Health Lessons from Europe

Time, Eben Harrell, Copenhagen, May 20 - High infant mortality, low life expectancy, soaring health-care costs — the symptoms are numerous and the diagnosis unmistakable: America's health-care system is ailing. But like a patient who coughs or limps his way through an illness, the U.S. has often been reluctant to look for help.

That's changing. The Obama Administration promises to offer universal coverage, introduce electronic records and wrestle health-care costs under control — in short, at least part of the health-care revolution that many Americans have advocated for years.

Inevitably, perhaps, that means Americans are looking to European models, hailed by some, dismissed as socialized medicine by others. In truth, European health care is neither the nirvana of Michael Moore's imagination, nor the publicly funded money pits that so scare conservatives. For one thing, Europeans spend less — about $4,000 a person less, in some cases — than Americans on health care annually, and often with better outcomes. The good news is that without reassembling its entire health-care system, there are many relatively simple measures that could help the U.S. get a handle on soaring costs — and keep its population healthier, too. America, here is your prescription:

Denmark: Electronic records save money and improve outcomes

At the Frederiksberg University Hospital in Copenhagen, there are no clipboards. Instead, doctors and nurses carry wireless handheld computers to call up the medical records of each patient, including their prescription history and drug allergies. If a doctor prescribes a medication that may cause complications, the PDA's alarm goes off. In the hospital's department of acute medicine — where patients often arrive unconscious or disorientated — department head Klaus Phanareth's PDA prevents him from prescribing dangerous medications "on a weekly basis," he says. "There's no doubt that it saves lives."

President Obama recently pledged $19 billion to computerize America's medical records by 2014. Denmark has already made the transition. The country has a centralized computer database to which 98% of primary care physicians, all hospital physicians and all pharmacists now have access. While basic records go back to 1977, a detailed history is available of all "patient contacts" since 2000. A recent study by the Commonwealth Fund, a health-care-reform nonprofit, rated the country's health-care IT systems as the most efficient in the world, with computerized record-keeping saving Danish physicians an average 50 minutes a day of administrative work. "That's essential for [U.S.] doctors," says Jeff Harris of the American College of Physicians, who points out that U.S. family physicians have the highest administration costs in the developed world and "are already under strain from all the paperwork required to run an office."

Denmark boasts several advantages that have helped in the early adoption of electronic health records. It is small (population: 5 million) with a tech-savvy citizenry and a public sector-run health system. Trust in the government is high. Most crucially, when the health service established a National Patient Registry in 1977 — a system that required doctors to file patient visit details in order to be reimbursed for their work — the country unknowingly laid the groundwork for electronic health records by putting in place centralized record-keeping.

But there have been slipups. After the government decided to move away from paper records in 1999, a team of officials came up with a coding system that required doctors to insert information and notes in alphanumerical form. The system was never implemented and eventually abandoned in 2006 after physicians and nurses complained. Now, instead of a single system, record-keeping utilizes various compatible systems, linking networks established by regional health agencies. "What we found is that adoption of electronic health records must be done by evolution rather than revolution," says Jens Andersen of Sunded.dk, the state health-care web portal. "You have to work with the systems already in place."

The latest phase of the program focuses on telemedicine. In the past year, the health-care service has piloted two home-monitoring programs for patients with diabetes and those on blood-thinning medication — groups at high risk of emergency hospitalization. At Frederiksberg Hospital, Dr. Phanareth is running a ground-breaking study to test whether patients with exacerbation of chronic obstructive pulmonary disease — responsible for 10% of all hospital admissions in Denmark — can be treated at home using telemedicine technology. "Sometimes, a lack of resistance is all you need for change to happen," Phanareth says.

Germany: Easing the burden of chronic disease; strengthening peer review

Sudden illness may be what scares most people, but chronic conditions place the greatest strain on health care. Around 75% of the U.S.'s $2 trillion annual health-care expenditure goes toward ailments such as heart disease, asthma, diabetes and certain cancers, and the vast majority of that is spent when these conditions require hospitalization and emergency care. The problem is particularly acute in the U.S. public sector: over 20% of U.S. Medicare patients have five or more chronic illnesses.

Preventing these conditions from developing in the first place is helped by a holistic approach to preventive medicine that encourages changes in what people eat or how much exercise they get. But for those patients already battling a chronic illness, there are steps health-care providers can take to keep them stable and out of hospital — as Germany's experience shows. The solutions can be as simple as educating patients about their condition, having nurses call patients to make sure they are staying on top of their medication and allowing doctors to compare their success rate with other physicians.

Germany's "disease-management programs" began in 2002 and cover some 3 million chronic patients. The results are promising. One survey by the University of Heidelberg of some 11,000 patients in the Saxony Anhalt and Rhineland-Palatinate regions found that the death rate in older diabetics in the program was about 8% lower than among diabetics who received regular care. And when one of Germany's largest insurers tracked 20,000 coronary heart disease and diabetes patients enrolled in disease-management programs for 15 months, it found the percentage of patients requiring hospitalization dropped from 4.3 to 2.9 — and 25% of the patients also gave up smoking.

The challenge is finding the funding to implement such schemes. In America's health system, there are few financial incentives for providers to take proactive measures to keep people healthy: the longer and more extensively a doctor or hospital treats a patient, the more income they recoup. That's why the American College of Physicians and others are calling for reform in health-care reimbursement, with the Federal Government and large insurance companies setting up "Patient Centered Medical Homes" in which a portion of doctors' pay will be linked to performance targets. As in Germany, these homes will target chronic diseases by allowing doctors, nurses, dietitians and therapists to educate all patients — especially chronic ones — on how to stay healthy. In 2007, Geisinger Health System began a pilot program in Pennsylvania, hiring nurses to check on patients with diabetes, heart disease and other chronic ailments, as well as linking 20% of physician income to targets in areas such as patient weight loss, smoking cessation and cholesterol levels. After the first year of the study, hospitals reported a 20% fall in admissions in the area and health-care expenditure dropped 7%.

The Germans have also shown how effective it can be to allow physicians to compare their performance against their colleagues. The country has the largest database on hospital performance in the world, which helps spread best practice. Such ideas would prove equally effective in the U.S., according to Karen Davis of the nonprofit Commonwealth Fund, but change needs to come at the policy level. "Right now we can see how successful these programs are in places like 
 Germany and Pennsylvania but then doctors and hospitals come back and ask, 'Who's going to pay for it?'," she says. 
 "It's a fair question."

Britain: How much is a year of life worth?

Placing a cap on drug costs could save U.S. health care billions. But it's not without controversy. England and Wales have set up a body called the National Institute for Health and Clinical Excellence (NICE) which reviews treatments to decide which are the most cost-effective and which the National Health Service (NHS) should pay for. A new drug has to offer value for money — and if it doesn't, whether it is life-saving or not, NICE won't approve it.

NICE uses a metric called "quality-adjusted life year," or Qaly, which grades a person's health-related quality of life from 0 to 1. Say a new drug for a previously untreatable condition comes on the market and the drug is proven to improve a patient's quality of life from .5 to .7 on the scale. A patient on the drug can expect to live an average of 15 years following the treatment. Taking the new drug thus earns patients the equivalent of three quality-adjusted life years (15 years multiplied by the .2 gain in quality of life). If the treatments costs $15,000, then the cost per quality-adjusted life year is $5,000.

Taking its lead from Britain's Department of Transport — which has a cost-
per-life-saved threshold for new road schemes of about $2.2 million per life, or around $45,000 per life year gained — NICE rarely approves a drug that costs more than $45,000 per Qaly (the fictitious drug would easily pass).

Not only does the equation make hard-nosed sense in a public-health system, its use can reduce costs in other ways. Eager to gain NICE's approval, drug companies have started giving away portions of expensive treatment for free in Britain in order to ensure their drugs meet the threshold. Sir Michael Rawlins, chairman of NICE, believes that if the U.S. adopted a similar system, it would revolutionize the culture of major pharmaceutical companies, many of which spend more on marketing than research and development. A 2008 study in the New England Journal of Medicine predicted that incorporating information about cost-effectiveness into the design of U.S. insurance would save $368 billion over 10 years.

NICE approves over 90% of new drugs, and those it rejects are rarely life-saving. But it has turned down some expensive treatments that prolong life — most notoriously, the kidney cancer drug Sutent in 2008 — angering patients and oncologists. The organization has since promised to approve more expensive life-saving drugs for illnesses affecting fewer than 7,000 patients a year. Rawlins concedes that NICE is "muddling through" uncharted waters: "The biggest lesson we've learned is to be open and transparent. But you have to be willing to make difficult decisions."

Aware that the idea of "rationing" health care would prove controversial in the U.S., advocates of reform — from the American College of Physicians to the advocacy group Center for Medicine in the Public Interest — have suggested a system of review that doesn't take into account the cost of new treatments. This would help doctors decide a course of treatment, as currently they have no way of comparing the efficacy of different drugs for the same condition. But it could also raise prices. "In a free-market economy the manufacturers may use the effectiveness review to charge higher prices for the best drug," says Jeffrey Harris, president of the American College of Physicians.

Peter Pitts of the Center for Medicine in the Public Interest says higher prices are a risk America will have to take. "Because NICE is concerned about saving money and not what's in the best interest of the patient, its methods are not only imprudent, they are unethical," he says, arguing that pharmaceutical firms use profits to fund research and development. Rawlins has a different take. "All health-care systems have implicitly, if not explicitly, adopted some form of cost control. In the U.S. you do it by not providing health care to some people. That's a rather brutal way of doing it."

