will lead to anything other than at best - a diagnosis.

Thanks for all your thoughts. It certainly gives me a bunch of different things to consider while I'm actually supposed to be doing my homework.

You're all so important to have around - what a great support network!!

Result number: 132

Message Number 168990

Re: Need some advice from my foot friends View Thread
Posted by Dorothy on 2/13/05 at 15:27

Wendy -

For me, the question of risk would certainly be part of the decision, but only one part. What would make me decide to take the risk is whether the "risky" test would reveal something I want to know - for whatever reason - and whether the "risky" test would lead to something that I want to pursue. I am a very curious person so I might pursue the test just to gather information. (Doctors I have known do not really suggest testing routinely, although I have had biopsies and various other procedures and surgeries over the years. My experience and that of people I know is that doctors we have had are very "stingy" with any kind of testing, even the most basic and obvious - unless it is mammograms they do in their own offices or x-rays done in their own offices; they like those - profits are high. In the U.S. the 'system' is different, I think. I have several close friends who are doctors or who are married to doctors, also friends; they own airplanes, multiple homes, and lead lavish lives.....while many Americans are in deep medical trouble. I also worked in close collaboration with doctors of various stripes in my previously held profession, so you have to take anything I say with this grain of salt: I do not automatically trust the motives or good hearts of doctors at all - but I live here and you live there....)

I think your last two questions in your post can't really be answered by any one here; only you can answer them. I will say that I think the label of "uncooperative patient" is not a constructive or useful one, but I know it is one that doctors and other professionals use to discount the concerns of a patient who is reluctant, for whatever reasons, to do what the doctor wants. The expression “uncooperative patient” is demeaning to human beings who are of equal status, regardless of doctors’ wishes for it to be regarded otherwise!

I think a patient's willingness to follow a doctor’s recommendations should be tied to commitment to that patient's well-being and well-being encompasses trust, confidence, peace of mind, and a whole lot of other factors.... If you have doubts and you have time – and you do have time because you are apparently not dealing with concerns of an urgent nature – then maybe time will lead you to the comfort and confidence and willingness you do not have now. On the other hand, you can also say – in spite of not having those feelings of confidence about this procedure, I’m going to take a leap of faith and do it.

Will these tests contribute to any of the matters that have importance to you?? Will they rule anything in or out definitively? You seem to be saying that they will not, but why is the doctor recommending them? Now, having said that - I don't know how things work in Canada but in the U.S. doctors are extremely (to a fault, I think) reluctant to do any kind of tests because the "health care" system is geared to one thing: increased profits through reduction in cost. So if a doctor wanted to do not one, but many and variable, MRIs here, that might give me pause; it might make me believe that there must be a valid reason. I share your concerns about having dye injected into the body but I know it's done routinely and most of us knowingly and unknowingly put all sorts of substances into our bodies that are probably bad ideas... You drink wine, you’ve probably had various dental procedures with chemical adjuncts, you’ve gone through childbirth and possibly some injections with that, etc….. Just trying to put this in some perspective related to your broader experience.

Many others here – Julie, Ralph, Suzanne D and probably others I have not yet had a chance to read – have given you excellent advice. I certainly can’t add anything of wisdom or experience to what they’ve said – but I do tend to lean towards Suzanne’s words of trusting your own gut instincts. I think they usually speak our own truth – plus, you can always change your mind if and when you feel better about doing it. I generally favor less not more medical intervention, but then again, “my hero” Lance Armstrong had every major medical and chemical intervention known for the urgent and devastating problems he had. Even with the very dire PROGNOSIS that accompanied his DIAGNOSIS, he took some of that precious time to get second and maybe third opinions; that is to say, he was trusting his gut instincts about what he was being told. In the end, he made the plunge and had no regrets. Julie was in tremendous pain that was totally outside of the norm for her and she had medical diagnoses that needed clarification that would come from further testing. If that is true for you, then maybe that will guide your decision. I think Suzanne’s caveat about RSD is worth considering; it is an added factor in any decision you might make about any medical intervention, I would think. Julie and Ralph have both given you valuable insights into the actual experience of MRIs with dye and, again, they are done routinely (I know - that is not necessarily mitigating enough to tilt the balance towards confidence, but it can inform one's decision...)

So, summing up – You have time. Nothing has really changed to prompt more invasive procedures. You can always change your mind. Trust your gut instincts. Your own experience is your own. The tests being recommended are pretty routine and have very low incidence of problem. You may or may not get answers you may or may not want. The old dictum “if it ain’t broke, don’t fix it…” may apply.

Here is my question to you: if this were your husband or your children, what would YOU recommend to THEM?? That might also lead you to your best answer. I am not giving you specific advice because I am not qualified by profession or experience to do that, but I am offering some ways of thinking about it and of considering the components of your decision-making that might help. I hope so.

Best wishes to you, Wendy.

Result number: 133

Message Number 168980

Re: Need some advice from my foot friends View Thread
Posted by Suzanne D. on 2/13/05 at 13:37

I agree with Kathy: you are intelligent and informed, and I certainly do not think you are reacting as an uncooperative patient in this situation.

You stated, "I can't think of any reason to agree to a potentially risky procedure". I really can't either, Wendy. If by doing so you would help yourself in some way, it might be worth considering. But under the circumstances, I can't see it helping. And, who knows, perhaps injecting the dye could set off a chain of unpleasant reactions - particularly if you are dealing with RSD as you have been told you might have in the past.

I'd go with my gut instinct on this if I were you. If you receive additional information that changes the situation, then you can reconsider. You don't want to just be an interesting subject of study; if you can't be helped, then you don't want to risk being hurt.

Those are my feelings on the subject after reading your post. Best wishes to you as always!
Suzanne :)

Result number: 134

Message Number 168977

Re: Need some advice from my foot friends View Thread
Posted by Kathy G on 2/13/05 at 13:10


Wendy,

I most definitely would not agree to any tests that have any risk involved! You are not being an uncooperative patient; you're being an intelligent person.

All of the doctors have agreed that they don't know what's wrong with you. You have good days and bad days but you've quite admirably learned to cope with your ups and downs with patience and humor. You say your overall health and quality of life is excellent. What more can one ask for?

It's unfortunate and frustrating that they can't come up with a specific diagnosis for your condition but that seems to be more their problem than yours. And as you say, there is nothing to be gained by giving a name to a condition that might carry a negative prognosis, a prognosis that could actually be wrong. Why worry about something that may not happen? Doctors are often wrong when they predict the future of an illness because no one knows how one person's body is going to respond. Two years ago, one doctor told me that I would be begging for hand surgery at this point in my life and he was wrong. I dismissed his warning and was able to put it out of my mind, but his words were certainly unwarranted.

Go with your instincts. You're a bright, educated woman and you are on the right track! :)

Result number: 135

Message Number 168976

Need some advice from my foot friends View Thread
Posted by wendyn on 2/13/05 at 12:35

I'm wondering if you folks would give me your objective opinions on my dilemma....

Some of you may recall that I have a long history of unexplained pain, lumps, neuropathy, swelling, and biomechanical issues in my lower back, legs, and feet.

Despite numerous bone scans, xrays, blood tests, visual exams, and an MRI - none of my doctors know what's wrong with me. Maybe it's RSD, maybe it's Rheumatoid arthritis, maybe it's an underlying inflammatory condition that they can't find, maybe it's idiopathic neuropathy.

Regardless of what it may be, it is highly unlikely that I can be fixed. All the medical professionals agree on this one point.

I accept this, and I've come to terms with it. I have pain and limitations (some days more than others) but by and large, I have an excellent quality of life and I'm in exceptionally good health (mentally and physically).

My doctors are frustrated that they can't put a name on my problem. My rheumatologist asked me to go for an MRI on my feet, and since there is no risk to this procedure anyway - I agreed.

I found out today that the radiologist wants to do two separate MRI's (on two separate days) with contrast dye. Although the risk is not huge, there is risk. I told the nurse that I will want to talk over the risks versus benefits with the radiologist, but that it's highly unlikely I will agree to the dye.

This is my conundrum. I can't think of any reason to agree to a potentially risky procedure. Regardless of what they find on the MRI, it's extremely unlikely that I can be "fixed". There won't be a magic bullet like a pill or a simple surgical procedure that can make this all go away.

At "best" I think I might have a name for my condition. Names and labels also often carry a prognosis which will likely not be good. Is there any benefit to knowing for sure that your condition will deteriorate over the years? Personally, I would rather believe that my future is not cast in stone.

After 20 years of this, I'd like to think that I am obliged to do whatever I can to protect my health and quality of life, especially since conventional medicine has never provided me with any answers or helpful treatments.

What would you do? Am I being an uncooperative patient, or am I being a rational individual who is logically working through risks versus benefits?

I'd sure appreciate any thoughts you have on this!

Result number: 136

Message Number 166929

Re: Calling for Input View Thread
Posted by marie on 1/11/05 at 20:39

Aloha Dorothy!

Call ahead to the airport. They have wheel chairs and they have little golf carts you can ride in to get you from one end of the airport to the other. All you have to do is request it.

Now let me see long hours on and airplane can't be as bad as sitting on the sofa all day so I say GOOOOOOOOOOOOOO!

Warm weather and beautiful sunsets!

http://www.govisithawaii.com/images/hawaii-sunset.jpg

Gorgeous even when it rains!

http://wp.ekornveien.com/steder/Hanalei%20River%20Valley,%20Kauai,%20Hawaii.jpg

Waterfalls galore!

http://jamesblog.typepad.com/photos/hawaii/hawaii_131.jpg

Go Scuba Diving.......yeah don't have to walk!

http://www.gardettofamily.com/Files/VIDEOS/SCUBA%20in%20Hawaii%20WMV.wmv

Lots of men in bathing suits.

http://www.ambassadair.com/archives/0703/art/maui_surfers.jpg

Palm trees!

http://www.strengthinperspective.com/mpcompel/mpgal30/webpix/puuuhonua.jpg

Music and Entertainment!

http://rds.yahoo.com/S=96781308/K=Hawaii/v=2/SID=e/l=VDP/SIG=12hb8lcmr/EXP=1105583311/*-http%3A//www.zeldenhouse.it/Elvis/Elvis%20video/nomore_aloha.rm

And the locals love to dance!

http://www.sun-pro.co.jp/quick/HAWAII2003.mov

http://thm-sorbet.search.vip.scd.yahoo.com/image/1314334260

And lets not forget the HULA GIRLS! Hey what did you expect? ;)

http://neascool.com/images/Brendan_Wynn_Cooper-hula_girls.jpg

Have fun!

Result number: 137

Message Number 166288

Re: Tsunami Relief Organizations View Thread
Posted by marie on 12/29/04 at 19:57

Out of funds? Go to your local Red Cross they need blood donations.

Blood donors sought, with Westerners' Rh-, A, B and O groups most wanted

BANGKOK Dec 28 - Princess Maha Chakri Sirinthorn, executive vice president of the Thai Red Cross Society, has sent emails to several embassies seeking blood donations for tsunami victims in the southern provinces.

The Princess has also solicited the cooperation of the Thai hotel associations in urging foreigner guests to donate blood to foreign victims of last Sunday's tsunami disaster. Most of the injured were foreign tourists enjoying holidays in Thailand's beaches.

http://www.nationmultimedia.com/

http://www.komchadluek.net/breaking/read.p...en&newsid=33321

Result number: 138

Message Number 166145

Re: Merry Christmas to All! View Thread
Posted by Suzanne D. on 12/26/04 at 08:02

Staying at home with your family is the most wonderful of all, I think, Kathy! I am mostly a "homebody" who is quite content to stay close to home, but my husband finds that he cannot rest or relax unless he actually gets away from the area. Being a minister, he is always "on call" and never feels he is "off work" unless we're gone. So, the trip was something he wanted. But I did enjoy it and was thankful that my feet cooperated. A trip like that a couple of years ago would have been out of the question for me.

Glad you escaped most of the ice! Here there was snow, then a couple of inches of ice, then some more snow. With the frigid temperatures, our roads are still completely covered with ice and snow. It is treacherous to get around. But I am thankful we did not lose electricity.

Take care!
Suzanne :)

Result number: 139

Message Number 166127

Re: Merry Christmas to All! View Thread
Posted by Carole C in NOLA on 12/25/04 at 15:43

Merry Christmas, Suzanne! I'm glad you and your family had nice time at Disney World, and that your feet cooperated! Sounds great.

Yes, believe it or not, we have snow and sleet in New ORleans! Few New Orleanians know how to drive in the snow, so many of our major roads and freeways have been shut down for safety. How emazing that we would have a white Christmas (at least, white in shady areas, and glassy slick on streets and sidewalks).

Maybe the Saints really WILL win the Superbowl this year! (giggle)

Merry Christmas to all - -

Carole C

Result number: 140

Message Number 165468

Re: 6 mo lurker, seeking answers, heel pain that dr can't figure out View Thread
Posted by Ed on 12/11/04 at 01:32

Not sure what the problem is, but it sounds like your running/jogging/walking routine isn't helping the healing process. Whatever you find the problem to eventually be, you could be well served to rest the foot - especially from high impact activities.

I realize that this is a tough thing to do, even more so if you are on a weight-loss regime. I am a soccer player *and* the captain of my team, and I'm recooperating from my second bought with PF - it's been difficult for me to keep off my feet but knowing that doing so might make the problem worse has kept me on the sidelines for a short while. But, better to rest the tendon now than to suffer more damaging consequences later!

If you can, you might want to try swimming as a substitue for your aerobic routine.

Good luck!

