Singapore Loosens Grip on Internet

Image via CrunchBase
May 7, 2011

By SETH MYDANS

SINGAPORE — The tightly controlled city-state of Singapore took a step into the unknown in advance of its parliamentary elections on Saturday, loosening its grip on political discourse in the unruly world of the Internet, where Facebook, Twitter and other social media have amplified a clamor of voices and points of view.

In a nation where government opponents are often sued over defamation and where carefully vetted public speech has been permitted only in a little park called Speakers’ Corner (which has been shut down during the campaign), experts say the new opening, if only in the virtual world, appears to be a redefinition of what are known here as “out-of-bounds markers.”

Following recent changes to the Constitution and election laws, campaigning is now permitted throughout cyberspace — in podcasts, videos, blogs, instant messaging, photo-sharing platforms like Flickr, social networking sites and electronic media applications like those found on cellphones.

For the first time, campaign recordings can be posted as long as they are not “dramatized” or published “out of context.” Video taken at an election rally can be uploaded onto the Web without being submitted to the Board of Film Censors.

“Social media have lowered the barriers of entry into political discourse everywhere,” said Mark Cenite, an assistant professor of communication and information at Nanyang Technological University. “But that’s particularly significant in Singapore because here the barriers to entry into political discourse and the accompanying risks have been so high.”

Despite the changes to Internet regulations, demonstrations and public speech still require permits. Political speech is restricted to candidates. Opposition politicians and the news media face the possibility of defamation suits. The mainstream news media are tightly controlled and have not acted as a check on the government, experts say.

During the last parliamentary campaign, in 2006, a small number of current-events blogs were the main forum for online citizen participation. Political speech was technically illegal and demanded a greater level of risk and commitment.

“Now that the barriers to entry to political dialogue have fallen, the effect has been electric,” Mr. Cenite said. “Government critics are able to easily identify and support one another without making a headlong commitment to politics and take the accompanying risks.”

All of this has contributed to an intense campaign in which opposition parties — which now hold just 2 of 84 elected seats — are drawing bigger crowds to rallies, fielding more candidates and, in contrast to the past, contesting all but one constituency. In the last election, opposition parties contested just half the constituencies.

Analysts say it is impossible to know whether this enthusiasm will translate into votes against the People’s Action Party, which has governed Singapore since 1959.

But the campaign itself has been transformed as social media give smaller, poorer parties a wider audience, bringing greater inclusiveness and competitiveness to political debate.

Rather than trying to suppress online political organizing, as China and Vietnam have done, Singapore is taking a gamble on making it part of the legal campaign system.

“I don’t think they had a choice,” said Kin Mun Lee, known on his blog as Mr. Brown, who said he skirted the law in the last campaign by avoiding explicitly political comments. “Before, it was a very limited kind of provision for online speech. Definitely they had to change the rules because of the proliferation and availability of options.”

Opposition Web sites and Twitter accounts are being used to urge people to attend election rallies. They also send out streams of comments from rallies, hugely increasing their audience. The site Gothere plots out the locations of rallies on a map.

The site Party Time aggregates conversations about the elections and graphically represents who is getting the most buzz online.

Facebook is estimated to have up to three million members in Singapore, whose population is more than five million. All seven competing parties have their own sites, as do many of the candidates.

By one estimate, there are 900,000 local users of Twitter.

Online coverage has pushed the main pro-government newspaper, The Straits Times, to publish fuller and not always critical news and photographs of opposition campaigns, said Alex Au, a prominent blogger.

“In the present era, with the ubiquitous cellphone camera and rapid distribution channels that are well beyond blogs, the old editorial policy is no longer viable,” he said on his blog. “If the newspaper does not publish such pictures, others will, and its credibility can only suffer.”

The Straits Times has dedicated a portal on its Web site to extensive electronic election coverage, and it is now aggregating online comments from the social media on a page it calls Buzz, which gives a flavor of some of the newly energized online commentary:

“The opposition can make ferocious speeches, but can they deliver?”

“Is it true that civil servants will be ostracized if they vote for the opposition?”

“If the opposition is sincere in serving the people, it would have been on the ground in the last four years, not starting their engines only when the whistle is blown.” “Why must we be so dogmatic about democracy and stability being mutually exclusive?”

Implications of Bin Laden's Death for Indonesia

Image via Wikipedia
Sidney Jones, The Jakarta Post | 4 May 2011

Osama bin Laden is being hailed as a hero and martyr by radical groups around the country, with the Islam Defenders Front (FPI) holding a program of “gratitude for service” later today at its headquarters. Demonstrations against the US by other groups are planned. The question is whether there will be more serious consequences, and three come to mind.

One: a temporary shift back to foreign targets. For the last two years, Indonesian extremists have moved away from attacks on the West, symbolized by iconic brand names of American hotels and fast food chains, to hits and attempted hits on local targets, especially the police.

This was a direct result of anger at Detachment 88 for arresting and killing so many mujahidin after a training camp in Aceh was broken up in February 2010, but it also reflected recognition that international targets had no general recruitment value: Few Indonesians saw the logic of killing foreign civilians to avenge Muslim deaths in Iraq or Gaza.

Bin Laden was such a powerful symbol and so revered in the extremist community, however, that calculations of costs and benefits may be overridden by a felt need to respond somehow to his death. The ubiquitous television images of cheering Americans may strengthen that resolve.

As we wrote in a Crisis Group report last month: “No one should conclude that targeting of foreigners is gone for good. One lesson from this report is that there is a constant process of adaptation, and developments in the Middle East and Pakistan, as well as within Indonesia, could produce new strategic directions.” Bin Laden’s death could be one of those developments.

Two: possibility of revenge attacks. While the possibility of revenge attacks is real, it is not a simple matter to pull them off. Planning an attack takes time, so the danger is less likely to be in the coming days than in the coming months or longer, giving police more time to get wind of a plot. Indonesian extremists also do not have a successful track record in this regard.

Police operations in Poso, Central Sulawesi, in January 2007 killed 14 local fighters and led to demands within the movement for retaliation, but no group had the capacity to respond. The execution of the Bali bombers in November 2008 led to massive demonstrations at their funerals, but no counter-attacks, despite widespread fears.

The fastest retaliation thus far was the Sept. 22, 2010, attack on the Hamparan Perak Police station, North Sumatra, in which three policemen were killed.

It came only three days after police killed three suspects they were hunting for the Medan bank robbery. But the fugitives already had arms, motive, target and opportunity. Putting all that together for a response to Bin Laden’s death may not be so easy.

While that may be somewhat reassuring, it is also true that there are five or six constellations of possible perpetrators, and only one of them needs to be successful.

Three: Strengthened attachment to al-Qaeda. Another possible consequence of Bin Laden’s death is a strengthened attachment of Indonesian extremists to al-Qaeda, both to the idea and to specific parts of the network.

A succession of Southeast Asia extremists have tried to set up local affiliates of al-Qaeda, based more on shared ideology than direct institutional linkage. At the time of the second Bali bombing, Noordin M Top called his group al-Qaeda for the Malay Archipelago.

By 2009 and the Jakarta hotel bombings, he was calling it al-Qaeda for Southeast Asia, even though a Malaysian named Mohamad Fadzullah Abdul Razak (since arrested) was using the same time a year earlier for a completely different group that wanted to send fighters from Malaysia to southern Thailand.