France: The benchmark system is neither truly socialized nor fully equal

In 2000 the World Health Organization (WHO) used statistical measures, such as life expectancy and infant mortality, to rank the world's health-care systems. France topped the rankings. In 2008, researchers at the London School of Hygiene and Tropical Medicine followed up the WHO study by showing that France is not only a good place to stay healthy, but also a good place to be sick: of 19 industrialized nations, France has the lowest number of "amenable deaths" — fatalities that could have been prevented by good health care. (The U.S. had the highest.) But France is not immune to the challenges of modern health care. Despite massive government spending, its health-care system regularly runs over budget; in 2009 the deficit is expected to be $10.4 billion. Frustrated with the overstrained public-health sector, many people are now choosing private care.

France's state-run health insurance scheme reimburses 60% to 70% of most medical bills. The remaining costs are assumed by the patient. More than 90% of French citizens pay for supplementary health insurance to cover these costs — mostly from state-run providers called mutuals. But those who can afford it are increasingly abandoning mutuals in favor of private insurance. For most ailments, that makes little difference: 80% of France's general practitioners work under a regime that caps how much they can charge. But the reverse is true for specialists and surgeons — 80% of them set their own fees, often exceeding the reimbursement ceiling of most mutuals.

The result: a two-tiered system that runs counter to the utopian ideals of most health-care reformers. That's inevitable, says Dr. Roger Rua, secretary general of Syndicat des Médecins Libéraux, a union representing private practitioners. "Anywhere you've got a degree of socialization in a nation's health-care system, you'll eventually find people who feel they aren't finding what they want within it and decide to opt out," he says. "This is particularly true when systems begin having trouble financing themselves, and start cutting back on services."

Rua and others say that what's exemplary about France's system is that it has managed to foster patient choice while continuing to provide a generally high level of care for even the most vulnerable. All French citizens have affordable access to a doctor, thanks in part to one of the highest rates of doctors per capita in the world (3.4 per 1,000, compared to 2.4 in the U.S. and 2.5 in Britain). A sick French citizen who stays inside the public funding system might not get to choose from a list of specialists, but he or she will get a referral and the needed care. In some cases, patients even get paid to go to the doctor: for new mothers, a network of prenatal and early childhood facilities, called Protection Maternelle et Infantile, provides basic care, with financial incentives for the poor to attend.

France shows how a health-care system might realistically function in the face of daunting 21st century challenges: find a way to take care of your middle class and poor, and let the rich top up care as they see fit. As Rua puts it: "The [French] system ensures quality treatment for everyone, but it isn't there to eliminate the realities that exist in every country — and in every professional and economic sector — that give the more affluent a wider variety of choices, and the ability to seek élite care."

With reporting by Bruce Crumley / Paris and Stephanie Kirchner / Berlin

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Obama Hits A Home Run

The Nation, Robert Dreyfuss, Dubai, June 4 - I watched President Obama's Cairo speech from Dubai, the sprawling and frenzied city of gold and shopping malls on the shores of the Arabian--er, Persian--Gulf. (I'm on my way to Tehran tomorrow, to report on the July 12 presidential elections there, and I'd better keep my "Arabian" and "Persian" Gulfs straight.)

Based on early returns from a decidedly unrepresentative sample of Arab public opinion, Obama hit a home run. I agree. (Incidentally, it's not easy to find Arabs in Dubai, a desert kleptocracy run by a super-rich ruling clan, whose population is overwhelmingly from South Asia, East Asia, southern Sudan, and other parts of Africa.) In Dubai, at least, and in its media, Obama's speech was topic one, two and three all week.

That's good and bad. Obama's arrival in Saudi Arabia and Egypt was greeted in two ways. First, it had the trappings of a visit by an all-powerful but distant Great White Father--okay, he's black, but anyway--on whose words the fate of the Arab and Muslim world hangs, which is understandable in light of the fact that American troops and sailors are everywhere. And second, in contrast, sophisticated Arab opinion was truly hopeful that Obama's remarks would make concrete the sharp break with the Imperial America as represented by the administration of George W. "Crusader" Bush. I think the latter prevailed. Obama was appropriately humble, and he laid down important markers that signal a new U.S. approach to the Middle East and beyond.

And, as CNN reported, "No one threw a shoe at his head."

He acknowledged the current state of tension, along with the history of colonialism and Cold War power politics that treated Muslim nations as chess pieces. He correctly laid the root of the tension on the Muslim world's reaction, especially among conservatives and the Islamic right, to "modernity and globalization." He acknowledged that a speech doesn't change everything. He quoted the Quran, and he spoke eloquently of the West's (and the world's) debt to Islamic civilization. "I have known Islam on three continents," he said. And he added: "Islam is part of America." Words, true – but words that I have been waiting for a long time to have heard from a president of the United States.

With Osama bin Laden's recent communiqué still echoing, Obama drew out the contrast between Islam and bin Laden's version of "violent extremism." He said that the United States has no designs on Afghanistan and no plans to establish permanent bases there. And on Iraq, he said the same: "We pursue no bases, and no claim on their territory or resources"--i.e.,, oil. And he reiterated that all U.S. forces will be out of Iraq by 2012. (All of this, of course, will require some insistence by American voters and the "Arab and Muslim street" to hold Obama to his promises.)

But it was on Palestine that Obama hit the gong:

For more than 60 years they've endured the pain of dislocation. Many wait in refugee camps in the West Bank, Gaza, and neighboring lands for a life of peace and security that they have never been able to lead. They endure the daily humiliations -- large and small -- that come with occupation. So let there be no doubt: The situation for the Palestinian people is intolerable. And America will not turn our backs on the legitimate Palestinian aspiration for dignity, opportunity, and a state of their own.

How long has it been since a president spoke movingly about Palestinian suffering? And in a speech so high profile, even game-changing?

He even nodded to Hamas, acknowledging that Hamas has support among the Palestinians, and – amazingly – did not refer to the organization as a "terrorist group." And, of course, he kept up the pressure on Israeli expansionism by yet again slamming the settlements in the occupied territories – an issue, that likely as not, will bring down Bibi Netanyahu's right-wing government.

On Iran, Obama stated clearly that Iran has the right to peaceful uses of nuclear energy. Indeed, it is precisely that issue that will be at the core of the coming U.S.-Iran dialogue, since for Iran its ability to enrich uranium on Iranian soil is a no-compromise concern. Yet there are plenty of ways to finesse, regulate, and internationalize that.

On democracy, Obama said that "there is no straight line" to create representative governments in the Muslim world, such as Egypt – meaning that he won't push too hard, a la Bush and the neoconservatives, for instant democratic transformation. I think he hit precisely the right note.

His closing was pure Obama:

The Holy Koran tells us: "O mankind! We have created you male and a female; and we have made you into nations and tribes so that you may know one another."

The Talmud tells us: "The whole of the Torah is for the purpose of promoting peace."

The Holy Bible tells us: "Blessed are the peacemakers, for they shall be called sons of God."

The people of the world can live together in peace. We know that is God's vision. Now that must be our work here on Earth.

Okay, it's a speech. But it's a good start.

Source - http://www.thenation.com/blogs/dreyfuss/440904/print

After Waterboarding: How to Make Terrorists Talk?

Time, Bobby Ghosh, Washington, June 8 - The most successful interrogation of an Al-Qaeda operative by U.S. officials required no sleep deprivation, no slapping or "walling" and no waterboarding. All it took to soften up Abu Jandal, who had been closer to Osama bin Laden than any other terrorist ever captured, was a handful of sugar-free cookies.

Abu Jandal had been in a Yemeni prison for nearly a year when Ali Soufan of the FBI and Robert McFadden of the Naval Criminal Investigative Service arrived to interrogate him in the week after 9/11. Although there was already evidence that al-Qaeda was behind the attacks, American authorities needed conclusive proof, not least to satisfy skeptics like Pakistani President Pervez Musharraf, whose support was essential for any action against the terrorist organization. U.S. intelligence agencies also needed a better understanding of al-Qaeda's structure and leadership. Abu Jandal was the perfect source: the Yemeni who grew up in Saudi Arabia had been bin Laden's chief bodyguard, trusted not only to protect him but also to put a bullet in his head rather than let him be captured. (See pictures of do-it-yourself waterboarding attempts.)

Abu Jandal's guards were so intimidated by him, they wore masks to hide their identities and begged visitors not to refer to them by name in his presence. He had no intention of cooperating with the Americans; at their first meetings, he refused even to look at them and ranted about the evils of the West. Far from confirming al-Qaeda's involvement in 9/11, he insisted the attacks had been orchestrated by Israel's Mossad. While Abu Jandal was venting his spleen, Soufan noticed that he didn't touch any of the cookies that had been served with tea: "He was a diabetic and couldn't eat anything with sugar in it." At their next meeting, the Americans brought him some sugar-free cookies, a gesture that took the edge off Abu Jandal's angry demeanor. "We had showed him respect, and we had done this nice thing for him," Soufan recalls. "So he started talking to us instead of giving us lectures."

It took more questioning, and some interrogators' sleight of hand, before the Yemeni gave up a wealth of information about al-Qaeda — including the identities of seven of the 9/11 bombers — but the cookies were the turning point. "After that, he could no longer think of us as evil Americans," Soufan says. "Now he was thinking of us as human beings."

Soufan, now an international-security consultant, has emerged as a powerful critic of the George W. Bush — era interrogation techniques; he has testified against them in congressional hearings and is an expert witness in cases against detainees. He has described the techniques as "borderline torture" and "un-American." His larger argument is that methods like waterboarding are wholly unnecessary — traditional interrogation methods, a combination of guile and graft, are the best way to break down even the most stubborn subjects. He told a recent hearing of the Senate Judiciary Committee that it was these methods, not the harsh techniques, that prompted al-Qaeda operative Abu Zubaydah to give up the identities of Khalid Sheikh Mohammed, the self-confessed mastermind of the 9/11 attacks, and "dirty bomber" Jose Padilla. Bush Administration officials, including Vice President Dick Cheney, had previously claimed that Abu Zubaydah supplied that information only after he was waterboarded. But Soufan says once the rough treatment began — administered by CIA-hired private contractors with no interrogation experience — Abu Zubaydah actually stopped cooperating. (Read "Dick Cheney: Why So Chatty All of a Sudden?")

