Posts Tagged ‘Obama Administration’

Americas Trump is ‘reversing relations’ and returning US to ‘neo-colonial attitudes’, says Raul Castro

April 20, 2018

The 86-year-old spoke as he was replaced as Cuba’s president

By Andrew Buncombe New York

Raul Castro has stood down as Cuba’s president, bringing to an end the 59-year era of rule under he or his brother, but immediately indicating the philosophy and anti-US defiance that marked their decades of rule, are likely to guide the nation for some years to come.

The 86-year-old was replaced by Miguel Mario Diaz-Canel Bermudez, a vice president with little international profile. In an sign the world should not expect dramatic change overnight, Mr Diaz-Canel, 57, said he intended to pursue a policy of “continuity”.

View image on Twitter

Granma (English)@Granma_English

I confirm that Cuban foreign policy will remain unchanged. Cuba will not accept conditions. The changes that are necessary will continue to be made by the Cuban people http://bit.ly/2vydjRw 

Meanwhile, in his first speech as former president, Mr Castro, attacked Donald Trump for a foreign policy he claimed had restored America’s “neo-colonial” attitudes. He said that, after an historic restoration of diplomatic relations between the US and Cuba engineered by him and Barack Obama, the US was once again seeking to isolate Cuba and its allies.

Even before the comments of the two men at the ceremony at the National Assembly in Havana, it was apparent that what appeared on paper to mark an shift in the nation’s course, may turn out to be less transformational than it might.

Firstly, though he represents a generational change, Mr Diaz-Canel has a reputation as a party loyalist with little public reputation or charisma. Last year, a video of a Communist Party meeting was leaked in which Mr Diaz-Canel voiced several orthodox positions that included a promise to close some independent media.

Secondly, though said to be growing increasingly tired and desirous of moving to a home he has built in colonial city of Santiago de Cuba, Mr Castro will remain first secretary of the Communist Party, the most powerful organisation in the country.

Elizabeth Newhouse, a regional expert and director of the Cuba Centre for International Policy in Washington, said there would be pressure on Mr Mr Diaz-Canel to act quickly in some areas in order to help the economy, which she said was in a dire state.

She said she believed this was less the result of US sanctions, which were frequently blamed over the years, but continued mismanagement in Havana.

 She said Mr Diaz-Canel success as president would depend on how quickly he was able to show people he was capable and “able to make life better for them”.

She said the party had intentionally chosen someone with a modest domestic and international profile. “They were not looking for someone to replace Fidel,” she told The Independent.

 

Reports said that Mr Castro sat and nodded as Mr Diaz-Canel gave his first address.

“The people have given this assembly the mandate to provide continuity to the Cuban Revolution during a crucial, historic moment that will be defined by all that we achieve in the advance of the modernization of our social and economic model,” Mr Diaz-Canel said, according to the Associated Press.

He said Cuba was prepared to negotiate with the United States but unwilling to cede to any of Washington’s demands for internal change.

He also said reforms would follow a 12-year-plan laid out by the National Assembly and Communist Party that would allow moderate growth of private enterprise while maintaining important sectors of the economy in the hands of the state.

“I confirm to this assembly that Raul Castro, as first secretary of the Communist Party, will lead the decisions about the future of the country,” he said, during his 30-minute address.

“Cuba needs him, providing ideas and proposals for the revolutionary cause, orienting and alerting us about any error or deficiency, teaching us, and always ready to confront imperialism.”

Speaking after Mr Diaz-Canel, Mr Castro not only attacked Mr Trump but said he expected the younger man to become first secretary of the party after he stood down from the position in 2021.

castro-change2-0.jpg
(Getty)

“From that point on, I will be just another soldier defending this revolution,“ Mr Castro said, apparently unwilling to reflect on own mortality.

He said he expected Mr Diaz-Canel to serve two five-year terms as head of the party, saying he envisioned him guiding his own successor for three years after leaving the presidency in 2028.

Mr Castro took control of the country in 2006, after his brother, Fidel, fell ill. He officially became president in 2008 and enacted a series of reform that that expanded Cuba’s private sector, allowed citizens greater freedom to travel and access to information

Those changes presaged a remarkable announcement at the end of 2014 when Mr Castro and Mr Obama revealed they had been secretly negotiating to end the diplomatic stand-off that has existed for 54 years, during which time Washington had tried to assassinate Fidel Castro on countless occasions. He eventually died, peacefully, in 2016.

The rapprochement saw a lifting of US sanctions had been aggressively enforced for decades, and the opening of embassies in the two countries’ respective capitals. That re-engagement has somewhat faltered since the election of Donald Trump, who rolled back some of the Obama administration’s changes, including the ability of US citizens to visit Cuba.

Mavis Anderson of the Latin American Working Group, a Washington-based group that promotes closer ties, said US foreign policy was now in the hands-of hardline conservatives, including Mike Pompeo, who has yet to be confirmed as secretary of state,

At the same time, Cuba-specific policy is led by a pair of ultra-conservative legislators of Cuban origin – Senator Marco Rubio and Congressman Mario Diaz-Balart, both of Florida.

“[The ball is in the US’s court right now and that is] sad, because the court is broken,” Ms Anderson told the AFP.

Relations between the two countries have not been helped by the controversy surrounding the mysterious, alleged attacks on the health of US diplomats in Cuba, which led the State Department to say it was dramatically scaling back its diplomatic presence.

At least 24 US envoys and their family members have fallen ill with symptoms that resembled concussion but with no exterior signs of trauma, leaving investigators confused.

The illnesses were not only confined to the US embassy. In January, a senior Canadian official said 27 Canadian diplomats and family members were tested after complaining between April and December of dizziness, headaches and nausea.

https://www.independent.co.uk/news/world/americas/raul-casto-donald-trump-cuba-us-miguel-diaz-canel-colonial-a8313091.html

Advertisements

Pakistan reducing dependence on US arms: FT report

April 19, 2018

Dawn (Pakistan)

Updated April 19, 2018
.

Pakistan is gradually reducing its dependence on American military technology and China is filling the gap, says a Financial Times report, which also warns that this shift will have geo-political repercussions as well.

The long, almost 2,000-word report notes that the shift started in the last few months of the Obama administration, when Congress blocked the sale of eight F-16 fighter jets to Pakistan.

In Islamabad, this move was seen as a confirmation of Pakistan’s fear that the United States “could no longer be relied on as their armed forces’ primary source of advanced weapons”, the report adds.

The shift started in the last few months of Obama administration, when Congress blocked sale of eight F-16s to Islamabad

So, Pakistan shifted its focus from F-16s to the JF-17 fighter jets it is developing with China, and which is catching up with the F-16 in terms of capabilities.

The ban accelerated Pakis­tan’s efforts to shift its “military procurement away from American-made weapons towards Chinese ones, or those made domestically with Chinese support.

The report also quotes data from the Stockholm International Peace Research Institute, showing that since 2010, US weapons exports to Pakistan have plummeted from $1 billion to just $21 million last year. During the same period, those from China have also fallen, but much more slowly, from $747m to $514m, making China the biggest weapons exporter to Pakistan.

“The shift coincided with Islamabad’s growing suspicion about the closeness between the US and India, but was accelerated by the killing of Al Qaeda leader Osama bin Laden on Pakistani soil in 2011, which badly damaged relations with the US,” the report added.

US President Donald Trump’s decision to suspend $2bn of military aid to Pakistan — announced in January — further exacerbated the situation.

Identifying one immediate impact of the move, the FT noted that US officials were “now finding that Islamabad is less responsive than usual” to their requests for support in Afghanistan.

Harrison Akins, a research fellow at the Howard H Baker Jr Centre for Public Policy at the University of Tennessee, told FT: “The Trump administration’s decision … can only push Pakistan further into the arms of Beijing — especially with Pakistan’s shift from US military supplies to Chinese military supplies.”

The report also identified longer-term consequences of this development, noting that sales of weapons systems, often backed by preferential financial terms, were central to the way the US managed its network of military alliances and partnerships. But many of those countries were now buying some of that hardware from other governments, particularly China.

The Financial Times noted that Pakistan has been buying from Beijing for decades, starting after the US placed an arms embargo on it in the wake of the 1965 war with India. “After that, every time Islamabad has suffered diplomatic problems with Washington supplies of Chinese weapons have risen,” it added.

In the 1980s and 1990s, Beijing provided supplies and technical knowledge to help Pakistan develop its nuclear weapons, and in the early 1990s shocked Washington by selling its neighbour more than 30 M-11 missiles, capable of carrying nuclear warheads.

The report also noted that in the past decade, the nature of the military relationship between China and Pakistan had changed. China was now selling the “high-end systems in which the US once specialised to Pakistan’s military, and is co-developing many others”.

Jon Grevatt, an analyst at the defence research company Jane’s IHS Markit, told FT that in the last decade, China collaborated much more expansively with Pakistan. Since 2010, China has provided A-100 rocket launchers and HQ-16 air defence missile systems to Pakistan while VT-4 tanks were now being tested in Pakistan.

The report, however, focused on three weapons systems that encapsulate the new Chinese capabilities, and threaten US influence in South Asia.

The first is the JF-17 fighter aircraft.

Image may contain: airplane

In 2007, Pakistan flew its first two JF-17s, which cost about a third of the price paid for an F-16. Later, China also shared the designs so the Pakistan’s armed forces can build their own, and even export them.

In 2015, Pakistan used a drone to attack militants near the Afghan border, which strongly resembled a Chinese design.

In October 2016, just a month after the US refused to subsidise new F-16s, Beijing agreed to sell eight attack submarines to Pakistan for about $5bn — the biggest single arms export deal in the country’s history.

The report noted that submarines deal came at a time when Washington was relying on India to provide a bulwark against perceived Chinese maritime expansionism.

Published in Dawn, April 19th, 2018

https://www.dawn.com/news/1402479/pakistan-reducing-dependence-on-us-arms-ft-report

Syria: US in talks over Arab force to replace American troops — “In reality, the politics of putting a force like that together are almost impossible.”

April 18, 2018

Problematic proposal is backed by national security adviser John Bolton but could worsen conflict

A US military base in al-Asaliyah, Syria
 A US military base in al-Asaliyah, Syria. Donald Trump is keen to withdraw American troops. Photograph: Delil Souleiman/AFP/Getty Images

The Trump administration is renewing an effort to replace US troops in Syria with an Arab force, but the proposal faces substantial obstacles and could potentially exacerbate the conflict.

