Newsweek Blogs

Rep. Joseph Cao, the Sole Republican to Support Pelosi Health Bill

Daniel Stone — Sun, 08 Nov 2009 04:14:21 GMT

House Minority Whip Eric Cantor promised Capitol Hill protesters on Friday that not one Republican would approve the Democrats' health care bill. But Cantor's vow of unanimity slipped Saturday night when the final vote tally -- 220 to 215 in support of the bill -- revealed Rep. Anh "Joseph" Cao, a Republican from Louisiana, cast a yes vote.

His reason for being the lone GOP nod? "I have always said that I would put aside partisan wrangling to do the business of the people. My vote tonight was based on my priority of doing what is best for my constituents," he said in a statement quickly released by his office. Earlier in the evening, he also supported a controversial amendment (which also passed) from Democratic Rep. Bart Stupak prohibiting any federal money from funding abortion.

The demographics in Cao's district would seem to have given a picture of where he would come down on the issue, although Democrats have for weeks counted out any Republican support. He received no call from the White House early Saturday, unlike several Democratic leaders who were reportedly sitting on the fence. Cao (pronounced gow) represents an area in the southern part of Louisiana, which includes areas around New Orleans, that's affected by one of the highest rates of poverty in the nation. It's also a district that usually goes to Democrats, but due to some ethical questions surrounding his Democratic opponent last fall, Cao won one of the biggest political upsets of the year. Following the vote Saturday evening, several Democratic lawmakers said that Cao did show signs that he was open to persuasion, having refused to make firm statements about how he would vote. Cao's timing also suggests that even before the late-night vote, he was confident in his decision. He pressed the 'yes' button several minutes before the voting window closed, meaning he wasn't planning to only vote yes in the final moments if absolutely necessary.

It's unclear whether Republican leaders will discipline Cao for breaking ranks and allowing Democrats to claim the bill had "bipartisan support." But what Cao can look forward to is the instant catapult into the national spotlight that his fellow Republican Rep. Joe Wilson received after calling President Obama a liar back in September. That and some new friends on Capitol Hill. On such a close vote, Cao is a hero to Democrats. But to Republicans, he's the one that got away.

High Anxiety as Leadership Scrambles for Last Health Care Votes

Daniel Stone — Sat, 07 Nov 2009 22:01:13 GMT

The partisan spread in the House would seem to give a clear indication of how Speaker Pelosi’s health care vote will go down—or at least how she’d like it to. Democrats currently hold a 40 seat majority (258-218) over Republicans, which is sizable by historical standards. But as the House winds down its weekend debate of Pelosi’s brick of a bill, the vote won’t mirror the partisan spread. At least 20 conservative Democrats have already vowed to oppose it, and a growing yet unknown number say they’ll do the same. Would Pelosi open a vote on her own bill if it could actually fail?

President Obama visited the Hill early Saturday to offer a pep talk to the Democratic caucus. According to an account of the speech reported by the Washington Post, he told Democrats that they would look back on this bill as their “finest moment in politics," and warned that even a no vote wouldn’t inoculate them from GOP attacks in next year’s elections.

Who was the meeting meant to convince? Pennsylvania Rep. Jason Altmire got a few calls from the White House and Colorado Rep. Jared Polis got some handshakes too. With both of them, it was an issue of last-minute persuading, which worked. But the stakes are higher with Democratic leaders, especially committee chairmen James Oberstar and Collin Peterson. Both have signaled an inclination to cast a no vote (Petersen moreso than Oberstar, reports the Star Tribune.). But if Pelosi needs a few final extra votes to push the bill over the margin, she can play hardball with the two by threatening their leadership roles. It’s not a common thing the speaker does, nor does it help her image as a party unifier, but for an issue like health care that has sizable implications for her and Obama, she may be willing to pull out the big guns.

Earlier today, in an effort to quell some anxiety, and as a procedural measure, House leadership held a test vote, usually designed as a taking of stock of where the numbers stand. At that point, the bill survived, with a margin of 50 votes, a split of 242-192. But following the floor debate and the vote over a controversial amendment on abortion, the final vote will be much closer. Most of the reporters in the House gallery (your Gaggler included) have a hunch it’ll pass by the slimmest of hairs. The consensus is also that Pelosi would delay the vote unless she had the numbers completely firmed down. But on Capitol Hill, being absolutely certain of the spread is next to impossible--a reality that has kept everyone, Pelosi likely included, guessing.

Official: Timing of Hasan's gun purchase shows "Of course, he planned this."

Michael Isikoff — Sat, 07 Nov 2009 20:45:53 GMT

Just three weeks after being transferred to the U.S. Army base at Fort Hood, Texas, Maj. Nidal Hasan walked into the "Guns Galore" gunship in Killeen, Texas and purchased the high powered semi-automatic pistol that he allegedly used in the mass shooting at the base on Thursday, a senior law enforcement official briefed on the investigation told Declassified.

The timing of the purchase of the Belgian made FN Herstal 5.7 pistol -- a growing weapon of choice of Mexican drug cartels -- is being viewed by some investigators as a potentially important clue suggesting that Hasan may have been plotting the attack for some time.

Hasan bought the gun on Aug. 1 of this year, said the law enforcement official, who asked that his name and agency not be identified because of the ongoing investigation. (Although Hasan's purchase of the gun was reported Friday by ABC and other news organizations, the date of the purchase has not previously been disclosed. A second federal law enforcement official confirmed the Aug. 1 date to Declassified on Saturday.)

At the same time, Hasan also bought several high capacity 20 round magazines that allowed him to rapidly fire off multiple rounds during the attack without reloading, the official said.

"Why do you go out and buy a pistol with several magazines?" said the law enforcement official. "Of course, he planned this." The official added, "Nobody wants to say that," referring to the authorities' reluctance to refer to the shooting as a pre-meditated attack.

Hasan ended up using the Herstal semi-automatic and another handgun to fire off as many as 100 rounds during the Thursday attack that killed 13 people at the base and wound 38.

What is especially intriguing about the date of the purchase is that on July 7, according to Hassan's official Army records posted on Declassified on Friday, he was transferred from Walter Reed Army Medical Center in Washington D.C. to the Darnall Army Medical Center in Fort Hood.

The transfer -- and the gun purchase -- also came while Hasan may have been undergoing a period of increasing alienation from the U.S. and expressing sympathy for Muslim militants. An Internet posting written by someone with the screen name of "NidalHasan" compared Islamic suicide bombers to Japanese kamikaze pilots.

"To say that this soldier committed suicide is inappropriate," the posting read referring a recent attack on American soldiers. "It's more appropriate to say he is a brave hero that sacrificed his life for a more noble cause. If one suicide bomber can kill 100 enemy soldiers because they were caught off guard that would be considered a strategic victory. You can call them crazy [if] you want but their act was not one of suicide that is despised by Islam." (FBI officials say they have not yet confirmed that the Hasan who is the suspect in the Fort Hood shooting is the same individual who posted the writing on the Internet.)

To some in law enforcement - including the one who spoke to Newsweek -- the purchase of the high-powered gun, the Internet writing and Hasan's alleged shouting of "Allah U Akbar" (Arabic for "God is Great") during the attack - suggest that the Fort Hood shooting should be viewed more as a terrorist act by a "lone wolf" Muslim extremist than as the work of a troubled physician who "snapped" under pressure.

But FBI and Justice Department officials are reluctant-at this stage in the investigation-to reach any conclusions, at least officially. "We just don't know enough at this stage," a FBI spokesman said Friday night.

To Pay Abu Omar, CIA's Man in Milan Loses Villa

Michael Isikoff — Sat, 07 Nov 2009 17:29:44 GMT

When an Italian judge last week sentenced 23 Americans in absentia for the CIA-orchestrated abduction of Hassan Mustafa Osama Nasr--a symbolic condemnation of the Bush administration's extraordinary-rendition program--the CIA's top officer in Milan at the time, Robert Seldon Lady, got the harshest sentence (eight years). Nobody expects Lady to serve time. He has long since left Italy, and the government of Silvio Berlusconi--whose military-intelligence chief cooperated with the abduction--is unlikely to seek extradition.

But there may be some rough justice in the case after all: the country villa that Lady once purchased as a retirement home is now slated to be sold to pay the $2.2 million in court-ordered damages due the very man Lady was convicted of kidnapping. A magistrate seized the villa, in the northwest part of the country, more than two years ago (Italian law allows for the property of criminal suspects to be confiscated to pay court costs). "It's a beautiful house," Armando Spataro, the prosecutor who oversaw the case, told NEWSWEEK in a phone interview. Once the lawyer for Nasr--a radical Muslim cleric also known as Abu Omar--petitions the court, "the money will go to Abu Omar," Spataro says. Lady could not be reached for comment, and a CIA spokesman said last week that the agency would have no comment on any aspect of the case.

The sale of Lady's house may be the ultimate twist in a case that has proved a long-running embarrassment for the CIA. In early 2003 the agency's officers were convinced that Abu Omar was a serious "terrorist facilitator" after receiving "firsthand reporting" that he was preaching violence against American interests in Italy from his mosque in Milan, says a former senior agency official involved in the planning of the operation who asked not to be identified because of legal sensitivities. (Abu Omar has asserted his innocence.) But instead of cooperating with a criminal investigation of Abu Omar and his associates that Spataro was conducting, the CIA snatched Abu Omar off the street in Milan, hustled him into a van, and flew him to Egypt.

After Abu Omar was released from prison--he complained that he had been hung upside down and had electric prods applied to his genitals--Spataro launched a criminal probe into the circumstances of his abduction. The irony, says Spataro, is that if the U.S. government had cooperated with his initial probe, he probably would have been able to develop enough evidence to put Abu Omar away. "The kidnapping of Abu Omar was not only a serious crime against human rights, it was a [defeat] in the fight against terrorism," he says. "If he was not kidnapped, he would still be in jail today."

