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Speaking out on Gaza in the Lancet: Utilizing the power of a journal.

 

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When should a journal use the enormous power it has?

It can sometimes be hard to say. Scientists act as though science means a lack of subjectivity and freedom from politics. We expect our journals to be objective, publishing only data free from bias. Journals and readers ignore the implicit bias of accepting mainstream political explanations.

As of July 30, 1,330 Palestians have been killed in Gaza since Israel’s latest assault, at least 3/4 of them civilians, according to the UN, and 1/3 of them children, according to UNICEF. 1 in 8 people are homeless.

3 civilians (2 Israeli, 1 Thai) and 53 Israeli soldiers have been killed.

This is not only an attack and a war, but a huge humanitarian crisis that is targeting Gaza civilians. And a humanitarian crisis is the time for a medical journal to spend the capital it has earned, and to make its own political and philosophical links to societal issues.

The Lancet did so, publishing on July 23, 2014 “An open letter for the people in Gaza,” written by a group of physicians and scientists. The letter points out the asynchronous deaths and injuries of the current attacks, and the appalling circumstances that Gazans having been living in after 8 years of blockade by Israel and Egypt.

An Open Letter for the People of Gaza   http://www.thelancet.com/gaza-letter-2014

by Paola Manduca, Iain Chalmers, Derek Summerfield, Mads Gilbert, and Swee Ang on behalf of 24 signatories

We are doctors and scientists, who spend our lives developing means to care and protect health and lives. We are also informed people; we teach the ethics of our professions, together with the knowledge and practice of it. We all have worked in and known the situation of Gaza for years.

On the basis of our ethics and practice, we are denouncing what we witness in the aggression of Gaza by Israel.

We ask our colleagues, old and young professionals, to denounce this Israeli aggression. We challenge the perversity of a propaganda that justifies the creation of an emergency to masquerade a massacre, a so-called “defensive aggression”. In reality it is a ruthless assault of unlimited duration, extent, and intensity. We wish to report the facts as we see them and their implications on the lives of the people.

We are appalled by the military onslaught on civilians in Gaza under the guise of punishing terrorists. This is the third large scale military assault on Gaza since 2008. Each time the death toll is borne mainly by innocent people in Gaza, especially women and children under the unacceptable pretext of Israel eradicating political parties and resistance to the occupation and siege they impose.

This action also terrifies those who are not directly hit, and wounds the soul, mind, and resilience of the young generation. Our condemnation and disgust are further compounded by the denial and prohibition for Gaza to receive external help and supplies to alleviate the dire circumstances.

The blockade on Gaza has tightened further since last year and this has worsened the toll on Gaza’s population. In Gaza, people suffer from hunger, thirst, pollution, shortage of medicines, electricity, and any means to get an income, not only by being bombed and shelled. Power crisis, gasoline shortage, water and food scarcity, sewage outflow and ever decreasing resources are disasters caused directly and indirectly by the siege.1

People in Gaza are resisting this aggression because they want a better and normal life and, even while crying in sorrow, pain, and terror, they reject a temporary truce that does not provide a real chance for a better future. A voice under the attacks in Gaza is that of Um Al Ramlawi who speaks for all in Gaza: “They are killing us all anyway—either a slow death by the siege, or a fast one by military attacks. We have nothing left to lose—we must fight for our rights, or die trying.”2

Gaza has been blockaded by sea and land since 2006. Any individual of Gaza, including fishermen venturing beyond 3 nautical miles of the coast of Gaza, face being shot by the Israeli Navy. No one from Gaza can leave from the only two checkpoints, Erez or Rafah, without special permission from the Israelis and the Egyptians, which is hard to come by for many, if not impossible. People in Gaza are unable to go abroad to study, work, visit families, or do business. Wounded and sick people cannot leave easily to get specialised treatment outside Gaza. Entries of food and medicines into Gaza have been restricted and many essential items for survival are prohibited.3 Before the present assault, medical stock items in Gaza were already at an all time low because of the blockade.3 They have run out now. Likewise, Gaza is unable to export its produce. Agriculture has been severely impaired by the imposition of a buffer zone, and agricultural products cannot be exported due to the blockade. 80% of Gaza’s population is dependent on food rations from the UN.