The debate over the CIA's interrogation techniques and their effectiveness has intensified since President Barack Obama's decision to release Bush Administration memos authorizing the use of waterboarding and other harsh methods. Defenders of the Bush program, most notably Cheney, say the use of waterboarding produced actionable intelligence that helped the U.S. disrupt terrorist plots. But the experiences of officials like Soufan suggest that the utility of torture is limited at best and counterproductive at worst. Put simply, there's no definitive evidence that torture works.

The crucial question going forward is, What does? How does an interrogator break down a hardened terrorist without using violence? TIME spoke with several interrogators who have worked for the U.S. military as well as others who have recently retired from the intelligence services (the CIA and FBI turned down requests for interviews with current staffers). All agreed with Soufan: the best way to get intelligence from even the most recalcitrant subject is to apply the subtle arts of interrogation rather than the blunt instruments of torture. "There is nothing intelligent about torture," says Eric Maddox, an Army staff sergeant whose book Mission: Black List #1 chronicles his interrogations in Iraq that ultimately led to the capture of Saddam Hussein. "If you have to inflict pain, then you've lost control of the situation, the subject and yourself."

Read about a top interrogator who is against torture.

See pictures of the aftershocks from the Abu Ghraib scandal.

The Rules of the Game
There is no definitive textbook on interrogation. The U.S. Army field manual, updated in 2006, lists 19 interrogation techniques, ranging from offering "real or emotional reward" for truthful answers to repeating questions again and again "until the source becomes so thoroughly bored with the procedure, he answers questions fully and candidly." (Obama has ordered the CIA to follow the Army manual until a review of its interrogation policies has been completed.)

Some of the most interesting techniques are classified as "emotional approaches." Interrogators may flatter a detainee's ego by praising some particular skill. Alternatively, the interrogators may attack the detainee's ego by accusing him of incompetence, goading him to defend himself and possibly give up information in the process. If interrogators choose to go on the attack, however, they may not "cross the line into humiliating and degrading treatment of the detainee." (See pictures of the battle against the Taliban.)

But experienced interrogators don't limit themselves to the 19 prescribed techniques. Matthew Alexander, a military interrogator whose efforts in Iraq led to the location and killing of al-Qaeda leader Abu Mousab al-Zarqawi, says old-fashioned criminal-investigation techniques work better than the Army manual. "Often I'll use tricks that are not part of the Army system but that every cop knows," says Alexander. "Like when you bring in two suspects, you take them to separate rooms and offer a deal to the first one who confesses." (Alexander, one of the authors of How to Break a Terrorist: The U.S. Interrogators Who Used Brains, Not Brutality, to Take Down the Deadliest Man in Iraq, uses a pseudonym for security purposes.)

Others apply methods familiar to psychologists and those who deprogram cult members. James Fitzsimmons, a retired FBI interviewer who dealt extensively with al-Qaeda members, says terrorism suspects often use their membership in a group as a psychological barrier. The interrogator's job, he says, "is to bring them out from the collective identity to the personal identity." To draw them out, Fitzsimmons invites his subjects to talk about their personal histories, all the way back to childhood. This makes them think of themselves as individuals rather than as part of a group.

Ultimately, every interrogation is a cat-and-mouse game, and seasoned interrogators have more than one way to coax, cajole or trick their captives into yielding information. Lying and dissimulation are commonplace. When a high-ranking insurgent spoke of his spendthrift wife, Alexander said he sympathized because he too had a wife who loved to shop. The two men bonded over this common "problem"; the insurgent never knew that Alexander is single. The Army manual even includes a "false flag" technique: interrogators may pretend to be of other nationalities if they feel a captive will not cooperate with Americans. (Read "Beyond Waterboarding: What Interrogators Can Still Do.")

Other countries that have experienced insurgencies and terrorism have evolved rules too. From Britain, with its Irish separatists, to Israel, with its Palestinian militants, most such countries have tended to move away from harsh techniques. But institutional relapses can occur: human-rights lawyers and Palestinians with experience in Israeli prisons say some violent interrogation techniques have returned in recent years.

The Tricks of the Trade
Each interrogator has his own idea of how to run an interrogation. Soufan likes to research his captive as thoroughly as possible before entering the interrogation room. "If you can get them to think you know almost everything to know about them — their families, their friends, their movements — then you've got an advantage," he says. "Because then they're thinking, 'Well, this guy already knows so much, there's no point in resisting ... I might as well tell him everything.'" When Abu Zubaydah tried to conceal his identity after his capture, Soufan stunned him by using the nickname given to him by his mother. "Once I called him 'Hani,' he knew the game was up," Soufan says.

To get Abu Jandal's cooperation, Soufan and McFadden laid a trap. After palliating his rage with the sugar-free cookies, they got him to identify a number of al-Qaeda members from an album of photographs, including Mohamed Atta and six other 9/11 hijackers. Next they showed him a local newspaper headline that claimed (erroneously) that more than 200 Yemenis had been killed in the World Trade Center. Abu Jandal agreed that this was a terrible crime and said no Muslim could be behind the attacks. Then Soufan dropped the bombshell: some of the men Abu Jandal had identified in the album had been among the hijackers. Without realizing it, the Yemeni prisoner had admitted that al-Qaeda had been responsible for 9/11: For all his resistance, he had given the Americans what they wanted. "He was broken, completely shattered," Soufan says. From that moment on, Abu Jandal was completely cooperative, giving Soufan and McFadden reams of information — names and descriptions of scores of al-Qaeda operatives, details of training and tactics.

See pictures of a jihadist's journey.

See pictures from inside Guantanamo Bay's detention facilities.

Alexander, who conducted more than 300 interrogations and supervised more than 1,000 others in Iraq, says the key to a successful interrogation lies in understanding the subject's motivation. In the spring of 2006, he was interrogating a Sunni imam connected with al-Qaeda in Iraq, which was then run by al-Zarqawi; the imam "blessed" suicide bombers before their final mission. His first words to Alexander were, "If I had a knife right now, I'd slit your throat." Asked why, the imam said the U.S. invasion had empowered Shi'ite thugs who had evicted his family from their home. Humiliated, he had turned to the insurgency. Alexander's response was to offer a personal apology: "I said, 'Look, I'm an American, and I want to say how sorry I am that we made so many mistakes in your country.'"

The imam, Alexander says, broke down in tears. The apology undercut his motivation for hating Americans and allowed him to open up to his interrogator. Alexander then nudged the conversation in a new direction, pointing out that Iraq and the U.S. had a common enemy: Iran. The two countries needed to cooperate in order to prevent Iraq from becoming supplicant to the Shi'ite mullahs in Tehran — a fear commonly expressed by Sunnis. Eventually the imam gave up the location of a safe house for suicide bombers; a raid on the house led to the capture of an al-Qaeda operative who in turn led U.S. troops to al-Zarqawi. (See pictures of U.S. troops' 6 years in Iraq.)

The Ticking Time Bomb
Proponents of waterboarding and other harsh interrogation techniques say the noncoercive methods are useless in emergencies, when interrogators have just minutes, not days, to extract vital, lifesaving information. The worst-case scenario is often depicted in movies and TV series like 24: a captured terrorist knows where and when a bomb will go off (in a mall, in a school, on Capitol Hill), and his interrogators must make him talk at once or else risk thousands of innocent lives. It's not just fervid screenwriters who believe that such a scenario calls for the use of brute force. In 2002, Richard Posner, a Court of Appeals judge in Chicago and one of the most respected legal authorities in the U.S., wrote in the New Republic that "if torture is the only means of obtaining the information necessary to prevent the detonation of a nuclear bomb in Times Square, torture should be used ... No one who doubts that this is the case should be in a position of responsibility."

The CIA's controversial methods, argue their defenders, were spawned by precisely that sense of urgency: in the immediate aftermath of 9/11, amid swirling rumors of further attacks to come — including the possibility of a "dirty" nuclear bomb — the Bush Administration had no choice but to authorize the use of whatever means necessary to extract information from suspected terrorists. "We had a lot of blind spots after the attacks on our country," former Vice President Cheney explained in a May 21 speech in Washington. "We didn't know about al-Qaeda's plans, but Khalid Sheikh Mohammed and a few others did know. And with many thousands of innocent lives potentially in the balance, we didn't think it made sense to let the terrorists answer questions in their own good time, if they answered them at all."

But professional interrogators say the ticking-time-bomb scenario is no more than a thought experiment; it rarely, if ever, occurs in real life. It's true that U.S. intelligence managed to extract information about some "aspirational" al-Qaeda plots through interrogation of prisoners captured after 9/11. But none of those plots have been revealed — at least to the public — to have been imminent attacks. And there is still no conclusive proof that any usable intelligence the U.S. did glean through harsh interrogations could not have been extracted using other methods.

In fact, a smart interrogator may be able to turn the ticking-bomb scenario on its head and use a sense of urgency against a captive. During combat raids in Iraq, Maddox grew used to interrogating insurgents on the fly, often at the point of capture. His objective: to quickly extract information on the location of other insurgents hiding out nearby. "I'd say to them, 'As soon as your friends know you've been captured, they'll assume that you're going to give them up, and they'll run for it. So if you want to help yourself, to get a lighter sentence, you've got to tell me everything right now, because in a couple of hours you'll have nothing of value to trade.'"