Is Ft. Hood Like Columbine? By Columbine's Dave Cullen

Ashley Merryman — Sat, 07 Nov 2009 00:37:18 GMT

Today, like many other Americans, Po and I have been thinking about the tragedy at Ft. Hood – and how it brings back the memory of similar events such as the massacre at Columbine. But that raises a question: while the events feel similar, are they actually? It was a question I directed to Dave Cullen. Dave was a reporter at Columbine, on the day of the shooting, and he's been covering its aftermath ever since. The result of ten years of research was his haunting New York Times bestseller, Columbine. Here are Dave's thoughts.

___________

Is Ft. Hood like Columbine? That’s the gist of the question I’ve been asked repeatedly the past 24 hours, in various incarnations. It’s a natural question, which has been running through my own head incessantly. My brain is about to bust with all the apparent parallels to Columbine, Virginia Tech and 9/11, and the startling differences to each as well. But the only responsible answer to that question is I don‘t know yet.

If we have learned anything from these tragedies, is that we won’t get a firm handle on why for weeks, months or even years. At this distance from Oklahoma City, we were convinced it was the work of Arabs or Muslims, and what was the difference between those two anyway? The Columbine killers’ journals--far and away the most revealing evidence--were released in 2006, more than seven years after the murders.

The Ft. Hood perpetrator appears pretty transparent. The “obvious” factors include:

His religion
His ethnicity
The ridicule he endured for each
His profession as a soldier
His profession as a psychiatrist
His exposure to guns
Relentless exposure to Post Traumatic Stress Disorder (PTSD) in his patients
Opposition to the wars in Iraq and Afghanistan
Imminent deployment there

We have heard a lot of facts related to each of those factors already. I expect that most will turn to be true. Historically, we get the what right pretty fast. But we have a terrible record on why. An oddsmaker could reasonably predict that some of those items will prove relevant and others true but unrelated to the crime. The problem is predicting which is which.

If we guess now, the myths will be us forever. Ten years after Columbine, most of the public still believes it was about jocks, Goths and the Trench Coat Mafia. No, no and no. It wasn‘t even intended primarily as a school shooting: the failed bombs were supposed to be the main event. Eric Harris and Dylan Klebold were not loners, outcasts or misfits, nor were most of the school shooters. Most shooters do not fit the profile we have come to accept, because no accurate profile exists. Eric and Dylan don’t even fit a profile of each other: they were dramatically different boys in both personality and motive. They set the bombs and pulled the triggers for very different reasons.

With Columbine, speculation turned into accepted fact remarkably quickly. Most of the major myths solidified within the first 24 hours. Since then, journalists have shown great restraint. I was stunned by the coverage following Virginia Tech and most of the shootings: we learned that lesson and treaded lightly about motive. This week, it’s harder for me to assess the coverage, because I’m watching from Helsinki, where I’m attending an academic conference on school shooters. But I have been reading the blogs and the papers and watched video segments from each of the three big cable news networks, and so far, they understand the danger.

It’s OK to pose questions about all those bullet points above. Any good journalist is digging to unravel what was driving this man. All those look like good leads. It’s smart to ask the questions now. It’s smart to collect data toward the answers. But it’s foolish to start drawing conclusions.

From Ft. Hood to Florida: Lots of Questions, Few Answers on the Psyche of Shooters

Newsweek — Fri, 06 Nov 2009 22:35:15 GMT

by Rabeika Messina

We don’t know much about suspected Ft. Hood killer Nidal Malik Hasan: there are reports he gave away his possessions. There are reports he was terrified of being deployed. And there’s the fact that prior to his killing spree, Hasan worked as a psychiatrist, treating war-affected patients at both Walter Reed and Ft. Hood. Shouldn’t a psychiatrist have seen his own unraveling coming? Or are psychiatrists more likely to unravel than anyone else? What turns a man professionally endowed to treat the mental ailments of others into one who goes mental himself? And in his addled state, what did he think he’d achieve by opening fire into a crowd?

We may never fully know what Hasan was thinking the morning before his alleged killing spree, but we do know that some of his professional colleagues frustrated that this attack may be perceived as yet another black mark against their industry. Psychiatrists have long been plagued by jokes about instability, and while most are quite sane, there's some truth to the rumors: studies show that these doctors have the highest suicide rate among physicians. They are most likely to suffer from depression compared to surgeons and GPs, and they’re more likely to be critical of themselves and others. It makes sense: unlike an orthopedic surgeon, treats a broken bone, fixes it, and moves on, a psychiatrist, working to help people make peace with themselves and their troubled psyche, doesn’t get that same closure, the same sense of accomplishment, may feel helpless and frustrated as a result.

Being a psychiatrist doesn’t mean one holds all the keys to mental stability. While the majority of psychiatrists are well-balanced individuals, and according to an article in Psychology Today, an American Psychiatric Association study stated that those with emotional disorders are more drawn to the field than other types of medicine.

“Just because someone is a psychiatrist [does not mean] they’re not prone to the same evolvement of a mental illness,” said Dr. Kathryn Moss, a psychiatrist from the New York Presbyterian Hospital and the Weill Cornell Medical Center. Especially if Hasan was suffering from a something like a Pre-Post-Traumatic Stress Disorder. By routinely treating troops with disturbing experiences, he could have experienced enough strain and trauma to cause PTSD, even without deploying. “Exposure is not just to visceral traumas, but also to constant, ongoing stress,” explains Dr. Nancy Sherman, a Georgetown University professor with expertise on PTSD and the emotional and mental health of soldiers. “The mental health workers who are dealing with the current wars are under enormous stress, and it simply isn’t often recognized. Their needs must be addressed as much as those of the troops up for deployment,” she states.

But while PTSD can lead to violent outbursts in many returning troops, it has yet to result in such a gruesome, public crime. And there are plenty of depressed and dejected docs who don’t go on shooting rampages.

That’s because mass killers aren’t likely to be driven by conditions like anxiety, depression or bipolar disorder, which aren’t normally characterized by violent fits. Instead, says Moss, someone who inflicts this type of harm on other humans is under a much greater, more troubling psychosis. “They are delusional about what is going on in their environment,” says Moss. “They don’t share a view the reality that other people share, so they act in ways that other people wouldn’t act,” she says.

Nothing made that point more tragically clear than the shooting that occurred almost 24 hours later in Orlando, Florida. There, Jason Rodriguez turned himself in after cops surrounded his home, accusing him of shooting six people, killing one, in a Florida high rise. Rodriguez had no military background. He worked in at an engineering firm, not as a mental health profession. But he, like Hasan, was purportedly compelled to pull the trigger and shoot into a crowd. The only thing they likely had in common was a deep, troubling mental illness. “Mass shooters are impelled by a mental disorder, revenge, some type of ideological motivation or even perversion,” says Dr. Jeffrey Lieberman, chairman and professor at the Department of Psychiatry at Columbia University.

But to what end? What satisfaction do these killers get from attacking people in a public setting? “Sometimes, if they have some kind of delusion, these people feel that the group is a person,” explains Dr. Moss. “They see everyone as part of a conspiracy, out to get them. In the shooter’s mind, it is specific, because he chose that group.”

If these two men really are guilty of such crimes, could Hasan’s actions have impacted Rodriguez? Perhaps, says Lieberman. For those unstable enough to be considering such a thing, recent attacks can be triggering. “There is a contagion effect; there’s enough people out there who are mentally unstable and emotionally fragile that they can be influenced by the cultural environment,” he says.

A scary thought in a country that's seen more than ten mass killings in the past ten years. Something is triggering these killers, whether it's internal conflict, external stimulus, or a combination of both. Either way, the challenge is to discover what's motivating the shooters ahead of time, instead of wondering why after tragedy strikes.

Fort Hood Shooter: How Recently Was His Security Clearance Updated?

Mark Hosenball — Fri, 06 Nov 2009 22:12:21 GMT

Did Army security or intelligence officials miss potential warning signs in the behavior of accused Fort Hood shooter Maj. Nidal Hasan? One issue that is likely to be examined by the inquiries into Hasan’s shooting spree is the effectiveness of Army security-clearance procedures. According to Wayne Hall, a spokesman at Army headquarters at the Pentagon, everyone who receives a commission as a U.S. Army officer has to undergo a security investigation, which qualifies him or her, at a minimum, to handle information classified “secret.” While Hall said he could offer no specific information on the status of security clearances held by Hasan, he said standard practice is that officers normally have to receive their secret clearance before they are formally commissioned, and that sometimes commissions are held up pending the successful conclusion of the security check. Hall said that these rules apply to all Army officers, and indicated he had no reason to believe that Maj. Hasan was an exception.

Army officers who are on active duty are supposed to have their security clearances reviewed and updated every five years if they have a top-secret clearance and every 15 years if they have only a secret clearance. Hasan’s official military record shows that he was first commissioned in June 1997, meaning that if his clearance is top secret, he should have been reinvestigated twice, most recently in 2007, but that if his clearance is only secret, he's not due for an update until 2012. When it comes to civilian Pentagon employees, security-clearance updates have been known to fall behind schedule—sometimes years behind. But when it comes to military officers on active duty, the service tries to stick to the rules to ensure the reliability of troops if they are sent into the field.

Two national-security officials, who asked for anonymity when discussing sensitive information, said that the standard procedure for vetting people for secret security clearances usually involves what is known as a National Agency Check, or NAC (a copy of the basic NAC rulebook can be read here). The most perfunctory NAC is a review of federal agency records, including FBI fingerprint records, and, in the case of someone who has lived abroad or has relatives abroad, the records of intelligence agencies like the CIA.

Extended NACs, which the officials indicated are more likely for would-be military officers, would include checks of local and state police records in jurisdictions where the subject lived, as well as credit-bureau and financial-record checks. In the event that some kind of “derogatory” information turns up during these checks, one of the officials said, field investigators are likely to be sent out to conduct interviews, and the procedure could also include an interview with the security-clearance applicant. If an applicant is required to have a clearance for top-secret information or even more rarefied clearances (like a Q clearance for nuclear-weapons information or an SI/TK clearance for spy-satellite data), then investigators are supposed to conduct a full-field background check involving extensive interviews with references, former employers, acquaintances, and even neighbors of people under investigation. Employees of certain intelligence agencies, including the CIA and intelligence czar’s office, also have to undergo polygraph examinations before being granted final clearance.

