White House Physician Details Trump’s ‘Excellent Health’


President’s cognition fine, but weight and cholesterol are problems

WASHINGTON — White House physician Ronny Jackson, MD, a rear admiral in the Navy, said President Trump’s overall health is “excellent,” and that the president aced a cognitive screening, during a press briefing on Tuesday.

“All clinical data indicates that the president is currently very healthy and that he will remain so for the duration of his presidency,” Jackson said, while releasing a summary of medical tests he conducted last week.

The 71-year-old president received his first annual physical as commander-in-chief at Walter Reed Medical Center on Friday. The full exam lasted about 4 hours and included 12 consultants.

Jackson described the president’s cardiac performance as “very good” owing to a lifetime of abstaining from alcohol and tobacco. He also reported that Trump did receive a cognitive assessment, showing no impairment.

The president weighs 239 lbs and his height is 6’3″, Jackson said.

The president currently takes rosuvastatin (Crestor) at 10 mg/day to lower his cholesterol, low-dose aspirin for his cardiac health, and Propecia to prevent male pattern baldness. He also uses a cream for his rosacea, as needed, and takes a daily multivitamin, Jackson said.

Trump’s resting heart rate was 68; his blood pressure 122/74 and his heart exam overall was “normal.” Jackson reported a “regular rhythm, no murmurs or other abnormal heart sounds” and his ECG was also “normal” with a sinus rhythm rate of 71 at a normal axis.

 His total cholesterol was reported as 223; triglycerides 129; HDL 67; and LDL 143. Hemoglobin A1c was 5%. Trump’s uncorrected visual acuity was 20/30 and his thyroid function was reported as normal.

Trump received a transthoracic echocardiogram which showed an ejection fraction of 60%-65% which Jackson also described as “normal.” There were no signs of ischemia.

Christopher Cannon, MD, a cardiologist at Brigham and Women’s Hospital in Boston, said a standard risk calculator shows Trump with a 16.7% risk of a heart attack or other atherosclerotic cardiovascular disease event in the next 10 years.

That estimate is based on the age, lipid values, blood pressure, and other risk factors described at the briefing, using the American Heart Association/American College of Cardiology risk calculator.

That score is “pretty high, actually,” Cannon told MedPage Today. AHA/ACC guidelines would suggest Trump’s cholesterol needs attention, with a more intensive statin typically recommended for a risk profile like his.

 Jackson essentially concurred, reporting plans to make changes in the president’s diet, exercise, and drug regimes to address his major risk factors.

He said he would connect the White House chef with a nutritionist, because he believes the president would benefit from a diet lower in carbohydrates and fats. He also recommended that Trump begin an exercise regime, something “low impact” such as riding a stationary bike or riding a treadmill.

Trump agreed to a goal of losing weight, about 10-15 lbs, Jackson said, adding that he is raising Trump’s rosuvastatin dose “in order to further reduce his cholesterol level and further decrease his cardiac risk.”

“He’s more enthusiastic about the diet part than the exercise part,” Jackson said of the president.

White House spokesman Hogan Gidley said last week that the president’s physical would not include a psychiatric examination, and Jackson said he didn’t think a cognitive exam was clinically indicated, based on his previous interactions with Trump. But he said the president insisted on having a cognitive assessment. (Cognitive and psychiatric assessments are different, Jackson noted.)

Jackson chose the Montreal Cognitive Assessment and the president scored 30 out of 30.

“I’ve spent almost every day in the president’s presence since Jan. 20 … you know last year … I see him one, two, sometimes three times a day, because of the location of my office … I’ve got to know him pretty well and I have absolutely no concerns about his cognitive ability or his neurological function,” he said.

“The reason that we did the cognitive assessment is plain and simple, because the president asked me to do it,” Jackson added.

Prior to the visit a discussion over whether the exam should include a psychiatric or cognitive component, played out online and in the media, after it was reported that the president had been forgetting friends’ names and repeating stories.

Publicly sharing the details of a president’s physical exam is not unprecedented, noted ABC NewsWhen Jackson served under former President Barack Obama, Jackson shared a “detailed summary” of his medical assessment including the then president’s vitals, and a lengthy account of physical tests and laboratory results.

They Can See a ‘Stick of Butter from Space’ — The Billion Dollar Spy Agency You’ve Never Heard Of


While most Americans would consider the CIA, and perhaps the NSA, household names, one U.S. spy agency — whose headquarters surpasses the U.S. Capitol in size — has managed to keep to the shadows while possessing cutting edge tools of the surveillance trade.

Called the  National Geospatial-Intelligence Agency (NGA), even former President Barack Obama didn’t know of its existence when he first took officedespite that the agency employs some 15,400 people.

“So, what do you [do]?” Obama asked a customer at a Washington, D.C., Five Guys hamburgers in May 2009.

“I work at NGA, National Geospatial-Intelligence Agency,” he answered.

 “Outstanding,” then-president Obama asserted. “How long have you been doing that?”

“Six years.”

“So, explain to me exactly what this National Geospatial …” Obama asked, unable to recall the agency’s full name.

Timidly, the man replied, “Uh, we work with, uh, satellite imagery.”

