Archive for Φεβρουαρίου 2016

Who Exactly Are ‘the Kurds’?   Leave a comment

Are they terrorists, allies in the war against the Islamic State, or a nation in need of a state? The answer is yes to all of these.

The Turks are isolated, under pressure, the target of terrorists, on the brink of a wider conflict in Syria, and headlong into a diplomatic crisis with the United States.

The Turkish predicament is extraordinarily complex and has much to do with Ankara’s approach to Syrian President Bashar al-Assad, its willful blind eye to extremists fighting the Assad regime, and its foot-dragging when the United States asked for access to Turkish bases in 2014 to fight the self-declared Islamic State. I can hear the howling from Ankara already, but Washington has a lot to answer for as well. We’ll never know what might have happened had the United States intervened in the Syrian conflict early on when there was at least a chance of making a difference, but the series of half-measures and misbegotten ideas about a negotiated solution to the vortex of violence that has consumed Syrians at an astonishing rate is hard to get my head around.

For example, it seemed clear to me—and many others—that Moscow’s primary goal by intervening militarily was to create a situation in which the rest of the world would be forced to choose between Assad and the Islamic State. The Obama administration harbored a different view. American officials believed, rather, that Russian intervention would create an environment where all the relevant players—Assad, Iran, Saudi Arabia, Turkey, Syria’s opposition—would come off of their maximalist positions and negotiate in good faith. This did not even take into account extremists who are fighting in Syria for multiple other reasons only tangentially related to the quality of politics in Assad’s Syria. For the most part, the Obama administration has successfully kept the United States out of Syria, but it has looked weak and feckless in the process.

One of the reasons why is American reliance on “the Kurds” to fight the Islamic State in Syria, which has caught American policymakers in the confusing, contradictory, and often surreal world of Kurdish politics and the politics of Kurds in the region. Part of the problem is the way in which Washington thinks about Kurds, who they are, and what they want.

It goes without saying that when people say “the Kurds” they are simplifying to the point of meaninglessness. Besides the geographic distribution across Turkey, Syria, Iraq, and Iran, the Kurds are hardly a cohesive and consistent group in terms of worldview, political goals, and relationship to the states in which they live. Are the Kurds terrorists, allies in the war against the Islamic State, or a nation in need of a state? The answer is yes to all of these, which makes things extraordinarily difficult for American policymakers and underlines why observers cannot just invoke “the Kurds.”

Here is why: In Turkey, there are 14 million Kurds, many of whom are well-integrated into the political and economic life of the country, but many others who remain alienated. Religious Kurds have been an important and reliable constituency for the ruling Justice and Development Party (AKP). There is also the People’s Democratic Party, or HDP, whose leader Selahattin Demirtas has made a big splash among Western observers for his alleged liberalism. The AKP has sought to portray the HDP and Demirtas as no different from the Kurdistan Workers’ Party (PKK) that has been waging a war on Turkey since the mid-1980s.

Suffice it to say that HDP and Demirtas are not as guilty as the AKP suggests, but they are not as pure as their supporters and foreigner admirers believe. The bigger issue is, of course, the PKK. It is a terrorist organization. The Turkish government began a peace process with the group in 2013; those broke down during the summer of 2015 for a variety of reasons having to do with those talks, PKK stupidity, and Turkish politics. The Turks—along with the Syrian, Iraqi, and Iranian governments—have long suppressed Kurdish nationalism, fearing that it would lead to the fragmentation of Turkey.

After the American invasion of Iraq, Turkey was often invoked—okay, I often invoked it—as the most likely neighbor to invade. This was because the PKK ended a five-year unilateral ceasefire in 2004 with American forces occupying the country. This was awkward to say the least, especially since, with their hands full elsewhere, American commanders did not want to fight the PKK on behalf of the Turks.

Ankara was also worried that the destabilization of Iraq that ensued would result in the establishment of an independent Kurdish state in northern Iraq. That is likely to happen (perhaps sooner than anyone ever expected), but the Turks are no longer likely to invade, if they ever were. Rather, the AKP has very good relations with the Kurdistan Democratic Party (KDP) under the leadership of Massoud Barzani, the president of the Kurdistan Regional Government (KRG). There is a lot of Turkish investment in the KRG, and the Turkish port of Ceyhan will play a major role in Iraqi Kurdistan’s oil exports. Washington likes the KRG and Iraqi Kurds like Washington.

Relations between Turkey and the KRG soured after the Turks failed to help when the Islamic State threatened the KRG’s capital Erbil in August 2014. The KDP controls Erbil and Dohuk provinces, but not the other Kurdish province, Sulaymaniyah (often referred to as “Suli” or “Slemani”), which has been a stronghold of the Patriotic Union of Kurdistan (PUK). An offshoot of the PUK, called Gorran, has become a player in Sulaymaniyah as well. The PUK is said to be less tribal, more cosmopolitan, and more willing to deal with Baghdad than the KDP. The family of Jalal Talabani, a Kurd who served as president of Iraq following Saddam Hussein’s overthrow, is the major player in the PUK. The security forces of the two parties fought a brief civil war in the mid-1990s, during which thousands were killed. Even though the two sides have apparently let bygones be bygones, the wounds have not entirely healed. Much of this has to do with the fact that the PUK (and Gorran) do not want to allow the KDP to dominate Iraqi Kurdistan and other parts of the Kurdish world, which is where things get interesting.