At this point there is no reason to believe that Hasan had anything higher than the standard secret clearance required by all officers at his level—though nobody has ruled out the possibility that his clearance could have been higher. But the extent to which the Army checked him out—and kept watch over him as he earned his psychiatry degree and rose through the ranks—will almost certainly come under scrutiny as investigations into his background and the motives to his shooting spree continue.

Clarification: Following additional inquiries from NEWSWEEK, the Army informed us that its rules for updating security clearances have recently changed and that the information the Pentagon originally gave us on this subject was wrong. The new rules are that top-secret clearances are renewed every five years and secret clearances are renewed every 15 years, although additional investigations can be conducted earlier if warranted.

Fort Hood Shooter Got “Terror War” Medal

Mark Hosenball — Fri, 06 Nov 2009 21:12:13 GMT

One awkward aspect of the official military record of Maj. Nidal M. Hasan, the accused Fort Hood shooter, is the fact that he was decorated with something called the “Global War on Terrorism Service Medal.” What exactly is this decoration? An Army spokesman told NEWSWEEK that the medal is “awarded to all U.S. military personnel who are serving on active duty while the U.S. is engaged in the Global War on Terrorism, regardless of where they serve.” In other words, it’s not an award for heroism, achievement or valor—it’s awarded to everyone who has actively been on military service during the war on terror, which presumably means since 9/11. Though no evidence has so far emerged to link Hasan or his rampage to any international plot or terror group, there would certainly appear to be some irony in his receipt of a medal for fighting a war in which he arguably made a contribution—but ultimately to the wrong side.

Joe Lieberman: Climate Savior?

Katie Connolly — Fri, 06 Nov 2009 20:44:55 GMT

Joe Lieberman angered a lot of liberals recently with his declaration of opposition to Harry Reid's opt-out public-option provision. But liberals who also care about climate-change legislation may want to temper their rage. Lieberman has long championed climate-change legislation in the Senate, and is emerging as a critical player in the current effort. Politico reported back in September that Lieberman had been busy meeting with a bipartisan group to figure out a path forward on climate change. In a recent interview with the National Journal, Lieberman gave some insight into his negotiating strategy.

Lieberman knows they won't get to 60 without concessions on four key areas: nuclear, coal, agriculture, and manufacturing. Satisfying a few senators with interests in each of those industries might be enough to get the bill across the line. It looks as though Lieberman and his pals have found people to champion each issue. Tom Carper from Delaware is working on coal, Debbie Stabenow from Michigan is taking the lead on agriculture, and Sherrod Brown from Ohio is active on manufacturing. It sounds as though Lieberman himself will be central to nuclear negotiations, which makes sense given that he's close to Republicans like Lindsey Graham and John McCain who care deeply about expanding the nuclear sector.

The notion of concessions to farmers and coal burners probably makes environmentalists shudder. But it's also the only way a bill will pass in the Senate. They should consider that a bill, even an environmentally weak one, is better for the planet than no bill. Regulatory frameworks can be modified once they are passed, but it's usually passing them in the first place that is the hard part.

Lieberman has been around the block on this one—indeed the last major attempt at this legislation in the Senate bore his name. He's become somewhat of a realist on the topic and he likely knows that cobbling together an unholy alliance between coal, nuclear, manufacturing, and agriculture is the only way a climate bill will move through the Senate any time soon. Liberals may not like the idea of giving props to the wandering independent, but on this one, it looks like they'll have to.

Newsverse: Two Inconvenient Poems

Newsweek — Fri, 06 Nov 2009 19:48:20 GMT

By Jerry Adler

I. Carbon Country

Oh beautiful for spacious skies

Beneath which cows metabolize

All those amber waves of grain

And fill the heavens with methane.

For purple mountain majesties

Whose glaciers melt and lakes won’t freeze

Yes, my country, ‘tis of thee--

Land of private property--

I sing. And of the fruited plains

Which someday soon will sprout plantains.

And coconuts to fill the cargo

Holds of ships that dock in Fargo

When shining sea meets shining sea

In Iowa or Tennessee.

II. The Deep Blue Sea

Could global warming be a plot

To erase a certain spot

From the map, say, one specific

Island chain in the Pacific?

A clever scheme by hard-core birthers,

And others better called flat-Earthers,

To raise the ocean all around

Hawaii, till the place is drowned?

That’ll show Barack Obama!

It won’t matter who his mama

Was, because he’ll have been born in

A state from which you can’t be sworn in.

Because it isn’t on the map!

And on the flag we’ll leave a gap

For Hawaii’s missing star.

And appoint a Coastline Czar

To assure no son or daughter

Of a state that’s under water

Ever gets to raise a hand

To take the oath to rule the land.

Maj. Nidal M. Hasan's Official Military Record

Mark Hosenball — Fri, 06 Nov 2009 19:31:32 GMT

The following version of Maj. Nidal M. Hasan's official military record was released to NEWSWEEK by U.S. Army headquarters at the Pentagon:

NAME: Nidal (AbduWali) M. Hasan

RANK: Major

DATE OF RANK: Captain May 17, 2003; Major May 17, 2009

PRESENT AND PAST DUTY ASSIGNMENTS: Walter Reed Army Medical Center (Psychiatry Intern/Resident/Fellow) from June 2003 to 7 July 2009; Darnall Army Medical Center (Fort Hood, Texas) from July 2009 to present

FUTURE DUTY ASSIGNMENTS THAT ARE OFFICIALLY ESTABLISHED: He was on orders to deploy to Afghanistan as an Individual Augmentee to an Army Reserve unit to provide behavioral health support.

AWARDS AND DECORATIONS: National Defense Service Medal (two awards); Global War On Terrorism Service Medal; Army Service Ribbon

DIRECT COMMISSION: 22 June 1997

MILITARY AND CIVILIAN EDUCATION: Virginia Polytechnic Institute and State University at Blacksburg, Va., where he studied Biochemistry in 1997; Uniformed Services University of Health Science in Bethesda, Md., where he studied General Medicine in 2001; Combat Casualty CRS (AMEDD) in 1997 and AMEDD Officer Basic in 1997 Basic Branch where he was commissioned as a Psychiatrist

DUTY STATUS AT ANY GIVEN TIME: He has never been deployed

Another Ding for Crist on the Stimulus Flap

Arian Campo-Flores — Fri, 06 Nov 2009 19:22:46 GMT

I would add one thing to Holly's post on Charlie Crist yesterday. As she notes, Crist's denials that he ever endorsed President Obama's stimulus package are deeply unconvincing. Today, the St. Petersburg Times's PolitiFact amply documents the many ways Crist has displayed support for the program. The fact-checking crew there delivered a resounding "Pants on Fire" verdict.

But let's assume for a moment that Crist's pants aren't on fire. Let's accept his comment to CNN on Wednesday that "I understood [the bill] was going to pass, and I wanted to be able to utilize it for the benefit of my fellow Floridians." Well, if that was the case, he hasn't done a very good job. As The Miami Herald reported back in August, Florida ranked last among the states for federal stimulus dollars promised per capita. It also ranked last in spending the federal highway stimulus money it had been allotted.

I checked on the updated figures, and they're not much better. In terms of federal stimulus funds awarded per capita, Florida now ranks 49th out of 50 states, barely beating Pennsylvania. And as far as spending federal highway and bridge money, the state has climbed up to 35th place--a modest improvement, but hardly something to crow about. For someone who calls himself a "pragmatic conservative" and claims he was merely trying make the best of a stimulus package that was rammed down his throat, he didn't exactly deliver.

To be fair, I checked with Don Winstead, Crist's special adviser on the recovery act. He explained Florida's abysmal slot in the rankings this way. The bulk of the stimulus money has come in the areas of education, transportation, and energy. In all three, he says, Florida is at a disadvantage because of factors beyond its control. It gets less education money because its population skews older, it gets less transportation money because of what he considers unfair funding formulas, and it gets less energy money because of the state's moderate climate, which doesn't generate as much weatherization and heating needs. As for spending the transportation dollars Florida was awarded, that has been slowed by the fact that the state is pursuing more-ambitious projects that take longer to get going.

All of this is mighty complicated to convey succinctly, though. So count on Crist's opponents, who have bashed him in the past on this issue, to keep at it.

Is Facebook a Paradise for Scammers?

Daniel Lyons — Fri, 06 Nov 2009 17:02:35 GMT

Every day tens of millions of people log on to Facebook, the popular social-network site, and spend time playing goofy online games. But watch out. Some people playing these games are getting fleeced by scammers, tricked into signing up for products and services they didn’t want.

Worse yet, this isn’t happening by accident. The companies that develop games for Facebook make big money by selling ad space—some of it to scammers.

This week, Silicon Valley blogger Michael Arrington caused a ruckus by suggesting that Facebook itself has been turning a blind eye to the scams because it is sharing in the spoils. Arrington, who runs the influential TechCrunch blog, is on a crusade to pressure Facebook to clean up its act.

“Ultimately this is Facebook’s fault,” Arrington says. He says the social-networking site isn’t enforcing its own rules against scam ads. “It’s like with Major League Baseball and steroids. If the rules aren’t enforced, which is what’s happening on Facebook, then people are going to break the rules. Facebook needs to stop this.”

You Can't Friend Me, I Quit!

Steve Tuttle

On Facebook's fifth anniversary, a not-so-fond farewell.

Ben Mezrich on Facebook's Salacious Start

Q&A With Facebook's Founder

Love In The Facebook Era

Timeline: From Dorm to Phenom

Ben Mezrich on Facebook's Salacious Start

Seven Lies We Tell Ourselves About Facebook

Facebook's 'Porn Cops' Are Key to Its Growth

Facebook Grows Up: Can It Stay Relevant?

