Obama opens UN talks with diplomatic opportunities
Posted by Michelle Moquin on September 24th, 2013
Good morning!
Obama opens UN talks with diplomatic opportunities
Monday, September 23rd 2013, 5:24 am
By Julie Pace Ap White House Correspondent
President Barack Obama opens meetings at the United Nations with diplomatic opportunities on three vexing issues: Iran’s disputed nuclear program, Syria’s chemical weapons use, and elusive peace between Israel and the Palestinians.
All three pathways are fraught with potential pitfalls and hinge on cooperation from often unreliable nations. Obama also risks being branded as naive and misguided if the efforts fail, particularly in Syria, where he’s used the prospect of diplomacy to put off a military strike in retaliation for a chemical weapons attack.
Still, the recent developments mark a significant shift on a trio of issues that have long proved problematic for Obama at the United Nations. His former Iranian counterpart used the annual U.N. General Assembly meetings as a venue for fiery, anti-American speeches. Failed Middle East peace talks led the Palestinians to seek statehood recognition at the U.N. despite staunch American objections. And the Obama administration has been stymied on Syria at the U.N. Security Council due to intractable Russian opposition.
But this year, Iran has a new leader who is making friendly overtures toward Obama, raising the prospect of a meeting at the United Nations. U.S.-brokered peace talks between the Israelis and Palestinians have resumed — though on an uncertain course. And Russia has joined with the U.S. on a diplomatic deal to strip Syria of its chemical weapons.
Joel Rubin, a former State Department official who now works at the nonproliferation organization Ploughshares, said the confluence of events underscores an often frustrating aspect of diplomacy.
“You never know when it’s going to break,” said Rubin. He said Obama’s biggest test now is to recognize if opportunities morph into stalling tactics.
Obama’s advisers cast the sudden signs of progress as an outgrowth of the president’s long-standing preference for resolving disputes through diplomacy and, in the case of Iran and Syria, with pressure built up through economic sanctions and the threat of military action.
“He said we’d be open to diplomacy, we’d pursue engagement, but that there would be pressure if Iran failed to take that opportunity,” said Ben Rhodes, Obama’s deputy national security adviser. And on Syria, Rhodes said it was the credible threat of a U.S. military strike “that opened the door for this diplomacy.”
Obama was due to arrive in New York Monday afternoon. He will address the U.N. on Tuesday, a speech aides say will touch on developments in Iran, Syria and Middle East peace. The issues will also be at the forefront of some of the president’s bilateral meetings with world leaders, including a sit-down with Palestinian Authority President Mahmoud Abbas and Lebanese President Michel Suleiman, whose country is burdened by the flow of refugees from neighboring Syria.
But Obama’s most closely watched meeting may end up being with Iranian President Hasan Rouhani. No encounter is scheduled, but U.S. officials have left open the possibility the two men might talk on the sidelines of the international gathering.
If they do, it would mark the first meeting of U.S. and Iranian leaders in more than 30 years. A meeting could also be a precursor to renewed talks on Tehran’s disputed nuclear program — though bridging differences over Iran’s right to enrich uranium and maintain those stockpiles will be a far tougher task than arranging a handshake.
The election of Rouhani, a moderate cleric, signaled frustration among many Iranians with their country’s international isolation and the crippling impact of Western sanctions. Obama and Rouhani have already exchanged letters. And the new Iranian president’s rhetoric has so far been more palatable to the U.S. than former leader Mahmoud Ahmadinejad, who would threaten Israel as well as lambast the U.S. in his annual remarks at the U.N.
Trita Parsi, the president of the National Iranian American Council, said Rouhani shares with Obama a need to prove to a domestic audience that diplomacy can produce concrete results.
“If he can’t show that his diplomatic approach will pay more dividends for Iran that Ahmadinejad’s theatrics, then it’s back to the conservatives being in the driver’s seat. And the flexibility that Rouhani currently has will be lost,” Parsi said.
As Rouhani considers re-engaging with the U.S., he’s closely watching diplomatic developments in Syria, an Iranian ally.
A chemical weapons attack near Damascus in August brought the U.S. to the brink of a military strike. But an idea floated by Secretary of State John Kerry turned into a last-minute overture from Russia — another backer of Syrian President Bashar Assad — and resulted in a deal to turn Syria’s chemical weapons stockpiles over to the international community.
The breakthrough was particularly unexpected given that Russia has thwarted U.S. efforts to punish Assad through the U.N. Security Council. When Obama was on the verge of launching a strike against Assad’s regime, he said the U.N. had an “incapacity” to address Syria’s violation of international agreements banning the deployment of deadly gases.
Now the U.S. once again sees a role for the Security Council. The U.S. wants the panel to approve a resolution making the U.S.-Russian agreement legally binding in a way that is verifiable and enforceable. But a key obstacle remains, given U.S. and Russian disagreement over whether to put the resolution under Chapter 7 of the U.N. Charter.