In early 2010, the alliances of extremists that set up the camp in Aceh began calling itself al-Qaeda for the Verandah of Mecca, a common term for Aceh.

By the admission of one participant, the name was in recognition of Bin Laden’s leadership of the global jihad rather than anything more concrete. Finally, only a few days ago, a statement appeared on radical websites here, again in the name of al-Qaeda for Southeast Asia, praising the April 15 suicide bombing at a police station mosque in Cirebon, West Java.

Obviously the idea of al-Qaeda still resonates, to the point that most self-respecting jihadi groups want to identify with it.

But there are also more substantial links. On Jan. 25 this year, Umar Patek was arrested in Abbottabad, the same town where Bin Laden was living. It was probably not a coincidence (indeed, may have been part of the same operation).

Indonesian authorities need to be asking Patek, who remains in detention in Pakistan, exactly what the nature of his communication was with the al-Qaeda organization and who else from Southeast Asia is actively working with al-Qaeda in propaganda, training, or even operations.

In his desire to work with Bin Laden, Patek, a former Jamaah Islamiyah (JI) member who was one of the original Bali bombers, follows in the footsteps of Hambali, the JI leader detained in Guantanamo whose relationship with al-Qaeda until his arrest in 2003 is outlined in a recent WikiLeaks document.

But he is not the only one. Muhammad Jibril, founder of the ar-Rahmah publishing company and arrahmah.com, was in regular communication with al-Qaeda’s media outlet in Waziristan.

And other parts of the radical network in Indonesia are in communication with the radical Yemen-based preacher, al-Awlaki, who is active in al-Qaeda in the Arabian Peninsula (AQAP).

The death of Bin Laden could lead to a renewed push to bolster these ties or to an intensified propaganda campaign based on al-Qaeda materials, especially from AQAP, translated into Indonesian.

There is thus no reason to believe that the security situation in Indonesian has in any way been significantly improved by the killing of al-Qaeda’s founder.

The good news, if there is any, is that none of the groups that have emerged over the last two years have shown the kind of technical capacity that Noordin M Top used to such devastating effect. No one, however, should be celebrating the end of terrorism in Indonesia.

Sidney Jones is senior adviser to the Asia program of the International Crisis Group.

Thailand’s benevolent army

May 4th, 2011 by Aim Sinpeng, Guest Contributor · 5 Comments




The media coverage, particularly on television, of the Thai army has been peculiarly extensive in recent weeks. Most notably is the fact that the army is being portrayed in an almost exclusively positive light, doing all sorts of public service for the Thai people. Last night, for example, I watched the evening news on Channel 9 and the entire domestic news was focused on the “good deeds” the army was doing all over the country. This included rescue missions in flooded areas of the upper South, security work in the deep South, evacuation and emergency shelter preparation for border-town residents of Surin Province, patrols along the Thai-Cambodian border…the list goes on. I flipped over to another channel and it was the same story.

The army has long been part of the daily life in Thailand. It is indisputable that the main responsibilities of the Thai army stretch far beyond protecting sovereignty and national security to include functions such as natural disaster relief, internal security and animal rescue. While fewer young, educated people join the army today than in the past, being in the army still carries significant prestige among Thais. In fact, the notion that the presence of the army – or its militant culture – has penetrated Thai society in a variety of ways is truer than many would like to admit. Those following Thailand’s entertainment industry would know that the actor who plays King Naresuan in one of Thailand’s most popular (and most expensive) epics – The Legend of King Naresuan – is himself a lieutenant colonel. Scores of contemporary Thai lakorn and movies, such as Wanida, Legend of Suriyothai, Sam Pan Boke, Cha-leu Sak, just to name a few, continue to romanticize men in uniform.

This recent string of “positive” media coverage of the army’s various missions sits uncomfortably with a rumor of a possible coup that is spreading among close observers of Thai politics. Although the army still maintains a good grip on the media in Thailand, in general, it still strikes me as eerily odd that the army seems to be “everywhere” on the news. The seemingly one-sided story of the army’s work stands in sharp contrast to the violent and deteriorating situation between Thailand and Cambodia as well as the continued explosive situation in southern Thailand. I’m not disputing that the Thai army is “doing something”, but why the positive spin on everything they do (despite the outcomes)? Is the army trying to rally public support, via the media, before the election? Why? I fear we may already know their “hidden” agenda.

 

US Census Reports 17.3 Million Asians in America

Author Grace Ruch | Published: April 21, 2011


Monterey Park, California, outside of Los Angeles is considered the first of America's Asian-dominated "Ethnoburbs." Image by: New York Times, "Mapping America"

When US President Lyndon Johnson signed the Immigration and Nationality Act of 1965 removing decades-long restrictions on admission and citizenship for immigrants from Asia, Asian-Americans made up only 0.5% of the total population. Forty-five years later, the 2010 Census reveals a dramatically different American racial landscape. Today, 14.7 million identify as “Asian-alone,” comprising 4.8% of the population. More dramatically, the Census names Asians as the fastest-growing racial group of the past decade, increasing an astounding 43.3%.

While these numbers are significant in showing the role of Asians in the demographic changes of the US in the past generation, they do not provide the whole picture. A more accurate count includes the 2.7 million people who consider themselves to be multi-racial Asian, or 29% of those reporting to belong to two-or more racial groups. This brings the total of number people of Asian-descent to 17.3 million, or 5.5% of the US population.

America’s Asian population is also spreading from its traditional density in the West and Pacific to states across the country. Hawaii’s unique location at the crossroads of the Pacific remains evident in the data showing that well over half of its population, 57.4%, is of Asian descent. Meanwhile California is still home to the largest number of Asian-Americans, some 5.5million in 2010, but it is followed by New York, Texas, New Jersey, showing the spread of the population from coast to coast.

The growth of Asian Americans is leading to demonstrable demographic shifts in American cities and communities. The Washington Post reported that the influx of Hispanics and Asians prevented over half of the top 100 largest cities in the US from shrinking. Urban areas as disparate as Anaheim, California; Fort Wayne, Indiana; Baton Rouge, Louisiana; and Jersey City, New Jersey have their growing Asian populations to thank for maintaining positive growth. In New York City, the Asian population increased by nearly 250,000, a gain of 32% and the largest of any ethnic group, according to the Wall Street Journal.

As in the past, much of this growth is driven by immigration as a majority of new arrivals settle in cities seeking employment opportunities. According to the immigration statistics maintained by the Department of Homeland Security, in 2010 over 420,000 immigrants from Asia became permanent residents, while over 250,000 received full US citizenship. In both instances this was more than any other region in the world.

The demographic shifts have not been limited to urban communities. For the first time in its history, minorities make up the majority of the population in affluent Montgomery County, MD, outside of Washington, DC. Brookings demographer William Fry told the Washington post that the influx of Blacks, Asians and Hispanics is “reinvigorating” the region’s suburbs, making the DC area more globalized in the process. In California and other regions along the West coast, Asian “Ethnoburbs”— suburban municipalities dominated by a non-white ethnic group— show former immigrant populations moving out of the “Chinatowns” and “Little Tokyos” of the past and into large, prosperous, Asian-majority suburban communities.

The 2010 Census depicts a more diverse and dynamic American than fifty years ago. The Asian-American community has grown and spread throughout the country significantly in the past few decades; contributing to the trend of minority-propelled growth into the 21st century.