Why I Love It ...

... And Why I Hate It

Etiquette: Is It OK to Poke You?

Facebook denies Arrington’s charge. In an exchange via e-mail, David Swain, a company spokesman, tells NEWSWEEK that Facebook works hard to stamp out scammer ads and has already disabled two ad networks that were breaking the rules.

“We have, and will continue to, move aggressively to stop any activities that threaten or damage our users’ experience,” Swain says. “Any assertion to the contrary is false.”

Arrington responds that Facebook isn't doing a good-enough job, because when he checked out FarmVille, a popular Facebook game, "it took me about 10 seconds to find really scammy ads."

Facebook is the hottest site on the Internet, and it's growing like mad. The site has more than 300 million users, adding 50 million in the third quarter alone. Earlier this year Facebook board member Marc Andreessen said Facebook would rake in more than $500 million in revenue this year.

Facebook CEO Mark Zuckerberg announced in September that it had become “cash-flow positive” well ahead of schedule. It had expected to hit that milestone in 2010.

Facebook is booming because it’s a wonderful and useful Web site. But it also represents a ripe target for scammers. Here’s how they operate.

Let’s say you’ve signed up to play FarmVille, a game produced by Zynga, a company in San Francisco. Each month some 63 million people play the game, in which you plant seeds and harvest crops.

If you want to buy things in FarmVille, like seeds or land, you can either earn points or you can buy points. To buy points, you send Zynga some money from your credit card. Yes, people really do spend money buying seeds for an online game. I have no idea why.

There’s also another way to earn Zynga money: you can click on ads that promise to give you FarmVille currency if you perform some task, like filling out a survey.

You might take an “IQ quiz,” for which you answer a few questions, and then, to get your score, you must enter your cell-phone number. The scammers send a PIN number to your cell phone, and tell you to enter that PIN on a Web site.

In the fine print, there’s a message saying that by entering your PIN you are signing up to get a daily horoscope for $9.99 per month. Next time you get your phone bill, you’ve been stung.

When first contacted by NEWSWEEK, an exec from one company that distributes these ads claimed they’re totally legitimate. “There is no way a user can inadvertently sign up for anything,” said Matt McAllister, marketing director at Offerpal Media, an ad network in Fremont, Calif. “They have to opt in for it.” McAllister points out that this is nothing new. “These ads have been around for years.”

Two days after that conversation, however, Offerpal announced that its CEO and founder, Anu Shukla, would be stepping down. McAllister said her resignation had nothing to do with the charges about scammy ads. But then her replacement, George Garrick, posted a public statement admitting that "regrettably, Offerpal has been guilty of distributing offers of questionable integrity." Garrick vowed that the practice would stop.

It’s true that scam ads have been around for years. But one thing that is different about Facebook is that users share a lot of personal data with the site. This means scammers can create especially insidious ads, using software programs that dynamically insert your personal information—your name, the name of one of your friends—into the ads that you see. So a naive user might think the ads are just messages from Facebook, especially since scammers sometimes use the same typefaces and colors as Facebook does.

Better yet, scammers don’t need victims to hand over a credit-card number. All they need is a mobile-phone number. Guess who’s on Facebook? Millions of naive teenagers who may not have credit cards, but do have mobile phones. Cha-ching.

What gets Arrington’s goat is the fact that legitimate companies are profiting from this stuff.

See, Zynga gets paid to run ads with its games. And Zynga is making a fortune. The company is privately held and won’t say what its revenues are. But at least one analyst says it earns about $200 million, while published reports have placed Zynga’s revenues as high as $250 million this year.

That’s pretty amazing, considering the company was founded only two years ago, in July 2007.

To be sure, most of Zynga’s revenue comes from legitimate business, not from scammers. Zynga executives declined to give interviews. Instead they had an outside PR agency send five written statements via e-mail with instructions that these statements could be attributed to Zynga, the company, but not to any individual.

In the statements Zynga said it has a team dedicated to stamping out scammers and has already shut down some advertisers for breaking rules. Zynga’s statement list also points out that most of its revenue comes from people “directly paying for virtual goods” rather than clicking on ads and special offers.

After Arrington launched his crusade, Zynga CEO Mark Pincus posted a blog item on which he said, “We have worked hard to police and remove bad offers,” but also acknowledged that “we need to be more aggressive.”

Arrington fired back by digging up and posting a video clip in which Pincus earlier this year told an audience of developers that "I did every horrible thing in the book to just get revenues." Arrington's take: "Zynga has been scamming users from the beginning quite intentionally as part of their revenue model."

But Arrington says the ultimate responsibility lies with Facebook because (a) this all takes place on their platform; and (b) if you follow the money, a lot of it ends up at Facebook.

While Zynga makes money by selling ads that run with its games, it also spends a lot of money buying advertising space from Facebook to promote its games.

In fact, Arrington reckons Zynga is Facebook’s largest single source of revenue. He says Zynga will spend $100 million with Facebook this year. The research firm eMarketer doesn’t have an estimate for how much Zynga spends with Facebook, but says Zynga ranks as the eighth-largest advertiser on all social networks and is one of Facebook’s largest advertisers.

“Facebook is getting indirect cash payoffs from the advertising, and the amount is clearly massive,” Arrington says. “This is what helped them get to profitability this year.”

For this reason, Arrington surmises, Facebook has an incentive to ignore scammy ads, even when some of those ads violate its rules.

Facebook says that’s simply not so. Swain, the Facebook spokesman, insists the company aggressively enforces its rules, with Zynga as well as everyone else.

But consider this. Right after Arrington broke the story, Zynga announced it was taking down all of the ads that let people pay for stuff via a mobile phone.

This wasn’t exactly an admission of wrongdoing. But if those “mobile ads” were legitimate, why did Zynga take them down?

Swain says Facebook “will hold ad networks and developers accountable.” But scammers find ways to avoid detection. One trick is to “geo-block” scammy ads so that they don’t get displayed to Internet users in Northern California, where Facebook is located, so Facebook can’t spot them.

The good news is that scammers tend to hit a site for a while and then move along once people start to catch on. So eventually they’ll drift away from Facebook.

For now, though, Facebook remains a fantastic honeypot for scammers—a place with 300 million people who have been lured in with the promise of free fun and games, and who have willingly handed over all sorts of personal information about themselves. These naive, trusting souls represent such a ripe target that you almost can’t blame scammers for exploiting them.

Facebook has good reason to crack down on scammers. If it doesn’t, members may start to drift away. Also, Arrington says if the baby Einsteins who run these social-networking sites can’t police them, government regulators may step in and do it for them.

Conservative Media on Fort Hood Shooting

David A. Graham — Fri, 06 Nov 2009 16:37:11 GMT

A look at the conservative media this morning shows a variety of approaches to the Fort Hood shooting. While most commentators are interested in addressing the question of Islamic terror, and particularly homegrown Islamism, there's clearly a concern in many quarters to avoid generalizations or overstatements--although others, like Michelle Malkin, have decided to go full-speed ahead. But that caution has not prevented sharp criticism of mainstream media reporting or of President Barack Obama's response to the incident.

Several outlets are counseling caution before jumping to conclusions about alleged shooter Maj. Nidal Malik Hasan. The National Review's Corner blog is characteristically prolific but is hewing close to the facts, mostly noting what's being reported about Hasan, much of which deals with his religion. The magazine's Victor Davis Hanson, however, grapples directly with the question of Islam in the case, and argues that Americans' understanding of Islamic terror has not progressed in the last eight years and needs to be updated.

In other words, the narrative after 9/11 largely remains that Americans have given in to illegitimate "fear and mistrust" of Muslims in general. A saner approach would be to acknowledge that there is a small minority of Muslims who channel generic Islamist fantasies, so that we can assume that either formal terrorist plots or individual acts of murder will more or less occur here every three to six months.

Sean Linnane, writing for Frum Forum (the site formerly known as New Majority), points out that there has been a spate of recent arrests and episodes relating to Islamist terror plots, but also argues that it misses the point to focus solely on Hasan's--or anyone else's--creed:

Terrorists all the same, regardless of ideological or political stance–that is all posturing. Example: in the 1980s the Great Socialist People’s Libyan Arab Jamahiriya mounted a bombing campaign against U.S. and British targets in Europe. Several of the bombings were carried out on their behalf by the Baader-Meinhof gang, a secular group of Communists...It doesn’t matter whether it’s Islamic-themed, or Neo-Nazi, or Communist-inspired, terrorism is always the same: it is sheer lunacy, plain and simple.

Linnane's editor, David Frum, offers a series of pictures of the gravestones of Muslim soldiers killed serving in the U.S Army during the Iraq War and asks that people keep them in mind throughout the day.

This measured tone is a marked contrast from the tone at some more aggressive sites. Frontpagemag interviews Dave Gaubatz, who it identifies as a former civilian federal employee in Iraq. Gaubatz says Hasan is not a lone-wolf actor, but is a trained terrorist:

Malik Nabal [sic] Hasan is a terrorist supporting the ideology of Al Qaeda, Hamas, Hezbollah, and yes, CAIR. In Palestine, the leaders send out the young and vulnerable to carry out the murders in the name of Islam. The same is happening in America.

Gaubatz's allegations are a bit bizarre; he doesn't offer any evidence for Hasan's involvement with Al Qaeda, Hamas, or Hizbullah, but instead relies on common talking points that link the Council on American-Islamic Relations, a mainstream political organization, with the terrorist groups (Gaubatz, who claims to have found weapons of mass destruction in Iraq, has recently published a book called Muslim Mafia about CAIR). Michelle Malkin takes a similar tack, emphasizing Hasan's Muslim ties and decrying "political correctness" in the media, which she and others say has tried to whitewash any jihadist ties, an argument Mary Katherine Ham also makes at The Weekly Standard.

