Khatami Already Faces Obstacles

Iran’s presidential election is already heating up.  Only weeks after the announcement that reformist candidate and former President Mohammed Khatami would be challenging incumbent President Mahmood Ahmadinejahd, Ahmadinejahd’s hard-liner allies have made it clear that they will be making Khatami’s life difficult.

Only two days after announcing his candidacy Khatami was attacked by members of a mob wielding sticks and chanting “Death to Khatami”.  According to Khatami’s organization, the Baran Foundation, he was immediately surrounded by supporters and escorted by his bodyguards to a safe location.

On February 17th, The Guardian reported that an Iranian conservative newspaper, Keyhan, has stated that Khatami risks being assassinated like Pakistani politician Benazir Bhutto. The statement has been interpreted as a thinly veiled threat against  Khatami, especially since the paper is known to be closely connected to the Supreme Leader Ali Khameini.  One Tehran-based analyst, Saeed Leylaz, notes, “I worry that radicals will try to convince Mr Khatami not to participate by carrying out one or two terrorist attacks in the country. It could be not just he who is under threat, but people close to him.”

As recently as Friday, the Huffington Post reported that Iranian authorities had blocked two websites supporting Khatami.  Khatami’s official campaign website is still visible within Iran, but two sites set up to support his bid in the race have been blocked to all internet users inside Iran.  The editor of one of the sites, Behrouz Shojaei, observes, “Closing down our Web sites means hard-liners are not going to tolerate Khatami challenging Ahmadinejad”.  One of the sites was blocked simply because of it had reported the people’s views on Khatami’s candidacy.

In a way, these attacks and harassment are a good sign.  They mean that the conservatives in power feel threatened by Khatami’s decision to run.  But the fact remains that hard-liners in the Guardian Council and other positions of power could continue to be an enormous obstacle for Khatami.  They must approve all candidates in all political races and it is not yet clear if they will approve Khatami.  The hard-liners certainly hold the upper hand and they have made it clear that they will use any means they can to increase their advantage.

Polio Still Lingers…

In 1988, the world united in solidarity to eliminate the polio virus from our planet by the year 2000. Well, that time has now come and passed. Have we made great progress in the fight against such a debilitating virus? Absolutely. Has it been forgotten that polio still lingers in some of the poorest, least equipped places to handle this virus? I believe that answer is yes. Fortunately, the cause has been brought to light in recent months with a few exciting initiatives and announcements.

A recent BBC News article brings to light a film that provides great insight into this daily struggle, both for those trying to eradicate the disease and for those living with it. It details the story of a 38 minute documentary, The Final Inch, and how it has just been nominated for an Oscar in the short documentary category. The Final Inch is a story about protagonist M Gulzar Saifi, a 26-year-old Indian. Diagnosed with polio at 6 months old, Gulzar Saifi was raised in a village that didn’t vaccinate its children and suffered from great illiteracy and unawareness of the risks they faced. Thanks to the support of his family, as he outlines in the documentary, he is a post-graduate in economics and he runs a teaching center for people of the village.

The documentary also follows different health workers across India in their efforts to vaccinate children across India. What is most pertinent about the documentary is that it provides a personal touch to an often little known struggle. Gulzar Saifi’s region of India, Uttar Pradesh, has over 50% of the country’s recorded polio cases. According to the BBC article, “Extreme poverty, dismal hygienic conditions and resistance by the state’s Muslim community to the vaccination drive have all contributed to the problem.” Further, rumors that the vaccinations were secretly birth control have led to a shunning of treatment.

This documentary and recent troubles in Nigeria, India, Pakistan, and Afghanistan have brought the virus back into the light. This past January, the Bill and Melinda Gates Foundation, along with the British and German governments and other funding sources, announced a new pipeline of $630 million in funding to further the eradication cause across the world. The NY Times writes a good article about the topic here. It is this funding that is integral, because eliminating the last signs of the virus from our planet that prove to be most difficult and costly. Gulzar Saifi described it as not a disease, but a disaster because of how it affects a person. It is one that we must continue to attack with great resolve because if we do not remain vigilant, many children’s lives could hang in the balance. Bill Gates captures this sentiment in saying, “‘That is no alternative at all. We don’t let children die because it is fatiguing to save them.’”