The KDP’s Barzani has colluded with Turkey against the PKK and was noticeably slow to send assistance to Syria’s Kurds during the Islamic State’s siege of Kobani. This is because Barzani wants to be the king of the Kurds and does not want to upset Ankara, which is important to Kurdish independence in northern Iraq. The PUK, wary of the Turks and Barzani’s dominance, has coordinated with the PKK to balance both Ankara and Erbil. In Syria this meant that the PKK helped the Syrian Kurdish Democratic Union Party (PYD)—allied with the PUK—and set up the People’s Protection Units, or YPG, after the Syrian uprising began. The YPG has been in the news a lot lately because its fighters—men and women as the press likes to point out—have been effective against the Islamic State and have become an ally of the United States. Here is where it gets even more interesting.

As I implied just above, the ties between the YPG and the PKK are closer than the commonly used term “affiliated” would suggest. This has made life difficult for the American policymakers who correctly insist that Turkey has a right to defend itself against the PKK, while at the same time insisting on coordinating with the YPG against the Islamic State. This is an affront to the Turks who fear that the PYD, the YPG, and the PKK will carve out an independent entity in northern Syria, leaving what amounts to a terrorist state on its southern border with its eyes on southeastern Turkey.

The Obama administration has tried hard to maintain the fiction that the YPG and PKK are distinct entities, but this has convinced absolutely no one. Even as American diplomats were claiming last summer that they were making progress bringing the Turks around to the way the United States viewed the YPG, Turkish President Recep Tayyip Erdogan was declaring that Ankara would never accept what the Kurds call Rojava, meaning Western Kurdistan, which covers northern Syria. So now the Turks are shelling YPG positions in Syria while the YPG continues to coordinate with the United States as well as Russia, leading Turkish officials to conclude that both Washington and Moscow are colluding against Turkey. The Turks want the United States to choose between them or the YPG (and by extension the PKK). It is a bind for American officials. They can either sign up with the Turks, thereby undermining what they have going with the YPG against the Islamic State, or ditch Turkey altogether. Neither serves U.S. interests, so the administration has split the difference.

Presidents Barack Obama and Erdogan had a long call the other day. Thereadouts of the call that the two governments provided indicate differences between Washington and Ankara. For a long time Turks have suspected—erroneously—that the United States supports the PKK. It did not, but the emergency that the Islamic State represents has done funny things to American foreign policy. In Washington, it is time for a discussion of whether the PKK and YPG are terrorist groups or not. If they are not, policymakers should brace for a change in bilateral relations with Turkey. The Turks are not quite as indispensable an ally that they have been made out to be for a long time, so perhaps it is worth taking the hit. In the meantime, when Washington tells Turks that its stands with them, they have every right to be incredulous.


This post appears courtesy of the Council on Foreign Relations.

Posted Φεβρουαρίου 28, 2016 by msofcrete in Uncategorized

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2015: The Year in Breast Cancer   Leave a comment

BY GEORGE W. SLEDGE, JR., MD

 

GEORGE W. SLEDGE, JR., MD, is Professor of Medicine and Chief of the Division of Oncology at Stanford University. He also is Oncology Times’ Editorial Board Chair. His OT writing has been recognized with an APEX Award for Publication Excellence and a FOLIO: Eddie Honorable Mention award.

Breast cancer remains a fertile area of clinical research investigation, and 2015 revealed numerous surprises, involving local-regional therapy, adjuvant and neoadjuvant therapy, and metastatic disease. It is not a disease so much as it is a universe.

Screening Mammography
While there was nothing particularly new in terms of data in the screening field, screening mammography still made national headlines. The American Cancer Society presented its long-awaited updated screening recommendations, raising the age at which it recommends initiation of screening from 40 to 45. This follows the U.S. Preventive Services Task Forces recommendation to begin screening at age 50. The American College of Radiology, in turn, recommends beginning at age 40.

As all of these groups are operating off of the same data sets, it is important to realize that the differences in these recommendations largely represent differences in data interpretation, in particular the question of, «How many women does one need to screen (or how much money does one have to pay) to prevent a breast cancer death?» That ultimate guidelines committee—the United States Congress—has directed Medicare to ignore the USPSTF recommendations.

The differences between the different groups are confusing to women and physicians. My biases are these: 1) Even with the least aggressive guidelines, a significant percentage of the population does not undergo screening, so we need to improve access and education; 2) We are at the start of a process of diagnostic individualization—call it precision imaging—that will parallel the therapeutic individualization we have seen transform breast cancer. I suspect that a decade from now we will be taking a much more nuanced approach to estimating risk, and therefore a more individualized approach to screening recommendations; 3) As therapy for breast cancer improves, screening will necessarily have a lesser impact on outcome. We do not perform testis cancer screening because it would never be cost effective.

Radiation Therapy
Five years ago I thought I understood what optimal local-regional therapy was. I was wrong. We continue to alter our understanding of both surgery and radiation therapy for local disease. The role of post-mastectomy radiation therapy remains contentious. In 2014 the Early Breast Cancer Trialists’ Collaborative Group published a meta-analysis demonstrating that post-mastectomy radiation reduced disease-free and overall survival in all patients with positive lymph nodes.

This year saw two important new developments. The EORTC published the results of a large (greater than 4,000 patients) trial in women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement (NEJM 2015;373:317-27). Patients were randomized to undergo either whole breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole breast or thoracic wall irradiation alone (control group). Disease-free survival was improved (for both local-regional and distant recurrence) with what the authors described as a marginal effect (a 1.9% difference) in overall survival.

