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EDITORIALS

The elusive MPs
Even question hour has lost sanctity

M
embers
of Parliament are elected to represent their constituencies in the highest law-making body of the country and to diligently carry out legislative work. That is why the taxpayers spend Rs 14 lakh every hour to run Parliament. But in recent years there has been a steady decline in the commitment to parliamentary work. The ongoing session has been particularly bad. On the very first day, November 19, 175 MPs were absent. 

More US troops for Kabul
It’s part of Obama’s exit strategy

P
resident
Barack Obama has unveiled his much-awaited new strategy for tackling the Taliban in the Af-Pak region. In the course of his speech at New York’s Military Academy on Tuesday, he announced not only his decision to dispatch an additional 30,000 US troops to join the multinational forces battling against the Taliban but also declared that there would be troop withdrawal from Afghanistan after 18 months – beginning in July 2011. 


EARLIER STORIES

Growth picks up speed
December 2 2009
Positive signals from Obama
December 1 2009
RBI’s caution
November 30 2009
Pitfalls of anti-defection law
November 29 2009
Cutting carbons
November 28 2009
One year after 26/11
November 27 2009
Boost for ties with US
November 26, 2009
Babri trauma revisited
November 25, 2009
Fragile peace in Assam
November 24, 2009
Sena goes berserk
November 23, 2009
Arresting urban decay
November 22, 2009
Damage control on China
November 21, 2009
Whiff of fresh air
November 20, 2009


Punjab on the boil
Desperate youth can be easily led astray
Punjab
Director-General of Police P.S. Gill has more than once made it public that Pakistan’s ISI is trying to foment trouble in the state by luring foreign-bound Punjabi youths to countries like Malaysia and Greece with the help of Babbar Khalsa activists and training them in subversive activities with the aim of reviving terrorism. Although there is not much visible activity on the ground other than sporadic arrests of youths, dubbed terrorists by the police, one would expect the DGP to have credible information and to keep the police ready for any eventuality.

ARTICLE

Check excessive FII inflows
‘Hot money’ may be harmful for economy
by Jayshree Sengupta
News
about the Indian economy is rather puzzling because the “pink” papers declare that recovery from the financial crisis has begun strongly and is reflected in the more than 9 per cent industrial growth in September and the Sensex crossing the 17000 level. Analysts, on the other hand, warn of high inflation, more job losses and slow recovery in the near future. It is, however, true that India is fast reaching the pre-crisis stock market level. 



MIDDLE

One foot in Lahore
by Roopinder Singh
They
were a bunch of restive boys, whose visit to Chandigarh had begun with a pilgrimage to the Govt Museum and Art Gallery in Sector 10. They were tired after travelling back from the Queen of the Hills. A few had been sick, since they were not used to hill roads, but they perked up when their Principal told them the three-foot sculpture they were looking at was Buddha’s foot—“the other foot is in Lahore”.



OPED

How climate change may affect agriculture
by S.S. Chahal
The
pace of climate change is very fast. A rise in temperature is threatening the meltdown of glaciers, resulting in serious damage to our ecology and environment. Expected frequent floods, more land under water, prolonged droughts in certain areas and drastic shift in the monsoon are major concerns for Indian agriculture.

Europe’s call to intolerance
by Mona Eltahawy
My
question for Switzerland and other European countries enthralled by the right wing: When did Saudi Arabia become your role model? Even before 57.5 percent of Swiss voters cast ballots on Sunday to ban the building of minarets by Muslims, it was obvious that Switzerland's image of itself as a land of tolerance was as full of holes as its cheese. 

Health
Fighting a smarter war on cancer
by John L. Marshall
In
my practice as an oncologist specializing in gastrointestinal tract cancers, a recent week was fairly typical. I saw 50 patients, ranging in age from 32 to 87, equally divided between men and women. Though a couple of them have inherited a gene that may have caused their GI cancers, I have no explanation for why most developed their disease. It is as if they were simply struck by lightning.