High Tech Battles Bike Horn

As technological advances surge forward and permeate nearly every aspect of our lives from making our travels faster, communication easier and procrastination more action-packed via YouTube, it is of no surprise that technology has also thrown its metaphorical hat in the ring in regards to medication adherence.

A common discussion surrounding many arenas in health, from prevention and risk reduction to improving quality of life and longevity, adherence to medication is a pressing issue in ensuring that drug resistance is kept at a minimum, particularly in contexts where limited drug development is unable to maintain pace with rapidly morphing diseases such as extremely drug-resistant tuberculosis (XDR-TB) or human immunodeficiency virus (HIV). In the developing world, limited drug development is often compounded by limited access to those drugs that are already on the market; thus increasing the demand to maintain the effectiveness of accessible drugs.

A wide range of new technologies have been developed to assist with adherence issues throughout the world. From time-release pill boxes to regional medication exchange protocols, the possibilities stretch wide and far. Here are a few that I found particularly intriguing:

UBox – a pillbox that reminds the user to take the drug on time, records dosages and prevents a patient from double-dosing by using special software. Also, allows health center workers to monitor patient vitals.

SMART drugs – enables the creation of a breath-detectable version of any pharmaceutical drug by using markers and hand-held detector

MagneTrace – a magnetic sensory necklace that tracks medication adherence by identifying a tiny magnet in specially-designed pills, then transmits, notifies or reminds user and doctor of success or missed doses

Ambient Orb – system designed to increase medication adherence by sending signal from PillBox to Orb when it is time to take medication

Despite their glittery appeal these devices have yet to prove their applicability and usefulness in the field is yet to be determined. As with many types of technology, the paths (and funding) for distribution along with the difficulties associated with maintaining devices in the field can be quite difficult. The issue of cost also leads to the question of whether funds would be more effective if diverted to increasing the number of accessible drugs.

Finally, as a colleague suggested over lunch recently, “Sometimes the most effective approaches are those that use simple devices in new ways for the context.” We were discussing expanding access to care in rural, mountainous Nepal, where it is incredibly difficult to schedule regular visits from community health workers due to terrain and weather, though the villagers needed some indication of when the health workers would arrive.

The solution? A bike horn that had not yet been introduced into the villages. Sounded from several miles away, this unique sound provided the appropriate, advance notification that health was on the way.

Only time will prove whether the high-tech luster fades from the aforementioned devices (and others) in favor of simpler means.

Our Culture of Consumption

Sitting in a Starbucks I sipped my venti Iced green tea as I watched patrons order their laundry list of beverages.  I wonder if our ancestors could ever imagine the luxury of having our level of consumption.  We live our lives, unknowingly unaware of how much we actually consume and how much we throw away.   An American produces 1,584 pounds of waste per year while the world average is 330 pounds per person per year.  As a country, we consume 1/5 of the world’s 500 billion plastic bags that are produced annually.  The United States consumes 350% more cubic feet of wood than the world’s average.  So what happens to the cups of coffee we throw away once their purpose has been served?

Items that are not recycled or taken to an incinerator, are taken to a landfill to decompose.  The time it takes for our waste to decompose depends on the material.  Items like paper and wood, roughly half the waste in landfills, decompose quickly if exposed to oxygen and bacteria; however in a landfill this process may take more than 5 years.  In contrast, aluminum can take up to 500 years to decompose.  But plastic, like the 1,000 bags used per year by American families, is not decomposable. The sun, by a means of photodegrades, breaks the plastic down into molecules.  But the molecules will never decompose.  The problem is so bad, 1,000 miles off the coast of San Francisco there is an area called Garbage Patch.  Filled with 7 million tons of waste and plastic, it is the largest landfill on Earth.  Stretching to the waters of Hawaii, it is double the size of Texas and 300 feet deep. The patch is stuck in the North Pacific Subtropical Gyre, a slow moving, spiral of currents, created by a high-pressure system of air.  Samples of the water showed 6 parts plastic, one part plankton- the lifeline of the ocean. Every plastic created, even the first ones from the 1930’s, still exist today. How do we as Americans limit our environmental impact and decrease our level of consumption?