That trick led to Maddox's finest hour in Iraq. At 6 a.m. on December 13, 2003, the final day of his tour of duty, two hours before his flight out of Baghdad, he began interrogating Mohammed Ibrahim, a midranking Baath Party leader known to be close to Saddam Hussein. More than 40 of Ibrahim's friends and family members associated with the insurgency were already in custody. For an hour and a half, Maddox tried to persuade him that giving up Saddam could lead to the release of his friends and family. Then Maddox played his final card: "I told him he had to talk quickly because Saddam might move," he says. "I also said that once I got on the plane, I would no longer be able to help him. My colleagues would just toss him in prison. Instead of saving 40 of his friends and family, he'd become No. 41." It worked. That evening, Ibrahim's directions led U.S. forces to Saddam's spider hole.

Read Senator Patrick's Leahy's case for the Truth Commission.

Read about why Obama is still opposed to the Truth Commission.

Correction: The original version of this story identified Ali Soufan as an expert witness in cases brought by detainees. He has been a witness in cases against detainees.

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Obama Addresses World's Muslims

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President Barack Obama delivers much-anticipated message to Muslim world from auditorium at Cairo University campus, 04 Jun 2009

VOA, Paula Wolfson, Cairo, June 4 - U.S. President Barack Obama says it is time for a new beginning in relations between America and the world's Muslims. The president said they should unite to confront violent extremism and promote the cause of peace.

Fresh start

President Obama says, after decades of frustration and distrust, it is time for candor ... for dialogue ... and a fresh start.

"I have come here to Cairo to seek a new beginning between the United States and Muslims around the world; one based upon mutual interest and mutual respect, and one based upon the truth that America and Islam are not exclusive, and need not be in competition," the president said.

Seeking common ground

He spoke in a packed auditorium on the sprawling campus of Cairo University. But his intended audience was far broader: more than one-billion Muslims around the world.

"I am convinced that in order to move forward we must say openly to each other the things we hold in our hearts, and that too often are said only behind closed doors," President Obama said. "There must be a sustained effort to listen to each other, to learn from each other, to respect one another, and to seek common ground."

The president spoke of his own perspective as a Christian with Muslim relatives who spent part of his youth in predominantly Muslim Indonesia.

"That experience guides my conviction that partnership between America and Islam must be based on what Islam is, not what it is not," he said. " And I consider it part of my responsibility as President of the United States to fight against negative stereotypes of Islam wherever they appear."

Hatred of a few

President Obama said problems must be dealt with through partnership, and tensions must be faced head on.

He said extremists are playing on their differences, and are killing people in many countries of many faiths.

"The enduring faith of over a billion people is so much bigger than the narrow hatred of a few," President Obama said. "Islam is not part of the problem in combating violent extremism, it is an important part of promoting peace."

Eliminate friction

The president said it is important to talk directly about all the issues that have created frictions in the past, from the wars in Iraq and Afghanistan to the Israeli-Palestinian peace process.

"If we see this conflict only from one side or the other, then we will be blind to the truth: the only resolution is for the aspirations of both sides to be met through two states, where Israelis and Palestinians each live in peace and security," he said.

Israeli-Palestinian conflict

President Obama said the Palestinians must renounce violence, and Israel must cease settlement activity. He said all sides must look honestly and openly at the reality of the situation.

"Privately, many Muslims recognize that Israel will not go away," the president said. "Likewise, many Israelis recognize the need for a Palestinian state. It is time for us to act on what everyone knows to be true."

Nuclear proliferation

The president also spoke of the need to work together to curtail the spread of nuclear weapons, making specific mention of Iran's nuclear ambitions.

And he spoke bluntly of the need to promote democracy, religious freedom, and women's rights.

"I reject the view of some in the West that a woman who chooses to cover her hair is somehow less equal, but I do believe that a woman who is denied an education is denied equality," President Obama said.

Before the speech, Mr. Obama met with Egyptian President Hosni Mubarak and visited a mosque. After the address, he headed to the outskirts of the city to see the pyramids - a nod to the Egyptian capital's long history at the heart of the Arab world.

Source - http://www.voanews.com/english/2009-06-04-voa2.cfm

Exacting Change

On May 15, House Energy and Commerce Committee chair Henry Waxman and subcommittee chair Edward Markey unveiled the American Clean Energy and Security Act, addressing a priority of President Obama's reform agenda: the drive for new energy. The bill was both pathbreaking and disappointing, with major compromises from its initial draft. Cuts in carbon emissions that had been pegged at the international standard of 20 percent by 2020 (from 1990 levels) were reduced to 4 percent. Mandates on renewable energy for utilities were slashed. Standards on new coal plants were weakened. Instead of auctioning off pollution permits under a cap-and-trade system (raising revenue to relieve low-income ratepayers and spur investment in clean energy), the bill gives away 85 percent of the permits, with coal utilities, oil refineries and energy-intensive industries like steel getting huge handouts. The subsidies and deals bloated the bill to more than 900 pages, and Republicans introduced so many amendments that Democrats had to hire a speed-reader to get through them. The bill's fate in the Senate is even more uncertain.

Duke Energy, the Edison Electric Institute and various other energy producers praised the bill, along with some conservative coal-state Democrats. The environmental community split: Al Gore, Environmental Defense Fund and others endorsed the bill as an important first step, while Public Citizen, Friends of the Earth and Greenpeace questioned whether it would spur action toward renewable energy in the short term. "This bill has been seriously undermined by the lobbying of industries more concerned with profits than the plight of our planet," Greenpeace declared in announcing its opposition.

The climate bill isn't the only piece of legislation being compromised. Although the major banks are on life support, they were still able to block "cramdown," the linchpin of Obama's mortgage plan, which gives bankruptcy judges the right to reset mortgages of families facing foreclosure. That led Senate majority whip Richard Durbin to fume that the banks "own the place." Credit card companies are less popular than Somali pirates, but they managed to fend off any limit on interest rates they can charge customers.

All of the signature economic reforms the president has promoted--from healthcare to employee free choice--are under siege. Without a grassroots uprising that challenges business as usual in Washington, we aren't likely to get the change we were promised, much less the change we need.

The Reform Moment

It shouldn't be that tough. All the stars are aligned for launching the greatest era of progressive reform since the 1960s. We face stark crises that require fundamental structural reform. We have a powerful, popular president with a mandate for change--and a majority of Americans yearning for it. Catastrophes have left conservative ideas discredited, and Republicans are leaderless and divided.

Both houses of Congress enjoy large Democratic majorities with arguably the most liberal caucuses in four decades, if not longer. Nancy Pelosi, the strong liberal Speaker of the House, has helped to define and drive reform (one reason she is the target of withering Republican attacks over her comments on the CIA). In the Senate, normally the graveyard of change, Arlen Specter's switch and Al Franken's eventual seating will give Democrats the sixty-vote supermajority needed to shut down filibusters and move legislation. This doesn't resolve the difficulty of rounding up sixty votes, but it should concentrate the mind of the majority leader, Harry Reid. Democrats can no longer blame obstructionist Republicans for their inability to move. They will be expected to deliver.

Obama, whose watchword is pragmatism and whose gift is for compromise, has clearly grasped the moment. Whether you consider him a "pragmatic conservative," as Martin Wolf of the Financial Times suggests, or "the world's best salesman of socialism," in Republican Senator Jim DeMint's words, the president has been clear that "we cannot go back to the bubble-and-bust economy that led us to this point." We can't "recover" by restoring the old economy--and we should not want to.

Spurning the conventional advice of Beltway pundits to limit his agenda, Obama has acted boldly in response to the crisis. His recovery plan, despite being weakened in the Senate, includes the greatest increase in support for the poor since the Great Society and doubles the federal education budget. His budget calls for dramatic investment in core areas like healthcare and education. (In fact, it is caution, not audacity, that may most retard any recovery and haunt the president, as exemplified by Treasury Secretary Timothy Geithner's bank bailout.)

Obama has also championed issues that progressives have put on the agenda. He has pledged to move forward on new energy, the Employee Free Choice Act (EFCA), common-sense immigration reform, improved funding for education from pre-K to college and reregulating the financial sector to make it smaller and less destructive.

Together these reforms begin to define a new direction for the country, first steps toward a more just and sustainable economy. Needless to say, the administration's ability to chart that course will be largely determined by the path of the recession and the success of the administration's recovery plan, not to mention Afghanistan and Iraq. But these core economic reforms are the centerpiece of Obama's progressive promise.

In the Trenches

Each of these initiatives rouses the concerns of powerful and deeply entrenched corporate interests. All are mobilizing for a full-scale rumble, deploying legions of Democratic lobbyists and amassing war chests for advertising and "astroturf" campaigns. The healthcare industry tops the list for spending on lobbying in 2009, reporting about $127 million in expenditures in the first three months alone. The lobby's Swiftboat operation, Conservatives for Patients' Rights, vows to spend $20 million to scare Americans about Obama's reforms.The fight over EFCA "will be Armageddon," threatens Randel Johnson, vice president for labor policy at the US Chamber of Commerce. The National Journal reports that the Coalition for a Democratic Workplace, a major business umbrella group, alone has committed $200 million to defeat EFCA.The fierce struggle over the climate legislation is illustrative. According to the Center for Public Integrity, the climate lobbies had four lobbyists for every member of Congress at the end of last year, up more than 300 percent since 2003. The center reports that a staggering 880 groups and interests on all sides are signed up to influence the bill. The oil and coal industry spent about $76.1 million on ads in the first four months of the year, according to the Campaign Media Analysis Group.Most of the key reforms--healthcare, energy, EFCA and immigration (but notably not finance)--have sophisticated, independent progressive coalitions driving the issue. Health Care for America Now (HCAN) enlists more than 1,000 groups, with a budget of $40 million; it is already on the air urging support in key Democratic states. The unions may spend more than $100 million supporting EFCA, but they will be outgunned several times over. The environmental community mobilizes thousands of activists and has already expended millions on advertising: together, Gore's Alliance for Climate Protection, the Environmental Defense Fund and the Sierra Club spent $28.6 million in ads over the first four months of 2009. But enviros will be outspent some ten to one in lobbying and three to one in advertising.The progressive infrastructure built during the Bush years provides Obama with independent capacity that didn't exist in the Clinton years, from media monitoring to grassroots mobilization. Two new groups--Common Purpose Project and Unity '09--were set up and staffed by Obama campaign veterans to coordinate message and field operations in support of major administration reforms. They are complemented by the largest new operation of all, Organizing for America, the 13 million-person donor and activist list lodged at the DNC, which can flood House and Senate offices with calls and letters.

