Thursday, November 25, 2010

The War in Afghanistan s going NOWHERE!!

U.S. Afghan Presence Reaches Dubious Milestone
American-Led Coalition Now Fighting in Afghanistan For as Long as Soviets' Ill-Fated Slog: 9 Years, 50 Days
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The Soviet Union couldn't win in Afghanistan, and now the United States is about to have something in common with that futile campaign: nine years, 50 days.

On Friday, the U.S.-led coalition will have been fighting in this South Asian country for as long as the Soviets did in their humbling attempt to build up a socialist state. The two invasions had different goals - and dramatically different body counts - but whether they have significantly different outcomes remains to be seen.

What started out as a quick war on Oct. 7, 2001, by the U.S. and its allies to wipe out al Qaeda leader Osama bin Laden and the Taliban has instead turned into a long and slogging campaign. Now about 100,000 NATO troops are fighting a burgeoning insurgency while trying to support and cultivate a nascent democracy.

A Pentagon-led assessment released earlier this week described the progress made since the United States injected 30,000 more troops into Afghanistan earlier this year as fragile.

The top U.S. military commander in Afghanistan, Gen. David Petraeus, has said NATO's core objective is to ensure that Afghanistan "is never again a sanctuary to al Qaeda or other transnational extremists that it was prior to 9/11."

He said the only way to achieve that goal is "to help Afghanistan develop the ability to secure and govern itself. Now not to the levels of Switzerland in 10 years or less, but to a level that is good enough for Afghanistan."

To reach that, there is an ongoing effort to get the Taliban to the negotiating table. President Hamid Karzai has set up a committee to try to make peace, and the military hopes its campaign will help force the insurgents to seek a deal.

When the Soviet Union invaded Afghanistan on Dec. 27, 1979, its stated goal was to transform Afghanistan into a modern socialist state. The Soviets sought to prop up a communist regime that was facing a popular uprising, but left largely defeated on Feb. 15, 1989.

In 1992, the pro-Moscow government of Mohammad Najibullah collapsed and U.S.-backed rebels took power. The Taliban eventually seized Kabul after a violent civil war that killed thousands more. It ruled with a strict interpretation of Islamic law until it was ousted by the U.S.-led invasion.

Nader Nadery, an Afghan analyst who has studied the Soviet and U.S. invasions, said "the time may be the same" for the two conflicts, "but conditions are not similar."

More than a million civilians died as Soviet forces propping up the government of Babrak Karmal waged a massive war against anti-communist mujahedeen forces.

"There was indiscriminate mass bombardment of villages for the eviction of mujahedeen," Nadery said. "Civilian casualties are not at all comparable."

Michael O'Hanlon, a senior fellow at the Brookings Institution think tank and Afghanistan expert, said NATO forces have killed fewer than 10,000 civilians and a comparable number of insurgents.

The allied military presence has also been far smaller and more targeted. Even now, nearly all operations are restricted to the south and east of the country where the insurgency is most active. O'Hanlon points out that at the height of the resistance, there were 250,000 mujahedeen representing all Afghan ethnic groups fighting the Soviets, while "the current insurgency is perhaps one-eighth as large and is only Pashtun."

"We do have big problems. But there is no comparison between this war and what the Soviets wrought," he said.

"The Soviet war set Afghanistan back dramatically from what had been a weak but functioning state. NATO has, by contrast, helped Afghanistan to a 10 percent annual economic growth rate, 7 million kids are now in school, and most people have access to basic health care within a two-hour walk," O'Hanlon said.

He also points out that although Karzai was hand-picked by the United States after the invasion "he has since been elected twice by his own people."

The United States and its allies, however, have made strategic mistakes, including taking their eyes off Afghanistan and shifting their attention to the war in Iraq. In those crucial years, the Taliban and their allies surged back and took control of many parts of the Afghan countryside and some regions in the south - especially parts of Kandahar and Helmand.

Wadir Safi, a professor at Kabul University who served as civil aviation minister under the Najibullah government, said risks surround the U.S. effort because "the Americans never reached the goal for which they came."

"If they don't change their policy, if they don't reach their goals, if they don't reach agreement with the armed opposition and with the government, then it is not a far time that the Afghan people will be fed up with the presence of these foreign forces," Safi said.