The NCIC’s MA.20 trial (NEJM 2015;373:307-16), published back-to-back with the EORTC trial, examined whether the addition of regional nodal irradiation to whole breast irradiation improved outcome in node-positive and high-risk, node-negative women. While the additional therapy reduced the rate of recurrence, it had no effect on overall survival. My sense, as a non-radiation oncologist, is that radiation beyond whole breast irradiation appears to add relatively little to long-term outcome, and some real toxicity.

Guidelines committees are re-evaluating their post-mastectomy guidelines. Part of the problem faced by these committees is that systemic therapy has also changed, and reduced local-regional and distant recurrence. Numerous institutional studies, some quite large, are showing lower local-regional failure rates than reported in the Oxford meta-analysis and older randomized trials.

Dem Bones, Dem Bones
Going back now over 20 years, we have had preclinical evidence suggesting that anti-osteoporotic agents (both bisphosphonates and RANK ligand inhibitors) could prevent breast cancer bone metastasis. A large number of randomized trials, mostly underpowered, were subsequently performed. This year saw several decades of work come to fruition.

Let’s begin with the Early Breast Cancer Trialists’ Collaborative Group’s meta-analysis of adjuvant bisphosphonate trials (Lancet 2015;386:1353-61). I have become somewhat uncertain of the value of Oxford meta-analyses in an era dominated (on the one hand) by quite large Phase III trials, and on the other hand by rapidly emerging trials based around small genomics-driven subsets. But this is the sort of meta-analysis that shows the continuing value of the Oxford studies.

To summarize a large body of data, bisphosphonate use reduces the risk of distant metastasis and improves overall survival for early stage breast cancer. The reduction in distant metastasis is attributable entirely to a reduction in bone metastasis, biologically predictable but disappointing to those who felt there might be some spillover effect to other organs. The meta-analysis was composed of an astonishingly diverse array of studies, with differing bisphosphonates, different durations of therapy, and different patient populations. The only subgroup to satisfy a formal test for interaction was menopausal status: all the benefit was confined to postmenopausal women.

We lack a huge database of studies when we turn from bisphosphonates to RANK ligand inhibition. At present we have one drug (denosumab) in one study (ABCSG-18), and that study is frustrating. The Austrians randomized postmenopausal women receiving an aromatase inhibitor to either every six-month denosumab 60 mg or a placebo. The study’s primary endpoint was the prevention of skeletal-related events, with disease-free survival as a secondary endpoint.

The paper on skeletal-related events was published in the Lancet (2015;386:433-43). This was a real success, with denosumab markedly reducing osteoporotic fractures (hazard ratio = 0.50, p < .0001). The fracture rate in the control arm was higher than what we might have suspected, suggesting that we may have been missing AI-induced osteoporosis.

The ABCSG18 investigators next looked at disease-free survival… and that is where frustration enters the picture. Because of the impressive bone result, the study’s data monitoring committee felt there was an ethical obligation to report the results to the patients, allowing those on the control arm to cross over to denosumab therapy, with subsequent pollution of disease-free survival (DFS) results. The trialists (Michael Gnant presented their data at the 2015 San Antonio meetings) performed their analysis at a time that was clearly earlier than one would have liked, and demonstrated a «close but not quite there» p value of .051.

Where does all this leave us? First, we have great evidence for therapeutic benefit with bisphosphonates in postmenopausal early stage breast cancer. But which drug should we use, and for how long and in what dosage? Perhaps the guidelines committees will help us out on this. The RANK ligand data—such as it is—looks similar to the bisphosphonate data, with appropriate caveats. We await more denosumab data, but given denosumab’s track record in the metastatic setting, I doubt it will prove inferior to bisphosphonate therapy. Given its convenience and somewhat better tolerability, it may prove the ultimate winner.

Palbo
Estrogen receptor positive breast cancer had been a sleepy therapeutic area for much of the past decade. That changed in recent years, first with the approval of the mTOR inhibitor everolimus, and now with the introduction of the cyclin dependent kinase inhibitor palbociclib. Basic biologists have known for some time that estrogen’s growth actions require a pathway that includes Cyclin D and CDK’s 4 and 6. Palbociclib blocks CDK4/6, and in cell line models was shown to have striking activity in ER-positive breast cancer cell lines.

In April of 2015 the Food and Drug Administration gave palbociclib an accelerated approval based on the PALOMA-1 results. PALOMA-1 was a randomized Phase II trial (or, rather, a mash-up of two underpowered randomized Phase II trials) comparing letrozole alone to letrozole plus palbociclib. The trial, published in Lancet Oncology (2015;16:25-35), showed a rough doubling (from 10.2 to 20.2 months) in progression-free survival. PALOMA-1 was followed in short order by PALOMA-3, also published in 2015 (NEJM 2015;373:209-219), repeating the same experiment in a Phase III setting with fulvestrant as the endocrine agent. PALOMA-3 demonstrated a significant (statistically and clinically) improvement in progression-free survival, going from 3.8 to 9.2 months.

Palbociclib, as those who use it know, removes some of the joys of endocrine monotherapy. It is obscenely expensive and it adds toxicity to the mix, albeit manageable toxicity. Because CDK 4/6 inhibitors also affect neutrophil production, low neutrophil counts are common and require evaluation and not infrequent dose modification. Though the PALOMA-1 trial saw no neutropenic fevers, out in the real world older and frailer patients get hospitalized with infections.