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The elusive MPs
Even question hour has lost sanctity

Members of Parliament are elected to represent their constituencies in the highest law-making body of the country and to diligently carry out legislative work. That is why the taxpayers spend Rs 14 lakh every hour to run Parliament. But in recent years there has been a steady decline in the commitment to parliamentary work. The ongoing session has been particularly bad. On the very first day, November 19, 175 MPs were absent. Things got only worse the next day when 192 of them played truant. But the worst was November 30 when as many as 216 of them gave Parliament a miss. Usually, question hour is held sacred, but on that crazy Monday, something extremely serious happened. Thirtyfour members who had listed questions were absent. As a result, question hour simply collapsed. This was the first time after 1991 that question hour had fizzled out. Nobody seemed to have any concern that when a question is listed, it is studied and the response prepared with great care by the ministry concerned. It is the best occasion to corner the government. According to a rough estimate, it costs at least Rs 1 lakh to compile the answer for one question. What was all the more unfortunate was that both new and senior members were absent.

Even otherwise, the number of sittings has been diminishing at an alarming rate. Last year, there were only 46. What a decline it has been, considering that in the first decade of 1952-61, there was a yearly average of 124 sittings, which fell to 81 between 1992 and 2001. State assemblies take their cue from the Centre and are similarly cutting down their sittings. There is urgent need to amend the Constitution to ensure that Parliament meets for at least 100 days every year.

Even when the Honorable Members do meet, they indulge in frequent disruptions and slogan shouting. Now we have even had the ugly spectacle of physical assault in the Rajya Sabha (Amar Singh catching SS Ahluwalia by the collar). All such unacceptable happenings have brought down the reputation of the political class several notches. The rot is not confined to any particular party but is noticeable in the entire spectrum. The time to apply correctives is now.

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More US troops for Kabul
It’s part of Obama’s exit strategy

President Barack Obama has unveiled his much-awaited new strategy for tackling the Taliban in the Af-Pak region. In the course of his speech at New York’s Military Academy on Tuesday, he announced not only his decision to dispatch an additional 30,000 US troops to join the multinational forces battling against the Taliban but also declared that there would be troop withdrawal from Afghanistan after 18 months – beginning in July 2011. Nowhere in his speech did he mention that the US forces – whose number will go up to 98,000 in six months, taking the total of multinational forces to nearly 1,50,000 – would return home after winning the war. Mr Obama clearly said, “these additional American and international troops will allow us to begin the transfer of our forces out of Afghanistan.” What he has done in Iraq will happen in Afghanistan too. The basic idea is to strengthen the Afghan security forces to take care of the Taliban threat themselves.

Mr Obama’s strategy includes three core elements: “a military effort to create the conditions for a transition, a civilian surge that reinforces positive action and an effective partnership with Pakistan”. The multinational forces may intensify the war against the Taliban but keeping in view that there be minimum collateral damage. The US has, perhaps, come to realise that it cannot achieve its objective in the Af-Pak region if all that it does for bringing about peace goes to strengthen the anti-American sentiment there. This factor will get weakened once the Afghan forces take over the anti-extremist operations. In any case, they have to do it now, as “America has no interest in fighting an endless war in Afghanistan”.

It appears that the US wants to concentrate more on Pakistan and hence the talk of “effective partnership” with Islamabad and not allowing the tribal areas on the Pakistani side of the Durand Line to be used as “a safe haven for terrorists”. That is what it should be. But under no circumstances should Pakistan be allowed to play the double game as it has been indulging in so far. All kinds of terrorists must be targeted for peace in the region and elsewhere.

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Punjab on the boil
Desperate youth can be easily led astray

Punjab Director-General of Police P.S. Gill has more than once made it public that Pakistan’s ISI is trying to foment trouble in the state by luring foreign-bound Punjabi youths to countries like Malaysia and Greece with the help of Babbar Khalsa activists and training them in subversive activities with the aim of reviving terrorism. Although there is not much visible activity on the ground other than sporadic arrests of youths, dubbed terrorists by the police, one would expect the DGP to have credible information and to keep the police ready for any eventuality.