The United States has pledged that its commitment to Afghanistan will run past the 2014 date when NATO forces are supposed to transition to a noncombat role.

A Russian analyst said the Soviet Union tried to do something similar when it left Afghanistan. It backed Najibullah with money and weapons, and left behind a trained and heavily armed Afghan military. But it all crumbled and the mujahedeen took over Kabul in 1992. Najibullah stayed in the city's U.N. compound until Kabul fell to the Taliban in 1996, and he was hung from the main square.

"The Soviet Union tried to leave its protege alone to run the country, but that ended in the Taliban victory," said Alexander Konovalov, the head of the Moscow-based Institute of Strategic Assessment, an independent think-tank.

"The U.S. now wants to create a self-sufficient structure behind backed by some support forces," he said. "It remains to be seen how successful it could be in Afghanistan."

aerobics and resistance training may provide health benefits for diabetics

The one-two punch of aerobics and resistance training may provide the most health benefits for diabetics

Yet more support for the combination of aerobic and resistance training exercise: A new study released Tuesday in the Journal of the American Medical Assn. finds that combining the two was good for blood sugar levels in people with Type 2 diabetes, more than those who did not exercise or who did just aerobics or resistance training.

The study participants were made up of 262 sedentary men and women who had Type 2 diabetes and hemoglobin A1C levels of at least 6.5%. A1C levels are a measure of blood glucose over a two- to three-month period, and 4% to 6% is considered a normal range.

The men and women, average age about 56, were divided into three groups for the nine-month study: one that did resistance training, one that did aerobic training, one that did both, and a control group that did not do any exercise. Those in the exercise groups worked out for about 140 minutes per week.

The combination exercise group lowered its hemoglobin A1C levels minus 0.34% compared with the control group. The resistance and aerobic training groups showed less significant change; minus 0.16% and minus 0.24% respectively, compared with controls. Those in the combination group also lowered their hypoglycemic medications more than the other groups. Even small decreases in A1C levels may result in health risk reductions.

The participants in the combination exercise group showed even more improvements: They had the greatest increases in peak oxygen intake (a measure of fitness) and lost the most weight, compared with controls.

"Despite a population with many medical concerns," wrote the authors, "we obtained good exercise adherence and a low dropout rate. Furthermore, the exercise prescriptions performed are easily obtainable and well tolerated by individuals with diabetes, which has important implications for refining future physical activity recommendations."

Copyright © 2010, Los Angeles Times

What Murkowski's write-in win says about the electorate David S. Broder

If you have any doubts about the real meaning of this month's midterm elections, let me refer you to the most notable winner in those contests. I am talking about Lisa Murkowski, the reelected senator from Alaska.

The distinctive feature of the 2010 election was the energy generated among the voters by the combination of a severe economic recession and the widespread disillusionment with Washington and national politics as practiced by Barack Obama and both parties.

Murkowski was the most notable winner of the whole cycle because she was first a victim and then a victor. She is also the first person elected to the Senate as an independent write-in candidate since Strom Thurmond harnessed the racist forces in South Carolina in 1954 to win his seat.

The Murkowski saga began in the summer when she was upset in the Alaska Republican primary by Joe Miller, an attorney who had campaigned as the endorsed choice of the Tea Party and former Alaska governor Sarah Palin, the 2008 GOP vice presidential candidate.

Palin has conducted a vendetta against the Murkowski family, and she became governor four years ago by upsetting Lisa's father, Frank Murkowski, in another low-turnout GOP primary.

Before he left office, Frank Murkowski appointed Lisa to a vacant Republican Senate seat only to see her lose the nomination this year.

When she lost the primary, that was expected to be the end of her. Miller settled in for an easy race against a little-known Democrat in his Republican-leaning state. But Murkowski, with some notable help from anti-Palin elements and parts of the energy industry, decided to try a long-shot write-in campaign.

It is difficult under any circumstances. With the state's rather restrictive voter-identification system and the requirement of a 13-letter, five-syllable name to be correctly spelled, the chances of success seemed small.