“Obama appeared dumbfounded,” Foreign Policy’s James Bamford reports. “Eight years after that videotape aired, the NGA remains by far the most shadowy member of the Big Five spy agencies, which include the CIA and the National Security Agency.”

The NGA’s secretive identity belies the agency’s massive physical size and the scope of its surveillance activities, as Bamford continues,

“Completed in 2011 at a cost of $1.4 billion, the main building measures four football fields long and covers as much ground as two aircraft carriers. In 2016, the agency purchased 99 acres in St. Louis to construct additional buildings at a cost of $1.75 billion to accommodate the growing workforce, with 3,000 employees already in the city.

“The NGA is to pictures what the NSA is to voices. Its principal function is to analyze the billions of images and miles of video captured by drones in the Middle East and spy satellites circling the globe. But because it has largely kept its ultra-high-resolution cameras pointed away from the United States, according to a variety of studies, the agency has never been involved in domestic spy scandals like its two far more famous siblings, the CIA and the NSA. However, there’s reason to believe that this will change under President Donald Trump.”

Originally tasked primarily with cartography — before a mammoth expansion, the spy arm had been called the National Imagery and Mapping Agency — until a name and mission switch in 2003 gave the National Geospatial-Intelligence Agency its name, with the hyphen allowing a three-letter acronym so enamored by the government.

President Dwight D. Eisenhower, whose fondness for imagery intelligence became known when he served as a general during World War II, created the National Photographic Interpretation Center shortly before leaving office — an agency also later absorbed by the NGA.

Now, the NGA works in conjunction with the U.S. Air Force to analyze the staggering amount of data collected through aerial surveillance abroad — mostly by unmanned aerial systems, such as drones with high-powered cameras.

According to at least one source, as of 2013, the NGA was integral in the analysis of surveillance data pertaining to Iran’s nuclear capabilities.

Revelations on the depth and breadth of the Central Intelligence Agency’s domestic capabilities, long believed out of its territory, was exposed by Wikileaks Vault 7 recently to be on par with National Security Agency programs — so much so, analysts say it constitutes a duplicate Big Brother.

Data provided to the NGA by military officials has assisted in various U.S. operations in the Middle East by tracking vehicles believed responsible for planting improvised explosive devices, or IEDs, and for monitoring hot spots for insurgent breakouts.

But the NGA hardly only keeps to support operations, as David Brown — author of the book, “Deep State: Inside the Government Secrecy Industry” — explained,

“Before the trigger was pulled on NEPTUNE’S SPEAR, the mission to kill Osama Bin Laden, SEAL Team Six had access to a perfect replica of the Abbottabad compound where the terrorist mastermind was hiding. The details for the replica were gathered by the NGA, which used laser radar and imagery to construct a 3D rendering of the compound. How precise were its measurements and analysis? The NGA figured out how many people lived at the compound, their gender, and even their heights. But the NGA didn’t stop there: Its calculations also helped the pilots of the stealth Black Hawks know precisely where to land.”

With a combined budget request for 2017 of $70.3 billion, the National and Military Intelligence Programs — NGA falls under the latter — have seen a quickening of support from the authoritarian-leaning, pro-military Trump administration. This and additional factors — such as the astonishingly sophisticated equipment at the agency’s disposal — have ignited fears the NGA could be granted authority to bring its expert microscope into focus against the American people.

“While most of the technological capacities are classified, an anonymous NGA analyst told media the agency can determine the structure of buildings and objects from a distance, has some of the most sophisticated facial recognition software on the planet and uses sensors on satellites and drones that can see through thick clouds for ‘all-weather’ imagery analysis,” reports news.com.au.

Efforts to bolster NGA’s innovate staff pool ratcheted up on Thursday, as Business Wire reported,

“From navigating a U.S. aircraft to making national policy decisions, to responding to natural disasters: today’s U.S. armed forces rely on Geospatial Intelligence (GEOINT) to meet mission requirements. As the nation’s primary source of GEOINT for the Department of Defense and the U.S. Intelligence Community, the National Geospatial-Intelligence Agency (NGA) depends on the National Geospatial-Intelligence College (NGC) to produce top-tier talent to deliver intelligence with a decisive advantage. Today, Booz Allen Hamilton (BAH) announced that it has been awarded a five-year, $86 million contract by NGA-NGC to lead the Learning Management and Advancement Program (LMAP) that will provide high-quality learning solutions to equip a diverse workforce with the knowledge and skills necessary to meet current and future GEOINT mission requirements.”

Bamford points out for Foreign Policy the Trump administration intimated a significant expansion of spying on mosques and Islamic centers, while others admonish said surveillance could put Black Lives Matter and other protest groups in the NGA’s silent crosshairs.

Of distinct concern for privacy advocates are drones with uncanny zooming capabilities — features used against U.S. citizens before. Bamford continues,

“In 2016, unbeknownst to many city officials, police in Baltimore began conducting persistent aerial surveillance using a system developed for military use in Iraq. Few civilians have any idea how advanced these military eye-in-the-sky drones have become. Among them is ARGUS-IS, the world’s highest-resolution camera with 1.8 billion pixels. Invisible from the ground at nearly four miles in the air, it uses a technology known as ‘persistent stare’ — the equivalent of 100 Predator drones peering down at a medium-size city at once — to track everything that moves.