Sausage-Making

Ironically, the key targets for both the corporate and popular mobilizations are a remarkably small number of legislators. Most are Democrats--the handful of conservative "Blue Dog" and DLC representatives and their equivalents in the Senate--plus a few moderate Republican senators who aren't wedded to obstruction. House Republicans can do little but howl at the wind. The president's greatest challenge in passing reform is thus garnering support from his own party, not from the opposition.

Obama's leadership style encourages compromise: he lays out a broad vision, eloquently makes his case and invites all the stakeholders to the negotiations--paying special attention to efforts that forge common ground. For example, the climate bill used as a blueprint the plan released by the US Climate Action Partnership, which brought leading environmental groups like the Natural Resources Defense Council and the Pew Center on Global Climate Change together with giant companies like PepsiCo and Ford and many top energy providers.

Obama then allows Congress to work out the legislation, often counting on Pelosi to ensure that strong committee leaders drive the negotiations. White House aides, marshaled by chief of staff Rahm Emanuel, help to cut deals and build consensus backstage. Citizen groups are called upon to support the resulting legislation and to target swing legislators.

The White House mantra is, Never let the perfect be the enemy of the good. The president doesn't single out the Democrats standing in the way; he prefers compromise to pitched battle, particularly within his party. A senior White House aide has described Obama as a "raging minimalist," by which he means someone who believes that you should put all the parties at the table, find out what can be agreed upon and go with that.

Obama's emphasis on gaining as much consensus as possible, and his reluctance to challenge publicly the interests or legislators seeking to delay or dilute reform, has no doubt won him some support he might otherwise not have had. Corporate trade associations are seeking to shape reforms on climate and healthcare rather than to blow them up. But the emphasis on backstage compromise also weakens the president's ability to challenge the balance of forces in Congress by mobilizing public outrage. When a compromise is struck, progressives are asked to join the president in supporting it and to mute their criticisms. Passage of the recovery plan and the president's bold budget outline bear testament to that strategy. And no doubt, whatever progress is made on healthcare or energy or workers' rights will be in stark contrast to the black hole of the Bush years.

The danger is that this process may make the weak the enemy of the good. Legislated reforms always reflect the gulf between what is needed and what is possible. That gulf is very wide despite the economic crisis and the sea-change elections, because corporate lobbies still hold sway in Washington. Many Congressional liberals worry that there isn't enough push to overcome the opposition, particularly in the Senate. We could see a series of reforms with the heart cut out of them--healthcare without a good public plan, energy without strong cap-and-trade and renewable energy standards, EFCA without card check or binding arbitration--and immigration may not even make it to the table. To change that balance, the president may have to put his popularity on the line--or citizens may have to change the terms of the debate.

Compromise is inevitable. The hard question is whether the compromise opens the door to greater progress or forecloses opportunity. A weak public plan will make it hard to get healthcare expenses under control while extending care to all. Timid cap-and-trade standards won't spark the drive for renewable energy or substantially reduce carbon emissions. Without significant reform, workers' ability to organize won't improve all that much.

Moreover, the reform moment may not last long. Given the economic devastation and the wars abroad, the president's popularity is more likely to decline than to rise. Parties in power tend to lose seats in the first midterm election of a new presidency. If unemployment is still increasing next year, as seems likely, the Republican opposition could find its voice. Conservative Democrats and their corporate allies could grow bolder. And as bankers are bailed out while autoworkers get their pink slips and an increasing number of homeowners receive foreclosure notices, citizens could become disillusioned with the party in power.

The Progressive Challenge

Obviously, progressives can have the greatest impact by mobilizing voters to challenge those who stand in the way of reform. Legislators too often are more attuned to the needs of their donors than to those of their constituents. Many conservative Democrats seem wedded to old arguments, oblivious to the impact of the crisis on the people they represent. Independent organizing can have a significant effect, particularly in a time of dramatic change.

To forestall crippling compromises, reform coalitions must define the scope of the campaign early. Clear red lines must be drawn around the heart of the reform, putting everyone on notice that compromise beyond a certain point is a deal-breaker. Progressives should also be exposing the lobbyists, pointing out the parochial concerns and wrongheaded ideas of those opposing change, and mobilizing support in targeted states and districts. The pain of standing in the way should be made greater than the benefit.

HCAN has exemplified this strategy. The coalition helped to introduce comprehensive healthcare reform into the presidential campaign--itself a compromise from the single-payer plan designed to appeal to the 90 percent of voters who have some kind of coverage. HCAN then focused on the public plan, detailing its importance and anticipating that the insurance companies and Republicans would target it. When key Senate Democrats like Max Baucus and Ben Nelson began raising doubts about the public plan, HCAN worked with Progressive Caucus leaders to change the calculus. The caucus polled its members and released a statement that the majority of them would vote against any reform that did not include a strong public plan. They were soon joined by the Hispanic, Black and Asian-American Caucuses. At last count, more than 100 liberals have pledged to vote against any reform without a public plan. This provides a counterbalance in the negotiations and may help stiffen the leadership's spine. At the same time, HCAN has sponsored ads in recalcitrant legislators' districts, often singling them out by name.

The Obama administration prizes coordination of message and mobilization, and prefers that disagreements be aired in the back rooms rather than in the streets. White House aides argue that going after legislators--particularly Democrats-- publicly could make it harder for the administration to deal with them. This is, of course, particularly true for Organizing for America, run out of the DNC. But conservative legislators are likely to be skeptical of any White House claim that this most popular president couldn't curb the activities of progressive groups if he chose to.

At this point, most of the national constituency groups--labor unions, environmental groups, MoveOn--have organized independently to drive their causes. But they've chosen to co-operate with the White House, often muting disagreements on message or tactics.

Driving Progressive Change

The fate of the climate bill, cramdown, credit card and healthcare legislation, along with the fight over the rest of the agenda, suggests the limits of this strategy. Clearly, the balance of forces remains biased against significant reform. With Republicans committed to obstruction, only a few Democrats are needed to force major concessions or block key legislation.

We need a grassroots uprising against business as usual in Congress. The White House won't find it easy to spark that and may not support it. But without a movement that exposes legislators to the fury of their constituents, and challenges the cozy relationships between moneyed interests and incumbents, we risk blowing the greatest moment for reform in decades.

Moreover, independent organizing is vital because Obama's agenda--as he admits--is a beginning, not the end. Though it is ambitious, it is, not surprisingly, both imperfect and incomplete. Although reluctant to challenge a popular president, progressives have begun to question some of his initiatives. Joseph Stiglitz, Paul Krugman and a range of economists have criticized the bank bailout and sounded a call for a second round of stimulus spending. Fifty-one progressive House members voted against funding for escalation in Afghanistan, and many are calling for a clear exit strategy. And when Obama reversed his position on military tribunals and releasing the torture photos, this magazine and the human rights and civil liberties community responded with an uproar.

We also need to expand the agenda for reform. For example, if we are to make the investments vital to our future, as the president has called for, a sustained expansion of public investment is essential--and that will require a far bolder tax policy. Under current projections, domestic discretionary spending will decline to the lowest percentage of the economy since the early 1960s. We need a campaign for sustained investment linked with progressive tax reform to pay for it, featuring a higher rate for high-income earners, a tax on stock transactions to limit speculation, a crackdown on tax havens and taxation of income from wealth at the same rates as that from work.

Similarly, Obama has largely embraced America's role as GloboCop and calls for sustaining military budgets that are nearly as large as the rest of the world's combined. As the escalation in Afghanistan indicates, the American posture virtually guarantees involvement in constant wars and interventions across the globe. Changing this unsustainable strategy will require creative thinking about security and how to argue for it.

The struggle over financial regulation has only begun. The contrast between the treatment of bankers and the treatment of autoworkers and suppliers--between those, in Steelworkers president Leo Gerard's phrase, who shower before work and those who shower after work--has not gone unnoticed. Congress has passed legislation to set up an independent commission with subpoena power to detail what went wrong in the financial collapse and demonstrate the fraud, greed and regulatory malfeasance that drove us into this mess. Progressives should be pushing hard for aggressive hearings to help provide the popular mandate for fundamental reforms: restructuring firms "too big to fail," limiting leverage, outlawing exotic financial instruments, controlling consumer and credit card gouging and returning finance to its position as the servant, not the master, of the Main Street economy.

At the beginning of the administration Rahm Emanuel famously said, "You never want a serious crisis to go to waste." With Obama's leadership, Washington will produce reform. But even with coordinated efforts to support his agenda, it is likely to be deeply compromised unless an independent movement challenges business as usual and forces far bolder changes than Washington now thinks possible.

Robert L. Borosage is president of the Institute for America's Future

Katrina vanden Heuvel is Editor and Publisher of The Nation.

Source - http://www.thenation.com/doc/20090615/borosage_kvh

Groups on the Left Are Suddenly on Top

Washington Post, Dan Eggen, June 4 - Less than 24 hours after President Obama announced the nomination of Judge Sonia Sotomayor to the Supreme Court, an alliance formed solely to push the appointment launched a six-figure ad buy on the major television networks.

"Raised in public housing by a working mom who taught her the power of education," the text of the ad reads, as Obama talks in the background about the virtues of an ideal jurist. "Tough prosecutor. Distinguished judge. Practical understanding of the law."