Result number: 141

Message Number 165378

Re: Richard C-ped or anyone w/ knowledge or experience.... View Thread
Posted by RACHAEL T. on 12/08/04 at 18:36

Thanks Richard! - for your reply & info. Hmmm, I "think"....that my orth is pretty "close!" I think though, that there is one spot (which you may laugh when I tell you this) - but this is what I did yesterday & I plan on showing my ped. exactly my little "experiment" tomorrow for him to review & then, make an adjustment.....This is what I did to show him exactly where my discomfort & sore spot appears w/ the orthotics in my Brooks......I used nail polish & painted my "sore spot" on my foot & then, stepped into my sneakers w/o socks - while the polish was wet....thus, leaving a mark at the contact point on the orthotics. In this way, he can "reheat" the orth & press it down a bit there - & maybe then, I will be good to go. This particular "nail polish spot" is in front of my heel cup - progressing into the arch.....like my arch right there is a bit high when my fascia cord presses into it....yes, when I bend my toes back this sore spot is right on the protruded fascia cord. So, that is my experiment - I hope it is helpful to him in "finding" the place to adjust for me. & No, in ans. to your ? - my foot castings were not done standing. I like this guy - he's a very good listener & really tries to be helpful & cooperative w/ me. I am optimistic that he will figure it out w/ my observations & yet, your experience & knowledge is helpful to me too in trying to explain myself. Thanks to you!

Result number: 142

Message Number 165144

Richard Cped or others who may have this knowledge or experience View Thread
Posted by RACHAEL T. on 12/03/04 at 15:52

Writing to ask a question regarding my latest orthotics made by a ped. who is comfortable & cooperative w/ me regarding adjustments. I have been switching between sizes (7-1/2 & 8's) Ariat boots. The 7-1/2s are too tight w/ a boot sock & my orthotic & the 8 is a little loose with the orth & thick sock. In the 8, my foot feels like it is sliding front to back ~ & prob. not giving me enough control & support? That is my question. And, to correct this, I am wondering if we add more arch to the orth - would that help? I feel more discomfort (not pain at this point) in the ball of my foot from this "movement" - I see the ped. on Mon. & would appreciate a prompt reply from our resident pedorthist here as well as anyone who has had such an experience. I also want to ask this: In my Lady Ryka sneakers, this orthotic feels comfy & yet a little movement & feels like I could use more arch -- & yet, in my Brooks Ariels, I feel like the orth (even tho' we've lessened the arch this past month) is to "archy," - probably due to the way the Brooks is made.....Sooo, again - I ask....would it be wise to wear the orth w/ the Brooks feeling "too archy" or would it be better to increase the arch & wear the Rykas? I shall present all this to him & get his input on Mon. but thought your input would be helpful as well....I feel like I am soooo close to being "right" in my orth & staying healthy w/ my feet - I don't want to make a judgement error w/ this choice. Thanks for your input!

Result number: 143

Message Number 164658

Happy Thanksgiving! View Thread
Posted by Kathy G on 11/24/04 at 08:33


I hope you all have a nice day and get to spend it with family and friends. And I hope your feet cooperate and they have a nice day too!

I'm off to make the stuffing! :)

Result number: 144

Message Number 164570

Re: Elyse & Helene...I agree! View Thread
Posted by RACHAEL T. on 11/22/04 at 21:44

Yep, that is what I did; dropped the old doctor! And, actually - I found a great pedorthist who is also a fabricator of artificial limbs & breasts.....& he has been sooo helpful in my latest, greatest pair of orthotics thus far!
He has been cooperative in adjusting them - & feels that the slightest adjustment may be helpful in the long run (no pun intended) (-:

Result number: 145

Message Number 164022

Re: Brian View Thread
Posted by Dorothy on 11/15/04 at 23:29

I've tried to tie flies, but they're really hard to catch and they're not at all cooperative.

Result number: 146

Message Number 161858

Re: tarsal tunnel or rsd View Thread
Posted by Lorraine D on 10/20/04 at 18:49

i have been dealing with tarsal tunnel for many years now and it is now at the point were nothing helps and i can barely walk due to the constant pain i'm in . my doctor suggested surgery and now i've been in contact with a surgen i'm very scared due to my age of only 38 and my over weight all well as my dibeties any info you can pass would be great thank you for your time and cooperation in this matter

Result number: 147

Message Number 161857

Re: Ankle Brace View Thread
Posted by Lorraine D on 10/20/04 at 18:46

I have been wearing a custom ankle brace for almost a year and it failed to correct the tarcal tunnel in my left ankle. so now we are the surgery stage i am a dibetic and only 38 but overweight and i'm very scared about the surgery any information you can pass on will be good. thank you for your time and cooperation in this matter

Result number: 148

Message Number 161671

Why should you NEVER stand to take an impression? View Thread
Posted by JCooper on 10/17/04 at 06:11

I am currently experimenting with different orthotics. I have some that I heated, placed in my shoes, and stood with my feet hip-width apart and toes facing straight forward to mold them.

Then I saw Richard's post to never ever stand to take an impression...why? How do I mold my custom inserts?

Result number: 149

Message Number 160356

Re: BTW: RSD is a possibility View Thread
Posted by Michelle on 9/22/04 at 17:29

Kristie - I am not really sure if I had RSD at all. One doctor I was going to said I did after we immobilized my foot (non weight bearing) for 6 meeks and my foot reacted poorly to the cast. It swelled up like a ballon, was hypersensitive (I couldn't touch it to anything), the muscles around my ankle were spasming, and I had searing rippling pain that ran along my ankle when I tried to walk on it. So, he thought it was RSD and sent me to a pain specialist. But by the time I got into see this specialist, my symptoms has mostly gone away on their own (mind you I was still on crutches). Apprently lots of people who have mild cases of RSD can get better on their own (at least that is what this one doctor told me). I am certainly not an expert and now my doctors are thinking that its more TTS or nerve entrapment that was causing those symptoms than RSD. who knows... I sure wish these things were easier to diagnose!

Maybe you just need time to let all your injured muscles and nerves recooperate? One thing I did do that I think helped me was lots of rest, and *light* exercises (like moving my ankle in circles) to keep things moving.

Good luck and I hope your pain lessens.

Result number: 150
Searching file 15

Message Number 158758

Re: Have a date for cryosurgery View Thread
Posted by Curt on 8/26/04 at 18:28

Dr. Z,

If the pain from plantar fasciitis is caused by microscopic tears where the fascia attaches to the heel, isn't the pain that you feel conducted by the nerves in that area? So if you deaden those specific sensory nerves wouldn't you relieve the pain from the microscopic tears? I agree with you as far as having them contact the patient and having the patient then contact me. The lady in the office just wasn't very cooperative and I am going to try again. Every office seems to have one difficult employee!

Result number: 151

Message Number 153366

In response to Dr. Sandell View Thread
Posted by Elyse B on 6/18/04 at 07:40

I took the libery of doing some research, let me know what you think:

What is mobilization?
Mobilization is a hands-on manual therapy designed to restore joint movement, power, and range of motion. The therapist gently coaxes joint motion by passive movement within or to the limit of a joint's normal range of motion. The therapist's movement of the joint is very precise and is limited by the amount of joint play, which may be less than 1/8th of an inch.
The overall goal of mobilization is to restore normal joint function including the surrounding soft tissue (e.g. muscle, ligaments, fascia). Physical Therapists, Osteopaths, and Chiropractors perform mobilization.
What part of the spine is treated?
In the spine, any of the facet joints and/or the costovertebral articulations (thoracic spine and ribs) may become stiff causing joint dysfunction. When a joint is unable to move freely, a cycle of muscle spasm, pain, and fatigue may begin.
What causes joint dysfunction?
Joint dysfunction can be caused by poor posture, trauma, spinal disease, or congenital problems. Left untreated, joint dysfunction can affect the surrounding soft tissue and may lead to a loss of strength and flexibility.
Are other treatments involved in mobilization?
Myofascial release, or soft tissue mobilization, is a therapy used to release tension stored in the fascia. Fascia are sheets of fibrous tissue that encase and support muscles separating them into groups and layers. Fascia also covers joints capsules and ligaments. Following trauma, the fascia and muscles may shorten restricting joint movement and blood flow. The techniques used in myofascial release break up fascial adhesions and relaxes muscle tension helping to normalize physical motion within the joint capsule.
Rehabilitation of Soft Tissue Injuries in the 1990s

The days of prolonged immobilization are a part of the past for the treatment of soft tissue injuries. The increased attention toward sports medicine throughout the late 1970s and 1980s has led to research and many clinical studies that will outline the course of rehabilitation throughout the years to come. A review of the current literature on acute soft tissue injuries classifies different types of soft tissue lesions as well various phases of healing.1 Current literature redefines the aims and objectives of rehabilitation pointing out the many benefits of the use of modalities, early mobilization, and the importance of a full rehabilitation program.
Over the past two decades, soft tissue injuries have hit the spotlight. Almost all traumatic injuries, automobile accidents, athletic or other injuries result in some degree of soft tissue damage. It's now recognized that many soft tissue injuries result in a degree of permanent impairment and leave their host with some permanent pain, restrictions, and loss of function.2 To combat the debilitating (aftermath) of soft tissue injury, new technology and rehabilitation protocols have been developed.
Etiology of Soft Tissue Injuries, Direct and Indirect Trauma
Many soft tissue injuries come from direct trauma such as being struck by a moving object or a fall; other injuries may be classified as indirect trauma and result from overloading or chronic overuse, thus giving us the classification of direct and indirect etiology.3 Indirect can be further divided into three sub-classes: acute -- which occurs from sudden overloading as seen in many lifting injuries; chronic or overuse -- which are often seen in many assembly line or factory workers who must perform repetitive movements hundreds of times daily; acute on chronic -- occurs when a chronic conditions hits an acute phase. This third sub-class is also very common in the work environment where the same job is performed day in and day out. By first defining the etiology of a condition, we are on the proper course toward treatment and the prevention of further injury.
Phases of Healing -- Phase I
The current literature describes three main phases of soft tissue healing. An initial reaction phase which lasts up to 72 hours post-injury.4 This phase is also referred to as the acute inflammation phase.3 The reaction phase displays with the classic signs of inflammation with pain, swelling, redness and warmth. In the cases of indirect etiology, these classic signs may not be readily visible but are proceeding at the microscopic level.5
The long-used application of cryotherapy (ice) is still supported by numerous studies as very effective treatment in this initial phase.6,7,8,9 Cryotherapy slows the inflammatory process as well as provides an analgesic effect. Ultrasound may also be used to decrease swelling in this inflammatory phase, but must be used for short periods to prevent hyperemia.10 Transcutaneous nerve stimulation (TNS) and electric muscle stimulation (EMS) have also been shown to be effective.
The use of continuous passive motion (CPM) has been shown to clear hemoarthrosis (blood present in the synovial joints post-trauma) during the initial reaction phase. In the 24 hours following trauma, the synovial fluid in joints treated with CPM displayed less blood than immobilized joints. At 48 hours the joints treated by CPM demonstrated the synovial fluid was clear where as the immobilized joint remained grossly bloody.11
The use of manipulation can also be employed in the reaction phase and is suggested in the areas of fixation that have resulted from the injury. This will expedite the removal of hemoarthrosis, reduce spasms, edema and pain as well as reduce nerve root irritation when present.12 Cyriax states, "When free mobility was encouraged from the onset, the fibers in the scar were arranged lengthwise as in a normal ligament. Gentle passive movements do not detach fibrils from their proper formation at the healing breach, but prevent their continued adherence at abnormal sites."13
In the initial reaction phase, the use of CPM and manipulations (which are both mobilization techniques) must be used in a controlled protective manner to prevent any further damage to the healing ligaments.11
The initial reaction phase can be treated effectively using classic cryotherapy, specific modalities, as well as a controlled program of CPM and manipulations.
Phase of Healing -- Phases II and III
The second stage of healing, the repair phase, may last from 48 up to 6 weeks. This phase is characterized by the production and laying down of new collagen.4 During this phase, the collagen is not fully oriented in the direction of tensile strength.5
The third phase, the remodeling phase, which lasts from 3 weeks to 12 months or more, is the phase in which the collagen is remodeled and along with with phase II determines the functional capabilities of the soft tissue after the healing process is completed.14 True rehabilitation must focus on maintaining these functional capabilities. Oakes3 describes the aims of rehabilitation as regaining pain-free movement with full strength, power and range of motion, thus describing the functional capabilities of the soft tissue.
To regain the functional capabilities, stresses of function must be put on the healing tissue. As described by Roy:15 "If a limb is completely immobilized during the recovery process, the tissues may emerge fully healed but poorly adapted functionally with little chance for change, particularly if the immobilization has been prolonged." Mobilization techniques must take place throughout the repair and remodeling phases to insure proper tissue adaptation. Several benefits of mobilization have been defined which include increased strength3,16 and flexibility of healed tissue, less scar formation and adhesions,14 increased cartilage nutrition,17 and lesser incidence of recurrence of injury.18
Rehabilitation Protocol
Rehabilitation protocol following soft tissue injury must include mobilization techniques to insure good functional adaptation. A program combining manipulations, the use of modalities, mobilization technique, and a strengthening program will insure optimal rehabilitation.
Manipulations and modalities should be used during all three phases of healing to limit fixations, control pain and spasms as well as maintain neurologic integrity. Mobilization should be carried out within the limits of pain on the patient, starting with controlled passive motion. Controlled passive motion should be employed until a maximum range of motion is reached. At this point, active assistive motion should be employed. As the injury heals and the tissue adapts, the patient can be graduated to active resistive motion. Active resistive motion should be followed by a strengthening program of kinetic resistive exercise. This will insure a return to maximum strength for the patient. Keep in mind all rehabilitation should be performed within the patient's limits of pain and periodic re-evaluation and testing such as muscle testing and surface EMG should be performed to evaluate the patient's progress. Also remember that the final remodeling phase can last over a year post injury; rehabilitation should be directed accordingly.
By following this rehabilitation protocol and progression, a return to maximum functional capabilities can be insured, returning the patient to maximum pain free range of motion and strength.
Rehabilitation in the 1990's focuses on regaining function. After all, function does determine what we can do with our lives.
J. Scott Brown, D.C.