The Saudi foreign minister, Adel al-Jubeir, said his government was talking to Washington about raising such a force, confirming a report in the Wall Street Journal that said the new US national security adviser, John Bolton, had called the Egyptian intelligence chief, Abbas Kamel, to ask Cairo to play a part in building one.

There are about 2,000 US troops in Syria fighting Islamic State, but Donald Trump has repeatedly expressed a desire to withdraw them.

The idea of an Arab coalition force playing a role in Syria to combat extremist groups and contain Iranian influence has surfaced several times since 2015, but faces severe problems. Saudi Arabia and the United Arab Emirates are bogged down in a brutal war in Yemen, and have little manpower and few military resources to spare.

They are also locked in a dispute with Qatar, another potential contributor to a force, while Egypt is much closer to the regime of Bashar al-Assad in Syria than its would-be Gulf partners.

Middle East experts said it was feasible Arab states could fund an army run by private contractors and possibly help recruit soldiers from developing countries such as Sudan. Erik Prince, a Trump ally who founded the military contractor Blackwater USA and now advises the UAE, is lobbying to play a role, according to the Wall Street Journal.

A similar offer he made last year to replace US troops with private contractors in Afghanistan was turned down by the Pentagon.

But Prince may have more traction in the White House over Syria. Bolton has argued that the US has borne too much of the military burden in Syria and Arab states should supply troops and material assistance in the fight against Isis.

Meanwhile, the Saudi monarchy and its regional allies are uneasy that events on the ground in Syria are being dictated by external powers, none of which are Arab.

Emile Hokayem, the senior fellow for Middle East security at the International Institute for Strategic Studies, said: “The idea of an Arab expeditionary force emerges every couple of years, and it’s always seen as a politically brilliant idea to create a sense of ownership in the region.

“In reality, the politics of putting a force like that together are almost impossible.

“The question is, have the Saudis consulted the other countries before speaking on their behalf? The Saudis thought Egypt and Pakistan would come to help Yemen and they didn’t.”

The Saudi crown prince, Mohammed bin Salman, has launched an Islamic military counter-terrorism coalition, which held its first high-level meeting last year, but it has not appeared to be intended for combat.

Image may contain: one or more people, beard, hat and closeup

Mohammed bin Salman

Charles Lister, the director of the extremism and counter-terrorism programme at the Middle East Institute (MEI), attended the inaugural conference and said the force is intended for training and assistance programmes, rather than combat operations.

Lister said there was “no precedent” for an Arab expeditionary force in Syria.

“It sounds like the Saudis are continuing to align themselves with President Trump and not speaking the 100% truth about their intent,” he said.

Any Saudi troops deployed to Syria would find themselves directly confronting Iranian fighters and their allies, which could prompt a dangerous escalation in the conflict.

Randa Slim, who directs the back-channel Track II diplomacy programme at MEI said: “It is one thing for the Saudis to pay for other ‘Islamic forces’ to do the job, and a totally different thing to send their men to a conflict theatre where they are bound to enter into direct confrontation with an entrenched Iranian-Hezbollah force.

“The other factor to consider is what is Turkey’s response to this proposal. I do not see Ankara welcoming the positions of Egyptian and/or Emirati forces on its border,” Slim said.

The Obama administration also looked at the possibility of Arab allies deploying counter-terrorist forces against Isis in Syria, but Saudi Arabia and the UAE were drawn into the battle for Yemen against Iranian-backed Houthi rebels.

Nicholas Heras, a fellow at the Center for a New American Security, said: “They preferred to send intelligence officers and money, rather than put troops on the ground.

“But for the Saudis, the trouble is their territory is being breached by Houthis every day. It doesn’t make sense for them to shift their ground forces when they have trouble securing their own border.”

Heras said it was more likely Saudi Arabia would seek to outsource recruitment to countries such as Pakistan and Sudan. “I’m sure the Saudis are up for fighting in Syria to the very last Sudanese soldier,” he said.

Source:https://www.theguardian.com/us-news/2018/apr/18/us-syria-arab-force-replace-american-troops-saudi-arabia-egypt-uae

Related:

U.S. Proposes Arab Military Force in Syria: Replace American military contingent

April 17, 2018

Under plan, troops would replace American military contingent after ISIS defeat and help secure country’s north; proposal faces challenges

American troops looked out toward the border with Turkey from a small outpost near the town of Manbij, northern Syria, in February.
American troops looked out toward the border with Turkey from a small outpost near the town of Manbij, northern Syria, in February. PHOTO:SUSANNAH GEORGE/ASSOCIATED PRESS

WASHINGTON—The Trump administration is seeking to assemble an Arab force to replace the U.S. military contingent in Syria and help stabilize the northeastern part of the country after the defeat of Islamic State, U.S. officials said.

John Bolton, President Donald Trump’s new national security adviser, recently called Abbas Kamel, Egypt’s acting intelligence chief, to see if Cairo would contribute to the effort, officials said.

Image result for John Bolton, on the phone, photos

The initiative comes as the administration has asked Saudi Arabia, Qatar and the United Arab Emirates to contribute billions of dollars to help restore northern Syria. It wants Arab nations to send troops as well, officials said.

Details about the initiative, which haven’t been previously disclosed, have emerged in the days since the U.S.-led strikes on sites associated with the Syrian regime’s chemical-weapons capabilities.

Mr. Trump, who has expressed growing impatience with the cost and duration of the effort to stabilize Syria, alluded to the push on Friday night, when he announced the missile strikes.

Image result for Abbas Kamel, egypt

Abbas Kamel

“We have asked our partners to take greater responsibility for securing their home region, including contributing larger amounts of money,” Mr. Trump said.

In early April, Mr. Trump spoke about the need to speed the withdrawal of the 2,000 troops the U.S. has in Syria, a position at odds with many top advisers who worry that leaving the country too soon would cede ground to Iran, Russia, their proxies or other extremist groups. The new administration initiative is aimed at avoiding a security vacuum in Syria that would allow Islamic State to return or ceding hard-won gains to Iranian-backed forces in the country.

Image result for John Bolton, on the phone, photos

A spokesman for the National Security Council declined to comment about Mr. Bolton’s call to Mr. Kamel, who is widely regarded as one of the most powerful figures in the Egyptian regime.

Syria Airstrikes: Video Footage

U.S., British and French forces struck sites associated with Syria’s chemical-weapons capabilities on Friday. Video footage shows the missile launches and resulting damage. Above, a Syrian soldier films the damage. Photo: AFP/Getty

Other officials, however, acknowledged the conversation and noted the administration had reached out to the Gulf states as well.

“Saudi Arabia, Qatar and the U.A.E. have all been approached with respect to financial support and more broadly to contribute,” an administration official said.

Egyptian military officials and a spokesman for the Egyptian president’s office couldn’t be reached immediately to comment.

Some military officials said that completing the defeat of Islamic State in Syria remains a challenge. Moreover, any move to assemble an Arab troop contingent that would be deployed after U.S. troops left would face obstacles.

Charles Lister, a senior fellow at the Middle East Institute, said that assembling a new force would be a challenge because Saudi Arabia and the U.A.E. are involved militarily in Yemen, and Egypt would be reluctant to defend territory that wasn’t controlled by the regime of President Bashar al-Assad.

Nor, he said, would Arab states be eager to send forces to Syria if the U.S. military didn’t agree to keep some troops there.

“There is just no precedent or established basis for this shaping into a successful strategy,” he said.

And many questions remain about whether the U.S. military would maintain some involvement in executing such a plan. U.S. troops in Syria, and the Kurdish and Arab fighters they work with, have been protected by American air power. It remains unclear what role, if any, U.S. warplanes might play and who would call in airstrikes if they were needed by a future Arab force.

“It has to be strong enough to face down Assad or Iran if either seeks to reclaim territory, perhaps with Russia’s help,” said Michael O’Hanlon of the Brookings Institution, referring to the new force.

In early January, U.S. military officials were hoping to wind up their campaign in Syria in a matter of months and keep troops to support a continuing State Department effort to stabilize Raqqa and other areas formerly under Islamic State control.

But that plan was upended by developments in the field. Many U.S.-backed Syrian Kurdish fighters have abandoned the fight against Islamic State and rushed toward the city of Afrinand other areas in northern Syria that have been attacked by Turkish troops.

Mr. Trump’s insistence that American troops come home as quickly as possible left administration officials scrambling to develop an exit strategy that would shift the U.S. burden to regional partners after Islamic State is defeated.

While estimates vary, 5,000 to 12,000 Islamic State fighters are believed to remain in eastern Syria, a U.S. official said. The militants are operating in two locations in a pocket south of the Syrian town of Al-Hasakah and in a 25-mile stretch along the Euphrates near the town of Abu Kamal, the official said. They have been trying to regroup and even forage for oil to sell.

The mission of the regional force would be to work with the local Kurdish and Arab fighters the U.S. has been supporting to ensure Islamic State cannot make a comeback and preclude Iranian-backed forces from moving into former Islamic State territory, U.S. officials say.

The idea also has caught the attention of Erik Prince, the private businessman who founded Blackwater USA and who has helped the U.A.E. and Somalia set up private security forces.

Trump Announces U.S. Strike on Syria

President Donald Trump said the recent suspected chemical attack in Syria was the crime of a “monster” and the strikes aim to deter the production and use of chemical weapons. Photo: AP

Mr. Prince said Monday that he has been informally contacted by Arab officials about the prospect of building a force in Syria but that he was waiting to see what Mr. Trump would do.

Egypt’s willingness to support a new effort in Syria is far from clear. With one of the largest armies in the Middle East, Egypt is preoccupied with a fight against the local branch of Islamic State in the Sinai Peninsula and with securing the country’s vast desert border with Libya, which is ruled by a patchwork of militias.

Egypt rarely has deployed troops abroad since the country sent more than 30,000 soldiers to join the American-led coalition fighting Iraq in the 1991 Gulf War, and its government sometimes has made statements supporting the authorities in Damascus, though it says it hasn’t taken sides in the conflict.

If Egypt didn’t want to send troops, it could help in other ways, such as by training Syrian fighters outside of their country and with logistics, some experts suggest.

The Trump administration effort isn’t the first aimed at generating greater regional involvement in Syria. During the Obama administration, then Defense Secretary Ash Carter repeatedly voiced hopes that Saudi and U.A.E. commandos would participate in the American-led offensive against Islamic State in northern Syria—to no avail.

Saudi Arabia and the U.A.E. have helped pay the stipends for the Syrian fighters the U.S. is supporting, American officials say.