Opening Dialogue with Iran-A Citizen’s Account

The current rift between the US and Iran is argued to be based on false perceptions and speculated intentions of the other.  For the last four years, the Iranian government has chosen to pursue uranium enrichment without international inspectors overseeing its production and ensuring that it is for peaceful purposes of producing energy.  The reason for the Iranian government to refuse the IAEA to enter its nuclear facilities is where the speculation begins and political inferences and agendas are crafted.  Clearly, communication is the first step to clear the air of speculation and reconcile this highly politicized and vulnerable schism, but who will actually do something about it?

US President Barack Obama has already taken the first steps of extending an olive branch to the country very strategic for US interests.  Both on Obama’s first television interview and at Secretary of State Hillary Clinton’s first meeting last week on the matter with the world’s major powers, the Administration made it clear that there is a shift in US policy to Iran.  Obama is willing to directly speak with Iranian officials to find a resolution to the tumultuous relationship that has escalated since 2005.

In the US, peace organizations and activists are holding Obama under the limelight to ensure he follows through with the promises of his campaign.  Not only are activists pressuring government officials and legislators to be true to their word, they have even taken the matter in their own hands and have sent several peaceful delegations to Iran to meet with Iranian citizens there.  These delegations aim to promote citizen diplomacy and build bridges over the lack of communication that have plagued the two governments for the last few years.  As a country that largely expressed its support for the victims and their families of September 11th, Iranians’ sense of humanity is remarkable despite differences between their government and foreign governments.  Acknowledging their vast amount of similarities and empathy for the American community is a first step to reconciling a relationship for which each country has been starving.

The Iranian government, specifically President Mahmoud Ahmadinejad, has made many similar public statements of wanting to open dialogue and build this bridge of peace.  Without the pressures of being recorded, broadcasted, and having public demonstrations against his policies, I attended a meeting with Ahmadinejad last September where he repeated his sentiment for the need for open dialogue.  When we brought up the issue of permitting more Americans to visit Iran, he even concurred and pressed the Iranian officials present to address that issue.  This was a bold and reassuring step in my mind that he was willing to be proactive about the situation but I was also not going to hold my breath.

Thank God I didn’t.

I originally had plans to be on one of the citizen diplomacy delegations to Iran this past August 2008.  Unfortunately, the entire delegation’s visas were denied, which is one main reason why we confronted him with this issue in September.  I was rescheduled to go on a similar delegation this month but, alas, had my visa denied again.  I was a bit worried about this happening since not only was a US women’s badminton team had their visas denied a couple of weeks ago after being invited by Iran but also because a British organization that promote cultural and education ties have also been under scrutiny lately.  These events are contradictory to Ahmadinejad’s statements.  I can only speculate as to why the Iranian government has chosen to tighten down on foreign visas into Iran, but I am sure that it is the wrong direction for Ahmadinejad.  Barring communication and interactions between the two countries will prolong a unnerving relationship already on the rocks with false perceptions and speculations.  I can only ask for Ahmadinejad to uphold his convictions he convincingly portrayed five months ago and open the Iranian borders for others to witness the beauty of Iran and its people…the lasting effects will be priceless.

U.S. to Launch Comparative Effectiveness Research with Stimulus

On Tuesday, Barack Obama is expected to sign into law the $787 billion economic stimulus package in Colorado according to this AP press release. With this action, the bill will bring many new spending initiatives along with the tax breaks negotiated during the House and Senate conference sessions. As expected, health care in the U.S. will receive a hopeful boost from this economic stimulus package.

A couple important areas that will receive this new source of funding include $10 billion for the National Institutes of Health (NIH) and $1.1 billion for comparative medical studies research. The New York Times details well the process of how Senator Arlen Spector, a survivor of cancer twice and open-heart surgery, secured NIH such a boost in funding in an article. However, what I would like to focus more on is the second funding initiative as described in the NYTimes. One prevalent issue in health care today is the debate over whether wide-scale research studies should be conducted to test whether a drug, surgery, medical device, or other strategy work to cure a specific sickness better.