When Murkowski was asked recently by reporter Judy Woodruff on the PBS "NewsHour" how she had overcome Palin's endorsement of Miller to win, this is what she said:

"It is historic. It feels great." She exulted that more than 100,000 Alaskans had written in her name and that her 10,000-vote margin over Miller was so large that even if all the votes he has challenged were thrown out, she would still win by more than 2,000 votes. Under the circumstances, Miller's delay in conceding has no purpose, she said.

Then Woodruff asked what explained the outcome. Murkowski said, "Well, in an election, it's all about what that candidate has to offer. Joe Miller was clearly appealing to that more conservative element. But, in our state, we have got over 54 percent of the electorate that chooses not to align themselves with any party at all, not Republican, not Democratic, not green, not anything.

"And, so, it was important to make sure that all Alaskans, regardless of your political stripe, felt that they had somebody who's going to represent their best interests. I think that's what this election was about. They wanted somebody who was going to be a consensus-builder, someone that was going to work to bring people together to really work to effectively govern."

The demographics required that Murkowski seek support from Democrats and independents, as well as Republicans. But she said their expectations did not differ from group to group. "I think what they are looking for is the same thing that any Alaskan is looking for: Represent our state. Work together with people that have opposing viewpoints to build good policy that allows our state and our nation to go in a positive direction.

"I think that's what voters are looking for. I don't think that most are looking for somebody that is going to follow the litmus test of one party or another, and never deviate from it. I think they want us to think, and I think they want us to work cooperatively together. So, that's my pledge to all Alaskans, regardless of whether you are the most conservative Republican or the most liberal Democrat, I'm going to try to find a way that we can find common ground to help the state and to help our country."

Want to know what the election was about? That's an authoritative answer.


Pat-Down Protests Fizzle

Hope you didn’t cancel your Thanksgiving travel plans because of the TSA pat-down protest. Holiday travelers reported late Wednesday that travel had mostly gone off without a hitch, with few protests despite the earlier hype about a shutdown.

In fact, one of the biggest travel delays on the East Coast was not at the airport, but at Interstate 95 in Delaware, where construction at a toll plaza backed up traffic so much the state stopped collecting tolls. At airports, passengers reported delays similar to regular work days.

There was, however, one protester at Reagan National Airport in Washington, D.C.—a 27-year-old college student who said he was “probably going to put on some terrorist watch list now” after his protest.

Study Finds No Progress in Safety at Hospitals (USA health care is for the Wealthy & Healthy)

Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.

“It is unlikely that other regions of the country have fared better,” said Dr. Christopher P. Landrigan, the lead author of the study and an assistant professor at Harvard Medical School. The study is being published on Thursday in The New England Journal of Medicine.

It is one of the most rigorous efforts to collect data about patient safety since a landmark report in 1999 found that medical mistakes caused as many as 98,000 deaths and more than one million injuries a year in the United States. That report, by the Institute of Medicine, an independent group that advises the government on health matters, led to a national movement to reduce errors and make hospital stays less hazardous to patients’ health.

Among the preventable problems that Dr. Landrigan’s team identified were severe bleeding during an operation, serious breathing trouble caused by a procedure that was performed incorrectly, a fall that dislocated a patient’s hip and damaged a nerve, and vaginal cuts caused by a vacuum device used to help deliver a baby.

Dr. Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.

But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.

The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.

“Until there is a more coordinated effort to implement those strategies proven beneficial, I think that progress in patient safety will be very slow,” he said.

An expert on hospital safety who was not associated with the study said the findings were a warning for the patient-safety movement. “We need to do more, and to do it more quickly,” said the expert, Dr. Robert M. Wachter, the chief of hospital medicine at the University of California, San Francisco.

A recent government report found similar results, saying that in October 2008, 13.5 percent of Medicare beneficiaries — 134,000 patients — experienced “adverse events” during hospital stays. The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year. And in 1.5 percent of the patients — 15,000 in the month studied — medical mistakes contributed to their deaths. That report, issued this month by the inspector general of the Department of Health and Human Services, was based on a sample of Medicare records from patients discharged from hospitals.

Dr. Landrigan’s study reviewed the records of 2,341 patients admitted to 10 hospitals — in both urban and rural areas and involving large and small medical centers. (The hospitals were not named.) The researchers used a “trigger tool,” a list of 54 red flags that indicated something could have gone wrong. They included drugs used only to reverse an overdose, the presence of bedsores or the patient’s readmission to the hospital within 30 days.