Much of Gaza’s buildings and infrastructure had been destroyed during Operation Cast Lead, 2008—09, and building materials have been blockaded so that schools, homes, and institutions cannot be properly rebuilt. Factories destroyed by bombardment have rarely been rebuilt adding unemployment to destitution.

Despite the difficult conditions, the people of Gaza and their political leaders have recently moved to resolve their conflicts “without arms and harm” through the process of reconciliation between factions, their leadership renouncing titles and positions, so that a unity government can be formed abolishing the divisive factional politics operating since 2007. This reconciliation, although accepted by many in the international community, was rejected by Israel. The present Israeli attacks stop this chance of political unity between Gaza and the West Bank and single out a part of the Palestinian society by destroying the lives of people of Gaza. Under the pretext of eliminating terrorism, Israel is trying to destroy the growing Palestinian unity. Among other lies, it is stated that civilians in Gaza are hostages of Hamas whereas the truth is that the Gaza Strip is sealed by the Israelis and Egyptians.

Gaza has been bombed continuously for the past 14 days followed now by invasion on land by tanks and thousands of Israeli troops. More than 60 000 civilians from Northern Gaza were ordered to leave their homes. These internally displaced people have nowhere to go since Central and Southern Gaza are also subjected to heavy artillery bombardment. The whole of Gaza is under attack. The only shelters in Gaza are the schools of the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), uncertain shelters already targeted during Cast Lead, killing many.

According to Gaza Ministry of Health and UN Office for the Coordination of Humanitarian Affairs (OCHA),1 as of July 21, 149 of the 558 killed in Gaza and 1100 of the 3504 wounded are children. Those buried under the rubble are not counted yet. As we write, the BBC reports of the bombing of another hospital, hitting the intensive care unit and operating theatres, with deaths of patients and staff. There are now fears for the main hospital Al Shifa. Moreover, most people are psychologically traumatised in Gaza. Anyone older than 6 years has already lived through their third military assault by Israel.

The massacre in Gaza spares no one, and includes the disabled and sick in hospitals, children playing on the beach or on the roof top, with a large majority of non-combatants. Hospitals, clinics, ambulances, mosques, schools, and press buildings have all been attacked, with thousands of private homes bombed, clearly directing fire to target whole families killing them within their homes, depriving families of their homes by chasing them out a few minutes before destruction. An entire area was destroyed on July 20, leaving thousands of displaced people homeless, beside wounding hundreds and killing at least 70—this is way beyond the purpose of finding tunnels. None of these are military objectives. These attacks aim to terrorise, wound the soul and the body of the people, and make their life impossible in the future, as well as also demolishing their homes and prohibiting the means to rebuild.

Weaponry known to cause long-term damages on health of the whole population are used; particularly non fragmentation weaponry and hard-head bombs.45 We witnessed targeted weaponry used indiscriminately and on children and we constantly see that so-called intelligent weapons fail to be precise, unless they are deliberately used to destroy innocent lives.

We denounce the myth propagated by Israel that the aggression is done caring about saving civilian lives and children’s wellbeing.

Israel’s behaviour has insulted our humanity, intelligence, and dignity as well as our professional ethics and efforts. Even those of us who want to go and help are unable to reach Gaza due to the blockade.

This “defensive aggression” of unlimited duration, extent, and intensity must be stopped.

Additionally, should the use of gas be further confirmed, this is unequivocally a war crime for which, before anything else, high sanctions will have to be taken immediately on Israel with cessation of any trade and collaborative agreements with Europe.

As we write, other massacres and threats to the medical personnel in emergency services and denial of entry for international humanitarian convoys are reported.6 We as scientists and doctors cannot keep silent while this crime against humanity continues. We urge readers not to be silent too. Gaza trapped under siege, is being killed by one of the world’s largest and most sophisticated modern military machines. The land is poisoned by weapon debris, with consequences for future generations. If those of us capable of speaking up fail to do so and take a stand against this war crime, we are also complicit in the destruction of the lives and homes of 1·8 million people in Gaza.

We register with dismay that only 5% of our Israeli academic colleagues signed an appeal to their government to stop the military operation against Gaza. We are tempted to conclude that with the exception of this 5%, the rest of the Israeli academics are complicit in the massacre and destruction of Gaza. We also see the complicity of our countries in Europe and North America in this massacre and the impotence once again of the international institutions and organisations to stop this massacre.