How the U.S. found and finished Bin Laden

Image by Getty Images via @daylife

By David Ignatius, Monday, May 2, 12:58 PM

The assault on Osama bin Laden — as quick and ruthless an operation as you would see in any spy movie — shows that the CIA and the military’s super-secret Joint Special Operations Command have combined to create what amounts to a highly effective killing machine.

The shorthand for these operations is “find, fix, finish.” The CIA and other intelligence agencies typically provide the first two, and the bin Laden attack shows that this process can take years of patient detective work. JSOC warriors then come in for the finish.

A reconstruction of how this operation was put together shows how the pieces of America’s counterterrorism policy fit together. It also illuminates one of the CIA’s biggest puzzles, which is whether it can work effectively with Pakistan’s Inter-Services Intelligence directorate. The answer seems to be “sometimes.”

The trail that led to bin Laden’s hideout in the town of Abbottabad, about 75 miles north of Islamabad, began between 2002 and 2004 with the CIA’s interrogation of al-Qaeda “high-value targets” at secret CIA sites overseas. Several detainees mentioned the “nom de guerre,” or nickname, of one of bin Laden’s couriers.

Some of the detainees who confirmed the courier’s nickname were subjected to “enhanced interrogation techniques,” the CIA’s formal name for what is now widely viewed as torture. This adds a moral ambiguity to a story that is otherwise one of triumphal retribution and justice.

The CIA spent years trying to figure out the courier’s identity. Using sources that U.S. officials won’t discuss, the agency finally discovered the courier’s real name in 2007, along with the important fact that he had a brother. In early 2009, a team from the agency’s counterterrorism center traced him to a compound in Abbottabad that he shared with the brother.

Pakistan was told little about the bin Laden manhunt, for fear that the information would leak. But a U.S. official said the Pakistanis offered some help. “They provided information that helped us identify where one of the brothers might be located,” this official said. He added: “They didn’t tell us he was in Abbottabad, but their information allowed us to track him there.”

Now the agency had a suspect location but no firm idea bin Laden was there. Surveillance confirmed that this was an unusual compound. The surrounding walls were up to 18 feet high, and even the balconies had seven-foot walls. And the compound maintained unusual security: It had no telephone or Internet service, and trash was regularly burned.

As the CIA continued its surveillance, analysts concluded that another family was secretly living in the compound, along with the two brothers. The number of family members and other details matched bin Laden’s likely family group. This crucial “circumstantial” evidence was briefed to President Obama last August, says a U.S. official.

This year, JSOC began preparing the “finish” operation, using members of Seal Team 6, its most elite counterterrorism unit. Obama was given a choice between bombing the compound or staging the raid. Obama opted for the latter, believing the United States needed to capture bin Laden’s body.

One of the mysteries is whether the Pakistani government knew all along who was hiding in Abbottabad. It is hardly remote territory: A Pakistani military college is two miles away. A senior U.S. official says the CIA has carefully examined this question but has “zero evidence” of Pakistani government knowledge of bin Laden’s location. That’s not quite the same as saying for certain that the Pakistanis didn’t know, and it allows the ISI and CIA to continue working as sometime partners.

CIA Director Leon Panetta, who directed the operation, told Pakistan nothing until the helicopters had left Abbottabad to return to Afghanistan. But U.S. officials describe the subsequent Pakistani reaction as helpful. Pakistani officials urged Obama to make his unusual late-night announcement so the Pakistani public would immediately know the U.S. had attacked bin Laden, not a Pakistani target. And Islamabad promised to try to mitigate Pakistani popular anger, which officials did by issuing a supportive statement Monday.

Does bin Laden’s demise mean the death of al-Qaeda? CIA analysts won’t go that far. But they have concluded that the operation “will accelerate its demise,” and that the battered organization is now at a “tipping point” that could lead to collapse.

The hidden trophy of Sunday’s raid: The JSOC team captured intelligence materials from the compound that might reveal the location of Ayman al-Zawahiri, the organization’s new commander. “That’s where we’re going next,” says one U.S. official involved in planning the operation.

davidignatius@washpost.com

Shortages of key drugs endanger patients in US

Image via Wikipedia
By Rob Stein, Sunday, May , 3:14 PM

Doctors, hospitals and federal regulators are struggling to cope with an unprecedented surge in drug shortages in the United States that is endangering cancer patients, heart attack victims, accident survivors and a host of other ill people.

A record 211 medications became scarce in 2010 — triple the number in 2006 — and at least 89 new shortages have been recorded through the end of March, putting the nation on track for far more scarcities.

The paucities are forcing some medical centers to ration drugs — including one urgently needed by leukemia patients — postpone surgeries and other care, and scramble for substitutes, often resorting to alternatives that may be less effective, have more side effects and boost the risk for overdoses and other sometimes-fatal errors.

“It’s a crisis,” said Erin R. Fox, manager of the drug information service at the University of Utah, who monitors drug shortages for the American Society of Health-System Pharmacists. “Patients are at risk.”

The causes vary from drug to drug, but experts cite a confluence of factors: Consolidation in the pharmaceutical industry has left only a few manufacturers for many older, less profitable products, meaning that when raw material runs short, equipment breaks down or government regulators crack down, the snags can quickly spiral into shortages.

“It seems like there were a lot of things happening with consolidations and quality issues and more things coming from overseas,” said Allen J. Vaida, executive director of the Institute for Safe Medicine Practices, a nonprofit group that helped organize a conference last fall to examine the issue. “It just reached a point where the number of shortages was slowly going up and up, and now we have a national crisis with this huge shortage of critical medications.”

While the dearth that has garnered the most public attention is — ironically — for a barbiturate that is hindering prisons trying to execute inmates, the scarcities are having a much broader impact on keeping people alive, especially in emergency rooms, oncology wards and intensive care units.

No one is systematically tracking the toll of the shortages, but reports are emerging of delayed treatments, anxious searches for desperately needed drugs, devastating injuries from mistakes and less-adequate drugs, and even possible deaths.

Federal regulators have been rushing to alleviate the shortages, sometimes helping firms resume production more quickly or approving emergency imports of supplies from overseas.

The Food and Drug Administration eased a shortage of the anesthetic propofol last year by allowing foreign importation, for example, and this year approved bringing in several other medications, including two cancer drugs.

“The types of products we’re seeing shortages of are really concerning,” said Valerie Jensen, who heads the FDA’s Drug Shortages Program. “This is affecting oncology drugs, critical-care drugs, emergency medicine drugs. We’re doing everything we can under our current authority to try to deal with this situation.”

In Congress, legislation has been introduced to address the problem. For example, a bill would require companies to notify the FDA in advance about anything that might cause a shortage and give the agency new powers to try to assuage them.

“We can’t put patients’ lives at risk simply because there’s some snafus in a process or a manufacturer decides it’s less profitable to make a certain drug,” said Sen. Amy Klobuchar (D-Minn.). “Patients deserve better than that.”


‘Very global supply chain’

Many of the shortages involve older, cheaper generic medications that are less profitable, causing many firms to stop producing them and leaving fewer sources. Most involve “sterile injectable” medications that are more complicated to produce and therefore are more prone to manufacturing problems.

In addition, drug companies increasingly rely on raw materials from other countries.

“We’ve certainly reached a very global supply chain for drug products, with the active ingredients typically made outside of the United States,” said Gordon Johnston, vice president for regulatory sciences at the Generic Pharmaceutical Association. “It could be Europe, India — some cases China. If there’s a problem at a facility in Italy or India, it leads to disruption of the drug supply in the United States.”