Soft Tissue Injuries










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SOFT TISSUE INJURIES
Defined as an injury to muscle tissue, tendons, ligaments, fascia, and innervating nerve supply. It is common for soft tissue injuries to be coupled with joint pain, offering a worsening of pain upon initial movements (waking, sit to stand) or lessen with mild activity
History may reveal the following:
~ Blunt trauma
~ Rapid deceleration or acceleration (Such as injuries sustained in a motor vehicle accident)
~ Overstretching a tissue beyond its normal anatomical limits (Such as with over exertion or sports injuries)
Evaluation:
~ Range of motion-restricted due to pain- sensation of 'pulling"
~ Motor and sensory- possible decrease in sensory perception
~ Orthopedic testing- may not be positive for adjacent joints
~ Palpation-may elicit warmth and throbbing sensation. Edema and myospasm evident.
Treatment may include:
~ Cryotherapy (acute stages)
~ Interferential muscle stimulation
~ Hot fomentation
~ Ultrasound
~ Manual therapies including deep friction massage and joint mobilization
~ Passive and active stretching
~ Gentle, progressive resistance exercises both in office and at home
Due to the fact that there are three phases of soft tissue healing there are specific treatment objectives for each.
• Acute Phase- reduce inflammation, edema, and pain with physical therapy modalities
• Remodeling Phase- Scar tissue must be mobilized and tissue elasticity must be restored through manual techniques and passive and active stretching
• Rehabilitative Phase- It is important to strengthen all tissues in and around injured region. Education may be necessary for long-term prevention in the areas of posture, lifting techniques, and maintenance of exercise and overall health.
Physical therapy may be necessary to break the pain/myospasm cycle and to restore tissue to a normal pain free function. Additionally, there may be a need for gradual, supervised return to daily activity to avoid relapses.
Adverse affects of untreated injury could include:
Chronic pain or functional limitations due to:
~ Tissue shortening
~ Range of motion restrictions
~ Joint degeneration
~ Accumulation of adhesions along muscular fibers



Immobilization or Early Mobilization After an Acute Soft-Tissue Injury?
Pekka Kannus, MD, PhD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 3 - MARCH 2000

In Brief: Experimental and clinical studies demonstrate that early, controlled mobilization is superior to immobilization for primary treatment of acute musculoskeletal soft-tissue injuries and postoperative management. Optimal treatment and rehabilitation follow four steps that address response to trauma. First is treating the damaged area with PRICES: protection, rest, ice, compression, elevation, and support. Second, during the first 1 to 3 weeks after the injury, immobilization of the injured tissue areas allows healing without extensive scarring. Third, when soft-tissue regeneration begins, controlled mobilization and stretching of muscle and tendons stimulate healing. Fourth, at 6 to 8 weeks postinjury, the rehabilitative goal is full return to preinjury level of activity.
Acute soft-tissue injuries such as muscle-tendon strains, ligament sprains, and ligament or tendon ruptures occur frequently in sports and exercise. Without correct diagnosis and proper treatment, they may result in long-term breaks in training and competition. Far too often, injuries become chronic and end careers of competitive athletes or force recreational athletes to abandon their favorite activity. For these reasons, an increased focus has been on finding ways to ensure optimal healing. In this regard, the question has centered on immobilization or early mobilization in treatment.
Soft-Tissue Response to Trauma
Musculoskeletal soft tissue responds to trauma in three phases: the acute inflammatory phase (0 to 7 days), the proliferative phase (about 7 to 21 days), and the maturation and remodeling phase (21 days and thereafter; table 1). (1)

TABLE 1. Phases of Healing After an Acute Soft-Tissue Injury
Phase Approximate Days After Injury

Inflammation 0-7
Proliferation 7-21
Maturation and remodeling >21

Acute inflammatory phase. In this phase, ischemia, metabolic disturbance, and cell membrane damage lead to inflammation, which, in turn, is characterized by infiltration of inflammatory cells, tissue edema, fibrin exudation, capillary wall thickening, capillary occlusions, and plasma leakage. Clinically, inflammation manifests as swelling, erythema, increased temperature, pain, and loss of function. The process is time dependent and mediated by vascular, cellular, and chemical events culminating in tissue repair and sometimes scar (adhesion) formation.
Proliferative phase. These changes include fibrin clotting and a proliferation of fibroblasts, synovial cells, and capillaries. The inflammatory cells eliminate the damaged tissue fragments by phagocytosis, and fibroblasts extensively and markedly elevate production of collagen (initially, the weaker, type 3 collagen, later type 1) and other extracellular matrix components.
Maturation and remodeling phase. In this phase, the proteoglycan-water content of the healing tissue decreases and type 1 collagen fibers start to assume a normal orientation. Approximately 6 to 8 weeks postinjury, the new collagen fibers can withstand near-normal stress, although final maturation of tendon and ligament tissue may take as long as 6 to 12 months.
Injury and Four-Step Treatment
After an injury, the ideal treatment and rehabilitation program should include four steps.
PRICES. Immediately after injury, the damaged area should be treated with PRICES: protection, rest, ice (cold), compression, elevation, and support (table 2) (1,2). The aim is to minimize hemorrhage, swelling, inflammation, cellular metabolism, and pain, and to provide optimal conditions for healing (2). Since prolonged inflammation may lead to excessive scarring, early, effective treatment seeks to prevent it. On the other hand, one must remember that inflammation is not only the body's response to insult, but also the initial step in healing.

TABLE 2. Basic Treatment Plan for Acute Musculoskeletal Injury ('PRICES' Mnemonic)

P = Protection from further damage
R = Rest to avoid prolonging irritation
I = Ice (cold) for controlling pain, bleeding, and edema
C = Compression for support and controlling swelling
E = Elevation for decreasing bleeding and edema
S = Support for stabilizing the injured part

Immobilization and protection. The second step is immobilization and protection of the injured tissue area during the first 1 to 3 weeks. In the early phase of healing, immobilization allows undisturbed fibroblast invasion of the injured area that leads to unrestricted cell proliferation and collagen fiber production. Premature and intensive mobilization at this time leads to enhanced type 3 collagen production and weaker tissue than that produced during an optimal immobilization period (2). Protection (such as with a cast or brace) prevents secondary injuries and early distension and lengthening of injured collagenous structures such as a torn anterior cruciate ligament (ACL) (3).
Maturation. About 3 weeks after injury, collagen maturation and final scar tissue formation begins (1,2,4). In this phase, injured soft tissues need controlled mobilization. Less injured portions of the tissue or joint, however, can be mobilized earlier, sometimes even during the proliferative phase. Prolonged immobilization, though, must be avoided to prevent atrophy of cartilage, bone, muscle, tendons, and ligaments (5-12). Controlled muscle stretching and joint movement enhance new collagen fiber orientation parallel to the stress lines of the normal collagen fibers; these activities also serve to prevent tissue atrophy from immobilization. Treatment can be supported with physical therapy to improve local circulation and proprioception, inhibit pain, and strengthen muscle-tendon units.
Resumption of activity. Approximately 6 to 8 weeks after the injury, new collagen fibers can withstand near-normal stress, and the goal for rehabilitation is rapid and full recovery to activity. If the previous steps were followed, protection is no longer needed, and each component of the damaged soft tissue is ready for a progressive mobilization and rehabilitation program (2).
Soft-Tissue Healing: Experimental Studies
The current literature on experimental acute soft-tissue injury speaks strongly for the use of early, controlled mobilization rather than immobilization for optimal healing.
Knee joint. Studies by Woo and colleagues (reviewed in Woo and Hildebrand [13]) have shown that an experimentally induced tear of the medial collateral ligament (MCL) in animals heals much better with early, controlled mobilization than with immobilization. Early mobilization influenced healing even more than did surgical repair performed on the rupture. Exercise had an adverse effect on ligament healing and knee stability only when the animals' joints had been rendered unstable by transection of both the ACL and the MCL. These results probably reflect the poor regeneration potential of the ACL after rupture or transection (3,13).
Muscle. Much of the experimental data about the effects of early mobilization versus immobilization on muscle injury repair have come from studies in Tampere and Turku, Finland, and have been reviewed in Järvinen and Lehto (2). In experimentally injured rat gastrocnemius muscle, fiber regeneration is often inhibited by dense scar-tissue formation. Immobilization immediately after injury limits the size of the connective tissue area formed within the injury site. Penetration of muscle fibers into the connective tissue is prominent, but their orientation is complex and fibers are not parallel to the uninjured muscle fibers. In addition, immobilization for longer than 1 week resulted in marked atrophy of the injured gastrocnemius. Mobilization instituted immediately after injury resulted in dense scar formation and interfered with muscle regeneration.
In the rat model, the best results were achieved when mobilization was started after 3 to 5 days of immobilization. In the gastrocnemius, muscle fiber penetration through the immature connective tissue appeared optimal, and orientation of regenerated muscle fibers aligned with the uninjured muscle fibers. The gain in strength and capacity for energy absorption has been similar and as good as that of muscles treated by early immediate mobilization alone (2).
Tendons. Using a rat model, Enwemeka et al (14) demonstrated a significant increase in Achilles tendon strength after repair and early mobilization compared with repair and immobilization. In divided, unrepaired rat Achilles tendons, Murrell et al (15,16) obtained similar results. Gelberman at al (17) reported that mobilization of an animal extremity enhanced the orientation and organization of tendon collagen. Thus, after the inflammatory phase, a controlled stretching and strengthening of the regenerating, repaired tendon is likely to increase the final tensile properties of the tendon. However, suspicion remains that even with optimal therapy after repair, the collagen fibers in the tendon may be deficient in content, quality, and orientation (10). If so, this deficiency may present increased risk of inflammatory reaction, tendon degeneration, and tendon reruptures during later activities.
Soft-Tissue Healing: Clinical Trials
Early controlled mobilization. Controlled clinical trials of acute soft-tissue injuries support the results of experimental studies and have shown that early controlled mobilization is superior to immobilization, not only in primary treatment, but also in postoperative management. The superiority of early controlled mobilization has been especially clear in terms of quicker recovery and return to full activity without jeopardizing the subjective or objective long-term outcome. Evidence has been systematic and convincing for many injuries (table 3): acute ankle ligament rupture (18-20); after surgery for ankle ligament rupture (21); after surgery for chronic ankle ligament instability (22); knee ligament injury (6,23); articular cartilage injury (24); minimally displaced distal radius fracture (25); and complete Achilles tendon rupture (26-28). In addition, in many other injuries such as elbow or shoulder dislocation and many nondisplaced fractures, early mobilization yielded good results, although not all studies used a control group (10,29).

TABLE 3. Soft-Tissue Injuries That Have Been Shown to Have Better Outcomes With Early Mobilization Than With Immobilization

Acute ankle ligament tears
Postsurgery acute or chronic ankle ligament tears
Knee ligament injuries
Complete Achilles tendon ruptures

Randomized studies. The importance of results from prospective, randomized trials cannot be overemphasized; they may dramatically change our thinking and conventional treatment protocols. For example, 2-year results from a prospective, randomized study (27) from Hannover, Germany, (conservative functional treatment alone vs surgery plus similar functional treatment) support the use of early functional rehabilitation alone in complete Achilles tear. This finding is supported by an experimental observation in rats that surgical repair of a surgically divided Achilles tendon did not improve the outcome obtained by functional treatment (free-cage activity) alone (30).
Other examples come from investigations of patellar dislocation: Two randomized studies (31,32) from Finland indicate that after a 2-year follow-up, conservative treatment of acute patellar dislocation gives results at least as good as surgical treatment followed by similar conservative treatment. Comparable observations have been made in acute, complete rupture of the ankle ligaments: Early controlled mobilization alone gives results at least as good as surgery plus early controlled mobilization (18,21,33).
Practical Applications
Avoiding atrophy. Obviously, the best method for preventing immobilization atrophy is usage. Complete immobilization should be minimal and often is not needed at all. During the last 10 to 15 years, many postoperative protocols, especially those involving knee and ankle ligament injuries, have undergone a major change from long, complete immobilization to early, controlled mobilization using elastic or other bandages, rehabilitative braces, continuous passive devices, or a combination immediately after the trauma. Also, active joint motion and weight bearing is allowed earlier than before, and training during immobilization is becoming more and more effective (10). Even modern fracture treatment has considerably reduced the degree and duration of cast immobilization (10,25).
Early mobilization. Early mobilization is the best method to avoid joint contracture and its harmful consequences on articular cartilage. The technique also serves to maintain and return joint proprioception, which, in turn, may be important in preventing reinjury and in hastening recovery to full fitness. In addition, Frank et al (34) have suggested that joint motion may help reduce postinjury and postoperative pain, swelling, and thromboembolic complications.
The efficacy of early motion in preventing immobilization atrophy depends on how well it controls pain, inflammation, and swelling. Inflammation and pain result in voluntary inhibition of muscle activity across the affected joint. Spencer et al (35) have even reported that pain is not required to cause muscle inhibition; swelling alone is sufficient (so-called reflex inhibition). Therefore, primary treatment should control all three factors using early controlled motion in combination with other treatment modalities such as cold, anti-inflammatory analgesics, and transcutaneous neural stimulation.
Rehabilitation programs. For each joint and each type of injury, rehabilitation programs must be individualized, taking into account the injured structures that should be protected from premature and intensive mobilization, as well as the uninjured structures that should be mobilized as soon as possible. To prevent muscle dysfunction when immobilization must be used, diverse stimuli are needed throughout the entire period; these include strength, power, and endurance exercises. The modern operational principle in the treatment of acute soft-tissue injuries and during immobilization is that "within the limits of pain, everything that is not explicitly forbidden is allowed." (10) This, of course, requires good cooperation between the patient and the attending physician and physical therapist.
Take-Home Message
Controlled experimental and clinical trials have yielded convincing evidence that early, controlled mobilization is superior to immobilization for musculoskeletal soft-tissue injuries. This holds true not only in primary treatment of acute injuries, but also in their postoperative management. The superiority of early controlled mobilization is especially apparent in terms of producing quicker recovery and return to full activity, without jeopardizing the long-term rehabilitative outcome. Therefore, the technique can be recommended as the method of choice for acute soft-tissue injury.
MEDICO LEGAL NEWS
ALAN M. IMMERMAN, D.C.
DECEMBER 10, 1998
Copyright 1998