“With the capability to watch an area of 10 or even 15 square miles at a time, it would take just two drones hovering over Manhattan to continuously observe and follow all outdoor human activity, night and day. It can zoom in on an object as small as a stick of butter on a plate and store up to 1 million terabytes of data a day. That capacity would allow analysts to look back in time over days, weeks, or months. Technology is in the works to enable drones to remain aloft for years at a time.”

With cutting edge technology, a rapid enlargement underway, and billions in budgetary funds at the ready, the National Geospatial-Intelligence Agency is the cloaked, mute sibling of the nefarious Intelligence Community — but it’s time to pull the protective shell off this potential ticking time bomb before reining it in becomes an impossibility.

Source:http://thefreethoughtproject.com

 

THIS is Why Genius Minds Always Wear The Same Clothes.


A human being is capable of processing about 70 gigabytes of information daily.Shocking huh?! Intelligent people who can use a higher percentage of their brain are known to consume a lot of information, which ultimately causes Option Fatigue. They get tired, and it hampers their decision-making power.

Steve Jobs

And it’s the main reason why the majority of intelligent and genius individuals – who are known to create history in the world through their many smart inventions – wear the same types of clothes every day.

GENIUS AND THEIR SAME CLOTHES

A neuroscientist and a cognitive psychologist, Daniel Levitin, shares that information overload takes place when humans process way too much information than their brain’s potential to consume.

Steve Jobs Wears Same Clothes

He further says that most humans think they are capable of paying attention simultaneously to nine things.

But this is not right. The conscious mind is capable of focusing on three things at a stretch. And when we start handling more than three things at once, we tend to deprive our mental prowess. This is the reason behind the geniuses of the world wearing the same clothes every single day – from Albert Einstein, Mark Zuckerberg to Steve Jobs and Barack Obama.

Steve Jobs wore the black turtleneck, Albert Einstein his gray suit and Mark Zuckerberg wears a gray t-shirt.

MARK ZUCKERBERG AND BARACK OBAMA

In one interview – Mark Zuckerberg – said that he organizes his life so that his decision-making power is reliable. Thus, he wears the same type of clothes every day, so that he does not have to worry about social issues or obligations. In a Vanity Fair interview in 2012 Barack Obama said that he wears either blue or gray suits.

Mark Zuckerberg

It helps him to reduce his decision-making tasks. He also shared that he does not want to worry about making decisions related to the things he eats or what he wears – as he has way too many important decisions to make in life as the President of America.

Albert Einstein

SMART USE OF OUR BRAIN

Our mind makes use of nutrients and energy in the same proximity as it uses to make vital decisions in life.

Most of the time, we make our mind worry about things that do not make any difference in our life. And when we have to make little decisions, our brain is too tired to do so. Therefore, it is necessary to make smart use of our brain.

Obama

Every human being has the same type of brain with similar strength and potential. However, only a few make smart use of their brain by focusing their energy on things that matter. So, wearing the same clothes deduces decisions and allows us to put our focus on things in life that will make a difference and help us to grow – professionally and personally!

Source:http://www.truthinsideofyou.org

Paper in a Top Medical Journal Has Unexpected Author: Barack Obama


In an unusual move for a sitting president, Barack Obama has published a scholarly paper in a scientific journal.

The paper, which discusses the success and future of the Affordable Care Act (ACA), was published Monday (July 11) in the prestigious medical journal JAMA.

It may be the first time a sitting president has authored a complete academic article — with an abstract, findings and conclusions  — that’s been published in a scientific journal, at least in recent history. However, several other presidents have written commentaries or opinion pieces that have been published in scientific journals during their presidency, including George W. Bush, who wrote about access to health care in a paper published inJAMA in 2004, and Bill Clinton, who wrote a commentary published in the journal Science in 1997.

CDC approves Vitamin D-Nial drug to halt spread of Ebola .


We’re saved! The CDC has now partnered with the FDA to approve a new medical treatment for Ebola, guaranteed to offer 100% protection against the coming pandemic. The new anti-Ebola drug is called “Vitamin D-Nial” and will be offered free of charge at all voting booths on November 4.

CDC director Thomas Frieden held a well-attended press conference this morning, announcing that “When it comes to Ebola, D-Nial is the answer!” He also promised to send thousands of CDC agents into the field, “armed with D-Nial” to halt the perception of the pandemic.

When asked why a CDC employee called “clipboard man” was recently seen walking around the airport tarmac right next to an infected Ebola patient surrounded by medical staffers in hazmat suits, Dr. Frieden simply answered that “D-Nial is the only Ebola protection anyone really needs.”

D-Nial is the answer to Ebola hysteria

Upon seeing the CDC’s astounding news, media outlets such as the New York Times immediately followed with front-page headlines like, “D-Nial is Answer to Ebola Hysteria!” and “America cheers for D-Nial!”