Two other CDK 4/6 inhibitors are in Phase III trials, and along with palbociclib they cover the entire ER-Positive waterfront. Palbo, in turn, has entered adjuvant trials. These are good things, but I wish I knew more about CDK inhibitors. I have had metastatic breast cancer patients respond for a decade to an aromatase inhibitor. Will I need to give Palbo for a decade as well, and if so, at what cost, both financial and in terms of inconvenience and toxicity? Will we be able to predict who benefits? What are the mechanisms of resistance? How long (assuming it works there) will I need to give a CDK 4/6 inhibitor in the adjuvant setting? If I start a patient on an AI plus Palbo and the patient progresses, should I then switch to fulvestrant plus Palbo? Lots of work for clinical trialists, and lots of questions of importance to patients.

Pertuzumab and Lapatinib
This year saw the updated results from the CLEOPATRA trial in front-line HER2-positive breast cancer (NEJM 2015;372:724-34). This trial compared combination HER2-targeted therapy to trastuzumab monotherapy in the presence of docetaxel. These results are stunning, with an improvement in overall survival from 40.8 to 56.5 months, far more than I would have guessed, and clearly establishing dual HER2-targeted therapy as the standard of care in front-line HER2-positive disease. We can only hope that these results will translate to the adjuvant setting when the APHINITY trial matures.

However, a cost-benefit analysis estimated the cost per quality-adjusted life year of adding on pertuzumab at $713,000 (J Clin Oncol 2015 Sep 8. pii: JCO.2015.62.9105 [Epub ahead of print]).

While the CLEOPATRA results were exceptionally positive, lapatinib disappointed. The long-awaited adjuvant lapatinib ALTTO trial, presented at the 2015 ASCO Annual Meeting’s plenary session (and subsequently published in the Journal of Clinical Oncology), was essentially a negative trial, closing out a decade of work for this kinase inhibitor.

What Do We Do with This Data?
Every year sees some studies that make me wonder whether my hard-won worldview is wrong; there were two of these this year. The first involved the anti-VEGF agent bevacizumab. Bevacizumab prolongs disease-free survival but not overall survival in front-line metastatic breast cancer in numerous Phase III trials. Bevacizumab does not prolong disease-free or overall survival in the adjuvant setting in multiple disease subsets in multiple Phase III trials. The world, myself included (and I devoted a decade of my academic career to anti-VEGF therapy), had given up on bevacizumab for breast cancer.

I was surprised, therefore, to read the NSABP’s trial of bevacizumab in the neoadjuvant setting (Lancet Oncol 2015;16:1037–48). Comparing the chemotherapy alone to the same plus bevacizumab in the preoperative setting, the investigators saw an improvement in both pathological complete response rate and overall survival (though curiously only a trend toward improved disease-free survival). Bevacizumab finally has a positive trial where it counts.

What do we do with this data? Is it real or is it just one of those statistical outlier results that pop up every now and then when one does enough trials with a drug? If it is real, why? I can come up with an explanation involving the use of anti-VEGF therapy in the presence of an intact primary tumor, perhaps with a bow to VEGF’s immune effects. But I am perplexed.

The other «I don’t know what to do with it» trial involves post-neoadjuvant capecitabine. A group of Japanese and Korean investigators, led by Masakazu Toi, MD, presented this trial at the San Antonio meetings (2015 San Antonio Breast Cancer Symposium, Abstract S1-07). HER2-negative patients with significant residual disease after chemotherapy were randomly assigned to post-neoadjuvant capecitabine (in the FDA-approved dose and schedule for metastatic disease) or to the control group. The analysis showed statistically significant improvements in both disease-free (74.1% versus 67.7%) and overall (89.2% versus 83.9%) survival. Benefits were seen in both triple-negative and HR-positive patients.

Adjuvant capecitabine, in several large, well-conducted trials (including the NSABP trial that was positive for bevacizumab), failed to alter the destiny of early stage breast cancer patients. Again, I am perplexed.

Drug development remains mysterious and unpredictable. Focus on what wonderful surprises 2016 will bring.

Posted Φεβρουαρίου 26, 2016 by msofcrete in Uncategorized

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Anyone who thinks Westerners are flocking to Isil because of the Iraq war is a fantasist   Leave a comment

Isil and its jihadist ideology uniquely exploit underlying conflicts and offer the conspiracy theory solution: none of this is your fault.

 

12:11PM GMT 18 Feb 2016

The Telegraph

When Islamist radicals commit some heinous act, they very often try to justify this as a legitimate response to the West’s foreign policy in the Muslim world. The West is the aggressor in “Muslim lands”, oppressing Muslims, so an equally violent response is therefore just and appropriate.

 

I will start by stating the obvious: Western foreign policy in the Middle East has been hugely dysfunctional, and very frequently responsible for very damaging outcomes. The Iraq War is the paradigm example, but this is something that stretches back an entire century. Yet the notion that people both in the Middle East and in the West get radicalised in response to Western interventions in the Muslim world is nonsense.

This claim is nothing more than a rhetorical pillar for the grievance and victimhood “theology” of jihadism. Its purpose is to give colour to their Manichean black and white, Us vs Them worldview which sustains the most horrific excesses of the terrorists as “necessary” in their millenarian battle of “good” vs “evil”: “They are attacking Us! We are merely defending ourselves! We are the good guys here!” Obviously, they must teach young children to kill with callousness and gratuitous brutality in self-defence.

If it were genuinely the case that global Jihadism in its current incarnation was some kind of reaction to Western “imperialism” in the Middle East, you would expect this movement to have certain features, and to behave in certain ways. For example, you would expect the movement to try and unite Muslims, and even non-Muslims in the affected Middle Eastern countries, in a struggle against Western imperialist aggression, targeting specifically Western assets and interests.