Administration officials are calculating Arab nations will respond more favorably to a request from Mr. Trump, who already has asked Saudi Arabia to contribute $4 billion to restore former Islamic State-held areas of Syria.

Write to Michael R. Gordon at michael.gordon@wsj.com

Appeared in the April 17, 2018, print edition as ‘U.S. Seeks An Arab Force and Funding For Syria.’

https://www.wsj.com/articles/u-s-seeks-arab-force-and-funding-for-syria-1523927888

Israel Is Now Directly Confronting Iran in Syria

April 9, 2018

Israel won’t say it is indeed behind the overnight strike in Syria, but admitted in the past of attacking the T-4 air base. Iran continuing to establish a foothold in Syria may encourage an aggressive Israeli approach

.Israeli soldiers stand on a field overlooking Syria in the Golan Heights March 19, 2014
Israeli soldiers stand on a field overlooking Syria in the Golan Heights March 19, 2014REUTERS

It was a hectic night in the Middle East. In the early morning hours, still-unidentified planes struck the Syrian T-4 military air base near Homs. A short time later, Palestinians reported an Israeli air strike in the northern Gaza Strip against a Hamas target. The regional upheaval continues – and it seems Israel is no longer sitting on the sidelines, but rather is taking a more active role in the events.

There were reports of casualties at the Syrian base. The U.S. said it is not responsible for the strike. Russian and Syrian officials blamed Israel and Israel refused to comment. Twice in the past – in March last year and in February of this year – Israel has taken responsibility for attacking that very base, where Iranian military advisers are present. In the February strike, the Israel Air Force destroyed an Iranian control center at the base, after an Iranian drone entered Israeli airspace. It was a day of battle that also saw an Israeli F-16 fighter jet shot down.

Israel already set red lines back when the Syrian civil war began. It announced it will act to thwart smuggling of sophisticated weapons from Syria to Hezbollah in Lebanon, and since then foreign media attributed to Israel dozens of aerial strikes against weapon convoys and arms depots in Syria. Last year, another red line was drawn: Iranian entrenchment in Syria.

>> After Assad’s chemical attack, Israel awaits Trump’s next move in Syria | Analysis ■ How the West failed to prevent one Syrian chemical attack after another | Analysis

Syria's T-4 air base near Homs.
Syria’s T-4 air base near Homs.Google Earth
Photos of Iranian drones and control center, released by Israel after it struck T-4 air base in Feb.
Photos of Iranian drones and control center, released by Israel after it struck T-4 air base in Feb.IDF Spokesperson’s Unit

There are additional developments that should be noted in the context of Sunday night’s strike: Assad’s chemical attack on the rebels, the growing Russian-Iranian influence in Syria and the signals from the Trump administration about pulling out the American troops from the country. An Israeli strike – if one did indeed occur – should be viewed in the wider strategic context.

Just last Wednesday, the presidents of Turkey, Russia and Iran met in the Turkish capital, Ankara, for a summit dealing with arrangements dividing up the power and influence in Syria in the face of the Assad regime’s apparent victory over its adversaries.

At the same time, U.S. President Donald Trump was plying his intention to withdraw American forces from Syria, even if a final decision has not been taken and despite the fact that the idea is opposed by some of Trump’s advisers and generals. Is it any wonder that President Assad or someone who reports to him in the chain of command has interpreted recent developments as a window of opportunity, permitting the regime to massacre its civilians with chemical weapons to speed up the process of eliminating final pockets of resistance east of Damascus?

As in other instances in which proof of Russian involvement could embarrass Moscow, it’s not clear if Assad got a green light from the Russians to act. As expected, Damascus and Moscow are totally denying that chemical weapons were used. And it’s worth resorting to the rule that “nothing should be believed until the Kremlin denies it” (just as Russia denied involvement in the attempted assassination in Britain a month ago of former spy Sergei Skripal). With Russian backing, Assad has continued to engage in mass murder of civilians by various means, occasionally restoring to chemical weapons which shakes the West out of its apathy briefly.

Iranian presence in Syria

skip – Video by a Homs resident of the attack

>> How Russian military support is secretly airlifted to Syria’s Assad

The original sin here, it should be recalled, belongs to the Obama administration, which reconsidered punitive measures against Assad after his regime’s first proven massacre using chemical weapons in the summer of 2013. The agreement reached at the time, through Russian mediation, to get the Syrian regime to relinquish its chemical weapons did in fact dispose of most of Assad’s chemical weapons stocks. But it appears that the regime held onto a certain quantity of usable chemical weapons, in addition to its more frequent use of means that are somewhat less lethal, such as chlorine gas.

Trump is not acting that differently from his presidential predecessor. A year ago this week, Trump did in fact order a cruise missile attack on a Syrian air force base in response to the chemical attack in Syria on Khan Sheikhoun, but it appears that in the process (after the obligatory praise from the media), Trump’s interest in events in Syria had, as a practical matter, come to an end. Even if the United States carries out another punitive attack at this time, Assad knows that he can do almost anything he feels like, with Russian backing, and that the Americans are on their way out.

These events have several implications for Israel. They buttress the assessment about Assad’s self-confidence and his readiness to use any means to restore control over wide swaths of Syrian territory, an approach that will also be seen in the near future in the south of the Syrian Golan. They also again raise doubts about the wisdom of the decision to halt production and distribution of gas mask kits for the Israeli population.

Much of what was decided at the Ankara summit is of concern to Israel. It appears that at the summit, Tehran received backing for a continuation of its efforts to establish a presence in Syria, including in locations near the Israeli border. These are steps that could accelerate Israeli efforts to counter the Iranian presence, as Prime Minister Benjamin Netanyahu and Defense Minister Avigdor Lieberman have been threatening.

This is an aggressive approach, supported by the head of the Israeli security services, but it may still have consequences – from an American exit from Syria to an Israeli predicament there. In the north, Israel is now walking an ever-thinning line.

The Obama legacy: A raging problem with heroin and opioids

March 20, 2018

The Washington Examiner

University of Massachusetts Medical School nursing student Morgan Brescia, right, and others attend a simulation of treatment for a patient coping with addiction during class at the medical school in Worcester, Mass. (AP Photo/Elise Amendola)
Elise Amendola

Part of a magazine series examining The Obama Legacy. Read more about this series below.

President Obama made a surprise trip to West Virginia last fall to announce a new effort to fight prescription drug abuse, an epidemic that has shredded the rural state.

“This crisis is taking lives. It’s destroying families,” Obama said in Charleston.

Yet the crisis had been building for five years at that point, and critics say Obama’s reactions were too little and too late. Some say his government even contributed to the crisis by approving painkillers liable to abuse.

The Centers for Disease Control and Prevention (CDC) first identified prescription drug abuse as a major problem in 2011, when it released statistics that showed more people died from Centers for Disease Control and Preventionthan from car crashes.

Prescription painkiller and heroin overdose deaths have since risen to all-time highs. From 2009-14, the rate of overdose deaths from heroin abuse increased by 240 percent, from 1 per 100,000 people dying of an overdose to 3.4, according to data from the CDC.

Heroin is often connected to prescription drug abuse because it is cheaper and more available than painkillers such as Oxycontin. Patients can get addicted to painkillers after receiving them from a doctor and then turn to heroin.

When you add painkiller overdose deaths to the heroin numbers, the rate of overall deaths increased 25 percent from 2009 (nearly 12 people per 100,000) to 2014 (nearly 15 people), according to CDC.

In 2014, more than 14,000 people died of overdoses, the biggest total since the CDC began collecting data in 1999.

After visiting Charleston, the White House launched programs to expand addiction treatment, and added resources for first responders and to train doctors to prescribe fewer opioids.

“The goal today is to shine a spotlight on this, and then make sure that we walk away out of here, all of us committed to doing something about it,” he concluded.

The White House has taken some action in the past on opioid abuse, including additional grant funding for localities to start treatment programs, said Cynthia Reilly, head of Pew Charitable Trust’s Prescription Drug Abuse Program.

However, other experts say that while the new efforts are laudable, they are late.

“CDC identified [abuse] as a problem about six years ago. Now it seems to be the No. 1 or No. 2 health issue,” said Jeanmarie Perrone, professor of emergency medicine at the Hospital of the University of Pennsylvania.

Perrone had a front-row view for one of the most controversial decisions by the Obama administration: the approval of a powerful painkiller called Zohydro in 2013. She was on a panel of Food and Drug Administration advisers who recommended against approving the new hydrocodone painkiller because of the potential for abuse.

The approval sparked angry reaction on Capitol Hill. This year, Sen. Joe Manchin, D-W.Va., unsuccessfully tried to block Obama’s nominee for FDA commissioner. The senator cited the Zohydro approval as evidence that the FDA has turned a blind eye to the epidemic by approving opioids.

Perrone said the FDA overruled the panel’s recommendation, an unusual move, because it believed the product was safe and effective. But she noted that the agency hasn’t been taking into account the abuse potential of new products.

“Any opioid has an addiction rate of 5-25 percent. Can you really release another one on the market?” she said.

Proliferation of pot

Beyond presciption painkillers and heroin, several states have legalized the sale and use of marijuana under Obama’s watch.

Colorado, Alaska, Washington, Oregon and the District of Columbia have each passed laws that not only decriminalize marijuana, but allow for its recreational use.

In addition, 21 states have decriminalized possession of small amounts of marijuana, according to data from the National Conference of State Legislatures.

The Department of Justice, meanwhile, has essentially turned a blind eye to the recreational marijuana use in states, as residents who toke up are still violating federal law.

Justice released a memo in 2013 that made it clear marijuana is still illegal under federal law. However, the federal government traditionally relied on “state and local authorizes to address marijuana activity through enforcement of their own narcotics laws. This guidance continues that policy.”

Colorado’s neighbors may not be too happy about that.

Neighboring states Nebraska and Oklahoma sued Colorado, saying the law has significantly increased drug trafficking. The Supreme Court, which oversees such disputes among states, shot down the lawsuit.

The impact of Colorado’s marijuana law isn’t fully known yet, although a March 2016 report from the Colorado Department of Public Safety does offer some initial findings.

The report found that Colorado’s violent crime rate decreased 6 percent from 2009-14.

The department also analyzed data from the Colorado Hospital Administration and found that hospitalizations due to possible marijuana exposure increased from 803 per 100,000 people in 2001-09 to 2,413 from 2014-June 2015.

How the Obama administration handled the exploding problem of opioids

March 19, 2018

Barack Obama & the Opioid Crisis

My President’s Worst Failure

President Barack Obama and Attorney General Eric Holder Jr.