The researchers found 588 instances in which a patient was harmed by medical care, or 25.1 injuries per 100 admissions.

Not all the problems were serious. Most were temporary and treatable, like a bout with severe low blood sugar from receiving too much insulin or a urinary infection caused by a catheter. But 42.7 percent of them required extra time in the hospital for treatment of problems like an infected surgical incision.

In 2.9 percent of the cases, patients suffered a permanent injury — brain damage from a stroke that could have been prevented after an operation, for example. A little more than 8 percent of the problems were life-threatening, like severe bleeding during surgery. And 2.4 percent of them caused or contributed to a patient’s death — like bleeding and organ failure after surgery.

Medication errors caused problems in 162 cases. Computerized systems for ordering drugs can cut such mistakes by up to 80 percent, Dr. Landrigan said. But only 17 percent of hospitals have such systems.

For the most part, the reporting of medical errors or harm to patients is voluntary, and that “vastly underestimates the frequency of errors and injuries that occur,” Dr. Landrigan said.

“We need a monitoring system that is mandatory,” he said. “There has to be some mechanism for federal-level reporting, where hospitals across the country are held to it.”

Dr. Mark R. Chassin, president of the Joint Commission, which accredits hospitals, cautioned that the study was limited by its list of “triggers.” If a hospital had performed a completely unnecessary operation, but had done it well, the study would not have uncovered it, he said. Similarly, he said, the study would not have found areas where many hospitals have made progress, such as in making sure that patients who had heart attacks or heart failure were sent home with the right medicines.

The bottom line, he said, “is that preventable complications are way too frequent in American health care, and “it’s not a problem we’re going to get rid of in six months or a year.”

Dr. Wachter said the study made clear the difficulty in improving patients’ safety.

“Process changes, like a new computer system or the use of a checklist, may help a bit,” he said, “but if they are not embedded in a system in which the providers are engaged in safety efforts, educated about how to identify safety hazards and fix them, and have a culture of strong communication and teamwork, progress may be painfully slow.”

Leah Binder, the chief executive officer of the Leapfrog Group, a patient safety organization whose members include large employers trying to improve health care, said it was essential that hospitals be more open about reporting problems.

“What we know works in a general sense is a competitive open market where consumers can compare providers and services,” she said. “Right now you ought to be able to know the infection rate of every hospital in your community.”

For hospitals with poor scores, there should be consequences, Ms. Binder said: “And the consequences need to be the feet of the American public.”

Netflix’s Move Onto the Web Stirs Rivalries

In a matter of months, the movie delivery company Netflix has gone from being the fastest-growing first-class mail customer of the United States Postal Service to the biggest source of streaming Web traffic in North America during peak evening hours.

That transformation — from a mail-order business to a technology company — is revolutionizing the way millions of people watch television, but it’s also proving to be a big headache for TV providers and movie studios, which increasingly see Netflix as a competitive threat, even as they sell Netflix their content.

The dilemma for Hollywood was neatly spelled out in a Netflix announcement Monday of a new subscription service: $7.99 a month for unlimited downloads of movies and television shows, compared with $19.99 a month for a plan that allows the subscriber to have three discs out at a time, sent through the mail, plus unlimited downloads. For studios that only a few years ago were selling new DVDs for $30, that represents a huge drop in profits.

“Right now, Netflix is a distribution platform, and has very little competition, but that’s changing,” said Warren N. Lieberfarb, a consultant who played a critical role in creating the DVD while at Warner Brothers.

For the first time, the company will spend more over the holidays to stream movies than to ship DVDs in its familiar red envelopes (although it is still spending more than half a billion dollars on postage this year). And that shift coincides with an ominous development for cable companies, which long controlled home entertainment:
for the first time in their history, cable television subscriptions fell in the United States in the last two quarters — a trend some attribute to the rise of Netflix, which allows consumers to bypass their cable box to stream movies and shows.

Netflix now has the frothy stock price to show for its success. The stock has enjoyed a Google-like rise, nearly quadrupling from its 52-week low in January, and with a market value of nearly $10 billion, Netflix is now worth more than some of the Hollywood studios that license movies to it.