Paola Manduca:  New Weapons Research Group and University of Genoa, Genoa, Italy

Iain Chalmers: James Lind Library, Oxford, UK

Derek Summerfield: Institute of Psychiatry, King’s College, London, UK

Mads Gilbert: Clinic of Emergency Medicine, University Hospital of North Norway, Tromso, Norway

Swee Ang:  Barts and the Royal London Hospital, London, UK

On behalf of 24 signatories.

References

1 United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Occupied Palestinian Territory: Gaza emergency situation report (as of 21 July 2014, 1500 hrs). http://www.ochaopt.org/documents/ocha_opt_sitrep_22_07_2014.pdf. (accessed July 22, 2014).

2 Webb-Pullman J. Dignity or death—we cannot give up now. http://gaza.scoop.ps/2014/07/dignity-or-death-we-cannot-give-up-now/. (accessed July 22, 2014).

3 Gilbert M. Brief report to UNRWA: The Gaza Health Sector as of June 2014.http://www.unrwa.org/sites/default/files/final_report_-_gaza_health_sector_june-july_2014_-_mads_gilbert_2.pdf. (accessed July 22, 2014).

4 Naim A, Al Dalies H, El Balawi M, et al. Birth defects in Gaza: prevalence, types, familiarity and correlation with environmental factors. Int J Environ Res Public Health 2012; 9: 1732-1747. PubMed

5 Manduca P, Naim A, Signoriello S. Specific association of teratogen and toxicant metals in hair of newborns with congenital birth defects or developmentally premature birth in a cohort of couples with documented parental exposure to military attacks: observational study at Al Shifa Hospital, Gaza, Palestine. Int J Environ Res Public Health 2014; 11: 5208-5223. PubMed

6 Ma’an News Agency. 4 killed, over 50 injured as Israel targets al-Aqsa hospital.http://www.maannews.net/eng/ViewDetails.aspx?ID=715087. (accessed July 22, 2014).

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There has been outrage in response to the letter, with 2 examples being  The Lancet’s Latest Abuse of Medicine for Political Ends , and When Anti-Semitism Strikes Science and Medicine .

First author Paola Manduca, a geneticist at the University of Genoa who worked in Gaza in 2011, 2012, 2013, and 2014, has gone further than the Lancet article in a follow-up interview. For example, she is forthright about the tunnels to Israel, pointing out that these are not just roads for weapons, but are the main way any food or medical supplies get into Gaza past Israeli blockade. Dismayed that so few Israeli academics signed an appeal to the Israeli government about Gaza, she mentions the Israeli group “Physicians for Human Rights” and what a small minority they are in Israel: even though academics know full well that Palestinians cannot even participate in research freely, they still act as though Palestianians have the same rights as Israelis in Israel.

This is not the first time the Lancet has published letters and articles about Palestine as a humanitarian crisis. For example, in 2009, The Lancet launched a series of articles on “Health in the Occupied Palestinian Territory.” , written by a team of health scientists in Palestine, as well as by people in WHO, the UN, and academic institutions in the USA, UK, Norway, and France. There was a follow-up series in 2010, 2011, 2012, and 2013.

The Lancet editor Richard Horton wrote one of the opening articles of the series, “The occupied Palestinian territory: peace, justice, and health,” framing the healthcare issues as a direct consequence of the Israeli occupation.  He has visited Gaza, and has not only addressed the healthcare and humanitarian crisis by his own article authorship, and the editorial article choice in The Lancet, but by speaking out and writing in other forums. He is constantly attacked personally richardmillett.wordpress.com/tag/dr-richard-horton/ for his activism, with the charge of being anti-Semitic, and evangelical.

Horton speaks publicly on many other issues besides Palestine, for example, on GM food safety , the rationing of funds for science , and the need for scientists to engage with citizens .

Horton uses his power.

Here in the USA, which funds Israel weaponry, the carnage is still labeled as self-defense on the part of Israel.  Despite a growing lack of support for Israel government policy in Gaza, the US Senate voted unanimously to support Israel.

We need the Meducas and the Hortons of the scientific world to speak out, to realize that no scientist or health worker exists in a vacuum. There are avenues in which scientists as citizens can act to help in Gaza:

Resolutions in professional societies.