While taking credit for providing the research funding that resulted in the commercialization of D-Nial, the NIH also complained about the small size of its multi-billion-dollar budget which is sadly only larger than 153 world nations. “If we had been granted another billion dollars in research funding earlier,” NIH spokesperson Dr. Fauci explained, “We all could have achieved the power of D-Nial far sooner.”

In honoring the invention of Vitamin D-Nial, President Obama announced a plan to cover the drug free of charge for all Obamacare participants, calling it the “Obamacare Health Insurance D-Nial Plan.”

Offering further praise of D-Nial, President Barack Obama signed an executive order this morning declaring the month of November, 2014 to be “D-Nial Month.” During this month, the President said, “Americans should celebrate the power of D-Nial and the brilliant people who came up with it.” A Nobel Prize in Science is expected to be awarded, shortly after President Obama bombs another country or two in honor of the Nobel Peace Prize.

Vitamin D-Nial is administered rectally

Vitamin D-Nial is unfortunately administered rectally, but former TSA agents have been hired by Walgreens and CVS to deliver the medicine with experience and precision. The CDC is now preparing to plaster retail pharmacies with posters that declare, “Bend over for public health! Your dose of D-Nial is ready!”

Other patriotic posters in the planning stages will depict a line of smiling Americans bent over at the hips, saluting to the Con-mander in Chief while receiving their mandated doses, accompanied by the slogan, “My D-Nial saved my baby” and “When it comes to public health, nothing works as good as D-Nial.”

D-Nial might also work on superbugs

The inventors of D-Nial, a team of brilliant Big Pharma researchers who also invented ADHD and other fictional diseases, is now hopeful that D-Nial can be applied to many other potential health care challenges of our time.

“We think that D-Nial might also work to solve the problem of superbugs spreading through U.S. hospitals due to the medical abuse of antibiotics,” the researchers stated. “D-Nial has already proven itself to be such a powerful component of modern medicine that we see a wealth of applications across the industry.”

Vitamin D-Nial now takes its place among extraordinary government-funded medical discoveries such as the now-famous “Vitamin C Something Say Something” medicine invented by President Obama’s paranoia ministers.

A similar medical discovery expected to be announced later this year is reportedly called “Vitamin B Afraid of ISIS” whose sales will help fund the endless U.S. war effort against imaginary enemies that are used to frighten the American public into supporting a military surveillance state.

When it comes to solving problems with drugs, nothing beats government ingenuity. Because when times get tough, the one thing all U.S. government leaders have learned and mastered is that D-Nial is always the answer

Meet the BATKID.


Thousands of people in San Francisco have turned out to help a boy recovering from leukaemia fulfil his wish to be Batman for a day.

Miles Scott, five, participated in events across the city including fighting mock crimes and receiving an honour from the mayor.

Make-A-Wish Foundation, which organised the event, received pledges from more than 10,000 people to lend a hand.

Miles, in treatment for several years, is now said to be in remission.

According to local television, the youngster thought he was just on his way to get a Batman costume so he could dress like his favourite superhero.

Miles nabs villains

But then he heard a broadcast from San Francisco Police Chief Greg Suhr appealing for help from “Batkid”.

“Start Quote

This wish has meant closure for our family and an end to over three years of putting toxic drugs in our son’s body”

Natalie Miles’ mother

Next, the pint-sized superhero saved a “damsel in distress”, tied to cable car tracks along a major urban street.

A San Francisco Chronicle live blog of the day’s events showed hundreds of people cheering Miles on during the “rescue”.

Miles was ferried from events in one of two “Batmobiles“, or black Lamborghinis with Batman removable stickers, which were escorted by police.

Later, he foiled a faux robbery in the city’s financial district with the help of an adult Batman impersonator.

Authorities who participated in the day’s events pretended to apprehend the villain, the Riddler.

Miles also travelled to AT&T Park to rescue the San Francisco Giants baseball team mascot by disarming a fake bomb planted by another classic Batman baddie, the Penguin.

‘Military operation’

The US justice department even prepared an indictment for the Riddler and the Penguin.

Miles Scott in an undated photo
Miles Scott is now in remission following treatment for leukaemia

Towards the end of the day San Francisco Mayor Ed Lee gave Miles a key to the city.

US President Barack Obama praised the mini-caped crusader in a video from the White House, saying: “Way to go, Miles! Way to save Gotham.”

An estimated 7,000 people turned up to help make Miles’ wish come true.

The Make-A-Wish Foundation said the event was “on the scale of a military operation”.

In real life, Miles has defeated an enemy even more ruthless than Batman’s nemeses – he is presently recovering from leukaemia, with which he was diagnosed at 18 months old.

His mother, Natalie, said Friday was a “celebration” of her son’s completion of treatment in June.

“This wish has meant closure for our family and an end to over three years of putting toxic drugs in our son’s body,” she wrote in a statement on the foundation’s website.

His father, Nick Scott, thanked the charity and everyone else who took part.

“All the doctors, nurses and all the other parents that have to deal with the same thing we’re going through, I hope they get a conclusion to their illnesses like we’re getting,” he told KGO-TV.