In the fall of 2001, southern Virginia’s US Attorney John Brownlee launched an investigation of Purdue Pharma, a company he believed misled government officials and medical practitioners regarding the potentially addictive nature of its opiate painkiller OxyContin. Short-staffed and without much in the way of a budget, Brownlee and his investigators lumbered along, compiling evidence and building a picture of corporate negligence and wrongdoing. Finally, on October 19, 2006, they presented defense counsel a final settlement offer: a mix of plea deals, financial penalties, and modifications in the way Purdue Pharma presented Oxycontin in its marketing efforts. Take it, Brownlee advised, or Purdue Pharma and some of its key executives would face “other things.”

On October 24, the day the settlement offer was set to expire, Brownlee received permission from the Criminal Division of the Department of Justice to “accept a plea or charge the company.”

That evening he received a phone call.

On the other end of the line was Michael Elston, chief of staff to Deputy Attorney General Paul McNulty. Elston mentioned that his boss had been contacted by Purdue’s defense counsel, and he urged Brownlee to “slow down” his negotiations, a strange request to make of a litigator who led an an effort that stretched over half a decade, accumulating greater urgency with each passing year as overdose deaths mounted. After Brownlee refused, his name appeared on a list of US Attorneys to be fired by Attorney General Gonzales eight days later.

This attempt to interfere with an imminent criminal charge is recounted in Dreamland, Sam Quinones landmark book on the opioid crisis, and it also came in for extended discussion in a Senate hearing convened in 2007 to discuss the adequacy of the terms of settlement Brownlee ultimately concluded with Purdue Pharma. But omitted from all these accounts is the name of Purdue’s defense lawyer, a person who clearly enjoyed high level access to the Department of Justice, and was willing to use it to delay a settlement that entailed not just money to be used for treatment but also oversight over how Purdue Pharma marketed its product, including how it depicted the potential dangers and benefits of its blockbuster drug Oxycontin.

The person who phoned Deputy Attorney General Paul McNulty was Mary Jo White — a fact reported in only one place, as a detail in this 2007 article in The Washington Post. A former US Attorney for the Southern District, White was by the time of Brownlee’s settlement discussion a lawyer in private practice at Debevoise & Plimpton.

In 2013, President Barack Obama nominated White to serve as chair of the Securities and Exchange Commission. Her crass political intervention in the single most devastating case of corporate fraud in the modern era did nothing to deter Obama from putting her name forward to serve as a watchdog of Wall Street, nor did it strike Senate staff vetting her for confirmation as worthy of mention.

In light of her 2006 phone call to the Department of Justice, it comes as no surprise that Mary Jo White’s stewardship of the SEC was marred by controversy. Reviewing her performance for The Intercept, financial journalist David Dayen noted “persistent delays on finalizing rules mandated by the Dodd-Frank Act,” and, owing to her extensive corporate ties, frequent recusals that left the board deadlocked 2–2. Last October, citing White’s refusal to act on rules requiring corporate spending on political activities, Senator Elizabeth Warren sent President Obama a letter requesting that he fire her immediately, in what would have been an unceremonious departure with only weeks left in her term. Obama refused.

Most telling, throughout her SEC tenure, White preached a “broken windows” philosophy of enforcement against low-level infractions that she claimed would send clear signals to Wall Street. In reality, the SEC rarely extracted admissions of guilt. One recent study from a professor at Emory found that the SEC inflated its enforcement prowess by “double and triple counts” and overstated the severity of the fines it imposed.

This pattern of pursuing the low-hanging fruit, to much fanfare but no great effect, was replicated throughout the Obama administration, a kind of “performative enforcement” approach to corporate America that placated forces in the pharmaceutical industry at a time when they should have been confronted. Still, vignettes of insiders like Mary Jo White, whose work in government falls below the radar of most Americans, do not provide an adequate account of how the Obama administration handled the exploding problem of opioids. They point only to indifference — a terrain of half-measures and neglect, normally hard to discern, but when set against a drug crisis spiraling out of control, one that is difficult to defend.

Under President Obama, a small army of executive branch “slow-walkers” served as pallbearers, knowingly or not, to the grim march of overdose deaths from commonly prescribed opioids that was already underway in years before he took office. As the body count climbed, the Brownlee-led US Attorney settlement with Purdue, as well as West Virginia’s 2004 settlement against the same company, ought to have prompted scores of decisions to reign in opioid prescribing. Instead, the opposite happened: prescribing numbers continued to grow throughout Obama’s first term, reaching a peak in 2012. Despite subsequent reductions, they remain the highest in the world.

During Obama’s time in office, licit opioid prescribing increased not only in number but also in potency. Most notable was expanded use of the powerful synthetic known as fentanyl, a drug approved only for opioid-tolerant cancer patients suffering from pain beyond the reach of traditional opioids, but one that drug makers marketed in a manner of ways, including in advertisements that pictured construction workers and others employed in similar, physically demanding jobs. Although a reduction in opioid supply was desperately needed, and close scrutiny of opioid manufacturers more than warranted, the Obama administration declined to do either.

What most exacerbated the opioid crisis was the dramatic rise in overdose deaths from heroin and heroin adulterated with illicit synthetics (fentanyl and carfentanil). While Obama was president, illicit heroin underwent an industrial transformation: market expansion, innovation, and in many places, a reconfiguration of production and distribution. Yet the path of initiation to heroin via prescription pills that fueled its resurgence went substantially unchallenged by the president. In fact, it was strengthened and fortified.

Though Obama did not start the opioid crisis, it is a blunt and brutal fact that, under his administration, drug overdose became the leading cause of death for Americans under the age of 50, and the opioid crisis became the worst drug epidemic in American history. It is an irrevocable part of his legacy as president.

Does Obama shoulder the blame for this horrible turn? A statistic without a story is only a starting point for questions, not an answer. And questions must be reasonable: despite a tendency to make extravagant claims on behalf of favored candidates, most people know that what a president can control does not equate perfectly to developments for which he is credited or blamed. Some things, like drug cartels, conspire beyond a president’s reach; others, like the disappearance of work from deindustrialized communities, span decades, indicting an entire political class. It is unfair to charge Obama with responsibility for all this, and even more so to assess the shortcomings of his administration on opioids without also weighing his pertinent and hard-won achievements.

A sensible framework is available, and the issue urgent. Surprisingly, there has been very little attempt to review the record — or, as recently happened in the Washington Post, 60 Minutes” investigation, a bizarre effort to exonerate the president from the actions of his own administration. To me this suggests, among other things, an unwillingness to wrestle with hard questions while Democrats are exiled from national government.

But expulsion from power is not a moment for convenient memory and self-regard; that’s a chronicle of the lost. For the faithful, diaspora is a moment for truth-telling.

The Record

Obama’s record on opioids rests in large part on his stewardship of the parts of executive branch most involved in managing the crisis. In this regard, no institution has been more important than the Food and Drug Administration (FDA).

About 30 cents of every American dollar spent goes toward items that fall under the FDA’s purview. Despite its importance, the agency receives sustained attention only from a small corps of specialized reporters. As a result, we learn little from the news media about the FDA’s routine activities, or how these have changed over time.

For instance, most Americans would be surprised to learn that, in the two decades of the opioid crisis (commencing with the approval of Oxycontin in 1995), the agency switched its funding stream from government-only to a combination of both taxpayer dollars and money from the pharmaceutical industry. In that same period, returns on investment for pharmaceutical companies became an even more important component of the American economy, a “financialization” of Pharma that, unfortunately for investors, coincided with a time when breakthroughs in small-molecule (traditional) drugs slowed dramatically. Corporations pressed for returns looked to bio-similar, large-molecule investments for the future. To make do in the present, they launched a Hunger Games-like defense of their own patents and protected markets — and, paradoxically, they also focused on development of “me too” drugs, imitations of proven success. And in some cases, like opioids, drug companies looked to expand the clientele for existing drugs.

These changes quietly transformed the FDA. Lawmakers and special interests who regularly depict the agency as a source of obstruction worked to pressure Congress to lower the bar for drug approval and proof of clinical effectiveness. In this sense, the 1995 approval of Oxycontin, which overlooked substantial evidence against the effectiveness of Purdue’s “extended release” technology, was a harbinger of things to come, and a part of a larger culture change within the FDA itself.

As overdose deaths from prescription opioids climbed in the early aughts, the costs incurred by the quiet ascendance of a culture of lax regulation became more intolerable — and more apparent. In 2004, Connecticut Attorney General Richard Blumenthal filed a citizen petition urging the FDA to place stronger warnings on OxyContin. After it languished for four years, he sued the agency in 2008 to compel action.

Suffice it to say that by the time Obama assumed office, both he and his advisors would have been apprised of the federal government’s settlement with Purdue Pharma of 2007, as well as litigation against the same company in West Virginia and still underway in Kentucky. But they showed no great concern over it. To lead what should have been regarded as a troubled agency, the president opted, in the words of The New York Times, to “sidestep a battle” that pitted the preferred candidate of the drug industry, Dr. Robert Califf, against a well-known patient advocate, Dr. Steven Nissen. Instead Obama sent Clinton-supporter and mega-donor Dr. Margaret Peggy Hamburg to the FDA. Hamburg’s experience in managing epidemics made her more suited to run the CDC than the FDA (as the Times also noted), and her appointment fueled speculation that a long-rumored division of the agency between food and drugs was in the offing.

It never came. Instead, Hamburg retained power over the drug portfolio, and one of the first high-profile decisions under her stewardship granted Purdue Pharma approval for a tamper-resistant Oxycontin reformulation before it had been tested according to guidance the FDA had itself set out. Families of Oxycontin overdose victims filed a citizen petition to record their disbelief that the FDA would show such a lenient attitude toward a drug that was “perhaps the most abused product ever approved by the FDA.”

But the willingness to believe that tamper-resistant technology was both successful on its merits and a sufficient response to the opioid crisis was the least of the FDA’s sins on the opioid crisis. In 2012, “Physicians for Responsible Opioid Prescribing” (PROP) filed a petition urging the FDA to reconsider opioid prescribing for chronic pain. The agency resolved instead to add a risk-management strategy to extended-release opioids, and asked that opioid manufacturers undertake an analysis of the safety of their own drugs. In their petition, PROP raised the fact that no scientific evidence supported the use of opioids as an effective response to pain that lasted beyond 12 weeks; opioids had simply not been shown to work in that setting. In their reply, the FDA answered that no proof existed to the contrary — or, in other words, opioids had not been shown definitively to fail.