Chapter 7 deals with threats to international peace and security and has provisions for enforcement by military or nonmilitary means, such as sanctions. Russia is sure to veto a resolution that includes a mandate for military action.
The prospect of diplomacy in Iran and Syria has overshadowed tenuous progress in recent months in restarting direct talks between the Israelis and Palestinians. Talks resumed this summer after months of prodding by Kerry, but the prospect of a resolution on issues that have long had the Israelis and Palestinians at odds remain as slim as ever.
Palestinian leaders, frustrated by the stalemate, have taken their case in recent years to the United Nations, where there is broad support for their bid for statehood. While the U.S. supports Palestinian statehood, it says that status can only be achieved through direct negotiations with the Israelis.
That’s put Obama in the awkward position of arguing against Palestinian efforts during his previous trips to the U.N. American opposition stymied Palestinian efforts to become full U.N. members in 2011, but the Palestinians succeeded in a bid to gain implicit statehood recognition last year.
The 2012 measure passed overwhelmingly, with the U.S. and just a handful of other nations voting no.
*****
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September 24th, 2013 at 9:52 am
Prescription Drugs That Make You Sick
Appeared originally as “Is the Drug You’re Taking Triggering a Disease?”
When your doctor pulls out his/her prescription pad, you probably assume that your health problem will soon be improving. Sure, there may be a side effect or two—perhaps an occasional upset stomach or a mild headache. But overall you will be better off, right?
Not necessarily.
While it’s true that many drugs can help relieve symptoms and sometimes even cure certain medical conditions, a number of popular medications actually cause disease—not simply side effects—while treating the original problem.
Here’s what happens:
Your kidney and liver are the main organs that break down drugs and eliminate them from your body. But these organs weaken as you age. Starting as early as your 20s and 30s, you lose 1% of liver and kidney function every year.
As a result, drugs can build up in your body (particularly if you take more than one), become toxic, damage crucial organs such as the heart and brain—and trigger disease.
Older adults are at greatest risk for this problem because the body becomes increasingly less efficient at metabolizing drugs with age. But no one is exempt from the risk. To protect yourself—or a loved one…
DEMENTIA
Many drugs can cause symptoms, such as short-term memory loss, confusion and agitation, that patients (and physicians) frequently mistake for dementia. The main offenders are anticholinergic medications, which treat a variety of conditions by blocking the activity of the neurotransmitter acetylcholine.
Hundreds of medications are anticholinergic, and it’s likely that any class of drugs beginning with anti- is in this category—for example, antihistamines and antispasmodics. Cholesterol-lowering statins also can cause dementia-like symptoms.
Other offenders:
Beta-blockers (for high blood pressure or cardiac arrhythmias)…benzodiazepines (for anxiety)…narcotics…tricyclic antidepressants…anticonvulsants…muscle relaxants…sleeping pills…fluoroquinolone antibiotics…heartburn drugs (H2 receptor antagonists and proton-pump inhibitors)…antipsychotics…nitrates (for heart disease)…and sulfonylurea derivatives (for diabetes).
My advice:
If you or a loved one has been diagnosed with dementia, the patient should immediately undergo a comprehensive medication review—drug-induced dementia usually can be reversed by stopping the offending drug (or drugs). A competent physician or consultant pharmacist can always find an alternative drug to use.
Surprising threat:
Even general anesthesia can cause weeks or months of dementia-like confusion (and an incorrect diagnosis of Alzheimer’s) in an older person as the drug slowly leaves the body.
The anesthesia is collected in the fat cells in the body, and normal cognition may take months to return. The longer a person is under anesthesia, the longer it takes to recover.
CANCER
Medications known as biologics are frequently used to treat autoimmune diseases such as inflammatory bowel disease, or IBD, (including Crohn’s disease and ulcerative colitis) and rheumatoid arthritis.
This class of drugs includes adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade).
Important finding: The use of biologics was linked to more than triple the risk for lymphoma, breast, pancreatic and other cancers in a study that was published in The Journal of the American Medical Association.
The danger:
While these medications may have a role in the treatment of autoimmune diseases, they often are carelessly prescribed by primary care physicians. For example, a biologic that is intended for IBD may be mistakenly prescribed for irritable bowel syndrome (IBS), a far less serious digestive disorder.
If you are prescribed a biologic for IBD: Before starting the drug, ask for a comprehensive workup to confirm the diagnosis. This may include lab tests, imaging tests (ultrasound, CT or MRI), a biopsy and a stool analysis (to rule out C. difficile and other bowel infections that would require an antibiotic). Do not take a biologic for IBS.
If you are prescribed a biologic for rheumatoid arthritis: Before starting the medication, ask your doctor for a comprehensive workup to confirm the diagnosis, including lab tests and imaging tests (X-ray, ultrasound or MRI).