Miles Scott (right), walks with a man dressed as Batman in San Francisco, California on 15 November 2013  Crime never stops, but thankfully neither does Batkid – here’s the pint-sized superhero, aka Miles Scott, on his way to foil another dastardly deed
Miles Scott, dressed as Batkid, exits the Batmobile with Batman to save a damsel in distress in San Francisco, on 15 November 2013 The mini-caped crusader leaps from the Batmobile for his next caper
Batkid is hugged after rescuing a woman in distress in San Francisco on 15 November 2013 Batkid is hugged by a “damsel in distress” he has just rescued
A man dressed as The Riddler is taken away by a San Francisco police officer after being apprehended by five-year-old leukaemia survivor Miles dressed as Batkid in San Francisco on 15 November 2013 Kapow! Take that, the Riddler. That’ll teach you to mess with Batkid
Kayla Fry holds a sign as she waits to see five-year-old leukemia survivor Miles Scott in San Francisco on 15 November 2013 Miles’ adoring public are lost in admiration for his indefatigable heroics
This Friday, 15 November 2013 image released by the San Francisco Chronicle shows a front page of the Gotham City Chronicle to honour Miles Scott, as Batkid The San Francisco Chronicle transformed its masthead into the Gotham City Chronicle to honour Miles, with a front-page story penned by “Clark Kent”
The Penguin holds the San Francisco Giants mascot Lou Seal captive as they wait for the arrival of five-year-old leukemia survivor Miles, aka "Batkid" 15 November 2013 Holy smoke! The Penguin’s trying to make Giants mascot Lou Seal a Los Angeles Dodgers fan – a crime justice officials said was “in violation of all laws of Gotham City”. And he almost got away with it…
Batkid confronts the Penguin at AT&T Park on 15 November 2013 …until Batkid showed up
Batkid is congratulated by the cops at AT&T Park on 15 November 2013 Batkid takes a moment to accept the gratitude of the cops for his services to Gotham
Batkid speak to a fan at AT&T Park on 15 November 2013 And as he leaves the Giants stadium, Miles explains to a fan how he did it
Batkid smiles after apprehending The Riddler in San Francisco on 15 November 2013
We salute you, Batkid

NASA Announces Asteroid Grand Challenge.


 

NASA announced Tuesday a Grand Challenge focused on finding all asteroid threats to human populations and knowing what to do about them.

The challenge, which was announced at an asteroid initiative industry and partner day at NASA Headquarters in Washington, is a large-scale effort that will use multi-disciplinary collaborations and a variety of partnerships with other government agencies, international partners, industry, academia, and citizen scientists. It complements NASA’s recently announced mission to redirect an asteroid and send humans to study it.

“NASA already is working to find asteroids that might be a threat to our planet, and while we have found 95 percent of the large asteroids near the Earth’s orbit, we need to find all those that might be a threat to Earth,” said NASA Deputy Administrator Lori Garver. “This Grand Challenge is focused on detecting and characterizing asteroids and learning how to deal with potential threats. We will also harness public engagement, open innovation and citizen science to help solve this global problem.”

Grand Challenges are ambitious goals on a national or global scale that capture the imagination and demand advances in innovation and breakthroughs in science and technology. They are an important element of President Obama’s Strategy for American Innovation.

“I applaud NASA for issuing this Grand Challenge because finding asteroid threats, and having a plan for dealing with them, needs to be an all-hands-on-deck effort,” said Tom Kalil, deputy director for technology and innovation at the White House Office of Science and Technology Policy. “The efforts of private-sector partners and our citizen scientists will augment the work NASA already is doing to improve near-Earth object detection capabilities.”

NASA also released a request for information (RFI) that invites industry and potential partners to offer ideas on accomplishing NASA’s goal to locate, redirect, and explore an asteroid, as well as find and plan for asteroid threats. The RFI is open for 30 days, and responses will be used to help develop public engagement opportunities and a September industry workshop.

Source: NASA

 

Guantanamo Bay: A Medical Ethics–free Zone?.


American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should. Actions violating medical ethics, taken on behalf of the government, devalue medical ethics for all physicians. The ongoing hunger strike at Guantanamo by as many as 100 of the 166 remaining prisoners presents a stark challenge to the U.S. Department of Defense (DOD) to resist the temptation to use military physicians to “break” the strike through force-feeding.

President Barack Obama has publicly commented on the hunger strike twice. On April 26, he said, “I don’t want these individuals [on hunger strike] to die.” In a May 23 speech on terrorism, the President said, “Look at our current situation, where we are force-feeding detainees who are . . . on a hunger strike. . . . Is this who we are? . . . Is that the America we want to leave our children? Our sense of justice is stronger than that.” How should physicians respond? That force-feeding of mentally competent hunger strikers violates basic medical ethics principles is not in serious dispute. Similarly, the Constitution Project‘s bipartisan Task Force on Detainee Treatment concluded in April that “forced feeding of detainees [at Guantanamo] is a form of abuse that must end” and urged the government to “adopt standards of care, policies, and procedures regarding detainees engaged in hunger strikes that are in keeping with established medical professional ethical and care standards.”1 Nevertheless, the DOD has sent about 40 additional medical personnel to help force-feed the hunger strikers.