It’s a remarkable response — and a revealing one. Historically, ever since the landmark Kefauver-Harris Amendments of 1962, the FDA has required proof of both drug safety and effectiveness. But since that time, starting with the Reagan administration, growing pharmaceutical industry influence over the FDA weakened its commitment to this so-called “precautionary principle.” By the time of the Obama administration, the idea that the industry had an affirmative obligation to demonstrate the efficacy of their drugs — not via “surrogate endpoints” or other assumptions and extrapolations, but in actual randomized clinical trials — was on the defensive. The “21st Century Cures Act,” the last major piece of legislation signed by Obama, endangered the precautionary principle as a matter of law. Now pharmaceutical companies seeking FDA sign-off on a new use for an already-approved drug can submit “real world evidence” — observational or, as Adam Gaffney described, “really bad evidence” — in lieu of randomized clinical trials. As a result, during a year when the opioid crisis fueled an astonishing drug overdose fatality count of 63,632 lives, President Obama’s final word on the FDA was to make the scenario that unleashed the worst drug epidemic in US history more likely, not less.

There were several other decisions, specific to the opioid crisis, which baffled. Most egregious was the FDA’s 2013 approval of the opioid painkiller Zohydro, despite the agency’s own advisory committee voting 11–2 against it. That same year, a study that appeared in the journal of Drug and Alcohol Dependence found that four out of five new heroin users started their opioid consumption by misusing prescription opioids. By this point, no one could feign ignorance of the damage caused by over-prescribing and over-supply — except the FDA. After receiving criticism for its Zohydro decision, which included 28 state Attorneys General calling on the FDA to rescind approval, the agency moved to minimize future censure by refusing to convene an advisory committee for deliberations on Purdue Pharma’s tamper-resistant opioids Targiniq and Hysingla, both of which were approved.

After a long stint at the FDA, Hamburg left the agency in 2015. That was not the last she heard of her legacy, however. Hamburg is married to Peter Brown, who, alongside conservative ideologue Robert Mercer, runs Renaissance Technologies, a hedge fund that held investments in healthcare throughout Hamburg’s tenure — including, according to one lawsuit, investments in the makers of Zohydro. The suit also charges Hamburg with conspiring to shield dangerous side effects from a powerful antibiotic called Levaquin. Only after Hamburg left the agency did the FDA decide to place stronger labeling on the drug; her husband’s company also holds investments in Johnson & Johnson, makers of Levaquin.

The potential for conflicts of interest under Hamburg, once-removed and owing to the investments of her spouse, became a more direct concern when Obama put forward Dr. Robert Califf — the drug industry’s preferred initial candidate to lead the FDA — to succeed her. Califf’s financial ties to the drug and medical device industry prompted Senator Bernie Sanders to place a hold on his nomination. Massachusetts Senator Markey added an additional hold based on the agency’s “willful blindness” regarding the ever-expanding opioid crisis, and dismissed the FDA’s insistence that approval of tamper resistant opioid formulations constituted some manner of adequate response to the problem. Senator Joe Manchin of West Virginia vowed to filibuster the nomination.

After securing a promise to revamp opioid warning labels and a return to convening advisory committees, Manchin and others released their hold, but voted against Califf on the floor. “The FDA needs new leadership, new focus, and a new culture,” Manchin concluded. Richard Blumenthal, who had left the Connecticut Attorney General’s office to become a US Senator, showed the long memory of a litigator when he joined the small group of his colleagues in voting “no.” “In the face of a spiraling opioid crisis,” Blumenthal told a rally of public health and law enforcement officials gathered to oppose the Califf nomination, “the FDA has utterly, abjectly failed to protect Americans.”

Meanwhile and not surprisingly, the FDA, though possessing substantial enforcement power, declined to put it to use in the opioid crisis. The two significant cases brought against opioid manufacturers for violations of the Food and Drug Act, the agency’s core statute, came from US Attorneys (led by Brownlee) and whistleblowers who came forward in federal court, not the FDA. Even smaller enforcement tasks, some explicitly within the the agency’s purview, went unaddressed. The position of director of the FDA’s Office of Criminal Investigation (OCI) was left vacant for years, after a previous director retired in scandal. Finally, in 2014, Dr. Hamburg filled the post with a director who established a track record of going after dermatologists cutting corners by purchasing foreign versions of a popular injectable drug (field agents derisively dubbed themselves “the botox police”). But he declined to pursue more weighty cases, including investigation into counterfeit opioid painkillers sold on the street and often containing dangerous doses of fentanyl. According to reports, pop legend Prince overdosed and died from a counterfeit pain pill laced with fentanyl. Even in the wake of this shocking and high-profile event, the OCI dithered. After Republican Congressman Greg Walden requested answers regarding the office’s prosecutorial priorities, the OCI director stalled until the Trump inauguration, at which point he left the FDA to work for DLA Piper law firm. According to Reuters, he will represent drug and medical device industry clients.

It has not been difficult for Donald Trump’s nominee to the FDA, Scott Gottlieb, to improve upon the shabby opioid record of the Obama years. That’s not to suggest that his response has been adequate — only that he cuts an energetic figure compared to his predecessors. In early summer of 2017, the new director requested that the makers of Opana ER voluntarily withdraw a drug connected to HIV and Hep C outbreaks. Around the same time, Gottlieb also convened an advisory panel to discuss an expanded evaluation for tamper-resistant opioids that would incorporate public health considerations; he also extended the risk training in place for extended-release opioids to immediate-release formulations. In less than a year, he has done more than Obama’s FDA commissioners combined — although it’s imperative to note, he has shown no willingness to review the effectiveness of opioid prescribing for chronic pain, as a recent report from the National Academies recommended he do (essentially the very same recommendation PROP made back in 2012). Gottlieb has also looked to hasten drug approvals by accepting less rigorous data, citing the “real world evidence” judged to be sufficient by the Obama administration.

As poorly as the FDA performed during the Obama years, another agency compiled a record that was even worse: the Department of Justice, and specifically the Drug Enforcement Administration (DEA).

Most people are unaware of the critical role the DEA plays in regulating a large share of the country’s licit drug supply, opioids included. Like its predecessor agency the Bureau of Narcotics, tasked with essentially the same set of jobs, the DEA publicizes only its attempts to control the flow of illicit drugs to the United States, an expensive undertaking that has never met with any meaningful success.

On the other hand, the DEA’s control of licit drug supply is straightforward and effective: it sets a quota for the importation and production for all Schedule I or prohibited drugs as well as all Schedule II, or tightly monitored, drugs. (That’s right: the United States government has a production quota for prohibited substances. This allows for a small number of medical experiments that take place using these drugs — mainly with marijuana — as well as other uses the government deems appropriate.) This quota system is embedded in the global system used to regulate drugs, originally formulated by the League of Nations, and revived by the United Nations in the post World War II era. Each participating country sets its import and production quota based on its own determination of medical needs, and then submits this data to the International Narcotics Control Board, a quasi-independent body charged with implementing the latest international drug convention agreed upon by the UN. All quotas must comply with the convention, and all sanctioned imports must correspond to a sanctioned export.

That this system of regulation is rarely mentioned obscures several important facts that bear upon the current drug crisis. First, for the United States, opioids are a trade. The country does not grow its own poppies to make Oxycontin or any other drug; it never has. Legal or illegal, opioids come to the United States from elsewhere, either as a raw material or ready-for-sale (or close to it).

Second, there exists a tremendous misimpression that the opioid epidemic is the first drug crisis launched and abetted by the pharmaceutical industry. Not only does contemporaneous (and intensifying) methamphetamine abuse contradict this notion, the very structuring premise of international drug conventions — that licit drugs can be diverted to illicit channels — rests on an understanding of the role Pharma plays in all kinds of illicit drug use. In fact, the League of Nations initially developed the scheme of international conventions to deal with the diversion of one painkiller in particular: heroin. The United States ultimately persuaded the United Nations to prohibit heroin, driving all of its production and distribution channels underground. But if you go back far enough, nearly every illicit drug market can trace its roots to the pharmaceutical industry. (Even hallucinogens, a drug sector with vibrant innovation now mostly detached from industry, became of interest in the modern era as the result of a discarded compound in pharmaceutical industry experiment labeled “LSD-25”.)

The discomfiting origin story behind most illicit drug use is one reason the DEA stays silent about Aggregate Production Quotas — that is, to sustain a fiction that illicit transactions can be addressed and conceptualized separately from the pharmaceutical industry. Instead, as opioid users who turn to illicit heroin in record numbers now make plain, the patterns of licit and illicit drug use have always been deeply intertwined.

Finally, cloaking the production quotas in a veil of silence mutes an important distinction between the over-prescribing and the over-supply of licit opioids. Over-prescribing can mean either providing too many pain pills for acute care (doling out a 30-day course of pills when five or seven days would suffice), or it can mean using opioid pills in ways that science has yet to vindicate (to care for lower back pain, for instance). Some physicians would likely argue that using a maximum instead of a minimum dose of opioids is also a form over over-prescribing. Taken together, all over-prescribing starts from a prescription pad.

In contrast, over-supply starts with the Aggregate Production Quotas. Over-supply makes over-prescribing possible, and it also enables large- and small-scale diversion at any point in the chain of production, from factory to warehouse; from truck trailer to pill mill. Over-supply of dangerous drugs inevitably results in diversion and public harm. The quotas, created to define licit flows for precisely these kinds of drugs, represent a global acknowledgement of this fact: for dangerous and addictive drugs, supply will find a market, and generate its own demand.

Given that, one would assume that determinations of medical need, the ostensible guiding principle of the United States APQ, would involve medical professionals assessing need based on science and experience. One would be wrong. The DEA sets Aggregate Production Quotas by suggesting amounts, usually derived from last year’s quota and consulting the prescribing levels of their registered distributors, and publishing those suggestions in the Federal Register. Drug companies provide feedback, as is their prerogative. The DEA often incorporates that feedback, or it holds an administrative hearing to air disputes. Then the final production quota is set for the year and once again published. (See “Quotas”) In practice, the current process for setting annual APQs entails nothing more than a survey of drug companies regarding how much of any given drug they’d like to produce.

When it comes to opioids or important precursor drugs, the answer to the question has been: a lot.

Belatedly, the DEA announced in October of 2016 that it would cut APQs for 2017, citing the opioid epidemic in its announcement.

But as the chart above demonstrates, the Obama administration kept APQs extraordinarily high; even the 2017 retrenchment will mainly affect reserve stockpiles that accrued during peak APQ years of 2013–2016.