Conservative groups, by contrast, stumbled through days of disjointed messages and never mustered the resources for a major television campaign. By the end of the week, Republicans were fighting among themselves over the perils of attacking the nation's first Hispanic nominee to the high court.

The episode was one of the latest examples of how Obama's election has dramatically altered the landscape occupied by the advocacy groups, think tanks and lobbying firms that make up Washington's sprawling influence industry. Democratic and left-leaning groups are now ascendant, enjoying clout not seen in a generation and benefiting from close access to a White House brimming with former colleagues.

Nurses turn their backs to the Senate Finance Committee in silent protest during a hearing on health-care reform. (By Pablo Martinez Monsivais -- Associated Press)

Many of the groups spent the Bush years championing policies that had little chance of being adopted; now, their ideas and positions are at the center of the Washington debate. Obama's plan to offer public health insurance to compete with the private sector, for example, has its roots in a series of obscure papers circulated among liberal policy analysts several years ago. Some of those analysts are now briefing the administration and Congress on how the system could be implemented.

Several thousand liberal activists have gathered in Washington this week for a national conference that includes appearances by Labor Secretary Hilda L. Solis and other administration officials. The three-day event, "America's Future Now," focuses heavily on health-care reform, climate-change policy and other issues championed by Obama.

But liberal groups are also learning the limits of their influence, whether they are being thwarted by conservative Democrats in the Senate or undermined by a president who has pursued a centrist path on many terrorism and defense issues. One example came in April, when a proposal allowing bankruptcy judges to reduce mortgage payments went down to easy defeat in the Senate, despite support from Obama and consumer groups.

"We're in an era now where we have a president who has committed to a transformative agenda of progressive change, but it's absolutely clear that change will be impossible without enormous involvement from the grass roots," said Justin Ruben, executive director of MoveOn.org, an Internet-focused advocacy group that nearly doubled in size, to more than 5 million members, during the 2008 presidential campaign. "That's what our role is. It's not enough to change who's in power."

Many of the most influential liberal groups are new or relatively young. Fresh groups on the scene include Business Forward, which attempts to attract corporate support for Obama's economic policies; Unity '09, a coalition of progressive groups focused on pushing Obama's policy agenda; and Organizing for America, an Obama-sanctioned outreach project at the Democratic National Committee.

There are young left-leaning groups devoted to health care (Health Care for America Now), economics (the Center on Budget and Policy Priorities), defense (the Center for a New American Security) and labor issues (Change to Win). Another group, Common Purpose, holds seminars every Tuesday at the Capital Hilton near the White House, bringing together more than 100 liberal activists with Obama administration aides to debate policy and plot strategy.

Matt Bennett, public affairs director for Third Way, a center-left think tank, said the groups amount to "a new intellectual infrastructure" for progressives in Washington.

The granddaddy of the new vanguard is the Center for American Progress, a think tank founded with three employees in 2003 by longtime Democratic adviser John D. Podesta, who served as President Bill Clinton's chief of staff and ran Obama's transition office. Now with 180 employees and a $25 million annual budget, CAP has its own lobbying arm, called the Center for American Progress Action Fund; a student-focused project called Campus Progress; and a political blog called Think Progress.

Podesta began the project as a liberal counterpoint to conservative think tanks such as the Heritage Foundation and the American Enterprise Institute. He estimates that 40 staff members from his project are employed in the Obama administration, including domestic policy adviser Melody C. Barnes, deputy White House counsel Cassandra Q. Butts and climate envoy Todd Stern.

But Grover Norquist, a conservative activist whose influential Wednesday breakfast meetings served as an inspiration for the Common Purpose project, argues that left-leaning groups have too many "internal contradictions" to get along indefinitely.

"For the moment there's a false sense of comity," he said. "But at the end of the day, they're competing parasites. At some point, the unions will come up against the environmentalists, and the whole thing will start to fall apart."

Indeed, small cracks have appeared in the fragile coalition. Many grass-roots groups strongly object to expanded military involvement in Afghanistan, the bailouts of financial firms on Wall Street, and Obama's decisions last month to revive military commissions and block the release of photos that show detainee abuse. In Congress, Democratic-led hearings on health-care reform have been disrupted by activists demanding a "single-payer" nationalized insurance system, which Obama and his allies have explicitly ruled out.

Liberal activists acknowledge that disagreements between Obama and the groups that support him are inevitable. But Podesta said that "being in the wilderness concentrated people's attention on trying to be good collaborators. It's not like we're not being competitive. But people have done a pretty good job of keeping focused on the prize and trying to get the country moving in the right direction."

Robert L. Borosage, the founder of the Campaign for America's Future, which began as a group opposed to Clinton's centrist approach on welfare and other issues, said the "scope of the crisis" facing the country has so far tamped down potentially noisy disputes.

"There is a real argument going on with the Obama administration on some issues, but it hasn't gotten in the way of unity around other issues," Borosage said, adding: "You have to remember, Obama is enormously attractive to progressives in general. That goes a long way."

Borosage's group is a typical example of the expansion of liberal influence in Washington. His center's budget, which not long ago barely broke $1 million annually, has expanded to more than $5 million because of financial support from "regular people, foundations, unions and idiosyncratic rich people," as he jokingly puts it.

Source - http://www.washingtonpost.com/wp-dyn/content/article/2009/06/03/AR2009060303396.html

The Evolving Terrorist Threat to Southeast Asia: A Net Assessment

Book by Peter Chalk, Angel Rabasa, William Rosenau, Leanne Piggott

Terrorism is not new to Southeast Asia. For much of the Cold War, the activities of a variety of domestic ethnonationalist and religious militant groups posed a significant challenge to the region's internal stability. Since the 1990s, however, the residual challenge posed by substate militant extremism has risen in reaction to both the force of modernization pursued by many Southeast Asian governments and the political influence of radical Islam.

Building on prior RAND research analyzing the underlying motives, drivers, and capabilities of the principal extremist groups that have resorted to terrorist violence in the Philippines, southern Thailand, and Indonesia, this study examined the historical roots of militancy in these countries to provide context for assessing the degree to which local agendas are either being subsumed within a broader ideological framework or shaped by other extremist movements. Moving beyond simple terrorism analysis, this research also examined national and international government responses to militant movements in the region, including counterterrorist initiatives, military and policing strategies, hearts-and-minds campaigns, and funding and support from international organizations and governments (including the United States). Finally, the study broke new ground in assessing Cambodia as a potential future terrorist operational and logistical hub in Southeast Asia.

Pages: 264

ISBN/EAN: 9780833046581

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Use Adobe Acrobat Reader version 7.0 or higher for the best experience.

Contents

Chapter One:
Introduction

Chapter Two:
Malay Muslim Extremism in Southern Thailand

Chapter Three:
Muslim and Communist Extremism in the Philippines

Chapter Four:
Terrorism and National Security in Indonesia

Chapter Five:
The Regional Dimension: Jemaah Islamiyah

Chapter Six:
Counterterrorism and National Security in Thailand

Chapter Seven:
Counterterrorism and National Security in the Philippines

Chapter Eight:
Counterterrorism and National Security in Indonesia

Chapter Nine:
National Security in Southeast Asia: The U.S. Dimension

Chapter Ten:
Conclusion

Appendix:
Exploring the Potential for Emergent Operational and Logistical Terrorist Hubs in Cambodia

The research described in this report was prepared for the Office of the Secretary of Defense (OSD). The research was conducted in the RAND National Defense Research Institute, a federally funded research and development center sponsored by the OSD, the Joint Staff, the Unified Combatant Commands, the Department of the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

Source http://www.rand.org/pubs/monographs/2009/RAND_MG846.pdf

Documents of the Day, No. 2, June 2, 2009

The Religiosity of American College and University Professors
http://socrel.oxfordjournals.org/cgi/content/full/srp026v1

Timor-Leste Health Care Seeking Behaviour Study
http://www.sphcm.med.unsw.edu.au/SPHCMweb.nsf/resources/01_UNSW_Timor-Leste_Study_English.pdf/$file/01_UNSW_Timor-Leste_Study_English.pdf

The History of Violence and the State in Indonesia
http://www.crise.ox.ac.uk/pubs/workingpaper54.pdf

The Barong Wants to Go Out Again: Krisis Moneter and the Resurgence of Rituals in Indonesia
http://www.seas.at/aseas/1_2/pdf/ASEAS%201-2-A7.pdf

Identifying Key Concerns of Jemaah Islamiyah: The Singapore Context
http://www.pvtr.org/pdf/Ideology%20Response/Identifying%20key%20concerns%20of%20JI.pdf

Southeast Asia: Weathering the Economic Crisis

Business Week, Frederick Balfour, Cebu, May 28 - Painful economic slowdowns are nothing new to Southeast Asia. The region went through its own gut-wrenching financial crisis more than a decade ago in what now seems like a dress rehearsal for today's turmoil. Companies defaulted, banks collapsed, stock markets tanked, and economies shrank at double-digit rates as foreign investment slowed to a trickle. But Southeast Asia dutifully swallowed the bitter pill of austerity, devaluing currencies and working off debt while banks restructured and companies patched up balance sheets.

Now Southeast Asia is getting whacked again, a victim of sins on the other side of the globe. Last autumn the region's exports plunged as the U.S., and then China, slumped. Foreign investment, meanwhile, has plummeted as multinationals rein in spending. "It's frustrating that we are in a crisis that is not of our own making," says Thai Prime Minister Abhisit Vejjajiva.