The ethics standard regarding physician involvement in hunger strikes was probably best articulated by the World Medical Association (WMA) in its Declaration of Malta on Hunger Strikers. Created after World War II, the WMA comprises medical societies from almost 100 countries. Despite its checkered history, its process, transparency, and composition give it credibility regarding international medical ethics, and its statement on hunger strikers is widely considered authoritative. The WMA’s most familiar document is the Declaration of Helsinki — ethical guidelines for human-subjects research. The Declaration of Malta states that “Forcible feeding [of mentally competent hunger strikers] is never ethically acceptable. Even if intended to benefit, feeding accompanied by threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment.” The Declaration of Malta aims to set the same type of ethical norm as the Helsinki document. Physicians can no more ethically force-feed mentally competent hunger strikers than they can ethically conduct research on competent humans without informed consent.2

It’s hardly revolutionary to state that physicians should act only in the best interests of their patients, with their patients’ consent. At Guantanamo, this principle is seriously threatened because constant physician turnover makes continuity of care impossible; physicians’ historical involvement in “enhanced interrogation” that has irrevocably damaged detainees’ trust in military physicians; and the use of restraint chairs to break a 2006 mass hunger strike.3 Physicians may not ethically force-feed any competent person, but they must continue to provide beneficial medical care to consenting hunger strikers. That care could include not only treating specific medical conditions but also determining the mental competence of the strikers, determining whether there has been any coercion involved, and even determining whether the strikers want to accept voluntary feedings to continue their protest without becoming malnourished or risking death.4

Hunger striking is a peaceful political activity to protest terms of detention or prison conditions; it is not a medical condition, and the fact that hunger strikers have medical problems that need attention and can worsen does not make hunger striking itself a medical problem. Nonetheless, Guantanamo officials have consistently sought to medicalize hunger strikes by asserting that protestors are “suicidal” and must be force-fed to prevent self-harm and “save lives.”2 The DOD’s 2006 medical “Instruction” on this subject states: “In the case of a hunger strike, attempted suicide, or other attempted serious self-harm, medical treatment or intervention may be directed without the consent of the detainee to prevent death or serious harm.” This policy mistakenly conflates hunger striking with suicide.

Hunger strikers are not attempting to commit suicide. Rather, they are willing to risk death if their demands are not met. Their goal is not to die but to have perceived injustices addressed. The motivation resembles that of a person who finds kidney dialysis intolerable and discontinues it, knowing that he will die. Refusal of treatment with the awareness that death will soon follow is not suicide, according to both the U.S. Supreme Court and international medical ethics.2 The March 2013 guard-force–centered Guantanamo policy on “Medical Management of Detainees on Hunger Strike” seems to concede this point, since it makes no references to suicide. (Available atwww.globallawyersandphysicians.org/storage/AgendaHungerStrikeMeeting.pdf is the text and a summary of a meeting on physician participation in hunger strikes.)

A more troubling argument is that military physicians adhere to different medical ethical standards than civilian physicians — that as military officers, they must obey military orders, even if those orders violate medical ethics. Unlike individual medical and psychiatric assessments made in the context of a doctor–patient relationship, the decision to force-feed prisoners is made by the base commander. It is a penological decision about how best to run the prison. Physicians who participate in this nonmedical process become weapons for maintaining prison order.

Physicians at Guantanamo cannot permit the military to use them and their medical skills for political purposes and still comply with their ethical obligations. Force-feeding a competent person is not the practice of medicine; it is aggravated assault. Using a physician to assault prisoners no more changes the nature of the act than using physicians to “monitor” torture makes torture a medical procedure. Military physicians are no more entitled to betray medical ethics than military lawyers are to betray the Constitution or military chaplains are to betray their religion.5

Guantanamo is not just going to fade away, and neither is the stain on medical ethics it represents. U.S. military physicians require help from their civilian counterparts to meet their ethical obligations and maintain professional ethics. In April the American Medical Association appropriately wrote the secretary of defense that “forced feeding of [competent] detainees violates core ethical values of the medical profession.” But more should be done. We believe that individual physicians and professional groups should use their political power to stop the force-feeding, primarily for the prisoners’ sake but also for that of their colleagues. They should approach congressional leaders, petition the DOD to rescind its 2006 instruction permitting force-feeding, and state clearly that no military physician should ever be required to violate medical ethics. We further believe that military physicians should refuse to participate in any act that unambiguously violates medical ethics.

Military physicians who refuse to follow orders that violate medical ethics should be actively and strongly supported. Professional organizations and medical licensing boards should make it clear that the military should not take disciplinary action against physicians for refusing to perform acts that violate medical ethics. If the military nonetheless disciplines physicians who refuse to violate ethical norms when ordered to do so, civilian physician organizations, future employers, and licensing boards should make it clear that military discipline action in this context will in no way prejudice the civilian standing of the affected physician.

Guantanamo has been described as a “legal black hole.”3 As it increasingly also becomes a medical ethics–free zone, we believe it’s time for the medical profession to take constructive political action to try to heal the damage and ensure that civilian and military physicians follow the same medical ethics principles.