And some commentators are using the shooting as an opportunity to make a political point. WorldNetDaily says Hasan was an adviser to Barack Obama's transition team (a claim The Washington Independent debunks here). Michael Graham (no relation to your writer) asks how the massacre might tie into a death-penalty fight in the Massachusetts Senate race. The National Review's Jonah Goldberg poses perhaps the most interesting political question, wondering aloud about Obama's slow response to the shootings yesterday, and questions whether Obama's famed coolness could become a political liability by coming across as aloof and uncaring.

"This Is a Betrayal": A Chaplain Discusses the Long Recovery From Ft. Hood and the Lasting Legacy of PTSD

Eve Conant — Fri, 06 Nov 2009 14:12:11 GMT

An ordained Baptist chaplain and army captain, Roger Benimoff spent two tours of duty in Iraq and months between deployments counseling soldiers in the U.S. During his career, he provided spiritual guidance to American soldiers through crises of faith, bereavement, and trauma until he himself broke down. While training and working as a chaplain at Walter Reed during the height of its crisis, Benimoff was diagnosed with chronic PTSD and spent months of treatment at some of the facilities where he trained as a caretaker. NEWSWEEK's Eve Conant has tracked Benimoff's experiences over the years, starting with his time at Walter Reed, and recently in a book about his experiences, Faith Under Fire. Benimoff retired from the army earlier this year. He spoke with Conant from Dallas, where he is a hospital chaplain, about what might have happened in Ft. Hood, how the military families will cope with tragedy on the homefront, and why the army pushed him so far he had to leave.

Is "contact" or "secondary" PTSD a genuine problem?

Oh yes, definitely. I didn't have much time to counsel before I was deployed—I had only three weeks active duty before going over—but I would debrief my soldiers in Iraq all the time about events I was not present at. I remember when Eagle Troop had lost a soldier to a sniper and I did the CISD [Critical Incident Stress Debriefing]. I still have those images in my head. Or when one of Fox Troop's tanks went over a land mine. The soldiers told me about how the IED blew through their tank, how the driver's body was completely destroyed, how it was like spaghetti, and they were desperately trying to pull him out of the driver's seat while their command told them to leave the scene. They didn't leave him behind. But the tension of that, and their descriptions of that moment stay with me. When Eagle Troop lost a sergeant to an RPG, they told me about running into the hospital, seeing Iraq soldiers vomiting on the stairs after what they had just seen—walls covered in blood, brain matter on the floor. These images don't go away and I wasn't even there that day.

Besides the images, what does it feel like when you remember what the soldiers told you about, and how long did the feelings last?

Scared. It was haunting. People I cared about were suffering, which causes stress, but then you also get scared and depressed yourself. You are constantly having to respond and help even when you are feeling helpless. I remember just an overwhelming sense of all my feelings colliding at once, of not being able to compartmentalize. And when you are surrounded by tanks and equipment, whether in Iraq or at a base at home, it's even harder to compartmentalize.

Were you diagnosed with secondary PTSD as well as chronic PTSD? How does something like Ft. Hood affect you?

I know that my psychologist at Walter Reed talked to me about it, but I don't think it ever made it into the paperwork. But absolutely it was part of it. It's constantly being in that environment that is so hard. Even now, thinking about Fort Hood I'm depressed today. I can just picture people in the Readiness Center, because I've been in so many myself. I've led sessions. I know there was a chaplain there who must have responded to this. I'm 100 miles away from Ft. Hood right now, but I'm depressed and worried. I feel the same way today as I did back in the desert. I heard a soldier's wife talking on the radio about how they were supposed to be safe at home. This is such a betrayal.

Is it harder for army families—already so strained—to bounce back from something like this?

Military families have more resources than other families in a tragedy. But at the same time they are back in the U.S., and this is not supposed to happen here. Even in Iraq you don't often have 12 soldiers killed at once and here it's happened on our own soil. I don't think the families can bounce back from this. This shatters the paradigm that—wow—my loved one is back and finally safe.

How do you feel now, as a chaplain at a hospital?

I'm still in the healing process. But I'm reframing my experience—it's not that God abandoned me but that God provided space for me. My family stayed with me, my mentors and friends, even when I was lashing out.

Is it hard for caretakers to get help for themselves?

Yes. I didn't want to be judged. When people tried to help me I would study how they would engage me—if I sensed any canned statements or if I felt they were uncomfortable with me I would back off and close up.

What do you think was in the shooter's mind at Ft. Hood? Were you both at Walter Reed at the same time, since you both studied there?

I didn't know him, am not sure if we were at Walter Reed at the same time. But I know anyone there would have experienced a lot of secondary stress. After all, I became an inpatient soon after starting work at Walter Reed. But I can't imagine shooting anyone. I also don't know what role his religion played, if any.

Why did you leave the army?

I could not stay in the army any longer and do good. There was a part of me who hated all of humanity because I could not understand the atrocities that people would commit, the horrors that people are capable of. I hated humanity and I hated God and I hated myself. I was so burned out, so angry with God and with the army I knew I had to get away from that culture. I could not be an army chaplain any longer without doing harm to others. But I can't imagine how someone would shoot their own soldiers. When I say I would do harm I mean emotionally—I was closed off and cold. I could not give the spiritual and emotional care that soldiers needed.

Is Fort Hood a Harbinger? Nidal Malik Hasan May Be a Symptom of a Military on the Brink.

Andrew Bast — Fri, 06 Nov 2009 13:30:20 GMT

What if Thursday's atrocious slaughter at Fort Hood only signals that the worst is yet to come? The murder scene Thursday afternoon at the Killeen, Texas, military base, the largest in the country, was heart-wrenching. Details remained murky, but at least 13 are dead and 30 wounded in a killing spree that may momentarily remind us of a reality that most Americans can readily forget: soldiers and their families are living, and bending, under a harrowing and unrelenting stress that will not let up any time soon. And the U.S. military could well be reaching a breaking point as the president decides to send more troops into Afghanistan.

It's hard to draw too many conclusions right now, but we do know this: Thursday night, authorities shot and then apprehended the lone suspect, Maj. Nidal Malik Hasan. A psychiatrist who was set to deploy to Iraq at the end of the month, Hasan reportedly opened fire around the Fort Hood Readiness Center, where troops are prepared for deployments to Iraq and Afghanistan. And though this scene is a most extreme and tragic outlier, it comes at a time when the stress of combat has affected so many soldiers individually that it makes it increasingly difficult for the military as a whole to deploy for wars abroad. In an abrupt news conference, Lt. Gen. Robert Cone, the top commander at Fort Hood, said in response to the shooting that authorities would "increase the security presence" on the military base. On the surface, it seemed like a logical enough plan. But it makes one wonder how much any kind of lockdown will either get at the root causes of soldier stresses or better prepare them for more battle.

Hasan's perspective is unknown. He had yet to fight abroad. But the accusations against him can't help but bring to mind the violence scarring military bases all over the country after the duration of two long, brutal wars. In May, Fort Campbell—a major military base in Kentucky and the home of the "Screaming Eagles" of the 101st Airborne Division—went into a three-day stand-down after a soldier killed himself, the 11th suicide since the beginning of the year, more than on any other base. "Suicidal behavior is bad," Brig. Gen. Stephen Townsend said at the time. In black shorts, a T shirt, and running shoes, he climbed atop a podium in a field and addressed his troops. "It's bad for soldiers, it's bad for families, bad for your units, bad for this division and our Army and our country, and it's got to stop now." The pep talk and accompanying posters, imploring soldiers to take care of one another, had limited effect. Another six soldiers have killed themselves since the stand-down.

That the two wars currently being waged are taking a psychological toll on soldiers is no surprise. Some studies report that as many as a third of returning soldiers suffer from posttraumatic stress disorder, a constant, tension-inducing malady that leaves men and women detached from their family lives, numb to their peaceful life stateside, and, let it be said, sometimes angry as hell. "No one comes home from war unchanged," says the Iraq and Afghanistan Veterans of America. And while those who have faced multiple deployments are the most likely candidates to lash out irrationally after returning, it's impossible to discount how the grind of an eight-year war has affected the rest of the military, who see friends leave whole and return in pieces; who wonder constantly if they'll be next. (As a psychiatrist, Hasan may have been particularly vulnerable: there have been numerous accounts of chaplains suffering from depression and PTSD after counseling returning soldiers. Hearing their horror stories, sharing their pain, and being unable to help often pushed these men over the edge. The fact that they were supposed to be healers, that they had never seen combat themselves, made it much harder to ask for help.)

While policymakers discuss troop levels in an anesthetic language of numbers in the tens of thousands, a bone-rattling truth underlies so many of the lives of soldiers and their sons, daughters, wives, husbands, and families. Theirs is an insufferable emotional existence. "Deployment seems more and more to signal divorce," one wife of an Army soldier said privately. Statistics back up her claim in an unexpected way: divorce rates of female soldiers are spiking; they are now three times that of their male counterparts. There are also reports of domestic violence, of an increase in bar fights. Buffalo, N.Y., has set up its own court for returning vets to handle an increasing number of criminal, often violent, behavior from soldiers.

Of course, Hasan had not yet been deployed, and the true cause of Thursday's tragedy is still unknown. And yet some are already suggesting that Major Hasan's lack of combat experience precludes us from assuming the crimes were at all influenced by the stress of war. "They weren't in Iraq," author Dinesh D'Souza said on television Thursday night, analyzing the culprit. "They were living a normal, everyday life." But he is wrong. In the midst of two wars, those living as military and military family experience a different—often, more distressing—everyday experience of "normal." And forgetting that, either in understanding this singular case, or making a decision about more deployments, is dangerous at best, and morally bankrupt at worst.