 

Yet Isil and their ilk do the very opposite of that. This does get repeated quite often, but it does not seem to sink in with Western audiences: the primary target of Isil and similar groups is not the West. It is other Muslims. Above all, Shia Muslims. But also other ethnic, religious and tribal groups.

The attacks on the West are relatively rare, and small scale relative to what the other groups have to endure. The largest attack against the West carried out by Isil was the Paris attack last November. 130 were killed, and 368 were wounded. A horrific attack by any measure, but compare it with some of the attacks on the Shia, or the Yazidi minority. In October 2014, Isil executed 1,700 Shia civilians in one sitting at Camp Speicher, and a further 670 Shia prisoners in a massacre in Tikrit. By 2015, the U.S. Holocaust Memorial Museum assessed that ISIS had committed genocide against the Yazidis, but also ethnic cleansing and war crimes against Shias, Kurds, Christians, Mandaean and other groups.

Small scale attacks, with fewer than 10 victims are much more frequent. In the West they seem to be happening at a rate of one every couple of months in past last year. By comparison, in the Middle East, random murders of Shia civilians or bombing of marketplaces or Shia mosques happen on a daily basis.

And let us not forget that the attacks that do happen in the West, especially the more recent ones in the United States, only have the most tenuous links to Isil. It often goes no further than one or two deranged gunmen who “pledged allegiance” to Isil in their bedroom, but had virtually no contact with the group beyond that.

For Isil, these attacks are important for PR and marketing. It allows it to recruit foreign fighters for its battles in the Middle East. And Western Media coverage that these attacks ensure give it clout and prestige. But for them, the real battles are against the Shia government of Iraq, the Shia Alawite government of Syria and the Kurds. And any non-Sunni, thus “non-Muslim” civilian minority caught in their “Muslim lands”.

If Isil really was about defending the Middle East from Western “aggression”, why on earth would they attack Indonesia, of all places – the largest Muslim country in the world? Indonesia has had absolutely nothing at all to do with Western foreign policy. Its only “sin” is that it largely practices a very tolerant and inclusive kind of Islam, and does so very successfully. And to the likes of Isil, there is nothing more threatening than a representation of Islam which is at peace with the world, and very successful for it. Indonesia is not oppressed by the Crusaders and the Zionists, and gets along rather well with all kinds of Islamic sects and non-Islamic religions. That is what makes them “un-Islamic” in the warped ideology of the jihadists. They simply do not fit the victimhood and grievance ideology, so they cannot possibly be Islamic.

 

But what about those Muslims radicalised in the West? Young men and women born and raised here, but who nonetheless become radicalised and either carry out attacks on Western streets, or travel to join the fighting in Syria. Are they radicalised by Western intervention in the Middle East?

No. Radicalisation is complex phenomenon. There are as many reasons for radicalisation as there are radicalised young Muslims. Each one of them has their own story with a complex mix of reasons, more or less rational, for why they have come to have the radical world view. Nonetheless, we can also observe some strong patterns amongst those radicalised emerging from the increasing body of interdisciplinary research on radicalisation.

For example, most come from unsafe, unstable social environments and have histories of petty crime, as well as drink and drugs problems. It is also notable that this tendency is especially acute amongst white Western converts. They may feel that their lives lack direction, but also feel disempowered and disenfranchised. They feel that they are not in control of their own destinies.

What an organisation like Isil offers them is instant reception. And moreover, a purpose. A direction in life. You can be an unemployed petty drug dealer one day but if you take a flight to Turkey and cross the border into Syria you are instantly transformed into a warrior of God.

Recruits get guaranteed salvation in the afterlife, but also, the opportunity to establish political utopia on Earth. Something that has not been on offer anywhere in the world since the collapse of communism. They get all that and they get free reign to vent their pent up aggression and their sexual frustration – and the research shows that the recruits have plenty of both. Where else can you get a sense of belonging, a purpose of building paradise on Earth, an opportunity to kill bad guys and sexually enslave as many of “their women” as you can get your hands on? Coming from cultures like ours that glorify sexual prowess, violence, and political utopianism, is it any wonder that so many are seduced by what Isil is promising them?

Western foreign policy? Sure, why not? Sounds like a legitimate argument. They will have it. But is that really what gets anyone out of bed in the morning? If the West “got out of Muslim lands” tomorrow, would anything really get better for anyone in the Middle East? And is there even any possible way for all Western countries to cut ties with the Middle East so drastically that they could be said to have “gotten out of Muslim lands”? In the mind of these zealots, even speaking to “non-Muslims” can corrupt one’s moral purity.

The bottom line is that a lot of this complaint against Western foreign policy is nothing more than an exercise in denial: what the Muslim world, and young Muslims here in our countries, are in denial about is that almost all problems Muslims face in the Muslim world is the fault of none other than the Muslims who live there. Local sectarian and tribal rivalries, regional rivalries between Iran and Saudi Arabia, rampant corruption and chronic economic mismanagement, gross social inequality between most people and a tiny elite who monopolise oil and other key resources, and a bulging youth population with no economic prospects and little to do other than pick up a Kalashnikov. Those are the fundamental problems of the Middle East, and they have next to nothing to do with the West, or its foreign policy in the region. But they do radicalise the local populations.