Letters to the editor.

Divestment and boycott campaigns.

Talking.

Neuroscientist and author Sam Harris has tried to look dispassionately/“scientifically” at the Israel-Palestine situation, seeing the present massacre as being a shame but a predicable and acceptable outcome. This is, in the face of the massacre that is occurring, is not acceptable.

Follow- up and activism- April 2015

There has continued to be enormous criticism of Richard Horton and The Lancet. A petition, initiated by British academics, scientists, and physicians, is currently requesting signatures. See http://handsoffthelancet.com/.

 

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Obituary: Arnold Relman and the medical industrial complex

 

4 Dr. Arnold Relman, 91, died on June 17, 2014.

Perhaps best known as the editor of The New England Journal of Medicine from 1977 to 2000, Arnold Relman was also an editor for the Journal of Clinical Investigation, a researcher on kidney function, a professor at Boston University, The University of Pennsylvania, Oxford, and Harvard. He contributed frequently to the New York Review of Books.

Relman was outspoken early in his position as editor at The New England Journal of Medicine. On October 23, 1980, he wrote an essay in the Journal in which he targeted profit-driven hospitals and other medical  industries. He was very clear that the desire for profit was adversely affecting patient treatment, and that investor-run companies could never have a primary goal other than profit. It was not a popular stance, and he had many critics who dismissed him as a conspiracy theorist or naive medical Don Quixote.

Aalg relman quote

Relman continued urging a reform of the American health care system, and suggested that a single-taxpayer-supported insurance system replace the private insurance companies. He considered the 2010 USA health care law to be only a partial reform, and said so.

The New England Journal  of Medicine, under Relman’s direction, was the first journal that required authors to disclose any financial arrangements that might affect their judgement of their research and publication. Many journals would follow this disclosure of conflicts of interest, and though there are those who still protest that the source of funding is irrelevant and that trying for such integrity was unrealistic, Relman’s stance was crucial in moving the medical and research culture to the expectation of accountability. (In 2002, under editor-in-chief Dr. Jefrey Drazen, The New England Journal of Medicine reversed the rule for authors for financial disclosure as so few authors had no industry financial ties.)

Relman was fortunate in having a work- and later, life-partner who agreed politically and philosophically with him, Dr. Marcia Angell. They worked together at The New England Journal of Medicine, lived together since 1994, and married in 2009. Together they won the George Polk Award for a 2002 article in The New Republic that documented how drug companies invested much more in advertising and lobbying than in research and development. Angell is now investigating the the influence of drug company money on the prescribing habits of physicians.

The New York Times obituary for Dr. Relman  and a New York Times 2012 interview with Relman and his wife, Dr. Marcia Zuger  are the source of the information of this short posting.

 

 

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Academics and scientists on preventing war

Academics and scientists on preventing war.

I was fortunate to work with a group of public health folks on looking for ways that public health workers  might not not just repair the effects of war, but be able to actually prevent it. The resulting paper in the American Journal of Public Health gives the reasons why war is rationalized, and suggests a curriculum and competencies that could reverse the presumption that war is inevitable.

The Role of Public Health in the Prevention of War: Rationale and Competencies

William H. Wiist, DHSc, MPH, MS, Kathy Barker, PhD, Neil Arya, MD, Jon Rohde, MD, Martin Donohoe, MD, Shelley White, PhD, MPH, Pauline Lubens, MPH, Geraldine Gorman, RN, PhD, and Amy Hagopian, PhD

American Journal of Public Health, Vol. 104, No. 6, June 2014: e34-e47.

http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2013.301778  to access AJPH website.

(AJPH charges authors $2,500 to make the papers open access. Many academics pay for this through grants, but we were unable to do so- antiwar research isn’t exactly a hot topic for government funding. AJPH refused to waive the fee.)

email kbarkerbtb@gmail.com to see a personal copy of the paper.

Here is a posting by antiwar author David Swanson on the AJPH paper:

Public Health Experts Identify Militarism As Threat

By David Swanson
http://warisacrime.org/content/public-health-experts-identify-militarism-threat
A remarkable article appears in the June 2014 issue of the American Journal of Public Health.