A café in Hanoi: Vietnam is a popular alternative for companies diversifying away from China Justin Mott

Yet this downturn is hardly a full-blown repeat of the Asian crisis. That's testament to the surprising strength of the 10 countries that belong to the Association of Southeast Asian Nations (ASEAN). The region's banks are virtually free of toxic assets and haven't needed government bailout money. Years of trade surpluses and high savings rates have contributed to record foreign reserves. Debt loads—for governments, corporations, and consumers—are a fraction of those in the U.S. and Europe, and inflation and interest rates have fallen dramatically. "Of course there is a slowdown, but [these countries] are well prepared to weather the storm," says Mark Mobius, president of Templeton Emerging Market Funds. "They have outperformed global markets, which is telling us they are going to do quite well." ASEAN bourses have led the recovery in emerging-market stocks, with Jakarta's benchmark index up 70% and Vietnam's up 80% from recent lows.

Some companies operating in the region continue to do well, as demand for everything from computers to discount airline tickets remains strong. Unilever Indonesia has sold so much Pepsodent toothpaste, Lifebuoy shampoo, and other goods that its first-quarter revenue jumped 18%, to $412 million, boosting earnings 9%, to $70 million. "The impact from the global crisis is minimal," says Franky Jamin, Unilever Indonesia's corporate secretary. And London's Standard Chartered Bank, which gets two-thirds of its revenue in Asia, says first-quarter profits were its best ever, indicating that the region's slump will be shallower and shorter than elsewhere. Consumer banking and lending to small companies are strong, while the mortgage business continues to grow, says Ray Ferguson, the bank's CEO for Southeast Asia. Foreclosures, he adds, "are not a feature of the market."

Southeast Asia's strength is an encouraging sign that the region is still a player. Though it may have been half-forgotten by many investors since the crisis, its educated workers, natural resources, and—in some countries, at least—first-class infrastructure make it worth paying attention to. ASEAN has a total population of 560 million, and its combined gross domestic product of $1.3 trillion is greater than India's. Indonesia, Thailand, Malaysia, the Philippines, Vietnam, and Singapore—which account for about 95% of the region's economy—attracted nearly $50 billion in foreign direct investment last year, vs. China's $92 billion.

General Electric (GE), for instance, has committed more than $1 billion to Southeast Asia in the past 18 months. Those investments include expanded aircraft maintenance facilities in Kuala Lumpur and a water-technology research center in Singapore. And in May, GE broke ground on its first project in Vietnam, a $61 million plant in the port city of Haiphong to produce wind turbine generators for export. "We wanted to put the GE footprint into a high-potential country," says Stuart Dean, the company's Southeast Asia president.

Scuttled Summit

That's not to say the region doesn't pose significant challenges for investors. Red tape and corruption are rampant; Indonesia is ranked 126 out of 163 by Transparency International, behind Nigeria and Nepal. Jakarta's opaque laws have prevented a country rich in gold and copper from attracting a single new foreign mining project in a decade. In Vietnam, traffic moves at a snail's pace along roads that can barely handle motorbikes, let alone the growing number of cars. And in Thailand, tourists and investors alike have been spooked by instability as anti-government demonstrators in recent months have forced the cancellation of an ASEAN summit and closed Bangkok's airport for days.

Those troubles, combined with the global crisis, are weighing on growth. Singapore and Thailand—which depend on exports—are contracting. The Asian Development Bank expects Vietnam to expand 4.5% this year, Indonesia 3.6%, and the Philippines 2.5%—near-recession levels for those countries. And new foreign investment in Malaysia fell 79%, to $931 million, in the first quarter, while in Vietnam investment inflows dropped 71%, to $2.8 billion.

Governments are fighting back by formulating stimulus plans. In Thailand, where the economy could shrink as much as 4%, retail sales have held up thanks to $58 checks mailed to 10 million low-income workers as part of a three-year, $45 billion stimulus package. Chipmaker Intel (INTC) expects stimulus-driven spending on health care and education to boost sales of computers that use its chips. Retail PC sales for the five biggest economies in ASEAN grew 17% year-on-year in the first quarter, more than twice as fast as in China, research firm GFK Asia estimates.

Up from Call Centers

The region is also growing fast as an outsourcing center. In the Philippine city of Cebu, nestled between emerald hills and luminous coral reefs, the seven-year-old Asiatown IT Park is home to two dozen call centers and software outsourcing shops. "It's not an easy job, but the salary is pretty good," says 29-year-old Leyland Canoy, who earns $470 a month at locally owned eTelecare, where he provides tech support to customers of Internet phone company Vonage (VG).

The Philippine outsourcing industry has been operating for years, but now it has big plans to grab as much as 10% of the global IT outsourcing market. Wipro (WIT), Accenture (ACN), HSBC (HBC), and others have opened scores of new back-office and tech-support centers in the country, helping to build an industry that saw $6 billion in revenue and employed more than 370,000 in 2008. "We are growing like crazy," says Marife Zamora, Philippines chief for Cincinnati-based Convergys (CVG), which hopes nearly to double its Philippines staff, to 20,000, this year. By 2010, industry leaders expect the sector to employ 900,000 and generate sales of $13 billion.

That's an ambitious target, but the country is just starting to move up from call centers. "There's work in finance and accounting, and corporate back offices have yet to be tapped," says Oscar Sañez, CEO of the Business Process Association of the Philippines. Accenture, which employs about 16,000 in the country, is helping clients upgrade IT systems to keep up with financial regulatory changes in the recession-racked U.S. JPMorgan Chase (JPM), S.C. Johnson & Sons, and Siemens (SI) are expanding their back-office work there. And Wipro is doubling its Philippine staff, to 1,550, by October. "The talent is really good," says Sanjeev Bhatia, vice-president for international operations at Wipro BPO. "We are really bullish."

Global corporations still come to Southeast Asia-to find manufacturing alternatives to China. First Solar (FSLR), of Tempe, Ariz., has chosen Kulim, Malaysia, for a $680 million solar panel manufacturing plant. British motorcycle maker Triumph is building a $73 million plant in Thailand. And Volkswagen (VLKAY) this summer is launching a joint venture to produce Touran minivans in Indonesia.

Vietnam, though, is the primary beneficiary of the move to diversify away from China. Its proximity to the mainland and the low tariffs it enjoys in Southeast Asia thanks to ASEAN trade agreements are big pluses, as are its productive labor force and entrepreneurial culture. In April, Samsung Electronics opened a $50 million mobile-phone plant outside Hanoi. Some 700 miles to the south near Ho Chi Minh City, Jabil Circuit (JBL) is building a $100 million circuit board plant in the Saigon Hi-Tech Park. Nearby, across former rice paddies muddied by afternoon rains, workers are readying a $1 billion Intel (INTC) plant that will open next year. "We expect more high-tech companies to follow," says Rick Howarth, general manager of Intel Products Vietnam. "The global crisis may have dampened companies' desire to invest, but they are also being forced to look at new markets for growth."

One of the region's greatest strengths is also a weakness: a growing reliance on exports, especially to China. The mainland's coastal factories use countless parts made in Southeast Asia for goods that are ultimately destined for the U.S. and Europe. When those Chinese exports get slammed, ASEAN economies suffer. "The region is excessively dependent on China, which does assembly, while ASEAN does components," says Charles Adams, a professor at Singapore's Lee Kuan Yew School of Public Policy. "What's needed is more intraregional trade in final goods."

The China Connection

There are few signs Southeast Asia will wean itself from that dependence anytime soon. Philippine outsourcers work primarily with U.S. customers. Intel plans to export most of its production from Ho Chi Minh City, since Vietnamese will buy just 3 million or so computers this year, while the Intel plant will be able to turn out hundreds of millions of chips annually. And Canon's (CAJ) $100 million laser printer facility outside Hanoi, its largest anywhere, ships its products overseas.

An ASEAN agreement that allows free trade in autos around the region may help reduce the importance of China and the West. Ford Motor (F), for example, ships sport-utility vehicles from Thailand to Vietnam, Indonesia, and the Philippines. The free trade "gives us enough volume," says David N. Alden, president of Ford's operations in Southeast Asia, where auto sales are about the same as in India. "Thailand's market alone could not have made this a business base."

AirAsia, a scrappy budget airline based in Malaysia, shows the potential of the regional market. In 2001, entrepreneur Tony Fernandes took a bankrupt carrier and relaunched it with just two planes flying out of Kuala Lumpur. Thanks to liberalization of air travel in much of the region, Fernandes has ramped up to 81 aircraft and 122 destinations in 16 countries—often smaller cities others had ignored. He expects to carry 24 million passengers in 2009, up 30% from last year. "We focused on building an ASEAN brand," says Fernandes. "We saw a huge opportunity no one was exploiting."

Source - http://www.businessweek.com/magazine/content/09_23/b4134034737154.htm

Happn.in Finds What’s Hot in Your City on Twitter

Mashable, Josh Katone, June 1 - Following trending topics on Twitter () (which you can do from the Twitter home page when you're logged in, or from the search page) is a great way to find out what people are talking about around the world.

Often, when a topic is trending on Twitter, it means that some major bit of news is unfolding about the trending term. But news that has global appeal might not be relevant to you when viewed through a local lens. A new site called Happn.in tracks trends locally on Twitter in 52 different metro areas around the world.

Happn.in tracks local Twitter users in 52 global cities, and computes a list of the top 10 phrases used in each city every hour. The top phrases used significantly more often that hour than the last are compiled into a list of trends. As Happn.in explains, "A phrase's hotness is calculated with the ratio of the [percentage of users who used that phrase during the past hour] to the [mean percentage of users who used that phrase over the past week]. Phrases decay exponentially, and quickly drop from the list once they have stopped being used."

Or, in other words, at any given time you should be seeing a list of the top trending topics in your area over the past hour. This is important because very often things trend locally that would be important to residents of that area, but not to the rest of the world. Without a way to track those local trends, it might be difficult to find that sort of news.