ACUTE SOFT TISSUE INJURIES: DO THEY HEAL PARTIALLY OR COMPLETELY?
As described by Kellett, there are three stages in the healing of soft tissue (referring to ligament and tendon):
1. Acute Inflammatory Phase: Marked by swelling, redness, warmth and pain, the acute inflammatory phase lasts about 72 hours. During this period of time, the body minimizes blood loss by activating the blood coagulation system; dilates (widens) the blood vessels so that healing elements may be more quickly delivered to the damaged tissues; and removes debris which results from the damage to soft tissue cells.
2. Repair Phase: This phase lasts from 48 hours to 6 weeks. Early in the repair phase the body finishes the job of cleansing the entire area of the soft tissue injury. Next the body synthesizes new fibers (collagen) to replace the damaged fibers. The new collagen is not, however, fully orientated in the direction of tensile strength.
3. Remodeling Phase: This phase lasts from 3 weeks to 12 months or more. During this phase, the body remodels the newly synthesized collagen in order to increase the functional capabilities of the tendon or ligament to withstand the stresses imposed on it. (Kellett, 1986)
It is important to note that normal ligaments are composed of type I collagen whereas damaged and healed ligaments contain a large proportion of type III collagen. Type III collagen is considered an "immature" form of collagen because it is deficient in the number of cross-linkages between and within the collagen subunits. Experiments which have studied ligament healing in rabbits have found that 40 weeks after injury the collagen is still deficient in content and quality. (Kellett, 1986) The cross-linkages are of critical importance in determining the strength of the newly synthesized collagen. (Loitz and Frank, 1993)
What do other authors say about the final extent of healing? Woo and Buckwalter in 1987 stated: "It became apparent that most injuries to the Musculoskeletal soft tissues do not result in repair that restores normal tissue structure and function and that the long-term results vary. Unlike bone, regeneration of normal tissue and complete restoration of normal function rarely occurs in the musculoskeletal soft tissues." (Woo and Buckwalter, 1987)
In 1993, Loitz and Frank stated: "Cellular changes indicative of scar maturation are present by 12 months and continue to approach normality for up to 30 months, but to date, no study has documented an end to scar remodeling and a return of the ligament to ‘normal.’" (Loitz and Frank, 1993)
CONCLUSIONS
The only reasonable conclusion that can be drawn from the existing research and literature is that acute soft tissue injuries never heal completely. Normal ligament and tendon is replaced by an inferior type of tissue.
Tissue Response to Injury
THE INFLAMMATORY REPSONSE
Acute Inflammation
Phase 1; Acute phase
- Redness
- Heat
- Swelling
- Pain
- Loss of function

- Cellular death continues after initial injury because of the following;
o Lack of oxygen caused by disruption of circulation
o Digestive enzymes of the engulfing phagocytes that spill over to kill normal cells
- Vascular response
o First hour; Vasoconstriction; Decrease in the diameter of a blood vessel
o Second hour; Vasodilation; Increase in the diameter of a blood vessel.
§ Exudate; Fluid with a high protein content and containing cellular debris that comes from blood vessels
and accumulates in the area of the injury
§ Permeable; Permitting the passage of a substance through a vessel wall
§ The vadodilator theory of autoregulation suggests that metabolic byproducts increase blood flow by
causing vasodilation in localized area
- Cellular response
o Mast cells; Connective tissue cells contain heparin (blood anticoagulant) and histamine
o Leukocytes; Consist of two types – granulocytes (e.g., basophils and neutrophils) and agranulocytes
(e.g., monocytes and lymphocytes)
o Phagocytosis; Process of ingesting microorganisms, other cells, or foreign particles, commonly performed
by monocytes (white blood cells)
o Macrophages engulf large quantities of bacteria
o Diapedesis is the process by which leukocytes squeeze through pores in the capillary wall
- Chemical mediators
o Histamine (Released by mast cells and platelets); Increased capillary permeability
o Serotonin (Released by mast cells and platelets)
o Bradykinin
o Prostaglandins
o Leukotrienes
- Complement system
o Leukocyte chemotaxis
o Phagocytosis
- Bleeding and exudate
o Blood coagulation; Thromboplastin + Calcium = Prothrombin = Thrombin = Fibrinogen
= Insoluble fibrin clot (+ Vitamin K)

Phase 2; Repair Phase (Fibroplasis phase); Scar formation
- Tissue repairs;
o By resolution
o By granulation tissue
o By regeneration
- Tissue repair depends on
o Elimination of debris
o Regeneration of endothelial cells
o Production of fibroblasts
- Fibroblasts become active during regeneration phase of the inflammatory response to begin building collagen

Phase 3; Remodeling phase (up to 1 ~2 years)
- Remodeling depends on the amount and type of scar tissue present
- Synthesis; Process of forming or building up
- Lysis; Process of breaking down

Chronic Inflammation
- Chronic inflammation can stem from repeated acute microtraumas and overuse.
Tissue Response to injury


Acute inflammation has a short onset and a short duration. It consists of hemodynamic changes, production of an exudate, and the presence of granular leukocytes. Chronic inflammation has a long onset and a long duration. It displays a presence of nongranular leukocytes and a more extensive formation of scar tissue.
Acute inflammation: vascular and cellular events

- 5 cardinal signs of inflammation (4) originally by Roman physician Celsius in 1st Century AD; Galen, a Greek physician added functio laesa in the second century.
- serve as reminder to athlete of injury and to prevent the athlete from exceeding safe limits and reinjuring area
Five signs
- redness (rubor)
- swelling (tumor)
- heat (calor)
- pain (dolor)
- loss of function (functio laesa)

Three phases: acute, reactive, or substrate inflammatory phase; the repair and regeneration phase; and the remodeling phase.

Acute inflammation

Phase I: Acute phase
The acute phase of inflammation is the initial reaction of body tissue to an irritant or injury and is characteristic of the first 3 or 4 days after injury. Acute inflammation is the fundamental reaction designed to protect, localize, and rid the body of some injurious agent in preparation for healing and repair. The main causes of inflammation are trauma, chemical agents, thermal extremes, and pathogenic organisms.

Vascular response
First hour. At the time of trauma, before the usual signs of inflammation appear, a transitory vasoconstriction occurs, causing decreased blood flow. At the moment of vasoconstriction, coagulation begins to seal broken blood vessels, followed by the activation of chemical influences. Vasoconstriction is replaced by dilation of venules, arterioles, and capillaries in the immediate area of the injury.
Second hour. Vasodilation brings with it a slowing of blood flow, increased blood viscosity, and stasis, which leads to swelling (edema). With dilation also comes exudation of plasma and concentration of red blood cells (hemoconcentration). Much of the plasma exudate results from fluid seepage through the intact vessel lining, which becomes more permeable, and from higher pressure within the vessel. Permeability is relatively transient in mild injuries, lasting only a few minutes, with restoration to a pre-injury state in 15 to 30 minutes. In slightly more severe situations there may be a delayed response with a late onset of permeability. In such cases, permeability may not appear for hours and then appears with some additional irritation and a display of rapid swelling lasting for an extended period.
A redistribution of leukocytes occurs within the intact vessels, caused in part by a slowing of circulation. These leukocytes move from the center of the blood flow to become concentrated and then line up and adhere to the endothelial walls. This process is known as margination, or pavementing, and occurs mainly in venules. The leukocytes pass through the wall of the blood vessel by ameboid action, known as diapedesis, and are directed to the injury site by chemotaxis (a chemical attraction to the injury). It should be noted that ameboid motion is a slow process, taking about 6 hours. With an injury there is also an increase in lymph flow because of a high interstitial tissue pressure.

Cellular response
In phase I of acute inflammation, mast cells and leukocytes are in abundance. Mast cells are connective tissue cells that contain heparin (a blood anticoagulant) and histamine. Basophils, monocytes, and neutrophils are the major leukocytes. Basophils leukocytes are believed to bring anticoagulant substances to tissues that are inflamed and are present during both acute and chronic inflammatory healing phases. The neutrophils representing about 60% to 70% of the leukocytes arrive at the injury site before the larger monocytes. They immigrate from the bloodstream. Neutrophils emigrate from the bloodstream through diapedesis and phagocytosis to ingest smaller debris than do monocytes. Phagocytosis is the process of ingesting material such as bacteria, dead cells, and other debris associated with disease, infection, or injury. Opsonin is a protein substance in the blood serum that coats microorganisms and other cells, making them more amenable to phagocytosis. The phagocyte commonly accomplishes this process by projecting cytoplasmic pseudopods, which engulf the object and ingest the particle through enzymes. When the neutrophils disintegrates, it gives off enzymes called lysozomes, which digest engulfed material. These enzymes act as irritants and continue the inflammatory process. Neutrophils also have chemotactic properties, attracting other leukocytes to the injured area. The monocyte, which is a nongranular leukocyte, arrives on the scene into large macrophages that have the ability to ingest large particles of bacteria or cellular debris.

Chemical mediators
Chemical mediators for the inflammatory process are stored and given off by various cells. Histamine, the first chemical to appear in inflammation, is given off by blood platelets, basophils leukocytes, and mast cells. It is a major producer of arterial dilation, venule, and capillary permeability. Serotonin is a powerful vasoconstrictor found in platelets and mast cells. With an increase in blood there is an increase in local metabolism. Permeability is produced by the contraction of the endothelial cells of the capillary wall, producing a gap between cells. Gaps allow plasma to leak proteins, platelets, and leukocytes. Plasma proteases, with their ability to produce polypeptides, act as chemical mediators. A major plasma protease in inflammation is bradykinin, which increases permeability and causes pain.
Heparin is also given off by mast cells and basophils and temporarily prevents blood coagulation. In addition, in the early stages of acute injury, prostaglandins and leukotrienes are produced. Both of these substances stem from arachidoic acid; however, prostaglandins are produced in almost all body tissues. They are stored in the cell membranes phospholipids. Leukotrienes alter capillary permeability and, it is believed, play a significant role, along with prostaglandin, in all aspects of the inflammatory process. Prostaglandins apparently encourage, as well as inhibit, inflammation depending on the conditions that are prevalent at the time.

Inflammation response Mediators
vasoconstriction serotonin from platelets and mast cells
vasodilation histamine from platelets, basophils, and mast cells
prostaglandin from arachidonic acid
leukotrienes from arachidonic acid
bradykinin from body fluids
margination and pavementing loss of micro-circulation, increase in blood viscosity
emigration of leukocytes leukocytes pass through capillary walls (diapedesis)
chemotaxis leukocytes attract other leukocytes
phagocytosis leukocytes, debris, complement, opsonization

Bleeding and exudate
The extent of fluid in the injured area is highly dependent on the extent of damaged vessels and the permeability of the intact vessel. Blood coagulates in three stages. In the initial stage thromboplastin is formed. In the second stage prothrombin is converted into thrombin under the influence of thromboplastin with calcium. In the third stage, thrombin changes from soluble fibrinogen into soluble fibrin. The plasma exudate then coagulates into a network of fibrin and localizes the injured area.

Phase II: Repair phase
The term repair is synonymous with healing, whereas regeneration refers to restoration of destroyed or lost tissue. Healing, which extends from the inflammatory phase (48 to 72 hours to approximately 6 weeks), occurs when the area has become clean through the removal of cellular debris, erythrocytes, and the fibrin clot. Tissue repair is accomplished through three processes: by resolution, in which there is little tissue damage and normal restoration; by the formation of granulation tissue, occurring if resolution is delayed, and by regeneration the replacement of tissue by the same tissue. The formation of scar tissue after trauma is a common occurrence; however, because scar tissue is less viable than normal tissue, the less scarring the better. When mature, scar tissue represents tissue that is firm, fibrous, inelastic, and devoid of capillary circulation. The type of scar tissue known as adhesion can complicate the recovery of joint or organ disabilities. Healing by scar tissue begins with an exudate, a fluid with a large content of protein and cellular debris that collects in the area of the injury site. From the exudate, a highly vascular mass develops known as granulation tissue. Infiltrating this mass is a proliferation of immature connective tissue (fibroblasts) and endothelial cells. Gradually the collagen protein substance, stemming from fibroblasts, forms a dense, fibrous scar. Collagenous fibers have the capacity to contract approximately 3 to 14 weeks after an injury and even as long as 6 months afterward in more severe cases.
During this stage, two types of healing occur. Primary healing, healing by first intention, takes place in an injury that has even and closely opposed edges, such as a cut or incision. With this type of injury, if the edges are held in very close approximation, a minimum of granulation tissue is produced. Secondary healing, healing by secondary intention, results when there is a gaping lesion and large tissue loss leading to replacement by scar tissue. External wounds such as lacerations and internal musculoskeletal injuries commonly heal by secondary intention.