To answer this longstanding question, the bill will create a “council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.” Charged with administering and evaluating the usage of the newly appropriated $1.1 billion, this group will oversee a research process that will primarily address two issues. First, the study will answer many of the long-standing questions that doctors have over the value of certain treatment courses, medications, procedures, etc. Second, it will attempt to evaluate the cost-effectiveness of these procedures in regards to their success rates. The hope is to not only provide better treatment to patients, but to do so at a reduced cost by eliminating extraneous treatments. In the U.S., we currently spend over $2 trillion per year, accounting for 16% of the national GDP. With this money to be distributed over the years, government officials hope to answer many of these complex questions.

However, with the new-found money and vast opportunities for comparative effectiveness research comes many concerns about its results. First, the Congressional Black Caucus expressed their reservations with the program because it will, “‘be based on broad population averages that ignore the differences between patients.’” This was supported by some leaders have expressed reservations that the studies will overlook differences in how drugs and treatment affect a patient, especially because they do not include enough women, blacks, or Hispanics. Congress did put in language to try to include women and minority groups, but the aforementioned leaders remain skeptical. Secondly, many legislators and professionals feel that this will represent an intrusion of the patient-doctor relationship by the government. They believe the government, with the results of these studies, will set mandates and treatment protocol that will intrude on personal health care choices. The results of this new research initiative will remain to be seen, as it has been met with mixed opinions when tried in Europe.

Legacy of Iranian Revoluion is Debated

Over the past two weeks there have been a number of celebrations throughout Iran commemorating the 30th anniversary of the Iranian Revolution and the establishment of the Islamic Republic.  Here’s a round-up of how some groups are marking the occasion:

• Iranian President Mahmood Ahmadinejahd spoke at a large rally commemorating the surrender of the Shah’s army on February 10th, 1979 at Azadi Square in Tehran.  His speech was full of the usual rhetoric and verbal posturing as he declared that Iran has achieved superpower status and as he announced that the “era of domination, force and mistreatment [by foreign powers] has come to an end”.  He did indicate that Iran would be open to talks with the United States, provided that they were based on “mutual respect”.  All in all, however, the tone of his presentation did not differ from his usual script of berating the West and asserting Iran’s power.  I have to wonder how he really couldn’t come up with anything more original to say on such an important occasion.
• The blog, Iran Human Rights Voice, offers a different take on the 30th anniversary of the return of Ayatollah Khomeini to Iran after his years of exile.  They note that it only took Khomeini a month of being in power for him to declare: “Don’t listen to those who speak of democracy. They all are against Islam.”.  They remind us that while the Revolution did dispose of the tyrannical Shah, the current regime has proved to be equally hostile to dissenting opinions.
• Amnesty International has created a video chronicling their work studying human rights violations in Iran.  They report that widespread human rights violations continue in the form of the arrests and harassment of political dissenters, women’s rights activist, labor organizers, and minority activists, and inhumane forms of punishment such as stoning and the execution of minors.  Malcolm Smart, Director of Amnesty International’s Middle East and North Africa Program, observes, “Thirty years on, some of the worst abuses of the Shah’s time – torture, executions and the suppression of legitimate dissent – are still being replicated in Iran, despite the efforts of the country’s growing and valiant community of human rights defenders,”.
• Reformers within Iran have also stated that the Revolution has not lived up to its potential and its promises.  One reformist politician, Rajabali Mazrouei argued, “We have achieved political independence. But two basic goals of the revolution — that is to say freedom and justice — have not yet been achieved nor have we achieved the economic development we had been promised,”.

It is clear that the legacy of the Iranian Revolution is a complex and conflicted one.  Most can agree that the overthrow of the Shah was an important and necessary revolt; but many argue that Iran has simply traded one form of tyranny for another since many of the Shah’s most repressive tactics are still being used against Iranian citizens.  Many of the participants of the Revolution are still waiting for the ideals which they acted on thirty years ago to become realities.  I only hope that they won’t have to wait another thirty years to see these dreams achieved.

Afghanistan: The Good War?

News coverage of Afghanistan has skyrocketed over the past few weeks. Reporters everywhere from CNN to PBS have regularly invited policy analysts to offer their opinions on the best strategies for Afghanistan.