Source: NEJM

Force-Feeding, Autonomy, and the Public Interest.


Hunger striking is a nonviolent act of political protest. It is not the expression of a wish to die, nor is it akin to the decision of a terminally ill patient to discontinue food and fluid intake. Rather, it is brinkmanship. Faced with hunger-striking detainees, prison authorities have three choices: force-feed the hunger strikers, let them die, or accede to their demands.

As the World Medical Association (WMA) suggests, most bioethicists unequivocally oppose force-feeding. Enteral feeding through a nasogastric tube while a detainee is strapped to a chair violates a mentally competent patient’s right to refuse treatment and is physically violent.1 The WMA is less categorical about artificially feeding unconscious or delirious hunger strikers through their abdominal wall. Under these circumstances, physicians may permissibly weigh their patient’s best interests and prior expressions of intent before deciding about continued treatment.

Physicians who care for hunger-striking detainees weigh autonomy and best interests; rarely must they consider security interests. Local authorities, however, do not have this prerogative. Whereas bioethicists are keen to uphold autonomy and avoid force-feeding, public officials are bound to maintain public order and prevent the deaths of detainees. Those responsibilities leave officials only two choices: forced or artificial feeding, or accommodation. Accommodation deserves first consideration because it may be a reasonable choice. Faced with hunger-striking Palestinian detainees in 2012–2013, for example, Israeli officials satisfied some prisoners by improving prison conditions or modifying their prison terms. Similarly, the Turkish government met some hunger strikers’ demands last year. In each case, the hunger strike ended. Strikers played their hands deftly, carefully choosing realistic aims and employing nonviolent protests to gain symbolic but important concessions. Local medical organizations also played a role: the Israeli Medical Association instructed its members to comply with WMA guidelines, thereby pushing public officials to earnestly explore accommodation.2

The situation at Guantanamo deserves similar creativity. The detainees’ demands are not monolithic. Prisoners who are cleared for release require expedited repatriation, whereas others may be satisfied with customary legal proceedings, better prison conditions, or both. Accommodating the protesters on some counts may not be impossible. But whereas the freed Palestinian hunger strikers were previously paroled prisoners, not public enemies, some Guantanamo detainees may be militants representing genuine security threats, and authorities may not be able to meet all their demands. Nor is it sensible to let prisoners die: widespread rioting, civil unrest, and attacks on military and civilian personnel often follow the deaths of hunger strikers. And if one cannot allow hunger strikers to die or accede to their demands, then force-feeding must be back on the table.

There is no doubt that when mentally competent people refuse to eat or be fed, force-feeding or artificially feeding them violates the principle of autonomy. But autonomy is not sacrosanct. Persuasive moral arguments appeal to the sanctity of life to permit caregivers to override respect for autonomy when necessary to avert an easily preventable death from starvation.3,4 Respect for autonomy, moreover, conflicts with other important, nonmedical principles. Among military personnel, for example, autonomy, privacy, and the right to refuse certain treatments are limited and subordinate to security interests and the conditions necessary to maintain a fighting force.5 Similarly, the imperative to respect a detainee’s right of informed consent is not obviously superior to the interests of public security. There are usually good reasons for keeping captured enemy combatants locked up and alive. In fact, that is the norm of military detention. A prisoner’s desire to go free or die trying cannot override this basic interest of the state. A democratic government cannot be so hamstrung that the possibility of viable incarceration evaporates.

Of course, this argument should not be construed as permission to violate a fundamental human right in the name of military necessity. But the right of informed consent is not such a fundamental right — it is subordinate to human rights that protect people from murder, servitude, torture, and cruelty. One might argue, then, that force-feeding assaults a person’s dignity, and surely that is true when the feeding is accompanied by physical violence. But that argument does not repudiate force-feeding; it only mandates a search for nonviolent and humane methods.

Two practical difficulties also plague any directive to prioritize autonomy. First, respecting autonomy requires firm knowledge of a striker’s intent, which caregivers and prison authorities are unlikely to have. Given the lack of continuity of care, along with cultural differences, language barriers, and instructions that detainees may have received from their leaders, it would be extraordinarily difficult for anyone to determine whether a detainee was acting autonomously or under duress. Under these circumstances, the case for autonomous decision making weakens sufficiently to allow physicians to weigh a patient’s best interest over his or her decision to refuse food. Second, clinicians face a crisis of confidentiality if hunger strikers agree to accept food and fluids once their condition deteriorates but demand that caregivers keep these instructions secret. In these instances, confidentiality maximizes a striker’s political leverage, draws doctors into the fight, and leaves medical workers to stand by helplessly if public officials make suboptimal decisions on the basis of erroneous information.