Phase III: Remodeling Phase
Remodeling of the traumatized area overlaps that of repair and regeneration. Normally in acute injuries the first 3 to 6 weeks are characterized by increased production of scar tissue and increased strength fibers. Strength of scar tissue continues to increase from 3 months to 2 years after injury. Ligamentous tissue takes as long a 1 year to become completely remodeled. To avoid a rigid, non-yielding scar, there must be a physiological balance between synthesis and lysis. There is simultaneous synthesis of collagen by fibroblasts and lysis by collagenase enzymes. The tensile strength of collagen apparently is specific to the mechanical forces imposed during the remodeling phase. Forces applied to the ligament during rehabilitative exercise will develop strength specifically in the direction that force is applied. If too early or excessive strain is placed on the injury, the healing process is extended. For proper healing of muscles and tendons, there must be careful consideration to mobilize the site. Early mobilization can assist in producing a more viable injury site; on the other hand, too long a period of immobilization can delay healing. The ideal of collagen remodeling is to have the healed area contain a preponderance of mature collagenous fibers that have a number of cross-linkages. As stated, collagen content and quality may be deficient for months after injury.

Chronic inflammation
If acute inflammation reaction fails to be resolves in 1 month, it is termed a sub-acute inflammation. If it lasts for months or even years, the condition is termed chronic. Major chemicals found during chronic inflammation are the kinins (especially bradykinin), which also cause vasodilation, increased permeability, and pain. Prostaglandin, also seen in chronic conditions, causes vasodilation. Prostaglandin can be inhibited by aspirin.

Soft tissue healing
All tissues of the body can be defined as soft tissue except for bone. The human body has four types of soft tissue: epithelial tissue, which consists of the skin and the lining of vessels and many organs; connective tissue, which consists of tendons, ligaments, cartilage, fat, blood vessels, and bone; muscle, which can be skeletal, cardia, or visceral and nervous tissue, which consists of the brain, spinal cord, and nerves.

Cartilage healing
Articular cartilage has limited capacity to heal. Cartilage has little or no direct blood supply. When chondrocytes are destroyed and the matrix is disrupted, healing is variable. Articular cartilage that fails to clot and as no perichondrium heals and repairs slowly. On the other hand, if the affected area includes the subchondral bone, which has a greater blood supply, granulation tissue is formed and the healing process proceeds normally.

Ligament healing
Ligament healing follows the same course of healing as other vascular tissue. If proper immediate and follow-up management is done, a sprained ligament will undergo the acute, repair, and remodeling phases in approximately the same time period as other vascular tissues.
During the repair phase, collagen fibers realign in reaction to joint stress and strains. Full ligament healing with scar maturation may take as long as twelve months.

Skeletal muscle healing
Skeletal muscles cannot undergo the mitotic activity required to replace cells that have been injured. In other words, regeneration of new myofibers is minimal. Skeletal muscle healing and repair follow the same process as other soft tissue developing tensile strength according the Wolffs law.

Wolffs Law
Wolffs law states that after injury both bone and soft tissue will respond to the physical demands placed on them, causing them to remodel or realign along lines of tensile force. Therefore it is critical that injured structures be exposed to progressively increasing loads throughout the rehabilitation process.

Nerve healing
Because of the nature of nerve cells, they cannot regenerate after they have died. Regeneration can take place within a nerve fiber. The closer the injury is to the nerve cell, the more difficult regeneration becomes.
For nerve regeneration to occur, an optimal environment must be present. If peripheral nerve regeneration occurs, it is at a rate of only 3 to 4 mm per day. Injured nerves within the central nervous system do not regenerate as well as peripheral nerves do.

Modifying Soft-Tissue healing
The healing process is unique in each athlete. Age and general nutrition can play a role in healing. The older athlete may be more delayed in healing than younger athletes are. The injuries of an athlete with poor nutritional status may heal more slowly than normal. Athletes with certain organic disorders may heal slowly. For example, blood conditions such as anemia and diabetes often inhibit the healing process.

Management Concepts

1. Drugs to treat the inflammation. There is a current trend toward the use of antiprostaglandin medications, or nonsteroidal anti-inflammatory drugs (NSAIDs). The intent of this practice is to decrease vasodilation and capillary permeability.

2. Therapeutic modalities. Both cold and heat are used for different conditions. In general, heat stimulates acute inflammation and cold acts as an inhibitor. Conversely, in chronic conditions, heat may severe as a depressant. A number of electrical modalities are used for the treatment of inflammation stemming from sports injuries.

3. Therapeutic exercise. A major aim of soft-tissue rehabilitation through exercise is pain-free movement, full-strength power, and full extensibility of associated muscles. The ligamentous tissue, if related to the injury, should become pain free and have full tensile strength and full range of motion. The dynamic joint stabilizers should regain full strength and power. Immobilization of a part after injury or surgery is not always good for all injuries. When a part is immobilized over an extended period of time, adverse biochemical changes occur in collagenous tissue. Early mobilization used in exercise rehabilitation that is highly controlled may enhance the healing process.

Fracture healing
The osteoblast is the cellular component of bone and forms its matrix; the osteocyte both forms and destroys bone, and osteoclasts destroy and resorb bone. The constant ongoing remodeling of bone is caused by osteocytes; osteoclasts are related mainly to pathological responses. Osteoclasts come from the cambium layer of the periosteum, which is the fibrous covering of the bone, and are involved in bone healing. The inner cambium layer, in contrast to the highly vascular and dense external layer, is more cellular and less vascular. It serves as a foundation for blood vessels and provides a place for attaching muscles, tendons, and ligaments.

Acute fracture healing
Acute fracture healing follows the same three phases that soft tissue does but is more complex. In general acute fracture healing has five stages: hematoma formation, cellular proliferation, callus formation, ossification, and remodeling.

Hematoma formation
Acute inflammation usually lasts approximately four days. When a bone fractures, there is trauma to the periosteum and surrounding soft tissue. With hemorrhaging, a hematoma accumulates in the medullary canal and surrounding soft tissue in the first 48 to 72 hours. The exposed ends of vascular channels become occluded with clotted blood accompanied by dying of the osteocytes, disrupting the intact blood supply. The dead bone and related soft tissue begin to elicit a typical inflammatory reaction, including vasodilation, plasma exudates, and inflammatory cells.

Cellular formation
The hematoma in a bony fracture, like in a soft-tissue injury, begins its organization in granulation tissue and gradually builds a fibrous junction between the fractured ends. At this time the environment is acid, but it will slowly change to neutral or slightly alkaline. A major influx of capillary buds that carry endosteal cells from the bones cambium layer occurs. These cells first produce a fibrous callus, then cartilage, and finally a woven bone. When there is an environment of high oxygen tension, fibrous tissue predominates, whereas when oxygen tension is low, cartilage develops. Bone will develop at the fracture site when oxygen tension and compression are in the proper amounts.

Callus formation
The soft callus, in general, is an unorganized network of woven bone formed at the ends of the broken bone that is later absorbed and replaced by bone. At the soft-callus stage, both internal and external calluses are produced that bring an influx of osteoblasts that begin to immobilize the fracture site. The internal and external calluses are formed by bone fragments that grow to bridge the fracture gap. The internal callus grows rapidly to create a rigid immobilization. Beginning in the three to four weeks, and lasting three to four months, the hard callus forms. Hard callus is depicted by a gradual connecting of bone filament to the woven bone at the fractured ends. Less than satisfactory immobilization produces a cartilaginous rather than bony union.

Ossification
With adequate immobilization and compression, the bone ends become crossed with a new haversian system that will eventually lead to the laying down of primary bone. The ossification stage is the completion of the laying down bone. The fracture has been bridged and firmly united. Excess has been resorbed by osteoclasts.

Remodeling
Remodeling occurs after the callus has been resorbed and trabecular bone is laid down along the lines of stress. Complete remodeling may take many years. The influence of biochemical stimulation (piezoelectric effect) is the basis for development of new trabecular bone to be laid down at a point of greatest stress. This influence is predicted on the fact that bone is electropositive on its convex side and electronegative on its concave side. The convex considered the tension side, whereas the concave is the compression side. Significantly, osteoclasts are drawn to a positive electrical charge and osteoblasts to a negative electrical charge. Remodeling is considered complete when a fractured bone has been restored to its former shape or has developed a shape that can withstand imposed stresses.

Management of Acute Fractures
1. If there is poor blood supply to the fractured area and one of the parts of the broken bone is not properly supplied by the blood, that part will die and union or healing of the fracture will not take place. This condition is known as avascular necrosis and often occurs in the head of the femur, the navicular of the wrist, the talus of the ankle, and isolated bone fragments.

2. Poor immobilization of the fracture site, resulting from poor casting by the physician and permitting motion between the bone parts, may not only prevent proper union but may also, in the event that union does transpire, cause deformity to develop.

3. Infection can materially interfere with the normal healing process, particularly in the case of a compound fracture, which offers an ideal situation for development of a severe streptococcal or staphylococcal infection.

Pain

Nociception
Pain receptors, known as nociceptors, or free nerve endings, are sensitive to extreme mechanical, thermal, and chemical energy. They are commonly found in meninges, periosteum, skin, teeth, and some organs.
A nociceptive neuron transmits pain information to the spinal cord via the unmyelinated C fibers and the myelinated A-delta fibers. The smaller C fibers carry the impulses at a rate of 0.5 to 2.0 m per second and larger A-delta fibers at a rate of 5 to 30 m per second. When a nociceptor is stimulated there is release of a neuropeptide (substance P) that initiates an electrical impulse along the afferent fiber toward the spinal cord. The faster A-delta afferent fiber impulse moves up the spinal cord at a moderately rapid speed to the thalamus, which gives a precise location of the acute pain, which is perceived as being bright, sharp, or stabbing. In contrast the slower-conducting smaller unmyelinated C fibers are concerned with pain that is diffused, dull, aching, and unpleasant. It also terminates in the thalamus, with projections to the limbic cortex that provide an emotional aspect to this pain. Nociceptive stimuli are at close to an intensity that produces tissue damage.

Endogenous analgesics
The nervous system is powered electromechanically. Chemicals released by a presynaptic cell cross a synapse, stimulating or inhibiting a postsynaptic cell. This is called a neurotransmitter. Two types of chemical neurotransmitters that mediate pain are the endorphins and serotonin. They are generated by noxious stimuli, which activate inhibition of pain transmission.
Stimulation of the periaqueductal gray area (PGA) of the midbrain and the raphe nucleus in the pons and medulla causes analgesia. Analgesia is produced by the stimulation of opiods, morphine-like substances manufactured in the PGA and many other areas of the central nervous system. These endogenous opoid peptides are known as endorphins and enkephalins.
Noradrenergic neurons stimulating norepinephrine can also inhibit pain transmission. Serotonin has also been identified as a neuromodulator.

Pain Categories
1. Fast or slow fast pain is localized and carried through A-delta axons located in the skin. Slow pain is perceived as aching, throbbing, or burning. It is conducted through the C-fibers.

2. Acute or chronic acute pain is less than 6 months. Chronic pain has a duration longer than 6 months.

3. Projected (referred) pain. Such pain occurring away from actual sire of irritation. Example Kehrs sign indicates an involved spleen.

Common to musculoskeletal injuries is the cyclic condition of pain-spasm-hypoxia-pain. Disrupting this cycle can occur trough a variety of means such as heat or cold, electrical stimulation-induced analgesia, or selected pharmacological approaches.
The gate theory and TENS
The gate theory, as developed by Melzack and Wall, sets forth the idea that the spinal cord is organized in such a way that pain or other sensations may be experienced. An area located in the dorsal horn causes inhibition of the pain impulses ascending to the cortex for perception. The area, or gate, within the dorsal horn is composed of T cells and substantia gelatinosa. T cells apparently are neurons that organize stimulus input and transmit the stimulus to the brain. The substantia gelatinosa functions as a gate-control system. It determines the stimulus input sent to the T cells from peripheral nerves. If the stimulus from a noxious material exceeds a certain threshold, pain is experienced. Apparently the smaller and slower nerve fibers carry pain impulses, and larger and faster nerve fibers carry other sensations. Impulses from the faster fibers arriving at the gate first inhibit pain impulses. In other words, stimulation of large, rapidly conducting fibers can selectively close the gate against the smaller pain fiber input. This concept explains why acupuncture, acupressure, cold, heat, and chemical skin irritation can provide some relief against pain. It also provides a rationale for the current success of TENS.

Result number: 152

Message Number 151737

hello View Thread
Posted by JudyS on 6/01/04 at 19:19

hello everybody! hope you all had a lovely weekend. we spent the weekend in las vegas where john had a tournament to play in. the weather there was beautifully bearable which was very unusual.

happy birthday Suzanne!

I have a thoroughly fractured finger which includes a ruptured tendon (playing ball of course!) but i couldn't get my mind to heal it right up so i guess the splint really will have to stay on it for six more @$%&%*&^*%(& weeks! i really don't get how you right-handers can do a darn thing with that hand as mine is quite uncooperative! one good thing - doc's printed instructions say 'no housework for six weeks'! lucky for me it doesn't say 'no softball.....'

john i too remember the flanders field poem from school days. your recollection of it here was wonderfully timely - thank you.

Result number: 153

Message Number 150031

Re: Pregabalin View Thread
Posted by Dorothy on 5/04/04 at 16:46

Pauline ~ You have actually indirectly hit on a sore spot with me: breast cancer. It is far from being the #1 killer of women, yet everything is pink-ribboned as if this is the primary form of disease among women. In fact, as you no doubt know, the #1 disease among women is heart disease.
Just as you indicate with women's health issues, this too has been distorted - and I think it is because it is about breasts. It is completely telling that women are, in most places, not to breastfeed their children in public (even when covered up!), the primary function of the breast, while the exposure of female breasts with sexual connotations (movies, other images) has become common. Likewise, the actual disease killer of women is ignored - and women presenting with symptoms to ERs are sent home, untreated! - but breast disease gets nationwide "charity" benefits, pink ribbons on clothing, etc etc. And WOMEN cooperate with this lie!
Not only is heart disease the #1 killer, but many more women live in daily pain and disability with other diseases far more debilitating than breast cancer (arthritis, for one example). RIDICULOUS!