In some ways, the closest parallel as a one-stop digital marketplace is iTunes, the Apple service that has put itself at the center of the digital world and has used that power to demand concessions from its suppliers.

“How did Hollywood end up supplying Netflix in the first place, particularly a product that was given to them on a flat-rate, wholesale basis?” said Jonathan A. Knee, a media investment banker and co-author of “The Curse of the Mogul.”

As recently as a few years ago, Netflix didn’t look like a case study in success: if anything, it seemed to be just the latest media company destined to be run over by technology.

From the company’s beginning in 1997, Reed Hastings, the chief executive and co-founder, had always thought of Netflix as an entertainment distribution service rather than a mail-order company, and by 2000, the company was experimenting with delivering movies over the Internet. In 2003, Netflix came up with a hardware solution, a $300 hard drive that would download films. But slow speeds — it could take six to eight hours to download a feature length film — doomed that effort. (Mr. Hastings declined to be interviewed for this article.)

But the advent of streaming — watching video in real time as opposed to downloading — gained prominence in 2005 with the explosive success of YouTube. Mr. Hastings decided that software, not hardware, was the key to delivering films over the Internet and pushed to develop high-quality streaming technology. Pricing remained an issue, however, and in a move that gave Netflix a big head start, the company decided to give the service away to existing mail-order customers.

Netflix now has more than 16 million subscribers. The company does not release figures on the most popular films or television shows streamed, but as a general rule, films that can be streamed instantly are not fresh out of theaters or plucked from the current TV season. People who want to relive past seasons of “The Office” can do so instantly, but if they are looking for the current season — or any season of “Mad Men” — they are out of luck.

“We are very proud to announce that by every measure we are now a streaming company, which also offers DVD-by-mail,” Mr. Hastings recently told Wall Street analysts.

Just as important, Netflix arrived with an open checkbook at a time when the film industry’s main source of profits, the sale of DVDs, was plummeting.

“As the home entertainment industry comes under pressure, they are the only guy standing there in a red shirt writing checks,” said Rich Greenfield, an analyst at BTIG Research. “That makes Netflix really unique right now.”

The biggest check came a few months ago, when the company spent nearly $1 billion to stream movies from three Hollywood studios — Paramount, MGM and Lionsgate.

Steve Swasey, the company’s vice president for communications, said, “As we move from paying U.S. postage to acquiring movies and television episodes from the studios and networks, Netflix can become one of their top customers.”

But digital economics can be much less lucrative to content companies. For example, under the terms of Netflix’s deal with Starz, the pay-TV channel, which allows Netflix to stream movies from Sony and Disney, Netflix pays about 15 cents a month for each subscriber, much less than the $4 to $5 a month that cable and satellite owners pay for access to Starz, according to research by Mr. Greenfield.

For that reason, Netflix is increasingly viewed as a threat by cable companies and movie studios, who are considering a variety of ways to put the brakes on the company’s growth.

For example, big media companies like Time Warner are moving quickly to offer their own streaming products. Studios have pushed back on release dates, requiring Netflix to wait through a window of 28 days while studios pushed more expensive and lucrative sales of the DVD and on-demand versions on cable.

And the studios are positioning themselves to demand more money in future negotiations over streaming rights, especially next year when Netflix’s deal with Starz expires.

“Though already a significant customer, they’ve grown faster than anyone anticipated, and going forward we expect the economics to improve significantly," said John Calkins, executive vice president of digital and commercial innovation at Sony Pictures Home Entertainment.

For now, Netflix has become a barometer of the apparently voracious consumer appetite for streaming movies: a recent study by Sandvine, a broadband equipment maker, showed that Netflix, surprisingly, accounted for more than 20 percent of all Internet download traffic in North America in peak evening hours.

“Netflix used an open-source network, the U.S. Postal Service, to launch an alternative distribution business without asking anyone for permission,” said Tim Wu, a Columbia University law professor and author of “The Master Switch: The Rise and Fall of Information Empires.” “Now they are using another open-source network, the Internet, to transform the business. It is much easier for Netflix to change, because they don’t have to undergo a kind of religious conversion like media companies will have to.”