The moral and practical difficulties of dogmatically upholding respect for autonomy suggest that the WMA would not allow physicians to stand by and watch hunger strikers die. It is unimaginable that any decent society today would leave 10 Irish Republican Army hunger strikers to die of starvation as the British did in Northern Ireland in 1981. Accounts of their slow and anguished deaths are harrowing, and no rights-respecting government or medical association should ever permit a repetition of that event. Instead, we should think about how to feed hunger strikers humanely. Once respect for autonomy falls to best interests or public interests, it makes no difference whether the authorities turn to humane force-feeding or to artificial feeding. But artificial feeding is not ideal: though less aggressive than force-feeding, it is also less salubrious — surely it is healthier to prevent starvation than to treat it. Politically, hunger strikes only galvanize prisoners and enflame their supporters. Letting strikes drag out until detainees are at death’s door is not a solution.

Hunger strikes by security detainees pose an excruciating dilemma. Physicians who decry disrespect of autonomy are left to watch treatable patients die. Physicians who extol the sanctity of life are committed to feeding healthy inmates by force. Public officials can neither accede to inmates’ demands nor allow them to die when negotiations stall but instead require humane methods to keep inmates alive. In this environment, the medical community faces two challenges. First, health care professionals will be called on to develop and administer humane methods for feeding striking detainees while providing general medical care under trying prison conditions. Second, health care professionals must also continue to scrutinize the behavior of public officials, cognizant of the medical interests of their patients and the collective interests of their community. Force-feeding should be rare, the product of serious but ultimately unsuccessful negotiations with strikers.

These are not easy straits to navigate. Armed conflict and other public emergencies pit personal, professional, and public interests against one another. Medical professionals, like other citizens in a thriving democracy, must simultaneously sustain the efforts of war and contain them.

 

Source: NEJM

 

 

 

NSA chief says data disrupted ‘dozens’ of plots.


The US electronic spying chief has said massive surveillance programmes newly revealed by an ex-intelligence worker had disrupted dozens of terror plots.

nsa

In a US Senate hearing, National Security Agency (NSA) Director Keith Alexander defended the internet and telephone data snooping programmes.

Also, US Secretary of State John Kerry said they showed a “delicate but vital balance” between privacy and security.

The programmes were revealed in newspaper accounts last week.

Meanwhile, the leaker has pledged to fight extradition to the US.

Edward Snowden fled his home in Hawaii for Hong Kong shortly before reports of the top secret programmes were published by the Guardian and Washington Post newspapers last week.

The 29-year-old former CIA and NSA contract worker has admitted giving the newspapers information about NSA programmes that seize vast quantities of data on telephone calls and internet communications from US internet and telephone companies.

US officials have confirmed the programmes exist, with President Barack Obama saying they were closely overseen by Congress and the courts.

Who is Edward Snowden?

snowdon

  • Age 29, grew up in North Carolina
  • Joined army reserves in 2004, discharged four months later, says the Guardian
  • First job at National Security Agency was as security guard
  • Worked on IT security at the CIA
  • Left CIA in 2009 for contract work at NSA for various firms including Booz Allen
  • Called himself Verax, Latin for “speaking the truth”, in exchanges with the Washington Post

‘Americans will die’

European leaders have expressed concerns over the scale of the programmes and have demanded to know whether the rights of EU citizens had been infringed.

Meanwhile, in a news conference alongside UK Foreign Secretary William Hague in Washington DC, Mr Kerry also said the programmes had “prevented some pretty terrible events.”

“With respect to privacy, freedom and the Constitution, I think over time this will withstand scrutiny and people will understand it,” he said.

Intelligence officials have insisted agents do not listen in on Americans’ telephone conversations. And they maintain the internet communications surveillance programme, reportedly code-named Prism, targeted only non-Americans located outside of the US.

Meanwhile, they have defended the programmes as vital national security tools.

“It’s dozens of terrorist events that these have helped prevent,” Gen Alexander said on Wednesday at a hearing of the US Senate intelligence committee.

Gen Alexander said intelligence officials were “trying to be transparent” about the programmes and would brief the Senate intelligence committee behind closed doors before any other information became public.

But the NSA chief said some details would remain classified “because if we tell the terrorists every way that we’re going to track them, they will get through and Americans will die”.

He added that he would rather be criticised by people who believed he was hiding something “than jeopardise the security of this country”.

Review the process

Senator Susan Collins, a Maine Republican, asked whether it was true or false that the NSA could, as Mr Snowden has claimed, “tap into virtually any American’s phone calls or emails” including the US president’s.

“False,” Gen Alexander responded. “I know of no way to do that.”

But Gen Alexander said the agency needed to investigate how Mr Snowden, a relatively low-ranking contract employee, had been able to obtain and leak such sensitive information.

The processes “absolutely need to be looked at”, he told lawmakers.

“In the IT arena, in the cyber arena, some of these folks have tremendous skills to operate networks.”

Some members of Congress have acknowledged they had been unaware of the scope of the programmes, having skipped previous intelligence briefings.

“I think Congress has really found itself a little bit asleep at the wheel,” Tennessee Representative Steve Cohen, a Democrat, said.

Meanwhile, Democratic Senator Ron Wyden, who warned about the programmes last year, has accused Director of National Intelligence James Clapper of misleading a Senate committee in March when he denied that the NSA collected data on millions of Americans.

Republican Congressman Justin Amash has called for Mr Clapper to resign, saying Congress could not make informed decisions “when the head of the intelligence community wilfully makes false statements”.

Source: BBC