Result number: 154
Searching file 14

Message Number 148611

Re: Ouch....Please..someone answer me. thanks View Thread
Posted by RACHAEL T. on 4/08/04 at 23:09

Diana - Sorry no one has yet answered you....& I shall only say this - REST some & if possible, alot. I think this is the ans. to most footpain - so try to get some rest for the next 2 wks. before your MD visit. Hope your Easter is a happy one & that your feet cooperate w/ you!

Result number: 155

Message Number 148391

Re: Dr. Z please read View Thread
Posted by Will B on 4/04/04 at 17:45

Mine was done by a doctor Max S. Ribald 934 North Cooper St. Arlington TX (817) 860 9121. I got he info about docs in Texas that do the Dornier in Texas from:

Central Texas Ortho Partners, LTD.
(877) 309-7105

Dr Lifchen also came recommended and is in a few prestigious medical publications. He is part of the Baylor Medical Center Groups and his office is out of Irving (972) 254-0680.My experience with Lifchen was not very good. He seemed to want to start from ground zero with me (which is not always a bad thing) but when i explained the pathology of my injury to him - he basically tries to dell me on a regimen if NSAIDS and better shoe inserts. I got X-rays (again) and he gave me some high quality inserts and told me to put them inside my tennis shoes. He asked "why' I was not putting them right away in my new Brooks shoes - and I told hm because the brooks feel pretty good as is. Verbatim from him "If the insert that comes inside the shoe is thin you can use that insert inside your shoe". He actually put the inserts he gave me inside of my brooks. I told him 'not' to do that please as I told him that I knew for several reasons that it was 'not' a good idea to do this - no matter the shoe because it can create an unstable, many times too tight environment in a shoe, especially a tennis shoe. He told me I would get "used to it". Again, I say I am stunned at times with what supposedly experienced doctors will tell you about simple things that are flat out wrong, and if you think about the fact that this person also operates on feet, that left me thinking about his judgement and decision making with simple things, much less a complicated operations or other matters. The doc you mentioned that I saw along with your Husband was much the same but in differning ways. Just being bright, or at the top of any medical class, or being advertised in the local paper- I found out does not make a doctor "in tune' or "up to date" with simple, or comlicated matters. Here is how I feel. If they don't inderstand the basics of foot care and shoe care, and understand how to diagnose - past verbal communication - then don't use that doctor. It's just that simple. Doctor Ribald I would recommend as a general Podiatrist. He communicates extremely well and is friendly, and understands that basics of foot care. But right now I am in the stage of "wait and see" for my second ESWT. I would not recommend Marciano or Lifchen. Lifchen struck me as someone who had done many operations and does do the Ossatron ESWT, but as a pay by cash patient was going to charge me $4800.00 to $3250.00 for Ribald. Lifchen while coming across very knowledgeble, seemed to not understand basic footcare (sans putting inserts in my brooks tennis shoes even when I told him we would need to remove the inserts thet were "in" the shoes as the inserts he gave me were full length and very, very thick). So lifchen was a no go for me. Even Marciano offered me a much better deal with ESWT with the Ossatron over Lifchen - but in final alalysis, since Ribald was much more personable, and understood basic foortcare on a personal level, and he offered the Dornier at a respectable per cash basis. I went with Ribald because I could accept the level of basic treatment he could give me. Later, if ESWT does not help I may need another podiatrist for testing (MRI, Nerve conductor tests etc) from possibly an Orthopedic surgeon. Problem is that podiatrists that understand how to test and that actually believe in them is another matter I have found out. Podiatrists like the ones on this board are hard to find locally here in DFW. I wish I could. Anyway - I will let you know what happens with me and I again think the Dr's here on this very important board. I am also thinking of starting a website dedicated to heel pain sufferers for people here in DFW, or where ever. I moderate a very respected PC (computer) hardware forum and I can't see wht I can't take the same hard work and help people that suffer from this type pain. I am in the process of gathering data on who offers what here (Ossatron, Dornier, Sonocur, Diag. MRI - etc.. ART, Pain Management). Eventually I would like to allow a few docs to moderate the Q and A section of the forums should I decide to do this, and link local ESWT services (all of them) locally on the web page.

Result number: 156

Message Number 146175

Re: Heelspurs View Thread
Posted by Ed Davis,DPM on 3/05/04 at 20:55

Judy:
I have not changed. Well, maybe you could say I have had a change of opinion. No, I am not interested in directing the peace -- you are welcome to do it. Actually, it is something EVERYONE must do there part in as I am not sure there can be one "director."

Sorry about yesterday as I was going against my own advice. It is just that things need to move forward in a productive direction, one that will benefit everyone and the site and I am willing to do my part.

Being a moderator is not easy. Dr. Z is a fair guy, made what I believe was an honest mistake in deleting more that he intended and has not heard the end of it.

Yes, I still have the same ideas about certain things, things that I will not discuss here because doing so is unproductive. Those ideas only represent a small portion of what I do and who I am and are not relevant to the subject matter of this site. I have ideas about other things that many of us probably agree on so I don't think that old arguments about the things we don't agree about should be the obstacle to moving forward toward trying to make the site a friendlier, more hospitable place.

Do I have an ulterior motive? Well, partially. I have to admit that I have referred a lot of my patients to the site to read Scott's Heel Pain Book. I think some just read the book, some left, some read the boards, a few post now and then and maybe one or two come here to vent now and then (I am getting into patient confidentiality issues and cannot go further on that aspect).

My patient philosophy is very consistent with that of ScottR -- I like my patients to know as much as possible so this site has been valuable in that sense. It needs to be a hospitable, friendly place. Things have gotten too far off track too often. Everyone is still on edge months after I assumed they would be and it seems that some form of "closure" is needed.

Beyond that, I really do like a number of people on the site. Some like me and some don't. Dorothy has very interesting views on a number of things and hoped to maintain a dialogue but I am not going to get her interested in talking to me. Julie has been a valuable resource to patients-- we would probably be good friends if we had simply met on the street one day and and our discussion did not stray into politics. I am not one to hold grudges and believe that it is in no one's interest not to work together to make this site a friendly place where there is a reasonable level of rapport. I don't plan on spending a lot of time here largely because I have a lot to do and a family. I don't spend a lot of time on any one place though online. What should be quick friendly visits to check up on things have ended up with me spending way too much time, partially because I wind up getting into debates which I expected to have been friendly but did not. I will take the blame for getting some going and not knowing when to quit. Beyond that, even as an outsider looking in and standing away from the scene I realize that the prime directive here needs to be a change in tone to a much kinder, friendlier place. It is not practical to keep reminding ourselves of who said what and when because things need to move forward. So again I just have to ask what it will take to accomplish that and ask everyone to move forward in unison to meet that goal because I cannot believe that anyone here would not see that as a worthy goal. I think that once an overall positive tone and direction is established, it will take the full cooperation of everyone to maintain. Anyone who would like to claim leadership as "chief peacemaker" can step forward, I am just putting forward the idea and am willing to go with whoever will lead on this. I just see this as something that needs to be done.
Ed

Result number: 157

Message Number 144297

Re: tarsal tunnel help View Thread
Posted by nora b. on 2/14/04 at 00:26

Have you heard of prolotherapy? This is a non-surgical treatment endorsed by C. Everett Cooper. It strengthens the ligaments, thus relieving pressure on the nerve. After being almost unable to stand, 8 or 10 prolo treatments have allowed me to feel almost human again. They are expensive because Medicare doesn't recognize them (some insurance cos do) and the shots hurt especially the first one as they go into joints. But they are unveievably strenghtening and pain releiving--at least they have been for me, try to find an orthopedic doctor who gives them. Of course a surgeon is not going to endorse them and pharmacology companies have no interest because shots are inexpensive glucose solution which sets up an inflammation temporarily that heals tissue damage. Google prolotherapy for more info.

Result number: 158

Message Number 144239

Re: more foot stuff..... View Thread
Posted by Dorothy on 2/13/04 at 02:46

This is from the Footsmart online catalog. www.footsmart.com

Chopat® Achilles Tendon Strap
Recommended for:
Achilles Tendonitis

Slip on relief and step away from Achilles pain

Experience immediate relief from Achilles tendonitis and return to your normal activity level. Even if you don’t stretch enough before you exercise, or inflexibility is starting to creep up on you – don’t let that slow you down. This Achilles Tendon Strap, developed in cooperation with the famed Mayo Clinic, fits comfortably while strategically applying pressure to reduce stress where the Achilles tendon attaches to the heel. Wear over or under socks. Hand wash. For size, measure circumference at widest portion of ankle. Small (up to 10 1/2"), Medium (10 3/4 - 11 1/2"), Large (11 3/4 - 12 1/2").

Result number: 159

Message Number 143705

Re: heelspurs View Thread
Posted by Pauline on 2/05/04 at 16:58

Kathy,
Well I found this too, so we might as well add it to the other messages. Brad mentioned this when I spoke to him so I'm glad I found it in print too. It makes me feel better about his product.

From: pdlabs

pdlabs

November 12, 2003

RE: Transdermal Calcium Channel Blockers

Filling prescriptions of topical verapamil for the treatment of connective tissue disorders such as Peyronie's disease.

Please be advised that William J. Easterling, R.Ph. holds U.S. utility Patent numbers 6,031,005 and 6,353,028 for the use of topically applied calcuim channel blockers for the treatment of Peyronis's Disease and related fibrotic connective tissue disorders. Prescriptions Dispensing Laboratories, Inc., San Antonio, Texas is the only U.S. pharmacy that has been licensed to provide this medication until such time that it becomes commercially available through the FDA approval processes.

Any entity, including but not limited to a referring insurance company, physician, pharmacy or hospital that compounds, uses, dispenses, or offers for sale topical or transdermal calcium channel blockers for the treatment of connective tissue disorders, is liable for damages and other remedies under applicable patent laws (see 35 U.S.C. 271, et seq).

On September 26, 2003 PDLabs was granted a permanent injuction as well as a substantial monetary award against the owner of one of a series of componding pharmacies whom PDLabs intends to direct its patent enforcement activities. PdLabs wishes to avoid taking legal action; however, the patents will be enforced.

I suggest that you discuss this issue with appropriate legal counsel and advise all appropriate personnel and management of the existence of these patents.

Patients presenting prescriptions to componding pharmacies, should be directed to PDLabs at 1-800-687-9014. Thank you for your cooperation.

Sincerely,

Jerry Easterling, R.PH.

CEO and Patent Holder

Prescription Dispensing Laboratories

Result number: 160

Message Number 141897

changing times in education... View Thread
Posted by Suzanne D. on 1/12/04 at 15:36

You make some good points, John. This is my 24th year teaching, with two years of full-time subbing before that. I have seen lots of trends come and go. I was required to take modern math in college as this was going to be what we would all be expected to teach. By the time I had my first job, it was out the window.

I think in education, the biggest mistake that is made is going from one extreme to the other. The pendulum swings one direction, and everything we did before is thrown out, even the good things that worked. Then things swing back the other way. I couldn't begin to count the number of huge binders that have collected dust on my shelves of new programs that came and went.

I have always tried to do what I thought was right and helpful to the students regardless of what the latest fad in teaching was at the time. Sometimes I have had to be pretty creative in doing those things, because I had to satisfy the new requirements while still teaching the basics the way I thought they should be taught. I learned that I often could do more good by just quietly closing my door and teaching the way I thought best than by trying to put up a fuss about whatever the latest
requirements were. (Not that everything new is bad, of course, but I have seen some ridiculous things.) I told a young teacher not long ago, "Sometimes it doesn't work to make a fuss. They just watch you more. Smile, be pleasant, hand in the paper work, and teach to your very best potential the way you see fit. If it works and the children succeed, keep doing it that way. If it doesn't work, find a way that does."

We are fortunate in my school to have a PE teacher who firmly believes in helping each child be fit and reach their potential. He has a great plan for building muscles and strenth, etc., and has taken our primary and intermediate fitness teams to the Marine Fitness Meet every year since he came. After about three years, we have won every year. All our children have PE three days a week.

What you wrote about teachers "observing" makes me think about a workshop I attended several years ago. The presenter made a big deal of saying that we had to get over the old-fashioned way of the teacher being the "sage on the stage" and become the "guide on the side". Children were to choose what they wanted to learn. How can they choose things they don't even know about? Sure, I believe in "hands-on-learning", but I'm 51, and they're 6. I should know more what they need to learn than they do!

Well, mention education, and you all know I will have to respond! :) One last thing, speaking of homework. My children have math homework every night (not a huge amount, but something to reinforce our lesson that day). After about a month of school, if they don't turn it in, they sit out at recess time (when it is nice weather, we can do out to the playground although we're not supposed to call it "recess" in our lesson plans. So my creative next-door teacher who has taught 41 years calls it CPD - cooperative physical development :) ) A new teacher this year said to me in front of my children, "Oh, are you going to be mean and make those poor little children sit out today? Does it really do any good??"

That really got to me, but I just smiled and said, "Oh, yes. They have to learn that there are consequences to their actions." If we don't teach them, how will they get that point?

Well, I'll come down off my soapbox now!