The authors, experts in public health, are listed with all their academic credentials: William H. Wiist, DHSc, MPH, MS, Kathy Barker, PhD, Neil Arya, MD, Jon Rohde, MD, Martin Donohoe, MD, Shelley White, PhD, MPH, Pauline Lubens, MPH, Geraldine Gorman, RN, PhD, and Amy Hagopian, PhD.

Some highlights and commentary:

“In 2009 the American Public Health Association (APHA) approved the policy statement, ‘The Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War.’ . . . In response to the APHA policy, in 2011, a working group on Teaching the Primary Prevention of War, which included the authors of this article, grew . . . .”

“Since the end of World War II, there have been 248 armed conflicts in 153 locations around the world. The United States launched 201 overseas military operations between the end of World War II and 2001, and since then, others, including Afghanistan and Iraq. During the 20th century, 190 million deaths could be directly and indirectly related to war — more than in the previous 4 centuries.”

These facts, footnoted in the article, are more useful than ever in the face of the current academic trend in the United States of proclaiming the death of war. By re-categorizing many wars as other things, minimizing death counts, and viewing deaths as proportions of the global population rather than of a local population or as absolute numbers, various authors have tried to claim that war is vanishing. Of course, war could and should vanish, but that is only likely to happen if we find the drive and the resources to make it happen.

“The proportion of civilian deaths and the methods for classifying deaths as civilian are debated, but civilian war deaths constitute 85% to 90% of casualties caused by war, with about 10 civilians dying for every combatant killed in battle. The death toll (mostly civilian) resulting from the recent war in Iraq is contested, with estimates of 124,000 to 655,000 to more than
a million, and finally most recently settling on roughly a half million. Civilians have been targeted for death and for sexual violence in some contemporary conflicts. Seventy percent to 90% of the victims of the 110 million landmines planted since 1960 in 70 countries were civilians.”

This, too, is critical, as a top defense of war is that it must be used to prevent something worse, called genocide. Not only does militarism generate genocide rather than preventing it, but the distinction between war and genocide is a very fine one at best. The article goes on to cite just some of the health effects of war, of which I will cite just some highlights:

“The World Health Organization (WHO) Commission on the Social Determinants of Health pointed out that war affects children’s health, leads to displacement and migration, and diminishes agricultural productivity. Child and maternal mortality, vaccination rates, birth outcomes, and water quality and sanitation are worse in conflict zones. War has contributed to preventing eradication of polio, may facilitate the spread of HIV/ AIDS, and has decreased availability of health professionals. In addition, landmines cause psychosocial and physical consequences, and pose a threat to food security by rendering agricultural land useless. . . .

“Approximately 17,300 nuclear weapons are presently deployed in at least 9 countries (including 4300 US and Russian operational warheads, many of which can be launched and reach their targets within 45 minutes). Even an accidental missile launch could lead to the greatest global public health disaster in recorded history.

“Despite the many health effects of war, there are no grant funds from the Centers for Disease Control and Prevention or the National Institutes of Health devoted to the prevention of war, and most schools of public health do not include the prevention of war in the curriculum.”

Now, there is a huge gap in our society that I bet most readers hadn’t noticed, despite its perfect logic and obvious importance! Why should public health professionals be working to prevent war? The authors explain:

“Public health professionals are uniquely qualified for involvement in the prevention of war on the basis of their skills in epidemiology; identifying risk and protective factors; planning, developing, monitoring, and evaluating prevention strategies; management of programs and services; policy analysis and development; environmental assessment and remediation; and health advocacy. Some public health workers have knowledge of the effects of war from personal exposure to violent conflict or from working with patients and communities in armed conflict situations. Public health also provides a common ground around which many disciplines are willing to come together to form alliances for the prevention of war. The voice of public health is often heard as a force for public good.
 Through regular collection and review of health indicators public health can provide early warnings of the risk for violent conflict. Public health can also describe the health effects of war, frame the discussion about wars and their funding . . . and expose the militarism that often leads to armed conflict and incites public fervor for war.”

About that militarism. What is it?