At his press conference in Chandigarh on Tuesday the DGP also pointed to increased activities of Left-wing extremists in Punjab to deal with which the police has set up a special anti-Naxalite cell. Though the Maoists and Naxalites are mostly active in West Bengal, Andhra Pradesh and Orissa, their plans to spread over to other states are well known. If they are eying the border state of Punjab now, the police has all the reason to prepare itself before it is too late. In fact, reports say that Israeli experts are being invited to train the Punjab Police in anti-terrorist operations, riot control and disaster management. These are the areas which the police in every state must learn to handle.

The threat from the ISI and Leftist extremists may be real, but it is not enough – and may be even dangerous – to leave it to the police alone. That police methods of dealing with disgruntled youth can be counter-productive need not be over-emphasised as Punjab had witnessed much bloodshed for more than a decade in the not-too-distant past. The mistakes committed at the police, administrative and political levels should not be repeated. The situation is on the boil as disillusioned youth are either heading abroad or turning to drugs in large numbers. The state leadership needs to focus on creating jobs through development and making youth employable by improving the quality of education and health.

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Thought for the Day

Everyone is always in favour of general economy and particular expenditure. — Anthony Eden

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Check excessive FII inflows
‘Hot money’ may be harmful for economy
by Jayshree Sengupta

News about the Indian economy is rather puzzling because the “pink” papers declare that recovery from the financial crisis has begun strongly and is reflected in the more than 9 per cent industrial growth in September and the Sensex crossing the 17000 level. Analysts, on the other hand, warn of high inflation, more job losses and slow recovery in the near future. It is, however, true that India is fast reaching the pre-crisis stock market level. This means a huge amount (nearly $16 billion) of “hot money” or foreign institutional investment (FII) is coming in and this is being used to buy equity in well-known Indian companies as well as debt.

No doubt, India is now considered a top emerging market which is prompting FIIs to borrow money in western countries where interest rates are near zero and investing in India, where the prospects of growth are brighter as compared to the industrial countries, many of which are still struggling to get positive GDP growth.

The proposed disinvestment of major public sector undertakings and the promise of further reforms by the UPA government have acted as positive signals for the FIIs and they expect India to grow at a high rate in the next one year. But there is no guarantee that these institutional investors would like to remain in India for long. We suffered from their mass exit soon after the financial crisis hit the world in 2008 when they withdrew $14 billion, causing distress in the financial markets in the form of a severe liquidity crisis.

Hot money is also going to other emerging markets because while industrial countries as a group are to grow at 1.3 per cent in 2010, the “emerging” market countries are supposed to grow at 5.1 per cent. Thus, countries like Brazil are also facing a similar situation of a huge inflow of FII funds. This sudden surge in foreign institutional investment inflows led to the Brazilian currency (the real) hardening against the dollar. Brazil took the bold step of imposing a 2 per cent tax on all FIIs recently. Malaysian Prime Minister Mahathir Mohamad also imposed a tax on such foreign inflows in the post-Asian crisis era of 1997.

In the case of Brazil, it was done mainly to prevent a further rise in the value of the real (it had gained 36 per cent against the dollar) and, therefore, preserve Brazilian exporters’ competitiveness. If the real is costlier, then imports would be cheap and exports expensive. Taiwan has banned foreign investment in time deposits and Indonesia is thinking of banning overseas investors from acquiring central bank bills.

India is facing a similar problem of the rise in the value of the rupee in terms of the dollar (by 6 per cent in the last four months), which is hurting exports. Besides raising the value of the rupee, strong FII inflows are going to lead to too much liquidity in the financial system and this could be inflationary. Many are worried that food prices, which have been rising phenomenally (nearly 16 per cent annually) and hurting the poor, will go up further. To control inflation, the RBI will have to raise interest rates which may harm investments and result in lower industrial growth.

Many economists are also pointing out that the asset (equity) prices have been artificially jacked up by the FII buying spree. If the stock prices are going up and do not reflect the ground reality of the companies’ performance and profits, then clearly a bubble is being formed which will be followed by a bust. That the bubble is going to bust, some think, is imminent. This will bring about another slowdown. Today FII stakes in corporate India are at their highest in the nine-year history of FII investment. It is fairly concentrated in the top 10 to 25 stocks, which account for 60 to 75 per cent, respectively, of the current FII investments in the country.