Isil and its jihadist ideology uniquely exploit and amplify these underlying conflicts and offer the conspiracy theory solution: none of this is your fault. There is a big villain far away who has engineered all your problems. You are good people, and all of this will be magically fixed if we go now and kill the bad people. Who are the bad people? Don’t worry about it, we’ll show you when we get to the battlefront. In psychiatry, we call these denial and displacement respectively. In the real world, we have to call this the instrumentalisation of religion for an ideology of death – and a real tragedy.

Dr Azeem Ibrahim is an RAI Fellow at Mansfield College, University of Oxford and Research Professor at the Strategic Studies Institute, US Army War College.

Posted Φεβρουαρίου 19, 2016 by msofcrete in Uncategorized

DAVID JOHNSTON: Canada’s culture of research excellence   Leave a comment

Contributed to The Globe and Mail

Published Wednesday, Feb. 10, 2016 6:00AM EST

David Johnston is Governor-General of Canada.

His Excellency The Right Honourable David Johnston, Governor-General and Commander-in-Chief of Canada (Dave Chan for The Globe and Mail)

I was born in the town of Copper Cliff, now a part of Sudbury, a city famous for its minerals and for being the site of National Aeronautics and Space Administration (NASA) training missions in the early 1970s. To this day, the reason for those missions is misunderstood: Rather than training in Sudbury because its landscape resembled the moon – as the myth goes – the Apollo astronauts were there to study geology. Specifically, they were studying the Sudbury basin, a two-billion-year-old meteor impact similar to impacts found on the lunar surface. Those astronauts weren’t learning how to moonwalk in Sudbury, they were learning about moon rock.

Why am I telling this story? Not just because I’m a Sudbury native who wants to set the record straight. It’s because I’m in Washington attending meetings on the margins of the American Association for the Advancement of Science – a gathering of some of the world’s top science minds, including numerous Canadians – and Sudbury is again starring prominently in the world of scientific discovery. This time, it’s for what we’ve learned there about the sun.

That’s right, the sun! This time around, the Sudbury basin is the site of the Sudbury Neutrino Observatory (SNO), a lab the size of a 10-storey building located two kilometres underground in Vale’s Creighton Mine.

Recently, the SNO was awarded a prestigious 2016 Breakthrough Prize in Fundamental Physics, dedicated to encouraging physicists studying the deepest mysteries of the universe. The award was accepted on behalf of an international team by Arthur McDonald – himself a co-winner of the 2015 Nobel Prize in Physics for his work at the SNO.

To say the least, it has been a good year for Canadian physicists on the world stage – as well as for all kinds of Canadian scholars. In 2015, no fewer than 24 Canadians won prestigious international awards and prizes in science, engineering, health, medicine, the social sciences and humanities. This is a great achievement, and during my visit to Washington, I’m meeting with scientists and leaders from governments, universities, granting agencies and non-governmental organizations to find ways to build on that record and to further promote Canadian excellence. Because in a world where knowledge is a key currency, nothing attracts talent and resources like success. Global Excellence, an initiative I’ve been working on with academic institutions and government agencies, seeks to recognize and celebrate success so we enhance a Canadian culture of equality of opportunity and excellence.

How do we do this? The story of the Sudbury Neutrino Observatory provides us with some valuable lessons.

One, collaboration – often on a global scale – is critical to success. The SNO involved hundreds of scientists, technicians, institutions and agencies from Canada, the United States, Britain and Portugal. Even Dr. McDonald’s Nobel Prize is shared with Takaaki Kajita of the University of Tokyo, who led an earlier phase of the neutrino experiment in Japan.

Two, whether you’re an individual or community, leverage your local strengths. Think of Sudbury. Who would have thought a nickel mine would be an ideal place to observe neutrinos from the sun? Sometimes the competitive edge we need is literally right under our noses. What makes your community unique?

Three, recognize that Canada is home to some of the world’s brightest minds. We must support and celebrate their success. That means nominating our leading scholars and organizations for the world’s top prizes in the sciences, the arts, social sciences and humanities. Because sometimes the clichés are true: You miss 100 per cent of the shots you don’t take!

Together, in every sphere of activity, let’s build on our momentum and make sure the world acknowledges and celebrates the truly stellar achievements of Canadian trailblazers.

Posted Φεβρουαρίου 10, 2016 by msofcrete in Uncategorized

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Socialism Gets a Second Life   Leave a comment

Why do the young love Bernie Sanders? Because their experience of capitalism is different.

Nashua, N.H.

I was watching Bernie Sanders speak last week at a town hall in Bedford when an early intuition became a conviction:Take Mr. Sanders seriously. He is not just another antic presence in Crazy Year 2016. His rise signifies a major shift within the Democratic Party.

The big room was full, 700 to 800 people, good for 5 p.m. on a Friday. The audience wasn’t raucous or full of cheers as at his big rallies, but thinking and nodding. They were young and middle-aged, with not many white-haired heads. There was a working-class feel to them, though Bedford is relatively affluent.

“Let me disabuse you,” Mr. Sanders says to those who think he cannot win. He quotes New Hampshire polls, where he’s way ahead. He can defeat Donald Trump, he says.

Then the meat. He described America as a place of broad suffering—“student debt,” “two-job families” with strained marriages and insufficient child care, “the old on fixed incomes.”

We can turn it around if we make clear to “the billionaire class” that income inequality “is not moral.” The economy is “rigged.” Real unemployment is not 5% but twice that. “Youth unemployment is off the charts.” He wants job-training programs for the young. The minimum wage is “a starvation wage.” Raise it to “a living wage—15 bucks an hour.”

The audience is attentive, supportive. “Yeah!” some shout.

He speaks of Goldman Sachs, of “banksters” and of a Republican Party owned by “the oil industry, coal industry.”