Do not take a biologic for osteoarthritis. Besides increasing cancer risk, the suppression of the immune system opens the door for serious bacterial and viral infections.
DIABETES
Many commonly prescribed drugs increase risk for type 2 diabetes. These medications include statins…beta-blockers…antidepressants…antipsychotics…steroids…and alpha-blockers prescribed for prostate problems and high blood pressure.
Safer alternatives to discuss with your doctor, consultant pharmacist or other health-care professional…
If you’re prescribed a beta-blocker: Ask about using a calcium-channel blocker instead. Diltiazem (Tiazac) has the fewest side effects. The 24-hour sustained-release dose provides the best control.
If you’re prescribed an antidepressant: Ask about venlafaxine (Effexor), a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) antidepressant that treats depression and anxiety and has been shown to cause fewer problems for diabetic patients than any of the older selective serotonin reuptake inhibitor (SSRI) drugs.
If you’re prescribed an alpha-blocker: For prostate problems, rather than taking the alpha-blocker tamsulosin (Flomax), ask about using dutasteride (Avodart) or finasteride (Proscar). For high blood pressure, ask about a calcium-channel blocker drug.
HEART DISEASE
Nonsteroidal anti-inflammatory drugs (NSAIDs), frequently taken to ease pain due to arthritis, other joint problems or headaches, are widely known to damage the digestive tract. What’s less well-known is that NSAIDs have been found to increase the risk for cardiovascular disease.
My advice: No one over the age of 50 with mild-to-moderate pain should use an NSAID.
Fortunately, there is an excellent alternative. A daily dose of 50 mg of the prescription non-narcotic pain reliever tramadol (Ultracet, Ultram) and/or 325 mg of acetaminophen (Tylenol) works well and has less risk for adverse effects.
Acetaminophen, taken in appropriate doses (less than 3,000 mg daily) without alcohol use, is safe and effective. I also recommend 3 g to 4 g of fish oil daily—it has been shown to effectively treat joint pain. Talk to your doctor first because fish oil may increase risk for bleeding.
THE VERY BEST DRUG SELF-DEFENSE
If you’re over age 60—especially if you take more than one medication or suffer drug side effects—it’s a good idea to ask your physician to work with a consulting pharmacist who is skilled in medication management.
A consulting pharmacist has been trained in drug-therapy management and will work with your physician to develop a drug-management plan that will avoid harmful drugs. These services are relatively new and may not be covered by insurance, so be sure to check with your provider.
To find a consulting pharmacist in your area, go to the Web site of the American Society of Consultant Pharmacists, ASCP.com, and click on “Find a Senior Care Pharmacist.”
Also helpful:
Make sure that a drug you’ve been prescribed does not appear on the “Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Originally developed by Mark Beers, editor of The Merck Manual of Medical Information, the list has been recently updated by The American Geriatrics Society. To download the list for free, go to AmericanGeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf.
Source: Armon B. Neel, Jr., PharmD, a certified geriatric pharmacist, adjunct instructor in clinical pharmacy at Mercer University College of Pharmacy and Health Sciences in Atlanta and founder of the Georgia-based MedicationXpert, LLC, a private practice focused on pharmaceutical care for outpatients and institutional geriatric patients.
Dr. Neel is also coauthor of Are Your Prescriptions Killing You? How to Prevent Dangerous Interactions, Avoid Deadly Side Effects, and Be Healthier with Fewer Drugs (Atria). http://www.MedicationXpert.com
September 24th, 2013 at 9:56 am
Okay so most of the flood damage is over but remember this:The Guam EPA and the Department of Public Heath and Social Services have closed Inarajan Bay due to sewage leaks.
Residents are also cautioned against going into the water in Piti Bay because of raw sewage detected in the water.
The Guam Environmental Protection Agency has issued advisories for the two bays, saying sewage leaks have been identified in the vicinity of both areas.
Raw sewage poses a significant threat to the environment and increases public health risks, according a press release.
“We want to thank the village mayors and residents who notified us about the situation,” said acting Guam EPA Administrator Walter Leon Guerrero. “Any other residents with information about wastewater overflows or leaks can report them to Guam EPA at 300-4751 or through our website.”
Guam EPA will announce when the closure and advisory is lifted on the Agency’s website, Facebook page and Twitter account.
Swimming, fishing or playing in unsafe waters may result in minor illnesses such as sore throats or diarrhea. It might also result in more serious illnesses such as meningitis, encephalitis, or severe gastroenteritis. Children, the elderly and people with weakened immune systems have a greater chance of getting sick when they come in contact with contaminated water.
Hafa adai
September 25th, 2013 at 2:23 am
Why can’t my heart let you go? Why do you have to haunt me so!
September 25th, 2013 at 6:09 am
There is no need to feel that way. The needs of the many presently outweigh the needs of the few. Progress is being made, albeit not without extreme sacrifice and a loss of the need for solace with at least one being that can be trusted.