Thus, what should India do? The Securities and Exchange Board of India (SEBI) has tightened the rules regarding the Promissory Notes, a popular tool of investment for foreign investors (PNs are instruments issued contractually by FIIs to third parties reflecting a right to participate in the economic benefits of price movements and corporate action in Indian securities). A committee has also been appointed to look into the matter and prepare plans to scan FII holdings in firms frequently.

But should the government impose a tax like Brazil has done on FIIs - the so-called Tobin tax --- or should it let FIIs have a free run and come in unabated and leave when they want?

These are big policy questions, but keeping in mind the plight of the exporters, who even today are struggling to expand their sales abroad, stemming an unruly inflow of foreign funds into the Indian markets to prevent the rupee’s rise would be a wise step. There are others who argue that financial inflows are important, especially when they are going into infrastructure stocks, because these would help this important sectors' growth. FIIs have played a key role in keeping liquidity high in the markets and have helped interest rates remain low. Many also argue that restrictions on FII inflows can easily be evaded and are, therefore, ineffective. Such thinking is in favour of keeping the financial flows unchecked.

Recently, however, even IMF Managing Director Dominique Strauss-Kahn and the Asian Development Bank chief warned that the surge in capital flows into developing countries could destabilise local currencies and asset prices. What probably is best for India is foreign direct investment (FDI ) and this has been rising over the years quite remarkably - it was $24 billion in 2008. But India can never hope to attract the high level of FDI that China has been getting over the last 20 years. It is because of China’s skilled labour force and modern infrastructure that foreign investors feel assured of the returns. There is also smoother functioning of the government machinery which foreign investors find easy to deal with.

FDI brings in technology knowhow along with foreign exchange. Prime Minister Manmohan Singh promised recently at the American Business/Investors’ Forum in Washington that India would make FDI procedures smoother and also assured the opening up of more sectors.

Foreign investment has made funds available to the private sector, which has been the driving force behind the high level of growth achieved by India from 2005 to 2007. A total clampdown on FIIs is obviously not advisable, but keeping them under surveillance would be prudent to control the volatility of such flows.

If recovery from the aftermath of the financial crisis in India is indeed fast and is reflected in a higher rate of growth, the FIIs would stay. Otherwise, they would exit at the end of this year. Getting a clear picture of the economy’s health is important for FIIs, but it is far from easy.

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One foot in Lahore
by Roopinder Singh

They were a bunch of restive boys, whose visit to Chandigarh had begun with a pilgrimage to the Govt Museum and Art Gallery in Sector 10. They were tired after travelling back from the Queen of the Hills. A few had been sick, since they were not used to hill roads, but they perked up when their Principal told them the three-foot sculpture they were looking at was Buddha’s foot—“the other foot is in Lahore”.

Fakir Syed Aijazuddin, OBE, is uniquely qualified to talk about the two museums, and the treasures that they hold. He is chairman, Executive Committee of the Lahore Museum, and has been visiting Chandigarh since the mid-1950 when the museum was set up under the leadership of Dr M S Randhawa. Aijazuddin and his wife Shahnaz have fond memories of Dr Randhawa’s hospitality.

Aijazuddin wears many a cap — chartered accountant, author, columnist, now head of his alma mater, Aitchison College, Lahore, where many of the scions of the most-noted families of the region studied. He had come to India, leading a party of young students who had to join in the celebrations of another fine old institution, Bishop Cotton School, Shimla, as it celebrated its sesquicentennial this year.

My alma mater, Yadavindra Public School, Patiala, however, traces its lineage back to Aitcheson College because after Partition, the Maharaja of Patiala founded YPS around a nucleus of Aitchisonians — teachers and students — who had been displaced from Lahore. As a Yadavindrian, my friend Gurpreet Bhattal had asked me to join a delegation that met these Aitchisonians in Chandigarh, something I had gladly done.