Some industry representatives blame part of the problem on increased oversight by the FDA, which has made drug safety a higher priority after coming under intense criticism for being too lax.

“As you know right now, FDA has taken a heightened approach towards drug safety,” said Maya Bermingham, senior assistant general counsel at the Pharmaceutical Research and Manufacturers of America. “FDA has stepped up inspections. The more you look, the more you may discover problems.”

While acknowledging that the industry needs to do a better job of coordination, some company officials said the agency should coordinate enforcement actions and drug shortage issues more closely to avoid administrative requirements that cause interruptions.

“We’re not sure how much of that is going on recently because we’ve seen more and more shortages in the industry. We think that maybe some of those coordination issues can be worked on,” said Joshua Gordon, vice president and general manager of specialty pharmaceuticals at Hospira, the largest producer of specialty generic sterile injectables.

Shortages of pre-loaded epinephrine syringes and propofol, for example, occurred when suppliers dropped out just as the FDA was demanding additional documentation, he said.

“They are very focused on taking quick and and aggressive action,” Gordon said. “We applaud the agency’s role in assuring quality, but it can slow things down significantly.”

FDA officials dispute that greater government oversight is a major factor, saying manufacturing problems were the cause of most shortages.

“There has not been a significant increase in domestic enforcement actions (seizure or injunction) for this class of products in recent years,” Jensen wrote in an e-mail.

‘Too many . . . will die’

Whatever the causes, many of the affected drugs are mainstays of medical care, such as the potent painkiller morphine, norepinephrine, which is commonly used in emergency rooms, and electrolytes, which are often given to patients in intensive care.

But shortages have been reported in many categories of drugs, including antibiotics, and drugs central to the treatment of many cancers, forcing oncologists to delay or alter carefully timed chemotherapy regimens.

“We have heard some horror stories where patients are really begging to get the drugs from other sources and where practices or institutions are forced to kind of triage patients and save the drugs for those — quote — most curable, where they have the best prognosis and using substitutes where there isn’t a cure possibility,” Michael Link, president-elect of the American Society of Clinical Oncology.

The drug cytarabine has caused the most concern and gotten the most attention because it is highly effective for treating several forms of leukemia and lymphoma but must be administered as quickly as possible, especially to patients with acute myeloid leukemia.

“With this drug they can be cured and without this drug too many of them will certainly die. That’s the simplest way to put it,” said Deborah Banker, vice president for research communication at the Leukemia & Lymphoma Society. “The disease progresses so rapidly that untreated patients can sadly die within days. There is no time for delay and no certainty of a good outcome if you can’t get a full dose.”

Many hospitals are running low, and some have run out completely. That has required many facilities to ration the drug, giving priority to those who need it most urgently.

“It’s so unbelievable,” said Mary Collins, 57, of La Crosse, Wis., whose husband, Michael, 66, had problems obtaining cytarabine to fight lymphoma. “A cancer diagnosis is a long, very, very stressful circumstance. And then to learn that a particular drug is no longer available to you and that there seems to be no formalized mechanism in place to correct it just makes it worse.”

Cytarabine’s scarcity was caused by hitches that two out of the three manufacturers hit in obtaining raw materials, as well as the discovery of crystals in some shipments.

The third manufacturer was unable to make up for the shortfall. Some of the problems have been resolved, however, and the FDA is working on importing the drug.

The shortages are forcing hospital pharmacists to juggle supplies and hunt for new sources. Many hospitals, including several contacted in the Washington area, say they are usually able to patch together solutions.

But some resort to paying inflated prices or buying from unfamiliar suppliers, increasing the risk they may be getting counterfeits.

“When it becomes clear that some drug may be in short supply or going into a shortage, what happens is sometimes there are unsavory folks — small distributors — who buy up whatever is left and sell it back at exorbitant prices,” said Roslyne Shulman, director of policy development for the American Hospital Association.

‘Panic in the pharmacy’

When shortages occur, physicians turn to less optimal alternatives or find out too late that the drug they need is unavailable. Mark Warner, president of the American Society of Anesthesiologists, described two calamities that occurred in the past year because of shortages. In one, a 16-year-old boy suffered brain damage because doctors did not have one muscle relaxer needed to treat a complication from jaw surgery.

In another, a middle-aged woman was left in a permanent vegetative state because doctors did not have the drug epinephrine after she experienced complications from heart surgery.

“These are tragic cases,” Warner said. “It’s one of those things most anesthesiologists in the country think about when they are driving to work every day. We don’t know where the shortages are and they come on very quickly. ”

Nurses and doctors responding to emergencies, meanwhile, are losing precious minutes when they must work with unfamiliar substitutes or recalculate dosages, increasing the chances of overdosing or under-dosing patients. One of the biggest problems is a shortage of syringes pre-filled with precisely measured doses.

“Grabbing the right medication out of a crash cart that’s already in a syringe is a big advantage over having to get out the syringe, get out the needle, get the medication and get the measurement right,” said Angela Gardner, an emergency medicine physician at the University of Texas Southwestern Medical Center in Dallas and immediate past president of the American College of Emergency Physicians. “Those minutes are lives.”

Many hospitals are recalibrating electronic medication delivery systems or preparing the correct doses ahead of time, especially for the emergency room, to minimize mistakes.

“We’ve been extremely fortunate using strategies in cooperation with our medical staff,” said Jay Barbaccia, head pharmacist at the Washington Hospital Center. “We’ve had a lot of panic and inconvenience but minimal, if any, impact on our ability to provide care. It makes my life miserable — the panic is in the pharmacy when we’re scrambling around to find alternatives.”

Nevertheless, a long list of errors and near-misses have been reported, including incidents in which patients required emergency care to save them.

At least two patients reportedly died from overdoses of hydromorphone they received because of a morphine shortage.

At least 19 patients were sickened and nine died in Alabama this year after being infused with a solution through their feeding tubes that was apparently contaminated with bacteria by a pharmacy using an unfamiliar ingredient because of a shortage.

The shortage occurred because the manufacturer had trouble getting the product’s packaging.

“It’s horrible. It’s something that shouldn’t have happened,” said Donald J. Mottern of Alabaster, Ala., whose 71-year-old mother was one of the victims. “We lost the matriarch of our family. The loss to our family has left each of us very hollow.”

Drug makers develop medicines to meet Asia's needs

By Mariko Oi Asia Business Report, BBC World News
Woo Kum Tin managed to overcome liver cancer

Exactly eight years ago, Woo Kum Tin had to make a life or death decision.

The 56-year-old was diagnosed with liver cancer and was given three days to decide whether to undergo major surgery to save his life.

"I could not believe it," Mr Woo recalls, adding that his wife made the doctor's appointment after she noticed he had lost his appetite.

"I tried to bargain with the doctor. Give me one month. Give me two weeks," he laughs.

His surgery went well, and although Mr Woo had a large chunk of his liver removed, he remains healthy.

In Asia, this makes him extremely lucky, not least because three-quarters of the world's liver cancer cases in males and two-thirds in females occur in the region.

With a fatality rate of 93%, it is a particularly Asian disease that has a high human and economic cost. Deadly disease

According to the World Health Organization, liver cancer kills 700,000 people every year, which makes it the third most common cause of death from cancer worldwide.
Liver cancer does not respond well to chemotherapy

China alone has more than half of newly diagnosed liver cancer cases in the world, while fewer than 4% occur in the US.