Suzanne :)

Result number: 161

Message Number 141628

Re: Clarification of the facts from an old timer View Thread
Posted by Dr Kiper on 1/08/04 at 10:35

In all cases for paid services, some people guarantee their work (and there’s no reason you shouldn’t ask for that up front), some people simply charge for their efforts regardless of outcome.
You can always in a nice way ask the doctor for your money back, citing that his efforts have not worked for you, and that you still need further help. In most cases labs will reimburse him his lab cost, so he would just be out his time and there’s no reason you couldn’t continue to see him for other general services.
If he’s uncooperative, inform him that you will be writing a letter to his Board of Medical Examiners and the BBB and complain to them about your dissatisfaction. It may or may not get you anywhere, but he will not be happy (even if he doesn’t give you your money back).
If everyone did that, those people performing poor services may become more cooperative in cases where they failed to satisfy as complaints started to pile up as they do become part of public record.
Anyone can go to a web site in their state and check the credentials and disciplinary actions against any type of doctor. In Calif it is: http://www.medbd.ca.gov/
By the way, I give a money back guarantee up front, so that you don't have to ask.

Result number: 162

Message Number 141571

Re: PLAYING TENNIS View Thread
Posted by RACHAEL T. on 1/07/04 at 12:33

Seems like we are on the same page again Steve G. Yes, I am wearing SDOs in my Brooks Ariels; & Dr. K has been more than cooperative & kind w/ this attempt....my 2nd attempt in trying to wear them. I tried & failed last yr. when my feet were sooo bad. Anyway, I am soon off to Fla. for 2 mos! (I know, LUCKY ME!!) So, I shan't be around the boards for that duration - unless I hit a library there w/ pc availability. If so, I shall post then & "catch up" on the board posts!! In the interim, yes, tell Dr. K that you want to try them & that you apparently are at a similar level in healing as I am. At present, I think the SDOs are adjusted fine for me for normal living - I at times, think that the left (my bad foot) may need a little more liquid - but I am waiting to see with the Fla. retreat where I plan to swim alot as foot therapy; & bike & walk some to strengthen my feet.....then, when I return, I shall re-eval. them. Maybe after I do those exercise therapies, I shall be ok - that is my quest/hope!

Result number: 163

Message Number 141442

Re: tss and rsd View Thread
Posted by cooper on 1/05/04 at 18:09

thanks for the info. I will research both sites. I did make an appt. with my pain dr. so maybe he will have something to offer.

Result number: 164

Message Number 141409

Re: WOW! Such great reading... View Thread
Posted by Rick R on 1/05/04 at 11:49

Dorothy,

I can't believe a Jean Ritchie reference!! Well stick me with the silver dagger; I’m a folkie from way back. I grew up with the popular sanitized alleged folk music from the 60’s but came to appreciate the grittier real thing, as I got big and ugly. The thing I miss most from my single days is the time I used to spend listening to WFMT’s midnight special every Saturday night until 2:00AM.

Business has taken me to Knoxville every few months. I have been dragging folks into the Barley, a bluegrass club. I’ve taken people from California, New York, Amsterdam and Paris into the joint. Last month we had a trip to Gatlinburg planned but the weather didn’t cooperate. Personally, I can’t play a lick but I’m trying to learn Guitar. My wife got me a simple tin whistle for Christmas how cool was that!! I’m further ahead with the stinking whistle than the guitar.

Rick

Result number: 165

Message Number 140825

tss and rsd View Thread
Posted by cooper on 12/28/03 at 11:30

I know there are people who read this board with rsd. I would like to know if there is a board for people primarily with rsd. I would like to see if this leg pain I am having is realted to the rsd. I don't think the drs. I am seeing know. One dr. said if it was rsd it would show on the bone scan but I have read that that is not true. I will go to my pain dr. but I don't have a lot of faith in his knowledge of rsd. I think he just treats the pain. thanks for any info.

Result number: 166

Message Number 140819

Re: leg pain View Thread
Posted by marie on 12/27/03 at 16:19

Cooper,

RSD can present itself in an entirely different place than the original injury. You don't have to be a runner to be suseptable. There are several who post here with rsd...do a search and I'm sure you'll come up with some information.

best wishes marie

Result number: 167

Message Number 140761

leg pain View Thread
Posted by cooper on 12/24/03 at 14:00

I recently posted a note about the pain I have been having up the front of my leg. I am now in a cast because the removal cast caused some pressure on an other area that caused too much pain. The dr. does not really know what is wrong because the bone scan was negative for shin splints or a stress fracture. If this does not work she will order an mri but does not know if that will offer anything of use. Her only thought is exertional compartment syndrome although she does not know why I would have that because with the tss and rsd I certainly am not runner. The dr. I saw inorder to work with a cast suggested I see a vascular dr. to see if I have some kind of claudication. I do not fit the picture of a person with claudication but there seems to be no answers. My question is can the rsd cause this kind of problem. I get pain up the front of my leg when I walk a distance. The distance has become shorter and shorter that I can tolerate before the pain starts. It is better with the cast.
Thanks for any info

Result number: 168
Searching file 13

Message Number 139331

Re: leg pain View Thread
Posted by Nasim on 12/04/03 at 08:35

Cooper,

I have same problem that you mentioned, but the only difference is that I get this pain when I drive otherwise I am fine. I even have been tested for Lupus for this which luckily is negative. My orthopaedic surgeon has suggested to take 75 mg Voltaren twice a day which seems helpfull but I am going to have MRI on this foot and ankle. I can imagine this pain and be praying for you. Please keep posted. Best wishes.

Result number: 169

Message Number 139293

leg pain View Thread
Posted by cooper on 12/03/03 at 20:03

I have started with pain up the front of my leg. I thought it might be shin splints but had a bone scan which was negative for shin splints and stress fractures. This is the leg that I had tarsal tunnel release then got rsd. The orthopedic dr. says it could be tendonitis or maybe pain radiating from arthritis in my foot. The dr. said the outside chance is it could be exertional compartment syndrome. I did some reading on this and it says it involves the peroneal nerve which is one of the nerves damaged by the rsd. Has anyone else heard of this? I am presently wearing a removable cast which does help because there is no ankle motion but I do still get pain. Thanks

Result number: 170

Message Number 138836

Re: Birkenstocks View Thread
Posted by nancy s. on 11/26/03 at 23:51

kathy: i wear the bostons, which immediately when i started wearing them cut down on my pain substantially. arizonas have never felt good to me and i don't know why, but i'm very much in the minority on that; most birk wearers like them. i also wear cooper tatamis (from the birk tatami line), which they offered for only a short time -- i don't know why, because actually they became my very favorites, and i quickly ordered a second pair as birkenstock was phasing them out.

have never tried annapolis and don't know them.

i have a few others (sandal types) that i wear intermittently in the summer.

when you say you hope to switch to regular shoes after your walking boot with new balance, are you meaning birks as regular shoes? if so, i really hope they help you. they made a huge difference for me. i don't wear anything but them, except for when trodding through big snows in the winter -- and even then, i'm usually in a big hurry to get back into the birks.

nancy
.

Result number: 171

Message Number 138536

Re: a day at the beach with my little nieces, and what a tonic View Thread
Posted by Kathy G on 11/24/03 at 10:07

Nancy,

I love that comment from your sister's patient! I hope your dad doesn't experience needless pain and takes the pain meds, at least at night, so he can get needed sleep. but I can certainly understand where he's coming from. For elderly people, the doseage has to be adjusted because they do become more confused and sleepy. And let's face it. The older we get, the more it scares us to be confused. Unless you're like me. I've been confused my entire life! My daughter claims that if I ever get senile, no one will notice any difference!:)) (Not PC, I know, but it's funny!)

I'm glad you enjoyed the time with your nieces. Children are the antidote for frustration and weariness. They allow us to see everything through their eyes. And, yes, they sure can tire you out!

Glad the weather cooperated. What a beautiful weekend!

Result number: 172

Message Number 136577

Re: Advice re surgery & re Dr. Cooper View Thread
Posted by lauriel on 11/06/03 at 15:41

Sherry, I did do accupuncture for my TTS. it did help for awhile, I think it is like people comfort people get with cortizone shots, it helps for awhile but doesnt cure it. He was honest and said it helped and didnt help. I am like you I had different symptons than most, mine wasnt all of the time pain time that most people have. I would get electric shots like someone sticking an leectric cattle prod in my ankle, it wouldnt happen all of the time, but did get proggessely worse. It also depended on the type of shoes, some tennis shoes like Nike, the shock would be a lot more. I did resort to surgery last December, and I am almost fully recovered, except now I am dealing with PF which I never had. I like you didnt want to say "I cant do this anymore" It is really up to you on the surgery. Please do a search on my name Lauriel. I posted a lot on my recovery and what I went thru

good luck

Laurie

Result number: 173

Message Number 136446

Re: Scheduled for tts surgery 11/11/03 View Thread
Posted by Sherry on 11/05/03 at 13:47

Michelle: Wow. Sounds like we've had a similar experience, at least in one respect. I've got TT release surgery scheduled for 11/20 & am trying to decide whether to go through w/ it (see earlier thread I started about Dr. Cooper). And I've often wondered if I've gotten to this place BECAUSE of the fact that the anesthesia for my ESWT was shot directly into the nerve (one doc injected -- properly -- around the nerve; then, when my podiatrist didn't think I was getting numb fast enough, he took a turn and HIT the nerve -- my leg shot up about 2 feet, and I was very sore at the injection site for weeks after that). I do not remember having nerve involvement before that, just intractable PF. But I wasn't casted or on any painkillers; I just concluded that the ESWT didn't work for me and that, conincidentally, my condition also involved some nerve compression. But Dr. Cooper told me the botched injection could well have caused the nerve problem. I'm mid-40s and also active and wanting my prior life back (not ready to concede that I won't play tennis, run after kids or X-C ski again). I guess we both need to ask our doctors what "letting nature run its course" really means, b/c I too have wondered if there's any chance this will just go away. Dr. Cooper (w/ whom I'm meeting again on 11/14) has suggested that NOT releasing the nerve may result in more permanent damage. So, right now, I'm inclined to go ahead. But I'm conferring by phone w/ my internist this evening.
Good luck!
Sherry

Result number: 174

Message Number 136421

Re: Advice re surgery & re Dr. Cooper View Thread
Posted by BrianG on 11/05/03 at 07:53

Hi Sherry,

Me again, I found a link that I think will show you this man has the credentals to do your surgery. Not only is he a board certified surgeon, he is on the board of directors of AOFAS, Association of Orthopaedic Foot & Ankle Surgeons.

http://www.footdocs.org/boardstaff.html

Good luck
BrianG

PS: Don't forget your list, he is the only person that can really tell you what to expect.

Result number: 175

Message Number 136381

Re: Advice re surgery & re Dr. Cooper View Thread
Posted by BrianG on 11/04/03 at 17:51

Hi Sherry,

I think Pam has given you some good ideas to think about. Why don't you take everything she had to say, and put it in question form, for the Doctor. Make a list, and bring it with you when you meet with the doc. This will insure you don't forget to ask him anything. If it was me, I'd want to know what he is going to give me for pain? Will it be strong enough? How long will he give it to you for? If you have bad pain for 4 months, wll he continue to treat you for it, with adaquate pain meds? If not, will he refere you to someone who will? Personally, I think it is much easier to heal, without the intense pain that comes with surgery.

Will you need a wheel chair? Do you have help with your kids if your off your feet for a couple months? Do you work? If you return to the same job, will it agravate your injury? What about infection? When I had my EPF (failed) I insisted the Pod give me a round of antibiotics, as I am not one to need them very often.

If you do have the surgery, make sure you take plenty of Vit. C, it'll help with the overall healing. Just remember, once you are cut, there is no going back. Make damn sure this is what you want to do. I think you found the right man to do the job, but do some more homework, to ensure he has done enough of these procedures to be good, very good, at it !!!!

Good luck
BrianG.

PS: Please keep us advised

Result number: 176

Message Number 136342

Re: Advice re surgery & re Dr. Cooper View Thread
Posted by Pam S. on 11/04/03 at 10:22

Dear Sherry
I was just where you are several years ago. My pain was even worse than yours and I just wanted to FIX it right away. I did have the needle EMG and that was very unpleasant for me, however, it did confirm I indeed had TTS.

I am not sure how much your doctor (He sounds just amazing) has told you about the recovery process with this type of surgery, but it is a long and tedious process. I have to admit it took me almost a year for my foot to feel normal. I am probably an extreme case. I thought the pain after surgery was pretty bad to. I could not drive for quite some time and it was difficult with my kids.

I guess I am glad I had the surgery because I had relief for two or three years, but alot of my burning pain is coming back now. I do not really have the energy to figure out why right now. I suppose I am in the minority according to your doctor.

I do not want to be negative, but having this surgery is not a walk in the park. Also, have you had an MRI? If there is an obstruction in the tunnel, your chances of this surgery being successful are much greater. I learned that on these boards.

I have tried Acupunture and you are right, needles in the feet are just no fun at all no matter what they say. I could not tolerate it.

Have you had physical therapy?