“Health care is a right of all people, not a privilege.” He asks if any in the audience have high-insurance deductibles. They start to call out: “$4,000,” “5,000,” “6,000!” Someone yells: “Nothing’s covered!”

No one mentions ObamaCare, but it seems clear it hasn’t worked here.

Mr. Sanders says people don’t go to the doctor when they’re sick because of the deductibles. “Same with mental-health care!” a woman calls out. “Mental-health care must be considered part of health care,” he responds, to applause. He is for “a Medicare-for-all, single-payer system.”

How to pay for it all? “Impose a tax on Wall Street speculation,” he says, briefly. He does not elaborate and is not pressed to.

Mr. Sanders’s essential message was somber, grim, even dark. It’s all stark—good guys and bad guys, angels and devils. But it’s also clear and easy to understand: We are in terrible trouble because our entire system is rigged, the billionaires did it, they are the beneficiaries of the biggest income transfer from the poor to the rich in the history of man, and we are going to stop it. How? Through “a political revolution.” But a soft one that will take place in voting booths. We will vote to go left.

As the audience left they seemed not pumped or excited, but satisfied.

I listen to Mr. Sanders a lot, and what he says marks a departure from the ways the Democratic Party has been operating for at least a generation now.

Formally, since 1992, the Democratic Party has been Clintonian in its economics—moderate, showing the influence of the Democratic Leadership Council. Free-market capitalism is something you live with and accept; the wealth it produces can be directed toward public programs and endeavors. The Clinton administration didn’t hate Wall Street, it hired Wall Street. Big government, big Wall Street—it all worked. It was the Great Accommodation, and it was a break with more-socialist approaches of the past.

All this began to shatter in the crash of 2008, not that anyone noticed—it got lost in the Obama hoopla. In March 2009, when Mr. Obama told Wall Street bankers at the White House that his administration was the only thing standing between them and “the pitchforks,” he was wittingly or unwittingly acknowledging the Great Accommodation.

The rise of Bernie Sanders means that accommodation is ending, and something new will take its place.

Surely it means something that Mr. Obama spent eight years insisting he was not a socialist, and Bernie Sanders is rising while saying he is one.

It has left Hillary Clinton scrambling, unsteady. She thought she and her husband had cracked the code and made peace with big wealth. But her party is undoing it—without her permission and without her leading the way. She is meekly following.

It is my guess that Mr. Sanders will win in Iowa and New Hampshire. But the tendency he represents—whether it succeeds this time or simply settles in and grows—is, I suspect, here to stay.

A conservative of a certain age might say: “No, he’s a fad. Socialism is yesterday! Marx is dead, the American economic behemoth rolled over and flattened him. Socialism is an antique idea that rocks with age. America is about the future, not the past.”

I disagree. It’s back because it’s new again.

For so many, 2008 shattered faith in the system—in its fairness, usefulness and efficacy, even in its ability to endure.

As for the young, let’s say you’re 20 or 30, meaning you’ll be voting for a long time. What in your formative years would have taught you about the excellence of free markets, low taxes, “a friendly business climate”? A teacher in public high school? Maybe one—the faculty-lounge eccentric who boycotted the union meetings. And who in our colleges teaches the virtues of capitalism?

If you are 20 or 30 you probably see capitalism in terms of two dramatic themes. The first was the crash of ’08, in which heedless, irresponsible operators in business and government kited the system and scrammed. The second is income inequality. Why are some people richer than the richest kings and so many poor as serfs? Is that what capitalism gives you? Then maybe we should rethink this!

And Mr. Sanders makes it sound so easy. We’re rich, he says; we can do this with a few taxes. It is soft Marxism. And it’s not socialism now, it’s “democratic socialism” like they have in Europe. You’ve been to Europe. Aside from its refugee crisis and some EU problems, it’s a great place—a big welfare state that’s wealthy! The French take three-hour lunches.

Socialism is an old idea to you if you’re over 50 but a nice new idea if you’re 25.

Do you know what’s old if you’re 25? The free-market capitalist system that drove us into a ditch.

Polls show the generation gap. Mr. Sanders does poorly among the old. They remember socialism. He does well among the young, who’ve just discovered it and have little to no knowledge of its effects. A nationwide Marist poll in November showed Mr. Sanders already leading Mrs. Clinton, 58% to 35%, among voters under 30. She led him among all other age groups, and 69% to 21% among those 60 and older. By this month a CBS/New York Times poll had Mr. Sanders up 60% to 31% among voters under 45.

Bernie Sanders is an indicator of the Democratic future. He is telling you where that party’s going. In time some Democrats will leave over it, and look for other homes.

It’s all part of the great scrambling that is happening this political year—the most dramatic, and perhaps most consequential, of our lifetimes.

Posted Φεβρουαρίου 7, 2016 by msofcrete in Uncategorized

Μεταξύ Μπανγκλαντές και Μοζαμβίκης στον Παγκόσμιο Δείκτη Οικονομικής Ελευθερίας η Ελλάδα   Leave a comment

Μεταξύ Μπανγκλαντές και Μοζαμβίκης στον Παγκόσμιο Δείκτη Οικονομικής Ελευθερίας η Ελλάδα

 

Στην 138η θέση υποχώρησε το 2015 η Ελλάδα στον Παγκόσμιο Δείκτη Οικονομικής Ελευθερίας που καταρτίζει το Heritage Foundation, καθώς, όπως υποστηρίζει ο Οργανισμός, «έχασε τον έλεγχο» στην οικονομική και νομισματική πολιτική.