The main causes are alcoholism and infection with the hepatitis B virus (HBV) and hepatitis C virus (HCV).

These viruses are spread from person to person through sexual contact, blood transfusions, re-use of contaminated needles and childbirth.

Worryingly, fewer than 20% of patients who are diagnosed with liver cancer can opt for surgery, according to Professor London Ooi of the National Cancer Centre in Singapore.

And even if they undergo an operation, four out of five patients will see a recurrence within five years after surgery. Lucrative market

In the past, the pharmaceutical industry focused on designing medicines for more lucrative markets in the West. As a result, there was only a limited amount of liver cancer treatments.

But as Asian patients have become wealthier, with their purchasing power boosted by economic development in countries such as China and Singapore, drug makers are paying more attention to their needs.

Diseases more common in Asia
Head and neck cancer
Stomach cancer
Liver cancer
Hepatitis B
Tuberculosis
Dengue fever

Asia's pharmaceutical industry is estimated to be worth $168bn (£101bn) at the end of 2010, according to market research and information analysis company RNCOS.

And while that is much smaller than the West, the speed at which it expands is expected to be much quicker in coming years.

The pharmaceutical industry is expected to grow by about 9.5% this year, while the sectors in the US and Europe are forecast to grow by 3.2% and 4.5% respectively, RNCOS estimates.

As a result, companies such as Pfizer, the world's biggest drug producer, are now developing treatments for diseases which are more prevalent in Asia.

"The diseases that are more common here include head, neck, stomach and liver cancers, as well as infectious diseases like hepatitis B, tuberculosis and dengue fever," says Dr Chong Chew Lan, medical director at Pfizer's clinical research unit in Singapore.

"We are at the early stage of developing medicines for these diseases and we will definitely see an increasing trend of companies focusing their research on Asia," she says.

"This is because there is a large population in Asia and there is a growing middle class who can afford these medications." Traditional medicine

But while the companies are hoping to tap into rising demand, they will face competition from less modern medical miracles.

For thousands of years across Asia, people in the region have been relying on traditional Chinese medicine.

Liver cancer survivor Woo Kum Tin says he would have gone to his Chinese doctor and asked for herbal medicine, had he been given more than three days to decide over his surgery.
Many Asian patients still rely on traditional Chinese medicine

So is Western medicine well accepted in Asia?

"I remember the days when my grandparents would prefer to use traditional Chinese medicine," says Pfizer's Dr Chong.

"But with my own parents, I have seen that change," she adds.

"Now, they are more likely to use a combination of both. They go for Western medicine for a quick relief, while they use traditional Chinese medicine for an improvement of general health."

One company in Singapore, Eu Yan Sang, has been offering traditional products and services since 1879.

Dr Caryn Peh, senior general manager of the company's Clinic Services, says traditional medicine plays a complementary role.

"In Singapore, more than 80% of patients who are diagnosed by Western doctors also seek traditional Chinese medicine," she says.

"In developing nations, they might be more traditionalists in their ways of thinking," she added. Different responses

They may have a point, especially as some experts believe that Asian patients also react differently to Western medicine.

Dr Chong of Pfizer Clinical Research Unit says there is a need to understand the effects of drugs on Asian patients.

"The advantage of having a research facility in Singapore is the multi-ethnic population of Chinese, Malays and Indians that we have," she says.

"What we noticed is that Asians tend to be more sensitive to any central nervous system responses caused by drugs," Dr Chong explains.

"So for example, if the drug causes drowsiness, we notice it more quickly in our Asian patients."

While reactions may differ, there is very little disagreement over the need for better and more effective medicines in Asia.

And now that the region's growing wealth offers greater opportunities for pharmaceutical firms, there is every chance that Asia's patients will also get to live longer and more prosperous lives.

Is Dislike of SBY Driving Military Old Guard to Hard-Liners?

Image via WikipediaNivell Rayda | May 02, 2011

President Susilo Bambang Yudhoyono’s speeches often leave many Indonesians mystified, and the one he made shortly after a series of book bomb scares across the capital last month was no exception.

“To that group, [I say] if you don’t like me, don’t sacrifice the people. Don’t let them become victims,” he said on March 18, shortly after police discovered a fourth bomb sent to the house of a prominent music mogul.

To some, the president appeared presumptuous for assuming that he was the target, but Mufti Makaarim, executive director of the Institute for Defense, Security and Peace Studies, thinks that there is more to the remark than meets the eye.

“He knows that there are some people who benefit from religious violence and acts of terrorism. He senses that there are a few retired generals who would love to see him lose legitimacy to run this country,” he said. “For me the speech was clear. As vague and intriguing as it may seem to the rest of the nation, he was addressing military retirees.”

Connecting the Dots

Two other incidents that took place shortly after that speech seemed to crystallize what Yudhoyono meant.

On March 20, a little-known Islamic political analyst named Wachiduddin received thunderous applause from an audience of 500 veiled women and bearded men at a talk show organized by Hizbut Tahrir Indonesia, a hard-line group that seeks the formation of an Islamic caliphate.

Wachiduddin on that day said that it was important for hard-line Muslim activists to establish ties with warmongers and military officials. Excerpts and video recordings of the show have been circulating online since.

“Gaining support from ahlul quwwah [bearers of military might] in a revolution is a method exemplified by the great prophet, Muhammad,” he said. “The prophet and his disciples once convened with ahlul quwwahs throughout Mecca, asking them to convert to Islam and join his holy struggle.”

Muhammad eventually gained the support of Sa’ad bin Muaz, a prominent seventh-century warlord from Medina, Saudi Arabia, the self-proclaimed expert added. “Muslim activists [in Indonesia] must visit these generals. We must convince them that Islam is the only system blessed by Allah. Generals must become the 21st century Sa’ad bin Muaz,” Wachiduddin said.

On March 22, two days after the speech, Al Jazeera reported that “senior retired generals” were supporting the Islamic Defenders Front (FPI) and other hard-liners to incite religious violence and overthrow Yudhoyono.

The report included an interview with retired Army Chief Gen. Tyasno Sudarto, a staunch government critic who acknowledged his support for the groups that he said aimed to topple Yudhoyono in a “revolution.”

Coming Out

Besides Tyasno, there are more military men backing the hard-liners, according to Chep Hernawan, head of the Islamic Reform Movement (Garis). In an interview with the Jakarta Globe, he identified them as retired Maj. Gen. Muchdi Purwoprandjono, former commander of the Army’s Special Forces (Kopassus); retired Maj. Gen. Kivlan Zen, former commander of the Army’s Strategic Reserve Command (Kostrad); and retired Gen. Fahrul Razi, a former deputy chief of staff.

Chep said several meetings had already taken place since January between the ex-generals and conservative Muslim leaders to discuss their plans.

“We’re united by the Ahmadiyah issue, since these retired generals have also lost faith in how the president is managing the country. They are Muslims too and know very well that Yudhoyono’s hesitance in banning Ahmadiyah could spark public anger, particularly from Muslims,” Chep said.

He was referring to the minority sect deemed deviant by mainstream Muslims that has faced increasing persecution over the years, including from the state.

Islamic People’s Forum (FUI) secretary general Muhammad Al Khaththath had also acknowledged its movement to seek the dissolution of the sect was supported by retired generals but refused to divulge details into what sort of arrangements the hard-liners had with the generals.