“One-third of the Lahore museum came to Chandigarh,” Aijazuddin told his students, as he was escorted by the director, NPS Randhawa, who took them around, showing miniatures and sculptures of a heritage that preceded the international border. As Aijazuddin took diverse strands and wove them into a tapestry of artistic history of the region, he reminded one of Chandigarh’s own Prof B N Goswamy, interacting with whom is an education. No wonder the two families have strong ties.

“If we expect them to respect our culture, we must do the same,” he gently chided his boys, as they broke into giggles over some of the pictures, even as he explained the relationship between various gods and goddesses to them.

Aijazuddin laments that young Indians and Pakistanis are not aware of each other’s cultural heritage these days. As the visiting children were told to go to Sector 17 for shopping and recreation for a few hours, their Principal said he wanted more exchanges between people who have not visited each other’s countries, not just those who have the nostalgia for the land that was once there.

Many of us like my friend Gurpreet and I, who live in Corbusier’s modern city, have never visited Pakistan, but we have a foot in Lahore and quite like the Buddha statue, our ties transcend the physical divide.

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How climate change may affect agriculture
by S.S. Chahal

The pace of climate change is very fast. A rise in temperature is threatening the meltdown of glaciers, resulting in serious damage to our ecology and environment. Expected frequent floods, more land under water, prolonged droughts in certain areas and drastic shift in the monsoon are major concerns for Indian agriculture.

Climate change seems to be a key driver for agriculture in the 21st century. Under the present scenario climate risk could cost nations up to 19 per cent of their GDP by 2030 with developing countries being most vulnerable, according to a study carried out by a working group jointly set up by the Climate Work Foundation, the Global Environment Faculty, the European Commission, McKinsey, the Rockfeller Foundation, Standard Charted Bank and Swiss Republic.

Agriculture contributes to climate change as well is affected by it. Global agricultural activities account for 20 per cent of the total anthropogenic emission of green house gasses (GHGs). Deforestation and transforming soil into cultivable land and burning of crop residue release about 30 per cent of global carbon dioxide emissions. Flooding areas for paddy cultivation, activities related to animal husbandry, particularly raising ruminant animals, release most of methane and usage of nitrogenous fertilizer, legume cropping, animal waste contribute largely to nitrous oxide emission.

Major factors like change in temperature, rainfall pattern, increase in CO2 levels and surface runoff have important and differential global effect on agricultural productivity where some areas may gain, others will lose significantly.

Predictions that global agricultural production will have a small impact is based on the assumptions that small increase in temperature and availability of more CO2 will increase the production of crops like rice and wheat largely in temperate and developed countries.

However, the production in tropical and mostly developing countries will be worst hit, where the crops are mostly at the limit of their heat tolerance. Even a small increase in temperature will result in a significant yield reduction as is evident by crop-climate models.

Noted agricultural scientist M.S. Swaminathan says that an increase of 2°C temperature is likely to decrease per ha yield of wheat by 0.45 MT and rice by 0.7 MT in India due to the shortening of crop life and certain physiological changes in plants.

According to his estimates, just a 0.5° C rise in temperature could reduce the yield of wheat by 10 per cent in states like Punjab, Haryana and Uttar Pradesh.

An impact assessment of climate change on field crops, livestock and micro organisms under controlled environment and simulation models should be carried out for getting a clear picture of the issues.

Various aspects which require attention are agricultural production, spatial and temporal availability of surface and ground water for irrigation, sensitive plant processes like pollen viability, fertilisation, grain development, diversity and dynamics of hostile insects and micro organisms.

It is highly desirable to create inter-disciplinary climate change cells in universities to undertake research. Network projects will be desirable to address local and common problems. A number of agencies, including Rockfeller Foundation and Bill & Milinda Gates Foundation, are ready to provide necessary support for this priority area investigations.

Adaptive measures are required to be undertaken. The agronomic practices followed presently for raising crops need appropriation under the changed climate scenario. For example, nitrous oxide emission can be contained with a judicious application of nitrogenous fertilizers with better treatment and management of animal waste in agriculture practices.

The maintenance and enhancement of soil properties and reduction of fossil fuel through the use of multipurpose adapted livestock breeds are other concerns for consideration to reduce CO2 emissions.