In fact the only real success the Obama administration achieved on controlled substances was the 2014 decision to bump hydrocodone from Schedule III to Schedule II (“up-scheduling”), subjecting the drug to production quotas as well as tighter controls on refills. Other than that, and notwithstanding that noteworthy change, the Obama administration kept the spigot of opioid over-exposure running at full speed. That in itself represents serious culpability in the opioid crisis. Even apart from the actual amounts, it is inexplicable why the president’s team — had they been paying any sort of attention — did not revise the process for setting APQ’s to a more public health-oriented approach.

As one part of the Drug Enforcement Administration facilitated massive exposure of the American public to opioids, other officials in their agency were hindered from pursuing opioid wholesale distributors — companies that, under the law, must report suspiciously large orders of licit opioids. In practice, distributors that claimed ignorance made money as orders swelled to staggering heights.

Only recently have drug distributors faced (minor) financial penalties for inundating local communities with narcotics. Administrative foot-dragging frustrated former DEA diversion expert Joseph Rannazzisi, who was keen to pursue criminal penalties and large fines for drug distributors while he worked at the agency.

But Eric Holder’s Department of Justice saw it differently. According to the Washington Post, Rannazzisi was called to a meeting with the Deputy Attorney General in 2012, “to chastise me for going after industry.” When the Post first reported on the resistance Rannazzisi encountered, including a congressional bill passed to stymie his efforts, reporters mentioned that the lead congressman, Republican Tom Marino, cited Eric Holder’s desire to collaborate rather than confront the drug industry during hearings on his initial bill. That detail, and the actions of the Obama administration more generally, disappeared from the Post’s latest iteration of the same story, replaced by embarrassing efforts at spin by Obama-era officials who claim to be unaware of the bill’s obvious ramifications.

Contemporaneous reportings hows that to be absurd.

US Attorneys also declined to pursue significant cases against opioid manufacturers or distributors. There was every good reason to believe that the initial settlement led by Brownlee had come up short: the damage of prescription opioids only escalated, and companies continued to misrepresent their drugs, or covertly fund ostensibly neutral nonprofits to do that work for them. In the face of corporate malfeasance, Main Justice stood still — or, as Jesse Eisinger recounts in his book The Chickenshit Club: Why the Justice Department Fails to Prosecute Executives, “timidity coursed through the Holder Justice Department.” (In fact, all second generation lawsuits on the opioid crisis have come from State Attorneys General or county and city officials.)

That the Department of Justice balked while facing the worst drug epidemic in US history is shocking, but not surprising. For most of Obama’s presidency, DOJ was led by Eric Holder, a close guardian of corporate interests — so much so that journalist David Corn once dubbed him as representative of “what’s wrong with Washington [DC]”; a “poster child” for “selling out.” While in private practice in Covington and Burling in 2004, Holder represented Purdue Pharma when defending against a West Virginia lawsuit. A settlement was reached; records were sealed (only to be revealed in the blockbuster LA Times investigation of March 2016). But all along, while serving as Attorney General of the United States, Eric Holder knew exactly what Purdue Pharma did…and he did nothing.

In fact he did worse than nothing: he remained a biddable steward of corporate America. Because of Eric Holder, Obama will go down in history as a president oblivious to or complicit in the predations of financial capitalism; and the opioid crisis, the most brutal tally of its costs.

A Record of Success

Although President Obama declined to impose a public interest principle on setting drug APQs, he crafted several of note on the provision of health insurance in the United States as part of his sweeping Affordable Care Act (ACA). Of these, none proved more important to managing the opioid crisis than the instruction that mental health services, including substance use disorder (SUD) treatment, be offered and billed on par with other kinds of care furnished to a patient. (This component built upon the Mental Health Parity Act of 2008.)

So far, this remains an unattained ideal. In their interim report, Donald Trump’s Opioid Commission singled out non-enforcement of mental health parity regulations as an area of special concern. Still, the principle of parity has been enshrined both in law — which may be repealed — and as an expectation on the part of the American people when it comes to health coverage. Though far from complete, important strides have been made.

More attention has been paid to ACA-funded access to substance use disorder treatment via health insurance expansion. As is widely noted, the ACA funded Medicaid expansion in states that opted to pursue it; the legislation also encouraged states to establish health care exchanges for individuals to purchase health care or, if they declined, made access to a federal exchange available. In Ohio alone, almost a quarter million people receive access to treatment via one of these two routes. It is difficult to make the claim that many of these people would not have received either health insurance or access treatment via other means were it not for the ACA — difficult, but sadly not impossible, given the shameful state of health insurance prior to the ACA. By facilitating access to health insurance for millions, the ACA has saved lives, and not just in the context of the opioid crisis.

Medicaid’s Section 1115 waivers have been an overlooked story in the ACA and the opioid crisis. These waivers, allowing states to bypass certain Medicaid regulations in service to a special-needs population, improve efficiency, or expand coverage, predate the ACA. But Obama’s signature reform and the attendant expansion of Medicaid have prompted several states to apply the waivers to improve SUD detection, intervention, and care, an unheralded but significant transformation in treatment delivery. If Congress or the executive branch succeeds in repealing other elements of the ACA, the legacy of Section 1115 substance use disorder-focused waivers may prove to be Obama’s most enduring success in the opioid crisis.

Obama signed other pieces of legislation designed to expand SUD treatment capacity or access. For example, in July of 2016, he signed the Comprehensive Addiction and Recovery Act — a bill with a big name that did very little, given that all the money “designated” by the act relied upon the yearly appropriations process, and that Obama had asked for $1 billion in funding and received only $181 million. “This legislation includes some modest steps to address the opioid epidemic,” Obama noted during a subdued signing ceremony.

More fanfare — and much more funding — accompanied his December 2016 approval of the “21st Century Cures Act,” which secured up to a $1 billion in grants designed to target unmet needs in outreach or care. Already the first round of funding has earmarked close to half that amount for distribution. Unfortunately, as I’ve already noted, these new resources come at a steep cost to the American people. The 21st Century Cures Act further inscribes a culture of industry deregulation into the operations of the Food and Drug Administration; in this way, President Obama’s most decisive action on the opioid crisis demonstrates his total reluctance to heed one of its most important lessons.

As a matter of fact, all of these efforts by Obama to combat on the opioid crisis can be described as “end-stage,” a point considered by public health officials to be the least effective (and most expensive) to intervene. Almost all of them will result in profits for the drug industry. Companies like Indivior, makers of Suboxone, a popular form of Medication-Assisted-Treatment (MAT), stand to reap considerable gains. A small number of companies are involved in both sides of the business, producing opioid painkillers alongside opioid maintenance drugs, allowing them to make money, and make money again, regardless of the cost to the American people.

President Obama also showed himself to be inattentive and desultory at a time when urgency was required, both in a moral and a practical sense. Although Obama occasionally devoted some stern remarks to a crisis which spiraled out of control on his watch, and he directed his bored Secretary of Agriculture to form a “taskforce” on opioids when Vilsack complained of little to do, nothing much came of either. Likewise, the White House Summit on opioids held in August 2014 was probably well thought of by earnest people willing to work within Obama’s narrow parameters of reform: leave corporate profits and power untouched.

On opioids, Obama compiled a record of success in public relations and palliative remedies, and failure in the actual practice of power.

The exception to this proves the rule: in March 2016, the Center for Disease Control released opioid prescribing guidelines, a long overdue reassessment of when and how to prescribe opioids to relieve chronic pain. Later that month, in a public forum, Obama urged “consumers and families” to use the guidelines to hold opioid manufacturers “accountable.”

He said nothing of the federal government doing the same.

The Balance Sheet

Much can be said of this impoverished notion of progressive governance — one that ameliorates the effects of exploitation, but does nothing to curb its scope, or dislodge it from power. I want to make clear that here, I have exposed it to critique on its own terms, and not from the perspective of someone who considers drug prohibition to be an unmitigated failure (as I do), or who believes late stage capitalism is beyond salvaging (as most socialists do, but as someone who is not a socialist, I do not). Both provide valid leverage for critique, but would inevitably result in assailing President Obama for failing to adopt views he never espoused. That is a harsh standard to use when considering the opioid crisis as it unfolded in real time.

Instead I have offered an account based on what a reasonable person would expect from President Obama based upon his professed vision of government; the tools he had at his disposal; and the costs of the opioid crisis itself.

Those costs have only grown since Obama left office. There is little doubt that 2017 will exceed in overdose the deaths the previously record-setting year of 2016. Neither the ACA nor the “Cures Act” will effect dramatic change in this regard, nor will the recent efforts to cut back opioid prescribing produce immediate results. Deaths once driven by the greed of the pharmaceutical industry have now graduated to the even more callous greed of drug cartels, and we must await changes beyond what we can control, or beyond what can be expected in the short-term.

This bodes ill for for Barack Obama and his legion of admirers.

What follows a presidency dictates how it is remembered. Like other components of his legacy, Obama’s deficiencies on the opioid crisis have largely endured, while his accomplishments seem provisional, vulnerable to repeal. Right now, his failure shouts, while his success whimpers. Progressives can only hope that events reverse course, or that the principles embedded in his signature reforms will survive temporary reversal, only to return as emphatic and unassailable.

Even still, the Democratic Party (or any successor to it) will not collect the voting majorities needed to revive the best components of Barack Obama’s legacy unless and until they address the worst. First and foremost, that means reckoning with the foregoing account, a story of my President’s worst failure.

Nunberg episode marks the dawn of Mueller’s March madness — Many Expecting “Great Unravelling.”

March 6, 2018

Updated 3:05 AM ET, Tue March 6, 2018

Washington (CNN)The grinding pressure of special counsel Robert Mueller’s Russia investigation is starting to do strange things to people’s heads.