‘Awan Merah’

A source inside the military retiree circle told the Jakarta Globe that the hard-liners had benefited financially as well as politically from the relationship.

“These generals always finance pesantrens [Islamic religious boarding school] and madrasahs [Islamic schools] owned by hard-line figures. Their houses are always visited by hard-line groups and some return with plenty of donations,” the source said on condition of anonymity.

“In return they pledge allegiance and consider these generals as their patrons. [Hard-liners] are often exploited for a certain political gain.”

But the source said that the retired generals had a more sinister plot. “The other retirees are calling their actions ‘Awan Merah’ [Red Cloud], short for ‘Aksi Purnawirawan Militer Berdarah’ [Bloody Actions of Military Retirees],” he told the Globe.

“Their aim was to create another religious conflict like the ones in Ambon [North Maluku] or Poso [Central Sulawesi]. But this time, they want it to be close to the capital. It is likely that their target would be Kuningan or Parung.”

Around 2,000 followers of the Ahmadiyah faith live in Manis Lor village in Kuningan district, West Java, making it the largest Ahmadi community in Indonesia. An attack on the community occurs almost every year.

Parung, a small town about halfway between Jakarta and Bogor, is home to an Ahmadiyah center. It was last attacked in 2008.

“Other retirees are not too sure about their strategies. Toppling a president is not that easy,” the source said. “But what these generals have in common is that they all hate SBY, they’re devout Muslims or what some would describe as ‘green generals,’ they have close ties with hard-liners and in the past they had their hands dirty in cases of religious violence.”

Mufti of the IDSPS said the retired generals were discontented with Yudhoyono because he had failed to provide enough political positions for members of his former corps.

Only two retired generals sit in Yudhoyono’s administration: State Secretary Sudi Silalahi and Deputy Defense Minister Sjafrie Sjamsuddin.

“The aim is to topple Yudhoyono through de-legitimization of his rule, to show that civilian-controlled government is failing and that we should go back to military rule,” he told the Globe. “That has happened during the administrations of [former presidents] [B.J.] Habibie and Gus Dur [Abdurrahman Wahid].”

Mutual Interests

Muchdi, the retired major general, has confirmed that he has close relationships with hard-line Muslim figures. “I have friends from almost every Muslim organization and yes, some of them are radicals,” he told the Globe.

He was cautious, however, about revealing the extent of those ties with radicals. “All I can say is that these [hard-liners] don’t have a political vehicle to channel their aspirations. They just want their voices heard by the government,” he said.

“I don’t agree with violence and every Muslim organization that I have talked to feels the same way. There is not a single political party that can facilitate their needs, that is why some rogue elements within the organizations feel frustrated and do [violent] things.”

Muchdi, the former head of the National Intelligence Agency (BIN) who was controversially acquitted in 2009 of the murder of rights activist Munir Said Thalib, has also been cited as a senior adviser of FUI publication Suara Islam and of Media Dakwah, a publication tied to the Indonesian Islam Propagation Council (DDII).

Although he is open about opposing the existence of the Ahmadiyah, he denied playing a part in religious violence.

“After the cases in Cikeusik [Banten] and Temanggung happened, text messages began circulating saying that me and Tyasno Sudarto were behind the melees,” he said, referring to a mob attack on Ahmadis in Banten that left three sect members dead and the violent riot in the West Java town after a blasphemy trial.

“To me, rumors like that happen almost on a daily basis. Some issues we have to fight back but some I chose to ignore. I don’t know why, but people see me as a hard-line Muslim myself.”

A long time critic of Yudhoyono, Tyasno has been participating in various rallies and activities to oust the president. His disapproval for his former classmate in the military academy had led him to form an unlikely bond with radical Muslims, secular nationalists and other groups frustrated with the sitting administration.

In March 2010, Tyasno joined hard-line Muslim activists in an event organized by HTI to denounce the growing economic influence of the United States in Indonesia.

The retired Army chief did little to hide his alliance with hard-line groups during the interview with Al Jazeera.

“We work together to enlighten each other. Our angle is different. They fight in the name of Islam, we use national politics. But we have a common goal, which is change. We want to save our country, not destroy it. The revolution should be peaceful, not anarchist or bloody,” he said.

Al Jazeera cited a Web site that detailed a proposed cabinet line-up for the so-called Islamic government — which included Tyasno — drafted by FUI’s Al Khaththath, himself a member of the HTI and former chairman.

Like Muchdi, Kivlan denied sponsoring religious violence and suggested Muslim groups channel their resentment toward the Ahmadiyah in a court of law.

“For me, the solution is simple. Launch a legal action [against the sect]. The same with Ahmadiyah, if they feel intimidated, report it. Don’t take this problem to the street … let the court decide. Only then will all problems be solved,” he told reporters after his name circulated as a mastermind of attacks against members of the sect.

Old Ties

But despite the denials, it is hard not to question how hardliners have continued to enjoy impunity without the presence of political support from powerful figures.

In February, hard-line groups began demanding that Yudhoyono step down unless he issued a decree banning the Ahmadiyah, just days after the president announced plans to disband organizations that used violence to further their goals.

“The fact that the government is reluctant to dissolve hard-line groups suggests that these organizations have support from powerful people. He wouldn’t even touch HTI, which is clearly trying to establish an Islamic state and replace our national ideology. That’s treason,” human rights activist and noted military critic Usman Hamid told the Globe.

In 1965, the military began establishing close ties with Muslim groups in order to fight communists. It is widely estimated that close to a million people were killed in an ensuing witch hunt for Indonesian Communist Party (PKI) supporters.

During the Suharto regime, the military maintained the relationships, including with former elements of the Darul Islam and the Islamic Troops of Indonesia (TII), which launched a widespread rebellion during the Sukarno era in a failed attempt to establish a theocracy.

The military allegedly capitalized on the relationships during the final days of Suharto’s 32-year regime by inciting hatred toward the Chinese ethnic minority through rumors that they had caused the Asian financial crisis of 1997-98. A widespread riot occurred in May 1998, targeting Chinese businesses and homes.

After the fall of Suharto, the ethnic violence spread throughout the islands of Java, Borneo, Sulawesi and the Malukus.

Witnesses detected a similar pattern in the seemingly separate conflicts and reported the presence of unidentified men provoking an attack on other religious groups. “What we are seeing today is a re-establishment of old ties. There is a good chance that similar conflicts would occur again,” Usman said.

In a recent interview with the Globe, Mahmudi Haryono, alias Yusuf, a former terrorism convict who once participated in religious violence in Poso, said that the best possible way to disrupt national stability in Indonesia would be to incite another violent religious conflict.

“There are thousands of us who ‘graduated’ from Moro, Poso and Ambon. This is a time of peace so most of us just carry on with our daily lives. But when there is another conflict, they would leave their job and everything they have and fight. A lot of people that I know feel that way,” he said.

“I realized, even back then, that the jihadist movement has been exploited by political power to destabilize the government. But blind faith and the notion that Muslims are under attack can prompt radical Muslims to do just about anything.”

Moves to Undermine Egyptian Revolution

Image by Brooklyn Museum via FlickrBy Adam Morrow and Khaled Moussa Al-Omrani

CAIRO, May 1, 2011 (IPS) - More than two months since former president Hosni Mubarak was forced from office after 30 years in power, local political figures and analysts warn of "counterrevolutionary elements" still working behind the scenes to thwart Egypt's ongoing transition to democracy.