The U.S. is drawing down troops in Iraq at a quick clip, but Gen. Stanley McChrystal has requested tens of thousands more to fight in Afghanistan. Though President Obama has made no decision about the way forward, some suggest that as many 80,000 more could be sent in as reinforcements. That would put nearly 150,000 American soldiers in country for at least the foreseeable future, pushing a thumb down on an already stressed-out military. Of course, the vast majority of those under that stress, no matter how brutal, will not pick up a gun and shoot indiscriminately, like Hasan did. But the situation is bad, and getting much worse. From there, it isn't much of a leap to argue that to further tax our military would do as much as anything to guarantee that the homegrown terror on display today could well repeat itself in the future.

Russia's Auto Wreck

Owen Matthews — Fri, 06 Nov 2009 11:00:16 GMT

Two years ago, Russia was one of the fastest-growing auto markets in the world--but few Western carmakers were willing to risk a partnership there. Then, in 2007, Renault purchased a 25 percent stake in AvtoVaz, whose Lada brand was famous for the wrong reasons: its plants were fitted with Soviet-era production equipment and its 100,000 employees produced just 130,000 cars annually. Now, as Russian car sales tank in the wake of the financial crisis, it looks like Renault's gamble hasn't paid off. Prime Minister Vladimir Putin has warned that Renault's stake could be diluted if it doesn't put in more money--but at the same time he wants to minimize redundancies. The Kremlin has promised $1 billion in subsidies, but without a major management overhaul the company risks becoming a walking corpse. So far, Renault remains committed. "We do not regret the deal for a moment," says the company's Oksana Nazarova.

AvtoVaz is a test case of Putin's willingness to play by international market rules. It's one of the few Russian industries where a foreign investor has taken a major stake in trying to turn it around. The Kremlin now has to choose whether to help Renault bring real change, even if it means sacking half the workforce--or whether to continue throwing money at a decrepit industry in order to keep employment numbers up.

Why Teenagers Are Growing Up So Slowly Today

Po Bronson — Fri, 06 Nov 2009 01:59:23 GMT

Here’s a Twilight Zone-type premise for you. What if surgeons never got to work on humans, they were instead just endlessly in training, cutting up cadavers? What if the same went for all adults – we only got to practice at simulated versions of our jobs? Lawyers only got to argue mock cases, for years and years. Plumbers only got to fix fake leaks in classrooms. Teachers only got to teach to videocameras, endlessly rehearsing for some far off future. Book writers like me never saw our work put out to the public – our novels sat in drawers. Scientists never got to do original experiments; they only got to recreate scientific experiments of yesteryear. And so on.

Rather quickly, all meaning would vanish from our work. Even if we enjoyed the activity of our job, intrinsically, it would rapidly lose depth and relevance. It’d lose purpose. We’d become bored, lethargic, and disengaged.

In other words, we’d turn into teenagers.

This is the metaphorical vision of adolescent life Dr. Joe Allen paints in his insightful new book, Escaping the Endless Adolescence, coauthored with his wife, Dr. Claudia Worrell Allen.

Allen has concluded that our urge to protect teenagers from real life – because we don’t think they’re ready yet – has tragically backfired. By insulating them from adult-like work, adult social relationships, and adult consequences, we have only delayed their development. We have made it harder for them to grow up. Maybe even made it impossible to grow up on time.

Basically, we long ago decided that teens ought to be in school, not in the labor force. Education was their future. But the structure of schools is endlessly repetitive. “From a Martian’s perspective, high schools look virtually the same as sixth grade,” said Allen. “There’s no recognition, in the structure of school, that these are very different people with different capabilities.” Strapped to desks for 13+ years, school becomes both incredibly montonous, artificial, and cookie-cutter.

As Allen writes, “We place kids in schools together with hundreds, sometimes thousands, of other kids typically from similar economic and cultural backgrounds. We group them all within a year or so of one another in age. We equip them with similar gadgets, expose them to the same TV shows, lessons, and sports. We ask them all to take almost the exact same courses and do the exact same work and be graded relative to one another. We give them only a handful of ways in which they can meaningfully demonstrate their competencies. And then we’re surprised they have some difficulty establishing a sense of their own individuality.”

And we wonder why it’s taking so long for them to mature. The old explanation used to be they needed time for the wave of raging hormones to dissipate (more on this tomorrow). The newer explanation is that their brains simply aren’t developed yet: their prefrontal cortex hasn’t converted from gray matter to white matter, their amygdalas have a surfeit of oxytocin receptors, and their reward centers have a paucity of dopamine receptors. Few can say for sure yet how these anatomical features actually interact and create modern teenagers, but the gist of it is quite simple – until their brains are finished, they’re not ready for real life.

“Most parents will tell you that this idea of the immature teen brain is one of the few notions that truly provides them comfort,” says Allen. “They feel like it gets them off the hook – that it’s biological, not a fault of parenting.” But Allen speculates that our parenting style may indeed be causing their brains to be this way. Brains of teens a hundred years ago might have been far more mature. Without painful real-life experiences, modern teens’ brains never learn to tell the difference between what they should fear and what they shouldn’t. Without real consequences and real rewards, teens never learn to distinguish between good risks they should take and bad risks they shouldn’t. “We park kids on the sidelines, thinking their brains will develop if we just wait, let time pass, as if all they need is more prep courses, lessons, and enrichment courses. They need real stress and challenges.”

As for the risk behavior we associate with adolescence, Allen cautions that “We don’t give teens enough ways to take risks that are productive.” So they turn to drinking, drug use, delinquency, and the like – because those are the only things thrilling. “According to Allen, teens aren't naturally passive – their environment makes them passive. We’re writing them off at exactly the time we need to bring out their potential.

Allen came to this perspective partly from his scholarly research on teens, which we’ve written about before, and partly from his clinical practice with individual teens. His book tells the stories of a dozen patients who came to him in trouble. At first, these teens all manifested their problems differently, and seemed to have different symptoms. Sam was uncommunicative, unwilling to ever talk (she was forced to see Allen by the rules of her group home). Perry was a high-achieving boy who became an anorexic. Tim was pushing himself to success, when suddenly he dropped out to draw comic books. Tonya was a small, shy student on path to get pregnant and drop out, like her sister.

But what helped all these kids – Sam, Perry, Tim and Tonya – was a taste of real life. They found a way to do something meaningful in real life, interacting with adults, outside the realm of the high school artificial bubble, and outside the hovering control of their parents. For some, it was volunteering at organizations that really needed their help – where they felt they were making a real contribution. For others it was tutoring younger kids. For others, exploring a passion without regard to its value to their college application. Or it could be a job (not a McJob) where they interacted with adults. A little went a long way.

I hear often from parents whose teenagers are disengaged or withdrawn. They have a hard time caring what other kids think, or what society expects of them. They’re having a hard time playing the game of resume-building for a far-off future. Now I have the perfect book to recommend: Escaping the Endless Adolescence.

Club for Growth Calls Out Crist on the Stimulus

Holly Bailey — Thu, 05 Nov 2009 20:51:44 GMT

You knew it was coming. A day after Charlie Crist told CNN’s Wolf Blitzer that he “didn’t endorse” the $787 billion federal stimulus bill, Club for Growth is up with an ad featuring TV footage of the Florida governor onstage with President Obama earlier this year praising the bill. “We know it’s important to pass this stimulus package,” Crist said at a joint rally with Obama in early February, a clip that opens up the club's ad. The group then goes through a litany of statistics suggesting how the stimulus has not helped Florida, including the state’s rising unemployment numbers, as well as the increasing federal deficit.

On Wednesday, a day after GOP primary opponent Marco Rubio debuted a Web site trashing Crist’s appearance with Obama, the Florida governor defended himself on CNN, offering up the most unconvincing line we’ve heard since "I did not have sexual relations with that woman.” “I didn't endorse it. I didn't even have a vote on the darned thing," Crist, who also signed a letter urging the bill’s passage, told CNN. “But I understood that it was going to pass, and I wanted to be able to utilize it for the benefit of my fellow Floridians.” Today, speaking to reporters at the statehouse in Florida, Crist dug himself a little deeper, suggesting he wouldn't have even voted for the bill. Crist says he viewed the bill as taxpayer dollars coming back to Florida to “benefit” residents. “I, like all other Republican governors, utilized that money for the benefit of the people in my state,” the governor told CNN. “And that's what a pragmatic conservative does—a CEO, if you will, of a state does that.” That seems like a fair and reasonable argument: Crist was doing what he thought was best for Florida. But his attempts to walk a thin line between supporting and endorsing the stimulus has muddled all of that. You’d think Crist, who is a pretty savvy politician, would have known better.

Helicopter Shortage: State Department Fumbles Effort to Oust Blackwater from Iraq

Mark Hosenball — Thu, 05 Nov 2009 20:48:59 GMT

Your tax dollars at work: as part of their effort to stop doing business in Iraq with companies affiliated with the controversial paramilitary contractor formerly known as Blackwater, the State Department earlier this year hired a rival contractor to fly civilian U.S. personnel around the war-torn country by helicopter. But officials subsequently learned that helicopters the replacement contractor, Dyncorp International, was planning to use for this service didn’t meet government safety standards. So as a result, the Department was forced to extend for several months its air-transport contract with an affiliate of ... the contractor formerly known as Blackwater.

The State Department’s machinations are the latest chapter in the government’s turbulent relationship with companies affiliated with Blackwater, a North Carolina-based paramilitary training, protection, and transport outfit whose name became one of the most toxic words in American politics after a series of incidents in which security officers employed by the firm allegedly killed or injured Iraqi civilians. The incidents, which included eight Iraqis dying on September 16, 2007 after Blackwater employees allegedly fired automatic rifles and threw grenades into a crowd in Baghdad’s Nisoor Square, led to congressional hearings, multiple U.S. investigations of Blackwater personnel, and a declaration by the Iraqi government last March that it was withdrawing the license of Blackwater and its affiliates to do business in Iraq.