How else to explain a staggering, reality TV-style meltdown of short-lived Trump campaign adviser Sam Nunberg on Monday, played out in a batch of cable news interviews, marking the oddest twist of the Russia saga yet?
.
In a stunning blast of accusations, insults and non-sequiturs, Nunberg vowed to defy a grand jury subpoena, dared Mueller to arrest him and claimed the relentless prosecutor believed that Donald Trump was a Manchurian candidate.
.
It all unfolded in hour upon hour of car-crash television, in a compelling self-immolation that it was impossible to look away from and provided a reminder of the cast of erratic, oddball characters who drift in and out of the President’s employ — some of whom staffed his campaign and his White House.
 .
At times, Nunberg appeared close to the end of his rope, saying he had already spoken to Mueller’s team and did not wish to spend another “80 hours” digging through his communications with Trump aides that had been subpoenaed by the special counsel.
.
“Screw that,” Nunberg told CNN’s Gloria Borger when asked if he would testify to the grand jury on Friday. “Why do I have to go? Why? For what?”
.
His defiance risked landing him in jail on contempt charges and threatened to create a sideshow for the straight-laced special counsel while his outbursts were sure to trigger days of news coverage and will therefore likely infuriate Trump.
.
But though Nunberg’s emotional outpouring might be seen as the ramblings of someone under intense duress, it had enough hints of where the Russia investigation may be heading to worry the President.
.
“This guy is all over the map,” former FBI special agent Josh Campbell said, dubbing the Nunberg show “the Great Unravelling.”
.
“Up until this point Mueller’s team has been so tight, we haven’t seen the leaks so it has been very difficult to see what he’s looking for,” Campbell said. “I think it’s incredible, seeing today this episode unfold before our eyes because it gives us that insight into where the investigation is ultimately headed.”

What he said

.

Nunberg, apparently interpreting questions already put to him by Mueller’s investigators, said for instance that he believes that the special counsel has something on Trump related to the Russian meddling effort on the 2016 election: “I suspect they suspect something about him,” he told Borger.
.
He also claimed the special counsel is trying to prove that Trump associate Roger Stone colluded with Julian Assange, founder of the WikiLeaks site which is reputed to have links with Russian intelligence.
.
In another claim that would be highly significant if it turns out to be true, Nunberg claimed Trump knew about a meeting between his son Donald Trump Jr., campaign officials and a Russia delegation offering dirt on Hillary Clinton.
.
“He talked about it a week before and I don’t know why he did this,” said Nunberg, in his second CNN interview, this time with Jake Tapper.
.
“I don’t know why he went around trying to hide. He shouldn’t have,” Nunberg said.
.
The President has denied he knew anything about the meeting.
.
Nunberg also said he suspected that former Trump foreign policy adviser Carter Page had colluded with the Russians, and said he was a “moron” — though argued that he was too low-level to have much influence with Trump.
.
While much of what Nunberg said was insulting toward Trump and his staff, he also insisted that the President did not conspire with the Russians during the election, offering a rather backhanded defense of his former boss.
.
“Vladimir Putin is too smart to collude with Donald Trump,” Nunberg told CNN. “Donald Trump couldn’t keep his mouth shut if Putin colluded with him.”

White House reaction

.

whpb sanders nunberg response acosta sot tsr_00000120

 https://www.cnn.com/2018/03/06/politics/sam-nunberg-robert-mueller-investigation/index.html
White House blindsided, baffled by Nunberg 01:47
.
In the middle of his cable spree, White House press secretary Sarah Sanders delivered her daily briefing and suggested Nunberg was woefully misguided in his allegation that Trump may have committed wrongdoing during the campaign.
.
“I think he definitely doesn’t know that for sure because he’s incorrect,” Sanders said. “There was no collusion.”
.
But the manner of Nunberg’s unburdening on cable television and the eye-popping nature of his claims cannot have helped but attract the notice of Trump, an avid cable news viewer, and are unlikely to improve his festering mood over Russia.
.
In his interview with CNN’s Erin Burnett, Nunberg slammed the White House, saying the Trump team was doing a terrible job, given the President’s low approval ratings. “They can say whatever they want about me,” he said.
.
At least part of Nunberg’s motivation appeared to lie in his anger about how he and Stone were treated by Trump — a provocation that may be all but impossible for the President’s twitchy Twitter finger to ignore.
.
At the White House, Trump’s aides watched the Nunberg interviews in shock, calling them “nuts” and “bizarre” CNN’s Kaitlan Collins reported.
.
The outlandish nature of Nunberg’s charges are bound to raise questions about his credibility as a witness and will give the White House an opening as it seeks to discount his claims about the scope of the Mueller investigation.
.
At one point, Burnett said that she smelled alcohol on Nunberg’s breath. Though he said he had not been drinking, there must be some question about the state of his mind.
.
But there’s no doubt his appearances also present Trump’s team with a problem, since the President has been prone to his own emotional outbursts about the Russia probe, and any inflammatory reaction on his part will only prolong the story.
.
Even before the Nunberg meltdown, Trump appeared fixated and angry about the Russia investigation Monday, going further than before in accusing his predecessor Barack Obama of intervening in the 2016 election against him.
.
“Why did the Obama Administration start an investigation into the Trump Campaign (with zero proof of wrongdoing) long before the Election in November? Wanted to discredit so Crooked H would win. Unprecedented. Bigger than Watergate! Plus, Obama did NOTHING about Russian meddling,” Trump wrote on Twitter.
The tweet was wrong on a number of counts, but it may offer some insight into Trump’s own current state of mind.

More alleged scandals

Trump’s feelings can hardly have been tempered by two other prominent news stories about alleged scandals on Monday related to the bizarre eco-system of scandals and accusations surrounding his campaign and personal conduct.
.
The Wall Street Journal reported that Trump’s personal attorney Michael Cohen complained to friends he had not been reimbursed for a six-figure payment to a porn star alleged to have had an affair with the billionaire-turned-politician.
.
Cohen previously said he had facilitated a payment to Stephanie Clifford, better known as the porn star Stormy Daniels, but has denied that Trump and Clifford had an affair in 2006, as the paper reported.
.
For a while Monday, the scene of the Russia election intrigue shifted to Bangkok and a sweltering Thai detention center where a self-styled “sex coach” who claims to have detailed insider knowledge of Russian meddling in the US election told CNN she wants to cooperate with US investigators.
.
Image result for Anastasia Vashukevich, photos
.
Anastasia Vashukevich
.
Belarus-born Anastasia Vashukevich claims she has an hour of audio recordings and photos of meetings. She also claims to be the former mistress of Russian billionaire Oleg Deripaska, and says she witnessed several meetings in 2016 and 2017 between the oligarch and and at least three unnamed Americans.
.
Back in Washington, what passed for normality in the Trump era went on in the shadow of the Russia storm. Trump met Israeli Prime Minister Benjamin Netanyahu, who is himself under a legal cloud, fighting several cases of alleged corruption.
.
America’s allies piled desperate pressure on the White House to try to head of steel and aluminum tariffs promised by Trump that could spark a trade war.
.
But March 5, 2018, will forever be remembered as the day of Nunberg TV.
.

The Russian Indictments — Where were James Clapper and John Brennan and the American intelligence community when the Kremlin was meddling?

February 17, 2018

 

Russian President Vladimir Putin in Moscow, Jan. 29.
Russian President Vladimir Putin in Moscow, Jan. 29. PHOTO: ALEXEI NIKOLSKY/ASSOCIATED PRESS

The Justice Department on Friday indicted three Russian companies and 13 individuals for interfering in the 2016 U.S. presidential election, and the man who should be most upset is Donald J. Trump. The 37-page indictment contains no evidence of collusion between Russia and the Trump campaign, but it does show a systematic effort to discredit the result of the 2016 election. On the evidence so far, President Trump has been the biggest victim of that effort, and he ought to be furious at Vladimir Putin.

The indictment documents a broad social-media and propaganda campaign operating out of Russia and involving hundreds of people starting in 2014 that “had a strategic goal to sow discord in the U.S. political system.” It certainly succeeded on that score, as Democrats and the media have claimed that Mr. Trump’s election is illegitimate because he conspired with Russia to defeat Hillary Clinton. The charge has roiled American politics and made governing more difficult.

The good news for Mr. Trump is that the indictment reveals no evidence of collusion. The Russians “posted derogatory information about a number of candidates,” the indictment says, and by 2016 “included supporting the presidential campaign of then-candidate Donald J. Trump” and “disparaging Hillary Clinton.” But it adds that the Russians “communicated with unwitting individuals associated with the Trump Campaign,” and it offers no claims of a conspiracy.

 Image may contain: one or more people

Readers of the indictment will be amused at the comic opera details. In or around June 2016, for example, Russians posing online as Americans “communicated with a real U.S. person affiliated with a Texas-based grassroots organization.” This “real U.S. person” vouchsafed the deep political secret that the Russians “should focus their activities on ‘purple states like Colorado, Virginia & Florida.’” Sure enough, the Russians thereafter referred to targeting “purple states.” Someone actually paid Russians to collect this insight.

The indictment also contains no evidence that Russia’s meddling changed the electoral results. A U.S. presidential campaign is a maelstrom of information, charges and counter-charges, media reports and social-media chatter. The Russian Twitter bursts became part of this din and sought to reinforce existing biases more than they sought to change minds. Their Twitter hashtags included “#Hillary4Prison,” for example, which you could find at the souvenir desk at the GOP convention.

Yet none of this should let Twitter, Facebook or Google off the hook for being facilitators of this disinformation. The social-media sites and search engines clearly did far too little to police their content for malicious trolls and in the process misled millions of Americans. They need to do more to take responsibility for the content they midwife.

Image may contain: 1 person, eyeglasses and closeup

James Clapper

The indictment also makes us wonder what the Obama Administration was doing amid all of this. Where were top Obama spooks James Clapper and John Brennan ? Their outrage became public only after their candidate lost the election. If they didn’t know what was going on, why not? And if they did, why didn’t they let Americans in on the secret? President Obama sanctioned Russia for its meddling only after the election.

Image may contain: 1 person, closeup

John Brennan. Photo by J. Scott Applewhite, The Associated Press.

The indictment’s details underscore Russia’s malicious anti-American purposes. An authoritarian regime spent tens of millions of dollars to erode public trust in American democracy. As Senator Ben Sasse (R., Neb.) put it Friday, “Putin’s shadow war is aimed at undermining Americans’ trust in our institutions. We know Russia is coming back in 2018 and 2020—we have to take the threat seriously.”

All of which makes the White House reaction on Friday strangely muted. Its statement understandably focused on the lack of collusion evidence and made one reference to “the agendas of bad actors, like Russia.” But given how much Russia’s meddling has damaged his first year in office, Mr. Trump should publicly declare his outrage at Russia on behalf of the American people. The Kremlin has weakened his Presidency. He should make Russia pay a price that Mr. Obama never did.

https://www.wsj.com/articles/the-russian-indictments-1518825574

Related:

FBI Director James Comey and U.S. Attorney General Loretta Lynch attend a news conference at the Justice Department in Washington June 18, 2015. REUTERS/Yuri Gripas 

FBI Director James Comey and U.S. Attorney General Loretta Lynch attend a news conference at the Justice Department in Washington June 18, 2015. REUTERS/Yuri Gripas

.

Can the U.S. End Pakistan’s Double Game?