For example, in the city of Montreal today news that the Canadiens hockey team has named a new head coach is one of the top trends. That's clearly very important to many residents of the hockey-crazed Canadian city, but not very trend-worthy outside of that geographic area. If you live in Montreal and had no way of tracking local trends, you might miss that news on Twitter.

Happen.in offers a special Twitter account for each of the 52 cities it currently tracks, allowing interested users to get automatic trend updates via Twitter every few hours.

Local trend data could be very valuable for research purposes - for example, being able to track how information about a specific topic spread across Twitter within certain areas or from place to place. Happn.in's Labs page offers a glimpse into that potential, letting users load up trends for any past date (back to May 12, when the site launched). Additionally, more comprehensive data sets are available to researchers on request.

In the future, Happn.in plans to extend trend tracking beyond local metro areas to other groups of users, such as people with common interests, or presumably, the people you follow. Being able to track trending topics within a specific, predefined subset of topically-linked users could be infinitely valuable in terms of exposing relevant breaking news on Twitter.

Source - http://mashable.com/2009/06/01/happenin/

China Censors: The Tiananmen Square Anniversary Will Not Be Tweeted

Wired, Kim Zetter, June 2 - Chinese authorities have instituted censoring measures to block access to several internet sites and services in anticipation of Thursday's 20th anniversary of the Tianenmen Square protest and massacre.

The censoring began at 5pm local time on Tuesday as access to sites was blocked, though users could still reportedly reach some of them through proxies, VPNs and third-party desktop clients.

The blocked sites include Twitter, Flickr, and Microsoft's Hotmail, according to the Telegraph. FoxNews added the Huffington Post, Life Journal and MSNs Space blogging tool to the list. BBC viewers in China also saw their screens black out when the news service broadcast stories about the anniversary, and foreign news crews have been barred from filming in the square. Readers of the Financial Times and Economist magazine found stories about Tiananmen ripped from their pages. Authorities also plan to begin cracking down on unapproved internet cafes, according to reports from state media.

Photo: A Chinese policeman grabs a protester in Beijing's Tiananmen Square on the 15th anniversary of a bloody military crackdown on democracy protesters, Friday June 4, 2004. (AP Photo/Greg Baker)

The blocked sites are just a few among thousands that China's censors have targeted since the beginning of last year as a string of anniversaries is marked, including the 50th anniversary of the Tibet uprising. In April, access to YouTube was blocked after someone posted images of China's military police beating Tibetan monks.

Twitter became popular in China after last year's earthquake in Sichuan when people used it to get out reports of the devastation and signal news of their safety to friends and family members. The Times of London recently noted that Chinese users of Twitter can write terms that would normally be blocked if they typed them on other web sites, such as "6/4″ for the date of the Tiananmen massacre or "Charter 08," referring to a document published online last year by a group of intellectuals that calls for greater freedom and democracy.

As a result, the Times says, bloggers have been anticipating the blocking of Twitter.

"Twitter is a new thing in China. The censors need time to figure out what it is," blogger Michael Anti told the China-based blog Danwei.org. "So enjoy the last happy days of twittering before the fate of YouTube descends on it one day."

He noted that given the nature of the Chinese language, a Chinese tweet could crowd in much more meaning in the 140 characters allowed by Twitter per message, than can English users. "140 Chinese characters can make up all the full elements of a news piece with the '5 Ws' (Who, What, Where, When and HoW)," he said. "But the joy of the Chinese Twitterland is more fragile, and I hope that it will live longer in this country."

Source - http://www.wired.com/threatlevel/2009/06/china-censors-internet-before-tiananmen-square-anniversary/

The Facebook Controversy in Indonesia

Posted by: Bruce Einhorn on June 01

Indonesians still seem to be talking about the suggestion by some Muslim clerics last week that the government should regulate Facebook to prevent users in Indonesia from trading gossip or accessing porn. The Jakarta Post on Saturday ran a piece by Ary Hermawan with the great headline, "Thou Shall Not Facebook." (Here's a link, via UCLA's AsiaMedia site.) Peter Gelling, writing in the Global Post, has another useful take on the story. Some eye openers: According to Gelling, Indonesia has the world's fifth-largest Facebook population, behind the U.S., Britain, France and Italy. (This despite the fact that Internet penetration in Indonesia last year was just 10.5% of the total population.) Moreover, according to Gelling, Facebook has become "the most visited website" in the country.

Luckily for Facebook, the suggestion that the Indonesian government crack down on the social networking site seems to be going nowhere. The story does highlight, though, the potential that the company has in a part of the world that often gets forgotten. In Asia, China and India are the big markets that matter. But Facebook is an also-ran in China, where local companies rule, and it's a laggard in India, too, well behind Google's Orkut. (Thanks to Thomas Crampton's blog for linking to a survey by comScore on the Indian market.) Facebook seems to have hit fertile ground in Indonesia, a market with plenty of room still to grow - objections from some religious leaders notwithstanding.

Source - http://www.businessweek.com/globalbiz/blog/eyeonasia/archives/2009/06/the_facebook_co.html

Worldwide Incidents Tracking System

The Worldwide Incidents Tracking System is the National Counterterrorism Center's database of terrorist incidents.

According to NCTC definition, terrorism occurs when groups or individuals acting on political motivation deliberately or recklessly attack civilians/non-combatants or their property and the attack does not fall into another special category of political violence, such as crime, rioting, or tribal violence.

Posted via web from John's posterous

Documents of the Day - No. 1, June 1, 2009

These choice documents are all free, full-text, and open source. They all fall within the main topics covered by this blog (listed in the blog logo).

National Intelligence: A Consumer's Guide
http://dni.gov/reports/IC_Consumers_Guide_2009.pdf

Facebook and Academic Performance
http://www.uic.edu/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/2498/2181

Indonesia: Radicalization of the Palembang Group
http://www.crisisgroup.org/library/documents/asia/south_east_asia/b92_indonesia___radicalisation_of_the_palembang_group.pdf

Timor-Leste: The Dragon's Newest Friend
http://irasec.com/components/com_irasec/media/upload/publication_file_fr_287.pdf

That should be enough provocation for one day. I will try to make these posted research searches a regular blog feature.

Approval of U.S. Leadership Up in Some Arab Countries

Julie Ray and Mohamed Younis, Washington, D.C., June 1 -- President Barack Obama may find audiences in many Arab countries more willing to listen when he addresses the Muslim world Thursday from Cairo, Egypt. New Gallup Polls conducted in 11 Arab countries show that although approval of U.S. leadership remains generally low, ratings are up in 8 countries including Egypt.

Throughout much of President George W. Bush's second term, Gallup found U.S. leadership approval ratings in many Arab countries at times in the single digits and among the lowest in the world. Declines in approval were evident in several Arab countries over time, and in some nations, Egypt in particular, views soured significantly toward the end of Bush's term.

Surveys conducted roughly two months into Obama's presidency show median approval of U.S. leadership across the 11 Arab countries surveyed at 25%, ranging from a low of 7% in the Palestinian Territories to a high of 56% in Mauritania.

In eight Arab countries, including Egypt, Gallup recorded double-digit increases in approval from the last measurements of Bush's term. These upsurges, which ranged from 11 percentage points in Syria to 23 points in Tunisia, may reflect positive reception to Obama and his administration's public outreach to the Muslim world. The president's overtures toward pulling U.S. troops out of Iraq and closing Guantanamo Bay prison, two actions that respondents in previous Gallup surveys said could help improve the United States' image, also may have resonated with residents.

While approval is up in a number of countries, it is important to note that considerable numbers of respondents appear to be reserving their judgment or just didn't know enough about the new leadership in the United States to express an opinion. In countries such as Saudi Arabia, Syria, Tunisia, Lebanon, the Palestinian Territories, and Yemen, the percentage of respondents answering "don't know/refused" increased at least twofold.

Palestinians More Disapproving Than Before

Approval ratings took a negative turn in the Palestinian Territories, dropping from 13% to 7%. Perhaps related to Obama's silence during Israel's attacks on Gaza shortly before he took office, Palestinians grew more uncertain about the leadership of the United States between 2008 and 2009. Disapproval of U.S. leadership during this period remained steady at about 80%, but the percentages of Palestinians who did not have an opinion doubled from 6% to 12%. It's important to note that when Gallup asked Palestinians in 2008 whether it would make a difference who was elected president of the United States, a substantial majority (72%) said it would not.

In two other Arab countries surveyed, Yemen and Lebanon, approval ratings in 2009 didn't change significantly from ratings in 2008.

Bottom Line

Gallup Polls show that Obama will deliver his message Thursday with an arguably stronger basis of support than his predecessor ever had in many Arab countries. Nonetheless, approval remains low and underscores the work that remains as Obama seeks to pave a new, more positive way forward. Given the higher percentages of people in many Arab countries who do not have an opinion about U.S. leadership, Gallup surveys later this year in these same countries may provide a clearer picture of public opinion about the administration and its efforts to move relations forward.

In addition to policy decisions on matters of concern to the Arab world, Obama's Mideast policy will continue to figure prominently in future relations. The administration's reaction to Israel's shifts in rhetoric on the negotiation of a two-state solution will likely have a bearing on future views of U.S. leadership.

Survey Methods

Results are based on face-to-face interviews with approximately 1,000 adults, aged 15 and older, conducted in February and March 2009 in Egypt, the Palestinian Territories, Syria, Saudi Arabia, Qatar, Tunisia, Algeria, Mauritania, Yemen, Lebanon, and Kuwait. Non-Arabs were excluded from the sample in Saudi Arabia, Qatar, and Kuwait; samples in these countries are nationally representative of Arab adults. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error ranged from a low of ±3.3 percentage points in Tunisia to a high of ±3.8 percentage points in Yemen. The margin of error reflects the influence of data weighting. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

Source - http://www.gallup.com/poll/118940/Approval-Leadership-Arab-Countries.aspx?CSTS=alert