Blackwater, which renamed itself Xe Services, has denied corporate wrongdoing and recently won a victory in court: a federal Judge in Alexandria, Va., dismissed on legal grounds a series of wrongful death and injury cases filed by Iraqis against Xe Services, its affiliates, and its owner, Erik Prince. (The judge did invite the plaintiffs to amend their claims.) Despite being declared persona non grata in Iraq, Xe and its affiliates retain major contracts with U.S. government agencies—including the State Department, and reportedly, the CIA—in other parts of the world such as Afghanistan, say U.S. and private security-industry officials. State Department and industry officials also note that the incidents and investigations were related to the company’s ground-based bodyguard operations in Iraq. The company’s air-transport operations have not been implicated in scandal.

U.S. officials familiar with the State Department’s dealings with the firm, who asked for anonymity when discussing sensitive information, said that the Iraqi government, in withdrawing the company’s permission to do business, made it clear it wanted all company-related or affiliated operations to clear out of Iraq. This included an air-transport operation run by Presidential Airways, a Blackwater/Xe affiliate, which had been one of the principal means by which civilian U.S. officials traveled around Iraq. Initially, the State Department informed Blackwater/Xe that its air-transport contract in Iraq would end on September 4. To replace Blackwater/Xe, the Department solicited bids. The winning bid, for $915 million, was submitted by Dyncorp, another large paramilitary contractor which already had operations in Iraq.

As part of its winning bid, according to the government and industry officials, Dyncorp promised that it would acquire a fleet of helicopters. Toward the end of the summer, however, State Department officials learned to their dismay that the helicopters acquired by Dyncorp for the Iraq contract didn’t meet “airworthiness” standards set by the federal government. The State Department found itself in a serious dilemma: it had told Blackwater/Xe that it had to get out of Iraq by early September, but the contractor it hired to take over Blackwater/Xe’s air operations had a helicopter fleet that had not been deemed safe enough to perform its mission.

One consequence, according to government officials with direct knowledge of the problem, is that the State Department is renegotiating its deal with Dyncorp, who will also have to eat the cost of the fleet of unusable helicopters which it acquired. Another consequence, the officials said, is that the Department had to arrange for the Iraq air-transport contract of the Blackwater/Xe affiliate to be extended for several months—from September to January of next year.

The State Department’s International Narcotics and Law Enforcement Bureau is now diverting a fleet of 14 department-owned Huey helicopters which were acquired for use in drug wars in Latin America and South Asia to Iraq so that when Dyncorp finally takes over from Blackwater/Xe in the New Year, it will have some helicopters to fly. State Department officials acknowledge three of the government-owned Hueys which are being re-assigned to Iraq had been in use by antidrug forces in Colombia. But the officials maintain that due to efforts by the Colombian government to assume more responsibility for fighting traffickers, the three American Hueys had already been scheduled for withdrawal from Colombia, while the other 11 Hueys now earmarked for helping Dyncorp out of its jam were sitting on the ground at an Air Force base inside the United States. Officials also acknowledged, however, that if the department had not had to divert them to Iraq, all the helicopters probably would have been re-assigned to antidrug operations in places such as Afghanistan.

Government officials say that one reason behind the fumbling and maneuvering is that because of the Iraq War, the State Department’s Bureau for Diplomatic Security, once an obscure bureaucratic backwater, found itself running a complex air-transport operation, which it had never done before.

Charlene Lamb, Deputy Assistant Secretary of State for the Diplomatic Security Bureau, told NEWSWEEK in a written statement: “In order to meet our security requirements in country and ensure the safety of our personnel in Iraq, it was necessary to shift the aviation support to an organization that could provide mission-ready aircraft on the timeline required by the embassy.” Mark Corallo, a spokesman for Xe Services, insisted that Presidential Airways, the Blackwater/Xe affiliate which is still performing the Iraq air contract, is a “separate operation with [a] separate management chain of command” from other Xe Services affiliates.

Douglas Ebner, a spokesman for Dyncorp International, confirmed that the company had “reached a mutual agreement to a task order modification” with the State Department, and added that the company planned to use the helicopters that were deemed unsuitable for the Iraq contract for other business it plans to pursue.

Another Reason 2010 Isn't Exactly Like 1994

Katie Connolly — Thu, 05 Nov 2009 19:19:23 GMT

Earlier this week Holly wrote a really interesting piece about the electoral parallels between now and 1993—and the fact that the GOP is hoping for a dramatic Democratic defeat in next year's midterms, similar to what happened in 1994. Holly points out several flaws in the analogy: Republicans have more baggage going into next year's elections than they did in '94, congressional Republicans have exceptionally low approval ratings, the GOP lacks strong national leadership, and there's damaging infighting between conservatives and moderates. But I'd like to add another difference to the list: health-care reform.

The dismal failure of the Clinton health-care plan in the summer of 1994 helped crystallize support for the GOP. Its final whimper came just months before the '94 congressionals, ending a long, fierce battle on an abysmal note for Democrats. This time around, health-care reform will pass. It won't be an ambitious overhaul along the lines that Clinton had envisioned. And, in the end, it may not even include a public option (although the White House assures me it will.) But health-care reform, in some fashion, will be passed, and it will be done well in advance of the election. By the time the voting booths open, the health-care debate will be done. (Until, of course, it is revived, probably in the middle of the next decade, when the reforms have been implemented and either ambitious liberals attempt to strengthen it or conservatives try to stymie it.)

To be sure, the health-care debate has been damaging to the Obama administration, just as it was to the Clintons. But by the time midterms roll around, it won't be sucking up all the oxygen in the room, as it is now, and as it did in 1994. Sure, Republicans will try to attack vulnerable Democrats over the plan. We'll probably see more protests like the one on Capitol Hill today. Anti-abortion activists will no doubt remain energized. But my prediction is that health care won't be top of mind for most Americans in November next year. It won't be the vote winner it was in '94. It won't be the divisive force it was then (or it was this past August, for that matter). In all likelihood, Americans will be far more concerned about their economic security than a health-care plan they haven't started feeling the effects of yet.

Also diminishing health care's electoral potency will be the shellacking the Republican alternative plan received from the Congressional Budget Office (CBO) last night. Ezra Klein has the lowdown on the CBO analysis:

[In 2019] the Republican alternative will have helped 3 million people secure coverage, which is barely keeping up with population growth. Compare that to the Democratic bill, which covers 36 million more people and cuts the uninsured population to 4 percent. The GOP's alternative will shave $68 billion off the deficit in the next 10 years. The Democrats, CBO says, will slice $104 billion off the deficit. The Democratic bill, in other words, covers 12 times as many people and saves $36 billion more than the Republican plan.

This is a major embarrassment for the Republicans. It's one thing to keep your cards close to your chest. Republicans are in the minority, after all, and their plan stands no chance of passage. It's another to lay them out on the table and show everyone that you have no hand, and aren't even totally sure how to play the game. The Democratic plan isn't perfect, but in comparison, it's looking astonishingly good.

Sure, Republicans are already eyeing health-care reform as a battering ram for next year's elections, but a heck of a lot can happen in a year.

Pentagon Played Aerosmith and Nine Inch Nails to Torture Detainees; Artists Complain

Krista Gesaman — Thu, 05 Nov 2009 18:06:16 GMT

Will listening to hours of Britney Spears, Nine Inch Nails, or even the Meow Mix jingle make you lose your mind? That’s exactly what military officials were hoping for when they blasted hours of loud music to prisoners detained at Guantánamo Bay and in Iraq and Afghanistan prisons. The National Security Archive, an independent research institute that works to publish declassified information, submitted a Freedom of Information Act request on October 22 to a variety of government agencies including the Department of the Army, U.S. Central Command, Defense Intelligence Agency and the CIA, seeking all intelligence reports, briefings and recordings of loud music used during the detention and interrogation of detainees.

The request for information relied on 20 declassified documents, all of which refer to the use of “loud” music as a way to control Guantánamo detainees. One detainee claims he was subjected to hours of deafening music by Eminem and Metallica as a form of sleep deprivation. According to the FOIA request other artists possibly used include Aerosmith, James Taylor, and Tupac Shakur.

Predictably, several of the artists on the list were not pleased to see their music used as part of enhanced interrogation techniques that have been debated as possible torture. Former Rage Against the Machine guitarist Tom Morello was shocked. “Guantánamo may be Dick Cheney’s idea of America, but it’s not mine," says Morello in a statement. "The fact that music I helped create was used in crimes against humanity sickens me." Alternative hip hop band The Roots echoed: “When we found out that music was being used as part of the torture going on at Guantánamo, shackling and beating people—we were angry. Just as we wouldn’t be caught dead allowing Dick Cheney to use our music for his campaigns, you can be damn sure, we wouldn’t allow him to use it to torture other human beings.”

The broader question might be how exactly interrogators chose which music to make people go crazy. Kate Doyle, a senior analyst with the National Security Archive who drafted the most recent FOIA request, suspected that military leaders consulted music selections that had already been used for the same purpose. She referred to documents obtained after the 1990 capture of Panama leader Manuel Noriega, who was removed from power by the U.S. Noriega tried to avoid capture by camping out at the Vatican embassy, but U.S. military leaders rolled in loud speakers and hit play on an extensive list of rock and pop music—from Billy Idol to New Kids on the Block—to lure Noriega from hiding. He surrendered after 10 days.

In the wake of the newest revelations, recording artists might be able to make the government pay for its actions. A suit from artists, which some have suggested is already in the works, would seek royalties from the government each time a song was played. Although one lingering question is whether songs played at Guantánamo Bay and other prisons constitutes a private playing or a public performance, the latter of which would signal infringement. Whether U.S. copyright law should even apply to situations abroad in Cuba would also be left up to a judge.

Declassified documents containing detainee and prison-guard testimony helped the National Security Archive create list of artists for its FOIA request. It’s likely that when the government responds, which could take awhile, more recording artists will be revealed. The names of the specific songs used in the interrogation or possible torture techniques will also be unveiled in the response.