Throughout his campaign, President Obama repeatedly articulated his desire to proverbially “win” the war in this country. Last July, he wrote an op-ed calling for withdrawal of troops from Iraq and a more fortified military presence in this South Asian nation:

As president, I would pursue a new strategy, and begin by providing at least two additional combat brigades to support our effort in Afghanistan. We need more troops, more helicopters, better intelligence-gathering and more non-military assistance to accomplish the mission there. I would not hold our military, our resources and our foreign policy hostage to a misguided desire to maintain permanent bases in Iraq.

Many analysts argue the United States has lost much credibility in Afghanistan after air assaults left legions of Afghani citizens dead.  In an interview with Robert Frost on Al Jazeera, President Hamid Karzai reiterated this sentiment, citing haphazard night raids into Afghan homes and other military mishaps as reasons for mistrust of the American military.

Some  argue that President Obama’s current policy proposal to implement a surge of troops in Afghanistan would essentially be an extension of Bush administration policies. The New York Times reports that the proposed 30,000 troop increase would still leave troop levels at 200,000-400,000 less than in Iraq during the troop surge.

So, is military intervention an appropriate solution? Should President Obama embark on a military strategy that foreign policy experts allege may be inherently flawed? Should we implement a troop surge to mimic the Iraq model? If we’re not careful, this inherited war could easily become the “Iraq” of the Obama presidency.

As many Americans grow weary of continued investment in failed enterprises abroad, this may be exactly what we need to “win” Afghanistan. Yet, US government aid and development policies crucial to any success in the country have been woefully inefficient at best, and avariciously conducted at worst.

Andrew Bacevich, an international relations professor at Boston University, stated in the New York Times:

My understanding of the larger objective of the allied enterprise in Afghanistan is to bring into existence something that looks like a modern cohesive Afghan state. Well, it could be that that’s an unrealistic objective. It could be that sending 30,000 more troops is throwing money and lives down a rat hole.

What exactly does Bacevich mean by “rat hole”? Phillip Hilts, former New York Times health and science correspondent and author of the 2005 book, “Rx for Survival,” addresses the myth of the “rat hole.” Arguing against commentators who assert the need for “trade not aid,” Hilts claims that smart aid. such as investment in human capital and private domestic businesses, produce more results than hierarchical, wasteful corporate projects. Hilts argues that smart aid is what has propelled the development of East Asian countries.

In other words, post-conflict reconstruction in Afghanistan has failed primarily because of inherent flaws in funding allocation. Oxfam reports that much of USAID funding to Aghanistan has been funneled through US private contractors, who develop projects at sky-high, easily avoidable costs. Astoundingly, nearly half of USAID funds are allocated to private companies; much of this money is later lost in the quagmire of corporate profits.

This set-up represents both the inefficiency of US strategy to develop Afghanistan, as well as the utter lack of outreach to involve Afghanis in the process of nation-building. Should the United States wish for a sustainable, lasting peace in the region, many more localized and entrepreneurial development projects must be undertaken.

As we have all heard before, Afghanistan is at a crossroads right now. Facing a mounting humanitarian disaster, food shortages, deaths from inadequate heating, and a rapidly deteriorating security situation, the country is on the brink of collapse. Should the United States wish to alter Afghanistan’s future, current policies must be re-evaluated. The United States must recognize that any lasting peace in the country will only be achieved through collaboration with the Afghani people. A blind shipment of troops and extension of Bush-esque aid paradigms will only damage the country’s already tenuous security crisis.

A Meeting with the President

Feeling the cool breeze down my neck, I pulled the hood from my sweater over my head.  I forgot how cold a winter night could be in Florida.  My watch confirmed the midnight hour; it would be another nine until I achieved my objective.  At the height of morning commute, I received two tickets enclosed by a golden sheet of paper.  Feeling as if I was selected to see Mr. Wonka, I rushed home to share my news; I was going to see the President of the United States. 