"These elements have consistently worked to reverse the gains made by the Jan. 25 Revolution by sowing fear, chaos and fitna (discord) between different segments of society," Essam al-Arian, spokesman for Egypt's Muslim Brotherhood movement, told IPS.

In the first days of the 18-day uprising, the embattled Mubarak regime used its expansive state media machine to spread false news reports of murder and mayhem in hopes of terrorising the public and discrediting the revolution. It went so far at one point as to release convicted criminals from prison.

Mubarak, who relinquished executive power to Egypt's Supreme Council of the Armed Forces (SCAF) in February, is now under house arrest, while his ruling National Democratic Party (NDP) has since been dissolved. Nevertheless, many political observers point to "remnants of the former regime" still actively working to maintain the Mubarka-era status quo.

"The counterrevolution is directed by regime holdovers, including security elements and hired thugs, along with certain politically-connected businessmen," Diaa Rashwan, assistant director of the Cairo- based Al-Ahram Centre for Political and Strategic Studies, told IPS.

In an effort to destroy the national unity that had been an essential ingredient of the revolution's success, these elements - with help from the media - have tried to instigate sectarian conflict, say observers, especially between Egypt's Muslim majority and Christian minority.

On Mar. 4, for example, certain newspapers reported that several Christians had been killed after a church in the Atfeeh district south of Cairo was torched by a group of Muslims. Although the reports later turned out to be wildly exaggerated, they nevertheless resulted in violent clashes in which 13 people were killed - both Christians and Muslims - and scores injured.

"Media reports about the Atfeeh church incident were based on rumour and exaggeration intended to stoke sectarian conflict," Ammar Ali Hassan, director of the Cairo-based Centre for Middle East Studies, was quoted as saying in the local press. Hassan went on to accuse elements of Mubarak's now- dissolved State Security apparatus of being behind the incident.

Even before its demise, the Mubarak regime had long been suspected of instigating sectarian conflict for its own political ends. In the first week of February, information emerged suggesting that State Security had played a role in the bombing of a church in Alexandria last New Year’s Eve. At the time, regime officials had blamed the attack - in which 24 people were killed - first on "Al-Qaeda" and then on Palestinian groups.

Recent weeks have also seen an unprecedented rash of attacks on religious shrines revered by Egypt's Sufi Muslim community.

Although certain newspapers hastened to blame the attacks on Egypt's ultra-conservative Salafist movement, little if any evidence has been produced to this effect. Salafist leaders, meanwhile, strenuously deny involvement in the attacks and accuse the media of trying to fan the flames of conflict between the two sects.

"These crimes were not committed by Salafists, but rather by counterrevolutionary elements," prominent Salafist preacher Mohamed Hassan publicly charged on Apr. 20.

Magdi Hussein, secretary-general of the Islamist Labour Party (who is not himself a Salafist), pointed in particular to one recent attack on a Sufi shrine in the city of Qalioub north of Cairo. "Although the attack was widely attributed in the media to Salafists, subsequent police investigations found that the perpetrators were hired thugs with no religious affiliations," Hussein told IPS.

Even an official security source quoted earlier this month by IPS conceded that authorities could not rule out involvement in the attacks by "counterrevolutionary forces seeking to heighten sectarian tensions between Sufis and Salafists."

Observers have been quick to highlight the central role played by the local news media in exacerbating sectarian tensions.

"The counterrevolution is being aided by certain segments of the news media, which have been caught publishing false and potentially damaging reports on more than one occasion," said al-Arian.

Rashwan agreed, noting that "much of the news currently being reported by the local press on sectarian issues is based on rumour, innuendo and exaggeration." This state of affairs, he added, "has led many Egyptian commentators to accuse particular newspapers of promoting a counterrevolutionary agenda."

Independent political activist Abdelrahman Abu Zeid pointed to two prominent independent dailies, Al- Masry Al-Youm and Al-Youm Al-Saabaa, in particular. "Both papers, owned by business interests known for their closeness to the former regime, have actively contributed to recent incidents of sectarian unrest by twisting and exaggerating the facts," Abu Zeid told IPS.

Al-Masry Al-Youm is owned by a handful of prominent businessmen, including Sallah Diab and Coptic- Christian billionaire Naguib Sawiris. Al-Youm Al-Sabaa's chief stakeholder, meanwhile, is the son of former NDP secretary-general Safwat Sherif.

Some political figures have also asserted that Egypt's counterrevolution was being aided by Israel, which had publicly described the Mubarak regime as a "strategic treasure."

In mid-April, Grand Sheikh of Al-Azhar Ahmed al-Tayeb, Egypt's leading religious authority, while visiting the district of Atfeeh, said: "The sectarian disturbances that happened here last month are the work of the Zionist state, which wants to break the region into small, ethnically-based statelets."

Hussein agreed for the most part, saying that, "along with remnants of the former regime, the counterrevolution also involves U.S. and Zionist elements." He added: "After the fall of their chief agents in the region - Egypt's Mubarak and Tunisia's Ben Ali - religious discord now represents their primary means of influencing events on the ground."

But according to al-Arian, such attempts to sow discord in post-revolutionary Egypt are destined to fail, "due to a new political awareness on the part of the public and the solidarity between all segments of the Egyptian people."

"The counterrevolution has already started to wane with the impending prosecution of Mubarak and his henchmen," said Hussein. "And with the democratic election of a new parliament and president, it can be expected to die out completely."

Egypt is scheduled to hold its first free parliamentary elections in September, to be followed by presidential elections shortly afterward.

Running in the red: How the U.S., on the road to surplus, detoured to massive debt

Cover of George W. BushBy Lori Montgomery, Published: April 30

The nation’s unnerving descent into debt began a decade ago with a choice, not a crisis.

In January 2001, with the budget balanced and clear sailing ahead, the Congressional Budget Office forecast ever-larger annual surpluses indefinitely. The outlook was so rosy, the CBO said, that Washington would have enough money by the end of the decade to pay off everything it owed.


Graphic


From surplus to debt


Video


Treasury Secretary Tim Geithner discusses the U.S. budget deficit. Geithner, speaking with Peter Cook on Bloomberg Television's ‘’In the Loop,’’ also discusses banking regulation and the European debt crisis. (April 19)

Voices of caution were swept aside in the rush to take advantage of the apparent bounty. Political leaders chose to cut taxes, jack up spending and, for the first time in U.S. history, wage two wars solely with borrowed funds. “In the end, the floodgates opened,” said former senator Pete Domenici (R-N.M.), who chaired the Senate Budget Committee when the first tax-cut bill hit Capitol Hill in early 2001.

Now, instead of tending a nest egg of more than $2 trillion, the federal government expects to owe more than $10 trillion to outside investors by the end of this year. The national debt is larger, as a percentage of the economy, than at any time in U.S. history except for the period shortly after World War II.

Polls show that a large majority of Americans blame wasteful or unnecessary federal programs for the nation’s budget problems. But routine increases in defense and domestic spending account for only about 15 percent of the financial deterioration, according to a new analysis of CBO data.