“Militarism is the deliberate extension of military objectives and rationale into shaping the culture, politics, and economics of civilian life so that war and the preparation for war is normalized, and the development and maintenance of strong military institutions is prioritized. Militarism is an excessive reliance on
a strong military power and the threat of force as a legitimate means of pursuing policy goals in difficult international relations. It glorifies warriors, gives strong allegiance to the military as the ultimate guarantor of freedom and safety, and reveres military morals and ethics as being above criticism. Militarism instigates civilian society’s adoption of military concepts, behaviors, myths, and language as its own. Studies show that militarism is positively correlated with conservatism, nationalism, religiosity, patriotism, and with an authoritarian personality, and negatively related to respect for civil liberties, tolerance of dissent, democratic principles, sympathy and welfare toward the troubled and poor, and foreign aid for poorer nations. Militarism subordinates other societal interests, including health, to the interests of the military.”

And does the United States suffer from it?

“Militarism is intercalated into many aspects of life in the United States and, since the military draft was eliminated, makes few overt demands of the public except the costs in taxpayer funding. Its expression, magnitude, and implications have become invisible to a large proportion of the civilian population, with little recognition of the human costs or the negative image held by other countries. Militarism has been called a ‘psychosocial disease,’ making it amenable to population-wide interventions. . . .

“The United States is responsible for 41% of the world’s total military spending. The next largest in spending are China, accounting for 8.2%; Russia, 4.1%; and the United Kingdom and France, both 3.6%. . . . If all military . . . costs are included, annual [US] spending amounts to $1 trillion . . . . According to the DOD fiscal year 2012 base structure report, ‘The DOD manages global property of more than 555,000 facilities at more than 5,000 sites, covering more than 28 million acres.’ The United States maintains 700 to 1000 military bases or sites in more than 100 countries. . . .

“In 2011 the United States ranked first in worldwide conventional weapons sales, accounting for 78% ($66 billion). Russia was second with $4.8 billion. . . .

“In 2011-2012, the top-7 US arms producing and service companies contributed $9.8 million to federal election campaigns. Five of the top-10 [military] aerospace corporations in the world (3 US, 2 UK and Europe) spent $53 million lobbying the US government in 2011. . . .

“The main source of young recruits is the US public school system, where recruiting focuses on rural and impoverished youths, and thus forms an effective poverty draft that is invisible to most middle- and upper-class families. . . . In contradiction of the United States’ signature on the Optional Protocol on the Involvement of Children in Armed Conflict treaty, the military recruits minors in public high schools, and does not inform students or parents of their right to withhold home contact information. The Armed Services Vocational Aptitude Battery is given in public high schools as a career aptitude test and is compulsory in many high schools, with students’ contact information forwarded to the military, except in Maryland where the state legislature mandated that schools no longer automatically forward the information.”

Public health advocates also lament the tradeoffs in types of research the United States invests in:

“Resources consumed by military . . . research, production, and services divert human expertise away from other societal needs. The DOD is the largest funder of research and development in the federal government. The National Institutes of Health, the National Science Foundation, and Centers for Disease Control and Prevention allocate large amounts of funding to programs such as ‘BioDefense.’ . . . The lack of other funding sources drives some researchers to pursue military or security funding, and some subsequently become desensitized to the influence of the military. One leading university in the United Kingdom recently announced, however, it would end its £1.2 million investment in
a . . . company that makes components for lethal US drones because it said the business was not ‘socially responsible.'”

Even in President Eisenhower’s day, militarism was pervasive: “The total influence — economic, political, even spiritual — is felt in every city, every statehouse, every office of the federal government.” The disease has spread:

“The militaristic ethic and methods have extended into the civilian law enforcement and justice systems. . . .

“By promoting military solutions to political problems and portraying military action as inevitable, the military often influences news media coverage, which in turn, creates public acceptance of war or a fervor for war. . . .”

The authors describe programs that are beginning to work on war prevention from a public health perspective, and they conclude with recommendations for what should be done. Take a look.

David Swansons wants you to declare peace at http://WorldBeyondWar.org His new book is War No More: The Case for Abolition. He blogs at http://davidswanson.org and http://warisacrime.org and works for http://rootsaction.org. He hosts Talk Nation Radio. Follow him on Twitter: @davidcnswanson and FaceBook.

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This email may be unlawfully collected, held, and read by the NSA which violates our freedoms using the justification of immoral, illegal wars absurdly described as being somehow for freedom.

 

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