Όπως επισημαίνει η βρετανική Telegraph, η Ελλάδα χαρακτηρίζεται «ως επί το πλείστον ανελεύθερη» χώρα και η θέση της επιδεινώνεται διαρκώς μετά την προσφυγή της στην τρόικα που υποστηρίζει ότι προωθεί μεταρρυθμίσεις για να κάνει τη χώρα αποτελεσματικότερη, με μεγαλύτερη διαφάνεια, πιο σύγχρονη και ανταγωνιστική, αλλά στην πραγματικότητα εισπράττει χρέη για λογαριασμό των βόρειων πιστωτών της χώρας.

Η Ελλάδα έπεσε στην 138η θέση της κατάταξης -ανάμεσα στο Μπανγκλαντές και τη Μοζαμβίκη- ακριβώς επειδή «έχασε τον έλεγχο» σε επίπεδο οικονομικής και νομισματικής πολιτικής, ενώ σε αυτό συνέβαλαν και τα capital controls που περιόρισαν ακόμη περισσότερο την οικονομική ελευθερία.

Η κατάσταση στην Ελλάδα και ο παγκόσμιος μέσος όρος

Η κατάσταση στην Ελλάδα και ο παγκόσμιος μέσος όρος

Σε πιο στενό γεωγραφικό επίπεδο, η Ελλάδα κατατάσσεται στην 41η θέση στην Ευρώπη, με δυνατό σημείο της την ελευθερία των εμπορικών συναλλαγών και αδύνατα σημεία τη διαχείριση των δημόσιων οικονομικών, τη διαφθορά και την αποτελεσματικότητα των ρυθμιστικών αρχών.

Η συνεχιζόμενη έλλειψη οικονομικής ελευθερίας έρχεται να προστεθεί στο πρόβλημα που αντιμετωπίζει η Ελλάδα με την ανταγωνιστικότητά της και στην πολιτική αστάθεια, επισημαίνει το Heritage, προσθέτοντας ότι πρέπει να γίνουν τολμηρά βήματα για να αποκατασταθεί η δημοσιονομική βιωσιμότητα, να γίνει ελαστικότερη η αγορά εργασίας και να αντιμετωπιστεί η διαφθορά.

Σημειώνεται ότι πρώτο στη σχετική λίστα έρχεται το Χονγκ Κονγκ, με τη δεκάδα να συμπληρώνουν η Σιγκαπούρη, η Νέα Ζηλανδία, η Ελβετία, η Αυστραλία, ο Καναδάς, η Χιλή, η Ιρλανδία, η Εσθονία και το Ηνωμένο Βασίλειο.

Όπως επισημαίνει σχετικά το Heritage Foundation, η Ευρώπη κατέστη λιγότερο ελεύθερη οικονομικά το 2015, με παράγοντες όπως το κόστος των κανονισμών εργασίας και οι υψηλές φορολογικές επιβαρύνσεις να πλήττουν την ανάπτυξη.

Το αξιοσημείωτο στον δείκτη του 2016 είναι αυτή ακριβώς η σοκαριστική διαπίστωση της «ανελευθερίας» που χαρακτηρίζει την Ευρωπαϊκή Ενωση, όπου σήμερα υπάρχει μία ελεύθερη ζώνη στα βόρεια, η οποία εκτείνεται γύρω από τη Βρετανία, την Ιρλανδία, την Ολλανδία και την περιοχή της Βόρειας Θάλασσας και της Βαλτικής, ενώ η Ελβετία βρίσκεται πάντα κοντά στην κορυφή αλλά ασφαλής από τα «νύχια» των Βρυξελλών και τη ρυθμιστική ασφυξία.

Κάπου μέσα σε αυτό το πρώτο μπλοκ βρίσκεται και η Γερμανία, η οποία βρίσκεται στην 18η θέση της παγκόσμιας κατάταξης.

Την ίδια στιγμή, υπάρχουν άλλες δύο «ομάδες» κρατών με σοβαρά προβλήματα: μία φτωχή ομάδα στα ανατολικά με εύθραυστο κράτος δικαίου και οι υπερχρεωμένες χώρες του ευρωπαϊκού Νότου που αντιμετωπίζουν σοβαρά οικονομικά προβλήματα.

Όπως φαίνεται από τον δείκτη οι χώρες της ΕΕ είναι κατά μέσον όρο λιγότερο ελεύθερες από άλλες χώρες με συγκρίσιμο κατά κεφαλήν εισόδημα και επίπεδο ανάπτυξης.

Το επιτυχημένο παράδειγμα της Βρετανίας

Η χώρα που φαίνεται να διαφοροποιείται εμφανώς είναι η Βρετανία, η οποία άφησε μάλιστα πίσω τις ΗΠΑ στον Παγκόσμιο Δείκτη Οικονομικής Ελευθερίας, κερδίζοντας τρεις θέσεις, με αποτέλεσμα να τερματίσει 10η παγκοσμίως. Η επιτυχία αυτή αποδίδεται στο γεγονός ότι η χώρα μείωσε τη φορολογία για τις επιχειρήσεις, ενώ η συνεισφορά του Δημοσίου στο ΑΕΠ συρρικνώνεται. Επιπλέον, στη Βρετανία είναι πολύ εύκολο να ιδρύσει κανείς μια νέα επιχείρηση και οι νόμοι που διέπουν τα εργασιακά είναι ελαστικοί.

Posted Φεβρουαρίου 4, 2016 by msofcrete in Uncategorized

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