There is need to learn more from this year's drought in 246 districts of 10 states of the country. We need to be more proactive in approach to prepare contingency plans, particularly for temperature and rainfall related risks. Strengthening of the short, medium and long range weather forecast system will be highly beneficial for developing a data-based decision support system for translating advance information on weather into operational management practices.

The expected altered patterns and distribution of pest and diseases can be effectively managed by appropriate forecasting system, covering a wide range of parameters for preparing contingency plans. Preparation and adopting climate change triangle (host-pest-climate change), especially in relation to virus-vector plant diseases should be undertaken.

The search for biotic and abiotic stress tolerant genes must be intensified to create a gene bank, both for plants and animals for development of new heat, drought and flood tolerant genotypes.

The Indo-Gangetic plains is among the areas expected to be hard hit by warmer temperatures and water scarcity, according to a report by the Consultative Group on International Agricultural Research.

The report says that wheat in northern India is likely to suffer as the increase in heat is expected to shorten the grain filling period with a sudden rise in temperature, thus causing qualitative as well as quantitative loss.

This factor needs a careful and priority consideration while developing suitable genotypes to withstand the vagaries of this single effect of climate change to sustain wheat production in north Indian states.

Lastly, equally important is the capacity building process for which efforts must be intensified to increase the level of climate literacy among all stakeholders of agriculture like scientists, policy-makers, science administrators and much more important, the farmers, who must have the knowledge and ability to adjust to climate change by quickely adopting suitable and recommended practices.n

The writer is the Vice Chancellor, Maharana Pratap University of Agriculture and Technology, Udaipur

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Europe’s call to intolerance
by Mona Eltahawy

My question for Switzerland and other European countries enthralled by the right wing: When did Saudi Arabia become your role model?

Even before 57.5 percent of Swiss voters cast ballots on Sunday to ban the building of minarets by Muslims, it was obvious that Switzerland's image of itself as a land of tolerance was as full of holes as its cheese. When the right-wing Swiss People's Party (SVP) came to power in 2007, it used a poster showing a white sheep kicking black sheep off the country's flag.

This was no reference to black sheep as rebels – the right wing doesn't do cute – but to skin color and foreigners. Posters the SVP displayed before Sunday's referendum showed women covered from head to toe in black, standing in front of phallic-looking minarets. Such racism preceded and fed into the bigotry that fueled the referendum.

Predictably, the election results sparked cries of "Islamophobia," but the situation for Switzerland's 400,000 Muslims is not (yet) dire. The four existing minarets were not affected by the vote, and there are still 150 mosques or prayer rooms in which to worship.

Further, the Council of Europe, the continent's top human-rights watchdog – whose chairmanship, ironically, Switzerland recently took over – has already said the ban could violate fundamental liberties, and the Swiss justice minister said the European Court of Human Rights could strike down the vote.

But the real issue here is more fundamental than whether or when Muslims can build minarets in Switzerland. Until Europe confronts long-simmering questions about how it treats immigrants – Muslims and others – the continent will continue to convulse with embarrassing right-wing eruptions that strip it of any right to preach to anyone on human rights and liberties.

Europe is an aging continent that depends on the "foreigners" its right-wing politicians love to rail about. In Switzerland, for example, it's difficult for immigrants and even their children to get citizenship.

As a Muslim who believes in the separation of church (and mosque and synagogue) and state, I pay attention when people say they are opposed to political Islam. But to suggest, as nationalist parties in Switzerland did, that minarets are symbols of political Islam is ridiculous.

Minarets are used to issue the call to prayer, not to recruit people to Islamic political groups. If the SVP finds such prayer calls too noisy, I'd like to see it try to stifle church bells.

Raising the specter of "political Islam" or "creeping Islamicization" to frighten voters diminishes the concerns that ought to be discussed, such as an ideology's opposition to many minority and women's rights. And that's where the difficult questions lie for Europe's Muslims. They, too, have a right wing that breeds on fear and preaches an exclusionary and inward-looking Islam. It is the perfect foil for the non-Muslim political right wing on the continent. But while these conservative Muslim views might hold some moral sway, they have none of the political power of the SVP and its cohorts.