February 11, 2018
A Q&A with Pulitzer Prize-winning author Steve Coll on America’s forever war against the Taliban.
.
Bloomberg
.
U.S. commanders say they’re turning the tide, again. Photographer: Wakil Kohsar/AFP/Getty Images

Steve Coll’s Pulitzer Prize-winning “Ghost Wars” laid out in gut-wrenching detail the chain of events that led from one modern war in Afghanistan — against the Soviets — to the Sept. 11 attacks and the brink of another conflict. When the book came out in 2004, the U.S.-led war against the Taliban and Al Qaeda seemed on the wane, at least compared to the then-raging insurgency in Iraq. Soon, however, with the aid of their longtime sponsors in Pakistan’s Inter-Services Intelligence agency, the Taliban would reconstitute their movement and seize control over great swathes of the Afghan countryside, dueling the U.S. and the Afghan Army to a stalemate. If current trends hold, the U.S. will in the not-too-distant future be sending soldiers to the “graveyard of empires” that hadn’t even been born on 9/11.

Coll’s new book, “Directorate S: The C.I.A. and America’s Secret Wars in Afghanistan and Pakistan,” tells the story of this new war in equally magisterial fashion. The narrative is punctuated by folly, frustration and hubris, with the U.S. striving unsuccessfully to convince the Pakistanis to abandon support for their Islamist proxies — tools, generals in Rawalpindi believe, to counter Indian influence in Afghanistan — and to defeat the Taliban on the battlefield. It comes out just as a series of horrific attacks in Kabul have reminded the world how ineradicable the Afghan insurgency remains. I spoke with Coll about where he thinks America’s longest war is headed and how it might, finally, end. The following is an edited and condensed version of our conversation:

NISID HAJARI: Now that the Trump Administration has released its “new strategy” for Afghanistan, including an increase in the number of airstrikes, you’re starting to hear U.S. commanders talk again about gaining momentum and reaching a “turning point” in the war. After retracing the first 15 years of this conflict, what do you think when you hear such comments?

STEVE COLL: Well, the history is dispiriting when you excavate it because it’s so repetitive. And some of the reason is what you suggest, that new commanders come in, they don’t stay for longer than two years in high military command, sometimes shorter. Not to be too cynical about it, but their career depends on a narrative of achievement. I remember Eliot Cohen, who was a counselor to [then-Secretary of State] Condoleezza Rice during the Bush Administration, recounting how he discovered that the six-month command rotations had a common pattern: A new commander would come in and say, “This looks like it’s going to be very, very difficult.” And then, six months later, he’d say, “We’ve irreversibly changed the momentum of the war.” As a writer, it was a narrative challenge, because at a certain point I would think, “Haven’t I already told this story?”

NH: Do you see anything materially different in the Trump administration’s strategy compared to those that have been tried in the past?

SC: Well, yes and no. Yes, the administration has been more explicit about challenging Pakistan, and the decision to withhold [military] aid conditionally is a significant departure. Unfortunately, I don’t see the case that it’s going to be decisive in changing Pakistani conduct because the amount of aid, while significant as a top-line dollar figure, is not significant from the perspective of Pakistan’s political economy, especially because they have this deep, deep relationship with China.

Also, the problem is not just that American influence has diminished but that the Trump Administration has taken up the same line, in only a slightly varied form, of the Bush and the Obama administrations, which is, “Yes, we understand that there is no military solution to this war.” And yet what they resource, what they prioritize is military action without any predominant or even parallel political strategy. Trying really to get the Chinese to put pressure on Pakistan, having a clear idea of what you’re asking Pakistan to change about its conduct — I don’t see any of that happening.

NH: I was in Lahore recently, and among middle- and upper-class Pakistanis, there seem to be two narratives: One is that Pakistan no longer needs the U.S. because of China, and the other is that, in fact, Pakistan is quite vulnerable economically and may need to return soon to the International Monetary Fund, and that Chinese support isn’t unconditional. Which narrative do you favor?

SC: I think the assessment that Pakistan is vulnerable to IMF pressure and that China is ambivalent about Pakistan’s dysfunction and accommodation of militants is correct. That, at least theoretically, is an opportunity, although when really pressed to choose sides, the Chinese have been reluctant to do so — not necessarily because they think that Pakistan should be defended against all critics, but because the U.S.-Chinese relationship has so many other priorities and friction points.

Pakistan, I think, would actually prefer to have a balanced relationship with China and the United States. In the current international environment, where there is a lot of uncertainty about America’s role in the world, I think making a bet on China seems likely to be an easier decision [laughs] than it did 10 or 15 years ago. But, if you’re a small country like Pakistan is, and you’ve got great powers in your orbit, the natural strategy is to have access to both, to keep both in balance and try to use that equilibrium as a space to grow.

NH: What would it take to enlist Chinese help in changing Pakistani behavior?

SC: During the Obama administration, I participated in these Track 1.5 meetings with Chinese specialists on Afghanistan and Pakistan. You’d meet with these people that had been engaged in the region for a long time and try to have these conversations about exactly the question you asked. And I took away a couple of observations. One was that the specialists in China who thought about Pakistan and Afghanistan just weren’t influential enough to be heard over issues like South China Sea, future of North Korea, future of U.S.-China trade, great power balancing. We were on the C-list in U.S.-China relations.

And then secondly, when you did get around to Pakistan, they did have an interest in suppressing transnational Islamist movements that could inflame populations in western China. Definitely concerned about that. Definitely not opposed to U.S. counterterrorism efforts against transnational militant groups. But, their main interest was Pakistani stability and prosperity. And I remember one meeting where one of our Chinese counterparts said, “We used to track your strategy because we couldn’t figure out how to improve Pakistan. We noted that you switched from a centralized approach to a more of a province-by-province approach. Then we decided to switch from a centralized approach to a more province-by-province approach. And at the end of a couple of years we concluded that neither you nor we were succeeding.” [laughs]

NH: The unofficial Pakistani defense for supporting the Taliban has always been that India is the one destabilizing the situation, by seeking to dominate the Afghan government and thus encircle Pakistan. Do such claims have any merit?

SC: Well, it’s a complicated picture. Let’s start with the hardcore Pakistani allegations — for example that NDS [the National Directorate of Security, the Afghan intelligence agency] is an Indian project, or that the disposition of Indian consulates and the activities of Indian citizens in Afghanistan are really just a massive cover for destabilization operations inside Pakistan. That’s exaggerated if not entirely fanciful in my assessment. I mean, the NDS is a CIA operation. It has Iranian connections. It has Russian connections. It has a few Indian liaisons. But the idea that NDS is a proxy for RAW [India’s Research and Analysis Wing espionage service] is just incorrect.

You know, the Indians have been very careful about the kinds of things they do in Afghanistan — building hospitals, roads, a little bit of military training. From time to time they get a little bolder. Does India sponsor or run sometimes in cooperation with Afghan clients, covert action against Pakistan? Yes, they do. They clearly have their fingerprints in Baluchistan [the site of a long-running separatist insurgency]. When the war got really nasty and there was NDS collaboration with elements of the Pakistani Taliban, as a tit-for-tat response to Pakistani collaboration with the Afghan Taliban, was India aware of that? Did it perhaps support it at some level? Maybe. But NDS was in this game for its own reasons.

India asserts, and I think any reasonable person would recognize, that it has a right to provide aid to support Afghanistan’s recovery. Does it take satisfaction that this annoys Pakistan? Yes. Is it the most important priority in Indian foreign policy? Not at all.

NH: Pakistan’s support for the Taliban, and the sanctuary it provides Taliban leaders, is obviously critical to prolonging the war. But there’s an endless list of other contributing factors as well, from government dysfunction in Kabul to corruption to the drug economy. How would you rank them in terms of their importance to ending the conflict?

SC: I think the most important one, and it may be as important as the Pakistani sanctuary and ISI support, is the political crisis in Afghanistan among the elites. It’s kind of a paradox because Afghan nationalism is very strong and has been strengthened by the experience of Pakistani interference. I mean, the main thing that ISI has accomplished in Afghanistan, apart from seizing some territory through the Taliban, is to rally Afghans around a national idea greater than ethnic identity.

But having said that, ethnic factionalism and the failure to create a unity government after the 2014 elections has left Afghanistan in a grave position. And the other thing that’s new is social media, which has really modernized the country and plugged in a new generation, but also exacerbated factionalism and ethnic polarization. It’s really a virus.

NH: Really? You see something similar in Myanmar and other developing nations, of course, with Facebook and WhatsApp and other platforms being used to spread hate speech and vicious rumors about targeted communities.

SC: Yeah, yeah, it’s really rough. I happened to visit Afghanistan in September 2016 to report the epilogue for the book. I was in Kabul, and there was a violent dispute in the city between Uzbeks and Tajiks over the reburial of a forgotten Afghan king. I was sitting with some Panjshiri friends [ethnic Tajiks from the Panjshir Valley], and they were all on their phones, all day long, rallying [their followers] over this incident. And when I asked them about the role of social media in ethnic polarization, they were very clear that this is where people speak, it’s where they mobilize and there’s a lot of hate speech in those spaces.

NH: You mentioned earlier that you see no signs of a political or diplomatic push to try and end the war. What might one look like?

SC: The most interesting aspect of the negotiations that took place during the Obama years was the question, “What do the Taliban really want?” I think part of what [Taliban negotiators] were saying then was, “We learned from our last experience in power that we need to find legitimacy in the international system. We need a more capable government. We need a transition period. We are prepared to share power. We need a broader ethnic balance in Afghanistan; we can’t just be the Pashtun radical movement. We see that there are lots of different ways that Islamist movements like ours participate in politics, as in Egypt after the Arab Spring.” And, you know, you could dismiss that as the musings of a negotiator. But it’s evidence that the Taliban are a more internationally sophisticated, more internationally aware movement than they were in the days of obscurantist policies and isolation in Kandahar.

If this war doesn’t end with a victory ceremony, then the question is, how can the shared interests of the United States, China, Russia, Iran, Pakistan and India in an Afghanistan that is not engulfed in chaos, that is not a font of transnational violence — how can that be realized, even incrementally, even if it just involves reductions of violence rather than a full-blown peace treaty? As long as nobody attempts that kind of diplomacy, there’s really no reason to think that the structure of violence that we see in Afghanistan now is going to change. And that just feels grotesque.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

To contact the author of this story:
Nisid Hajari at nhajari@bloomberg.net

To contact the editor responsible for this story:
David Shipley at davidshipley@bloomberg.net