Gotta dash, Keep reading past sites on these boards too. There is alot of wonderful info. It is just a gamble as to what to do. I am not sure about permanent nerve damage if you do not have the surgery? Anyone know? Gotta dash but good luck and keep us posted. Warmly, Pam

Result number: 177

Message Number 136331

Re: Advice re surgery & re Dr. Cooper View Thread
Posted by Sherry on 11/04/03 at 09:23

Brian: Thanks so much for your thoughts and for finding the Post article. It certainly confirms the confidence I've felt in Dr. Cooper. The big question, I guess, is whether to do the surgery at all. I am constantly aware of either the pain (sometimes) or discomfort and tingling (most of the time), but I CAN get around fairly normally. I wince and/or limp when I first put weight on it and after a relatively full day on it (and if EVER I go barefoot). But people who don't know me well wouldn't be able to tell there was anything wrong. The big thing for me is that I've had to stop playing tennis and taking vigorous exercise walks, both of which I love -- AND, perhaps most frustrating, it's difficult for me to run after soccer balls w/ my kids. I really don't want to give up on all that stuff and start acting "old." On the other hand, I'd be walking into surgery as a person who can do most of the everyday things -- I still run (well, occasionally I only walk or I limp) up & down the basement steps 10 times a day to do the laundry or get something from the spare fridge, for example -- and the recovery process sounds so protracted and difficult (and outcomes not all that certain). I'm nervous about making things worse (though Dr. Cooper says that happens in only 2% - 5% of cases, usually involving scar tissue) or doing something unnecessary. On the other other-hand, I don't want to delay surgery if delaying it poses it's own risks (permanent nerve damage??). Since you're not usually pro-surgery, do you have any other suggestions. About the only thing I haven't tried that non-doctors have suggested (but not Dr. Cooper) is Accupuncture. Any additional thoughts?? I found the nerve study SO unpleasant (as well as the prospect of my insurance not paying for it) that I admit I'm a bit reluctant to try Accupuncture -- unless, that is, I get a sense there's really some point in it (unintended pun).
Thanks for any thoughts you or anyone else has. My surgery date is fast approaching & I've got to make some quick decisions.
Thanks. Sherry

Result number: 178

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: 179

Message Number 136285

Advice re surgery & re Dr. Cooper View Thread
Posted by Sherry S on 11/03/03 at 16:24

Hi all: I'm tentatively scheduled for surgery (still trying to decide) in Washington, DC, on November 20th. Has anyone had any experience -- positive or negative -- with Dr. Paul S. Cooper of Georgetown University? I'd seen 2 different podiatrists & been through a nearly 2-year treatment for plantar fasciatis (including having unsuccessful ESWT) before my internist referred me to Dr. Cooper. (My last podiatrist recommended surgery for a probable entrapped nerve (I'm not now remembering which one), so I went to my internist to consult.) Dr. Cooper is now recommending TT release surgery w/ a portion of the plantar fascia also being removed. I've had a nerve study that showed some, but not major, nerve problems. Anyone had any experience w/ Dr. Cooper? Thanks!

Result number: 180

Message Number 136031

Re: Hello Board View Thread
Posted by Suzanne D. on 10/30/03 at 21:07

Bev, it sounds like you had a great trip! And how nice that you didn't have to hurt your feet to enjoy yourself. I'm sure you got lots of pictures of the boys enjoying themselves! Glad the weather cooperated.

Suzanne :)

Result number: 181

Message Number 135658

Peter R View Thread
Posted by Scott R on 10/26/03 at 14:48

Peter R, please stop trying to post messages here. You have been banned. Anymore attempts to harm our system with your post will result in an attempt to have optiline disconnect your service since you are in violation of your contract with them...namely:

Cablevision does not routinely monitor the activity of accounts for violation of this Policy. However, in our efforts to promote good citizenship within the Internet community, we will respond appropriately if we become aware of inappropriate use of our Optimum Online Service.

You hereby authorize Cablevision and its distribution affiliates to cooperate with (i) law enforcement authorities in the investigation of suspected criminal violations, and (ii) and system administrators at other Internet service providers or other network or computing facilities in order to enforce this Policy. Such cooperation may include Cablevision providing the username, IP address, or other identifying information about a subscriber.

Result number: 182

Message Number 135324

Re: Myers-Briggs View Thread
Posted by Aly on 10/24/03 at 12:48

I finally had time to join in, and have learned that I'm an ESFJ Type:

Warm-hearted, talkative, popular, conscientious, born cooperators, active comittee members. Need harmony and may be good at creating it. Always doing something nice for someone. Work best with encouragement and praise. Main interest is in things that directly and visibly affect peoples' lives.

I love doing those tests, but they really ever help people figure out what to do with their lives?? :P

Result number: 183

Message Number 135270

Re: Results View Thread
Posted by Kathy G on 10/24/03 at 11:04


I'm an ESFJ.

I always wonder with these tests, are there results that you can get that say that you are a lousy, uncooperative, unimaginative, horrible person?:D

x


Result number: 184

Message Number 135227

Re: Myers-Brigg's View Thread
Posted by Bob G. on 10/23/03 at 23:50

I've been through similar stuff, personality types, Dominate, Proper, Adventous, Cooperative...

What it all boils down to is the MATURITY of the people involved. No matter what your type, it is the MATURITY of the individual that determines whether they can get along and work well with others.

If you take two opposites, ie, an Adventurous spirit and a quite, proper librarian or engineer, for example - if they are both MATURE, they will work well. But if one, or both, is immature, they will experience problems.

But if you want to spend your money, they're hustling you. That's my take; hope that helps.

Result number: 185

Message Number 135050

Advo Bulk Mail question View Thread
Posted by Pauline on 10/22/03 at 18:22

I'll say "sore feet" first to cover the rules, but I have a question and I was wondering if anyone has an answer.

Does anyone know how you go about stopping Advo Bulk mail from coming to your home?

I understand that it can be done, but besides calling somewhere you also need the cooperation of your postman/woman.

Has anyone done this and had success?

Result number: 186

Message Number 134781

Re: Insertional vs Proximal Plantar Fasciitis View Thread
Posted by Rachael T. on 10/20/03 at 21:35

Hi John! I also have Footmanagement Orthotics....& I sent mine back & they made the heel cup deeper for me upon my request & my Phys. Therapist's advisement. They did this even after I wore them for a while. In fact, I returned them 3 times to get what I wanted & they cooperated......so, maybe you should talk w/ your prescribing dr. who deals w/ the orthosis company. Good luck & I hope you get some relief.

Result number: 187

Message Number 134652

Re: House slippers? / soft-footbed birks free for the asking View Thread
Posted by nancy s. on 10/19/03 at 04:24

sher, what size birk do you wear? these wouldn't be as soft and cushy as house slippers, but they might be better than nothing: some soft-footbed birks. i wear only birks and went on an exploration craze a couple of years ago (and now wear only boston birks and cooper tatami birks).

i have two pairs of soft-footbed birks that i found i cannot wear (can use only the hard stuff!). they were worn maybe three or four times (and always with socks) -- size 40 narrow. one pair is the boston style (leather), the other monterey (i think suede -- some kind of soft material).

if you -- or kathy? or anyone else? -- could use them, i'd be glad to send them to you, and i don't want any money for them. life is expensive enough when you're trying to get this thing under control.

my birks are also good for breaking up a cat fight in the living room, with a (light!) toss.

nancy
.

Result number: 188

Message Number 132590

To Marie - Photography site View Thread
Posted by Aly on 10/07/03 at 11:42

Hi Marie,

I just signed up for Shutterfly.com - what a great site. Thanks for introducing me. :) So "Pets" is officially the first topic? I take really bad pets pictures for some reason, but I will try to capture my 3 feline friends as best as I can. We shall see if they cooperate.. ;)

Aly

Result number: 189

Message Number 132589

To Marie - Photography site View Thread
Posted by Aly on 10/07/03 at 11:42

Hi Marie,

I just signed up for Shutterfly.com - what a great site. Thanks for introducing me. :) So "Pets" is officially the first topic? I take really bad pets pictures for some reason, but I will try to capture my 3 feline friends as best as I can. We shall see if they cooperate.. ;)

Aly

Result number: 190

Message Number 132183

Re: Oh hurray! Missed You All! View Thread
Posted by Ed Davis, DPM on 10/04/03 at 13:56

marie:
Hope you have a great time. How old is your youngest?

I am doing paperwork in the office as I do on most Saturdays. Getting closer to becoming a paperless office with an integrated computerized system that should cut down the paperwork. Busy looking at quotes and hope to find a cooperative lending institution that will finance this very expensive project.

Ed

Result number: 191

Message Number 131773

Re: Has anyone with narrow feet bought Birk clogs? View Thread
Posted by Rachael T. on 9/30/03 at 16:55

I LOVE my Bostons! I will check out the Coopers as mentioned by another board writer....but for 2 years, Bostons have been my favs - & especially so when my feet "flare up!"

Result number: 192

Message Number 131725

Re: Has anyone with narrow feet bought Birk clogs? View Thread
Posted by nancy s. on 9/30/03 at 08:40

hi kathy. (hi kathy!) i don't know if the Bostons are officially clogs, but they're certainly clog-like, and they were the first pair of birks i ever bought (after robin b. on this site convinced me to try a pair).

i have four pairs of Bostons now, and i too have narrow feet. they do come in narrow, plus they have one side buckle and a few holes in the buckle strap to make them tighter or looser. they must do well for a lot of feet, because they've been one of the birk classics for a long time now.

i haven't tried any other birk clog. right now i'm hooked on Coopers, which for some reason they didn't make for very long. they've been my birk of choice for almost two years, but Bostons run a close second.

best to you from nancy
.

Result number: 193

Message Number 130948

Re: Imagine View Thread
Posted by Ed Davis, DPM on 9/24/03 at 20:37

marie:
The people of the region have so much to gain by peaceful cooperation and trade. The Israelis took arrid land and with modern irrigation and cultivation techniques "made the desert bloom." I have talked to so many Israelis who have desired to share those techniques with their Arab neighbors. It has been the leadership in the Arab nations who have had the need to maintain the state of conflict as a means of manipulating their people and maintaining power that is the problem.
Ed

Result number: 194

Message Number 130612

Re: Breaking in orthotics View Thread
Posted by Dr. David S. Wander on 9/21/03 at 09:06

Nan,

Yes, there are many doctors that will refund a patient's money if he/she is unhappy with the orthoses. I offer that and most of the doctors on this site also offer that to patients. If I have made several attempts to adjust or eliminate the problem with the orthoses and the patient still doesn't experience relief, I will offer a refund. My practice was built by doing the best for my patients and having a patient that has spent a few hundred dollars with no relief is not acceptable to my standards. Naturally, I'm not refunding money to patients after wearing the orthoses for one hour and not obtaining relief. If I believe a patient has been cooperative and has been patient and no relief is obtained, a refund will be offered. Fortunately, this has rarely occurred over the past 18 years. I consider myself very active/athletic and treat many sports injuries and although the SDO may be an excellent product (I've spoken with Dr. Kiper on the phone), there are many athletes and runners competing very comfortably with rigid orthoses, soft orthoses, semi-rigid orthoses, etc. It depends on the athlete, the foot type, the demands of the sport, the biomechanics of the individual, the weight of the individual, etc. It is too complicated to make a blanket statement that all runners should be using the SDO.

Result number: 195

Message Number 130199

You're talking snow; we're talking hurricaine! View Thread
Posted by Kathy G on 9/16/03 at 10:22

Actually, here in southern NH, we are just going to get some heavy rain and maybe some gusty winds, on Friday. But my sister in Annapolis is bracing for a hit if Hurricaine Isabel continues on its course. She lives on Chesapeake Bay and her house has not flooded in the thirty years she has lived there. She gets very nervous every time there's a hurricaine because she figures it's bound to happen sooner or later.

I am going to make sure my daugher, who is closer to the seacoast than I am, has batteries for her flashlight and some water on hand. They are more likely to lose power.

The wedding was this past weekend and the weather cooperated beautifully. It was cloudy earlier in the day but by the time of the wedding, 4:30PM, the sun was out and the sky was blue. Everything went well and naturally, I'm going to say my son looked very handsome and his new wife was beautiful. My daughter-in-law organized the whole thing by herself and she did a beautiful job.

I had booked a trolley for her as she wanted guests to be able to leave their cars at the hotel where the reception was and a trolley to bring them the half mile to the church, where parking was limited. It was really neat except that on the last route, he picked up only six people and left the rest of us standing on the stairs of the hotel! The attendants hitched a ride in the limo with the bride and groom and a van brought the rest of the guests. My husband and I were the last to arrive in our car as there was no room for us anywhere else! We actually held up the wedding for about ten minutes! When they called from the trolley company yesterday, I wasn't exactly nice about the whole situation! In retrospect, it was very funny. Of course, they could have started without us as the least important people in a wedding are the parents of the groom but it was nice they waited!:D

Result number: 196
Searching file 12

Message Number 129936

Re: To Dorothy View Thread
Posted by Mason M. on 9/13/03 at 22:27

Dorothy asked for an example, and I obliged. It is rather difficult around here to get credit for cooperation. This is one reason that I choose not to spend days doing research to answer other questions for the few who are not interested in another look at things anyway.

Perhaps I should encourage some of my conservative friends to post here. Yes, they do have feelings, bless 'em! We have many a lively discussion about subjects talked about here and much more; attack is not part of those discussions. I wonder why.

Result number: 197

Message Number 129825

Sounds like cooperation View Thread
Posted by Dorothy on 9/13/03 at 02:55

Sounds like cooperation: US, Allies, Practice Intercepting Weapons Shipments
Voice of America:
Australia, the United States, France and Japan have begun the first naval exercise aimed at intercepting shipments of weapons of mass destruction. The two-day operation began early Saturday off the northeastern coast of Australia.....

Result number: 198

Message Number 129559

Re: Leadership According to GWB View Thread
Posted by Dorothy on 9/11/03 at 00:31

"Meanwhile, various Bush administration officials are attributed with quotes and feelings that Woodward claims are the result of his receipt of more than 50 sets of notes covering National Security Council meetings..."

This appears to be the source of the quote - Bob Woodward (Washington Post editor in chief)had extensive interviews with GWB and all his advisors and cabinet for Woodward's book, Bush at War, AND he reportedly had all those notes from the National Security Council meetings - and that is apparently where that quote came from. GWB was fully cooperative with Woodward for the book.

That's the best I can come up with. As I said, I have it from two different mailers and both said "President George W. Bush to the National Security Council." This further cursory research appears to show that Woodward had those notes and quoted them in his book Bush at War or in interviews about his book. I don't know the date of the statement; maybe the Woodward book has it. I will continue to try to locate it more firmly.
I did find it referred to in MANY places, but not with a full and complete citation - yet.

Result number: 199

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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