President Obama planed a town hall meeting in Ft. Myers, Florida – a county with the highest foreclosure rates in the nation.  In an intimate setting, the President connected with his countrymen. Speaking on the stimulus package, he answered our questions concerning; unemployment, foreclosures, the credit crunch, and much more.  When asked questions on the environment, Obama had much to say.   “We need to lessen our dependence of foreign oil,” said Obama. “ To do that, we are going to double our alternative energy.”  In the stimulus package it calls for the $2.5 billion in funding for the development of alternative energy, including solar, wind, and geothermal. It also provides for more than $17 billion in tax credits for renewable energy production and weatherizing homes. Obama envisions states like Florida, developing enough alternative energy to not only power the state, but also export the excess energy to surrounding states. Using the newly built smart grid system, which is included in the stimulus, Obama said the energy would be sold and then transported through an electric grid that connects the nation. Not only will it lessen our dependence on oil, but it will also create thousands of jobs from manual laborers to skilled technicians for the development of such an infrastructure. Beyond the means to power ourselves, he also discussed how we should transport ourselves.

Russia’s Response? Drink It All In! (+ Other News)

When the world’s economy is in decline and your nation, run by a network of cartoonish oligarchs, is flexing its muscles more than Arnold Schwarzenegger–and you are Russian–there is always a solid response available: more vodka please!

What better way to pacify your people than to keep them drunk?  Apparently the Russian government is fully aware of the benefits of alcohol as a substitute for actual social and political progress, and as a result has prescribed a dramatic reduction in the tax on vodka in these troubled times.

Part of this tax is aimed at curbing the growing trend for Russians to circumvent the tax altogether by making their own alcohols and buying contraband alcohol, a game of (dare I say?) Russian roulette with each bottle that has resulted in “dozens” of deaths across the state.

Now I will not delve deep into psycho-analysis on this point, but I think that there are a few obvious polite “suggestions” that might be made to a government that needs to keep its people drunk to be happy.

Edit (1/27/09): Maybe getting them drunk will also help them to not notice you are killing off your political enemies too.  This is getting ridiculous.

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Another story out of Russia of particular interest to me (because of my current residence in London) is the purchase of the Evening Standard by russian oligarch Alexander Lebedev.  Anyone else have £1 lying around to buy a major newspaper?

Though I bring it up mainly to draw your attention to it, I think it is an interesting occurrence when major media outlets became controlled by foreign actors.  People talk about the “fourth branch of government” in the United States (particularly the press), and how exactly would this branch stand up if its editorial policy were to become influenced by another state?

Of course, though the principle still stands, this probably wouldn’t be such a big deal if the purchaser were not from the Russian oligarchical class of former KGB agents.  Those of us inclined to see a pattern in Russia’s recent behavior might hop on the conspiracy theory bandwagon and view the cynical motives for such a move.

In my experience here in London, it seems that such editorial controls would be useful–and not frowned upon.  There are several major papers competing for circulation in the UK and particularly in London, and everyone will be able to tell you which one leans which direction.  In perusing their papers, it seems that the idea of “objectivity” is not so heavily valued here as it is in the states; papers have an ideological perspective, and they don’t care if their slang terms for the opposing party and relative placement of opponents’ arguments at the end of each article expose this.

In addition, Londoners are big on public transportation: I met a woman from the states who has lived here for three years and–because its more convenient–does not own a car.  This leads to a large opportunity for newspapers, as everyone on the way to work seems to be perusing the day’s news in one form or another.  Evening Standard booths stand guard outside of every tube station, offering free umbrellas with purchase when it is raining or free coffee mugs or something of that sort–the exact thing to be sure that thousands of Londoners every day will read each paper in circulation.

The purchase of the Evening Standard could just be a business decision–but it makes for a better blog to think about the alternatives!

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The final piece of news that I want to highlight this week is the introduction of national healthcare in China.  Interestingly, China has gone for the Massachusetts approach (home state of my college, Boston College), providing basic insurance coverage (rather than a state-administered health program as in western Europe) to all Chinese people.  The administration they plan to set up sounds a lot more like the Commonwealth Connector than the UK’s National Health Service.

This turn of events will prove an interesting experiment for those wishing that the same be done for the U.S.  One of Mitt Romney’s killer flops was his disavowal of the system he put in place in MA; and while it is true that Massachusetts has seen rising enrollment that has exceeded the prescribed budget (and put the state in a squeeze in these tough times), people seem to the happy with the idea.  It will be interesting to see how it turns out.