In Letter, CDC Head Thomas Frieden Tries to Head off the Looming H1N1 Vaccine Wars

Newsweek — Thu, 05 Nov 2009 16:37:36 GMT

by Claudia Kalb

The H1N1 vaccine shortage isn’t just frustrating. It’s unleashing an ethical and emotionally charged debate about people’s shot-worthiness. Back in August, the CDC announced recommendations on who should be first in line for vaccination. The list: pregnant women, caregivers for babies under 6 months, health-care workers, anybody 6 months to 25 years old, and people with health conditions like asthma and diabetes. But we all know that vaccine distribution hasn’t gone perfectly—lines have been long, supplies have run out, and, yes, some Americans have gotten the shot when they shouldn’t have.

All of this blew up into a vitriolic exchange on a local moms bulletin board in Washington, D.C., after a mother said she’d gotten vaccinated at a Virginia clinic even though she didn’t qualify. And she urged other moms to do the same to protect their kids. Hello swine-flu mommy wars. One woman called her selfish. (And there were choicer words, too.) Another warned there would be a “day of reckoning” for people like her. And this: “To the people who have gotten the H1N1 vaccine and are not in the CDC priority groups—WHAT YOU DID IS DISGUSTING. YOU ARE DISGUSTING.”

The calmer posts said she wasn’t at fault: at least some health-care workers at the clinic, they reported, were encouraging people to get the vaccine while they could—even if they weren’t in one of the priority groups. But that’s not supposed to happen, at least not until more ample supplies of vaccine are available. Moms aren’t the only ones at war. A report that Goldman Sachs and other big New York companies have received vaccine has some people up in arms, even though Goldman says it’ll provide it only to high-risk groups. And then there’s the news that Gitmo detainees will get vaccines, too. House Republican John Boehner isn’t too happy about that—and neither are a lot of other people.

Now, CDC Director Dr. Thomas Frieden is pulling out his megaphone and trying to bring some order. In a letter sent to state and local health officers and released by the CDC today, Frieden said, “It is more important than ever to focus on ensuring equitable access to the vaccine for the priority groups.” He went on to ask local health officials to review their plans immediately and “work to ensure that the maximum number of doses is delivered to those at greatest risk as rapidly as possible.”

Frieden does a good job walking the line between thanking public health officials for their hard work—they are, after all, on the receiving end of vaccine frustration—and making it clear that they need to abide by the recommendations. Now it’s up to the vaccinators to listen.

Frieden’s letter in full:

November 5, 2009

Dear State/Local Health Officer:

Today we have 35.6 million doses of 2009 H1N1 vaccine allocated for ordering, with more coming every day. As you know all too well, at present, demand for the vaccine in your communities still exceeds the supply we have received from manufacturers. That means it is more important than ever to focus on ensuring equitable access to the vaccine for the priority groups identified by the Advisory Committee on Immunization Practices: pregnant women, caretakers of infants less than
6 months of age, health care workers, children and adults with health conditions such as asthma or diabetes, and people under the age of 25.
These are the people who are most vulnerable to 2009 H1N1 influenza, and it's our job to do everything we can to keep them safe this flu season.

I know you have been working hard to distribute vaccine to the people who need it most. You are on the front lines of the fight, and no one knows better than you how to reach people in your communities. I especially appreciate the many innovative ways you've found to reach them, including school-located vaccine clinics, special clinics for pregnant women, outreach to children with special needs, and making vaccine available to community- and faith-based organizations serving these high-risk populations.

The goal of the H1N1 vaccination program is to protect our population - focusing first on these high-risk groups and ensuring equitable access to the vaccine. While vaccine supplies are still limited, any vaccine distribution decisions that appear to direct vaccine to people outside the identified priority groups have the potential to undermine the credibility of the program.

It is important to make it clear to the public that we are all committed to the science-based vaccination recommendations established by the Advisory Committee on Immunization Practices. This may include making clear to the public as well as health care providers how the vaccine available to you is being targeted, and the basis for targeting. CDC expects all grantees to ensure that all vaccinators chosen by state and local health departments adhere to those recommendations. Toward that end, and in light of changing projections of vaccine availability, I ask each of you to review your plans immediately and work to ensure that the maximum number of doses is delivered to those at greatest risk as rapidly as possible.

I know how difficult your jobs are; we are ready and willing to help you any way we can.
Sincerely,
Thomas R. Frieden, M.D., M.P.H.
Director, Centers for Disease Control and Prevention, and Administrator, Agency for Toxic Substances and Disease Registry

Claudia Kalb is a NEWSWEEK Senior Writer

In Round One of the Census Battle, Vitter and Bennett Lose

Arian Campo-Flores — Thu, 05 Nov 2009 15:17:21 GMT

Here's an update to an entry I posted last week. As I noted then, the 2010 census has sparked a battle over whether undocumented immigrants should be part of the count and thus included in state tallies used to reapportion Congressional seats, as has been the case in past cycles. The opening round of that fight was a proposed amendment sponsored by Republican Sens. David Vitter and Robert Bennett that would have added a question to the census survey asking whether the respondent is a citizen or not. The aim was to later strip out non-citizens when it came time for reapportionment.

Well, the senators lost that round. Earlier today, the amendment was blocked when the Senate voted 60-39 to end debate on an appropriations bill. But don't expect the issue to go away anytime soon. A Vitter spokesman, Joel DiGrado, says the senator will try to find other legislative vehicles for the amendment and will continue to press the matter. He's "not going to just stop talking about the issue," says DiGrado.

Those opposed to including illegal immigrants in the census count are studying other options. One possibility would be to craft some alternative legislative challenge in Congress, says Ira Mehlman of the Federation for American Immigration Reform, which advocates reduced immigration. Legal action is a possibility, too, though a FAIR lawsuit in 1980 over this issue was thrown out for lack of standing.

The pro-immigrant forces think these tactics will fail. Senate Democrats have just shown they've got the votes to turn back future attempts to include a similar amendment. And in the House, the math just doesn't favor a measure like that, argues Andres Ramirez of the New Democrat Network. The undocumented are concentrated in the biggest states with the largest number of representatives, who won't exactly be keen on shrinking their ranks. Plus, says Ramirez, imagine if California were forced to subtract its population of illegal immigrants and lost five seats. When it came time for the Democrat-controlled state legislature there to redraw Congressional districts, guess which party would come up short? Same goes for other big Democrat-controlled states like New York and Illinois.

Still, Ramirez has no doubt that Vitter & Co. will keep the illegal-immigrant issue alive. "What they're trying to do is win in the court of public opinion," he says. "They want to get people riled up about it." That worries him and his allies, because the more controversy there is surrounding the census, the tougher it'll be to get comprehensive immigration reform passed next year.

Health Care's Prayer Provision: How Complementary and Alternative Medicine Fits Into Obama's Evidence-Based Model

Sarah Kliff — Thu, 05 Nov 2009 14:24:46 GMT

Should health-care reform require insurers to cover chiropractors? Acupuncturists? Yoga? Spiritual healers? These are the questions raised by a recently noticed health-care amendment requiring insurers to consider covering "religious and spiritual health care."

The amendment, covered in this Los Angeles Times article, comes with backing from Senate heavyweights like Orrin Hatch, John Kerry, and the late Ted Kennedy. And while it does not mention Christian Science by name, it's been widely interpreted as a protection of the church's prayer treatments, which it encourages as an alternative to medical help. Others have understood the provision as even more far-reaching as to include any health provider acting within the scope of their license.The Freedom From Religion Foundation has criticized the amendment as an unconstitutional violation of church and state.

Even with its powerful supporters, the amendment seems unlikely to make the final bill; Pelosi already dropped it from the House version. But just the suggestion of covering religious health care highlights a difficult question for reformers: how, exactly, does prayer fit into the president's support for evidence-based medicine? Or, more broadly, is there a place for any sort of unproven, alternative medicine, religious or otherwise, in health-care reform?

Requiring insurers to cover therapies with unknown outcomes runs counter to the White House's push for medicine with a proven track record. The basic idea behind evidence-based medicine is that doctors ought to use treatments that have the best possible evidence that they work. What counts as the best possible evidence? Randomized clinical trials. "The random clinical trial is the gold standard for any kind of medical knowledge," explains Stefan Timmermans, a sociologist at UCLA who has written extensively on evidence-based medicine. "They show whether treatment works and allow doctors to make decisions based on evidence."

Clinical trials work fine for drugs, where trials can quantify and compare outcomes. But for alternative treatments, things like prayer or even yoga, the evidence gets much less clear; randomized trials are more difficult to conduct. "For drugs you have placebos and double-blinded studies," says Timmermans. "But you cannot have a placebo for testing behavioral interventions." So alternative treatments are essentially on an uneven playing field when it comes to evidence-based medicine. Timmermans admits that "it's not an equal-opportunity methodology."

Religious organizations have attempted to run their own trials, to prove the efficacy of their methods, but none so far have panned out. "There's a big body of research trying to show that religion improves health, but there isn't much empirical evidence coming out of it," says Wendy Cadge, a sociologist at Brandeis who studies the relationship between religion and health care. "So that raises questions about how we as a society think about what should be paid for."

Requiring insurers to cover prayer treatment may be a bit too extreme for health-care reform. More interesting to explore though, are other forms of nontraditional medicine, floated in reform bills, that have a stronger claim to an evidence base. Take, for example, complementary and alternative medicine, a field often criticized for unproven therapies. Some 38 percent of Americans use some form of it. Moreover, the field has increasingly embraced traditional research methods. Just a decade ago, the government established a National Center for Complementary and Alternative Medicine. The center studies "alternative healing practices"—anything from the use of echinacea to treat colds, to acupuncture for irritable bowel syndrome—"in the context of rigorous science." They use that gold standard Timmermans mentioned: randomized, clinical trials.

So is complementary and alternative medicine deserving of a place in health-care reform? Depends whom you ask: the bill Sen. Tom Harkin introduced includes "licensed complementary and alternative medicine providers" in the definition of the "health-care workforce," but the consolidated House and Sen. Max Baucus bills do not. More so than the prayer provision, it will interesting to see how—or whether—alternative medicine fits into the final reform bill.