The biggest culprit, by far, has been an erosion of tax revenue triggered largely by two recessions and multiple rounds of tax cuts. Together, the economy and the tax bills enacted under former president George W. Bush, and to a lesser extent by President Obama, wiped out $6.3 trillion in anticipated revenue. That’s nearly half of the $12.7 trillion swing from projected surpluses to real debt. Federal tax collections now stand at their lowest level as a percentage of the economy in 60 years.

Big-ticket spending initiated by the Bush administration accounts for 12 percent of the shift. The Iraq and Afghanistan wars have added $1.3 trillion in new borrowing. A new prescription drug benefit for Medicare recipients contributed another $272 billion. The Troubled Assets Relief Program bank bailout, which infuriated voters and led to the defeat of several legislators in 2010, added just $16 billion — and TARP may eventually cost nothing as financial institutions repay the Treasury.

Obama’s 2009 economic stimulus, a favorite target of Republicans who blame Democrats for the mounting debt, has added $719 billion — 6 percent of the total shift, according to the new analysis of CBO data by the nonprofit Pew Fiscal Analysis Initiative. All told, Obama-era choices account for about $1.7 trillion in new debt, according to a separate Washington Post analysis of CBO data over the past decade. Bush-era policies, meanwhile, account for more than $7 trillion and are a major contributor to the trillion-dollar annual budget deficits that are dominating the political debate.

As Congress prepares this week to launch a high-stakes battle over whether to raise the legal limit on borrowing, the analyses offer a clearer view of the drivers of the debt — and of the difficulty of re-balancing the budget without new tax revenue.

Most Republicans reject raising taxes as part of the solution; House Speaker John A. Boehner (Ohio) has called it a “non-starter.” But Democrats won’t go for a proposal based solely on spending cuts. The“Gang of Six,” a bipartisan Senate group dedicated to debt reduction, is expected to unveil a strategy as soon as this week that couples sharp spending cuts with a rewrite of the tax code that would raise additional revenue.

(The debt ceiling, set at $14.3 trillion, covers all federal debt, including money the Treasury owes other federal entities, such as the Social Security trust fund. The CBO data focus on the portion of the debt borrowed from outside investors. The debt is the accumulation of annual deficits; if annual budgets are in surplus, the nation can pay down the debt.)

From surplus to debt

The annual surpluses that set the nation on this course emerged in the final years of the Clinton administration. In the typical American household, a surplus comes as welcome news. But the White House is not a typical household. When Treasury Secretary Robert Rubin saw the budget shift into the black in 1998, he immediately warned President Bill Clinton that, politically, it was a mixed blessing.

Rubin wanted to use the surplus to start repaying the debt, which was then just more than $3 trillion. The White House billed it as “saving Social Security first,” viewing the surplus as an opportunity to shore up the nation’s finances before huge numbers of the baby boom generation began claiming federal retirement benefits. “The problem was a whole other part of the political spectrum wanted to use the surplus for tax cuts,” Rubin said in an interview. “They said they wanted to give the people back their money. Of course, it was also the people’s debt.”

What to do with the surplus became a central issue of the 2000 presidential campaign, with Vice President Al Gore arguing that much of it should be put in a “lockbox” to protect Social Security and Medicare. Bush pushed for a broad tax cut, arguing that taxpayers at all income levels were owed a refund. “Some say that the growing federal surplus means Washington has more money to spend, but they’ve got it backwards,” Bush said as he accepted the GOP nomination in August 2000. “The surplus is not the government’s money. The surplus is the people’s money.”

As soon as he took office, Bush pushed Congress to make good on his tax pledge. Less than a week after his inauguration, he got a boost from Federal Reserve Chairman Alan Greenspan, who testified before the Senate Budget Committee that “tax reduction appears required” to prevent the federal government from accumulating too much cash. Greenspan feared that large surpluses would turn the government into the nation’s largest investor, creating distortions in the markets.

A chorus of skeptics warned against spending the surplus. Some stressed the inherent uncertainty of the CBO projections. Others said a big tax cut would unleash pent-up desire in both parties to pursue expensive priorities without the pay-as-you-go restraints that had helped produce the surplus.

Congress approved a $1.35 trillion tax cut in record time. A second package, worth $350 billion, followed in 2003. Together, they constituted one of the largest tax cuts since World War II, according to the conservative Tax Foundation.

Bush’s first Treasury secretary, Paul O’Neill, resigned after the White House decided to pursue the 2003 measure. “I believed we needed the money to facilitate fundamental tax reform and begin working on unfunded liabilities for Social Security and Medicare,” O’Neill said in an interview. But the White House, he said, was focused on improving economic growth for the fourth quarter of 2004. “They wanted to make sure economic conditions were great going into the president’s reelection.”

Proponents of tax cuts argue that the legislation merely returned tax collections to their appropriate levels. They note that the CBO’s 2001 forecast assumed that tax collections would stay above 20 percent of the nation’s gross domestic product (defined as the total of all economic output) — well above the historic average of 18 percent of GDP.

“It’s not obvious that America was ready to have taxes at a level this high persistently,” said Donald Marron, a former CBO director who now heads the nonprofit Tax Policy Center. “Some degree of tax cutting was inevitable.”

But some key advocates of the tax cuts now say such a large reduction was probably ill-advised.

“Nobody would have thought that all these things would have happened after you cut taxes,” Domenici said. “That you’d have two wars and not pay for them. That you’d have another recession. A huge extravaganza of expenditures” for the military and homeland security after the Sept. 11, 2001, attacks. “You would pause before you did it, if you knew.”

Bill Thomas, the former House Ways and Means Committee chairman who helped shepherd the tax cuts through Congress, defended the 2003 package as “fuel for the economy.” But he said in an interview that the 2001 measure was larded with “stuff that I was not all that wild about,” including bipartisan priorities such as a big increase in the child tax credit and a break for married couples — provisions Thomas believes did little to promote economic growth and amounted to “throwing money out the window.”

“I couldn’t do anything about it,” said Thomas, a California Republican who retired in 2006. “You’re the candy man when you advocate those kinds of tax cuts.”

In the end, Bush cut taxes and spent more money. Good times masked the impact, as surging tax revenues reduced the size of year-to-year deficits during the first three years of his second term. But after the economy collapsed during Bush’s final year in office, deficits — and therefore the debt — began to explode as Obama sought to revive economic activity with more tax cuts and federal spending.

Today, the CBO forecasts are unrelievedly gloomy, showing huge deficits essentially forever. As policymakers grapple with the legacy of the past decade, a demographic wave of senior citizens is crashing at their doorstep, driving up the cost of Medicare, Medicaid and Social Security.

William Hoagland, who was for years a top budget aide to Domenici and other GOP Senate leaders, said it is simplistic to think today’s fiscal problems began just 10 years ago. In 1976, as a young CBO analyst, Hoagland produced a long-term simulation that showed entitlement costs gradually overwhelming the rest of the federal budget.

“This situation really goes back to long before [the Bush administration], which is to say to old dead men that have long left the Congress,” he said.

Still, Hoagland said, the abandonment of fiscal discipline in the wake of the surpluses clearly didn’t help. “Nobody pushed for paying for this stuff,” he said. Not even after “it became very clear in the middle of 2003 that the line had turned on us. And the surpluses as far as the eye could see were no longer there.”

PANDORA, Australia's Web Archive

Image via WikipediaPANDORA, Australia's Web Archive, is a growing collection of Australian online publications, established initially by the National Library of Australia in 1996, and now built in collaboration with nine other Australian libraries and cultural collecting organisations.

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