Meanwhile, condemnations from the Muslim world – where some have semi-jokingly called for a boycott of Swiss chocolate – underscore the other sort of hypocrisy that must be confronted if Muslim complaints of bigotry are to be taken seriously.

The Grand Mufti of Egypt, for example, denounced the ban as an "attack on freedom of belief." I would take him more seriously if he denounced in similar terms the difficulty Egyptian Christians face in building churches in his country. They must obtain a security permit just for renovations.

Last year, the first Catholic church – bearing no cross, no bells and no steeple – opened in Qatar, leaving Saudi Arabia the only country in the Persian Gulf that bars the building of houses of worship for non-Muslims. In Saudi Arabia, it is difficult even for Muslims who don't adhere to the ultra-orthodox Wahhabi sect; Shiites, for example, routinely face discrimination.

Bigotry must be condemned wherever it occurs. If majority-Muslim countries want to criticize the mistreatment of Muslims living as minority communities elsewhere, they should be prepared to withstand the same level of scrutiny regarding their own mistreatment of minorities.

Millions of non-Muslim migrant workers have helped build Saudi Arabia. Human rights groups have long condemned the slave-like conditions that many toil under, and the possibility of Saudi citizenship is nonexistent. Muslim nations have been unwilling to criticize this bigotry in their midst, and Europeans should keep in mind that Sunday's ban takes them in this direction.n

By arrangement with LA Times-Washington Post

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Health
Fighting a smarter war on cancer
by John L. Marshall

In my practice as an oncologist specializing in gastrointestinal tract cancers, a recent week was fairly typical. I saw 50 patients, ranging in age from 32 to 87, equally divided between men and women. Though a couple of them have inherited a gene that may have caused their GI cancers, I have no explanation for why most developed their disease. It is as if they were simply struck by lightning.

My patients seek state-of-the-art therapy, access to clinical trials and new treatments, all of which we provide at our institution. Almost all of them have insurance, and most have some form of prescription drug coverage; their access to care is virtually limitless. We employ the latest diagnostic tests, targeted chemotherapy, minimally invasive surgical techniques and incredibly precise radiation. Yet, despite the many recent advances in detection and treatment, of the 50 patients, 40 of them are likely to lose the fight.

At the moment, there is a giant disconnect between patients, the cost of care and the clinical benefit of the treatment – a disconnect that has caused us to lose perspective.

When it comes to cancer care, we're not getting what we pay for.

Cancer medicine is often regarded as an area of significant progress and clinical research, so we should be able to tell without much difficulty what kinds of treatment are valuable and what kinds aren't. But given that 80 percent of my patients will die of their cancer, it's clear that we have not found an "optimum" therapy.

Few cancer clinical trials are designed to "cure" patients. They are commonly aimed at detecting small differences between the treatments being compared: an extension of average survival from 5 months to 6 months, for example. These trials typically cost millions of dollars (often including taxpayer support), take years to complete and can involve thousands of patients. It is this kind of care that many Americans are afraid they will lose access to as a result of health-care reform.

Globally, cancer care is a medical luxury. With some diseases such as colon cancer, the treatments alone cost more than $15,000 a month, yet on average add only a few months to survival. Most poor countries do not support any cancer care; most developed countries highly restrict it because of its cost and limited effectiveness.

In cancer medicine, fewer than 5 percent of all patients in the United States enter clinical trials. That means more than 95 percent are treated with the "standard of care" – a legal term denoting a minimum level of care for an ill or injured person.

How did we end up here? The answer is simple: Cancer patients are scared for their lives and will accept what is offered, and we oncologists want to offer improved outcomes and recommend the best treatments we can. Insurance will pay for these treatments. A portion of fees collected by cancer doctors and hospitals is based on how much chemotherapy we administer. So the more drugs we give, the more radiation we give, the more we collect from health insurance. The incentive system makes it less lucrative to talk to patients – to counsel them, to help with their decision-making – than to treat them, regardless of the value of the treatment.

The future of cancer care will rely on personalized medicine. This requires a significant change to our medical system, which is built around one size-fits-all treatment and seemingly unrestricted access to care. The system answers our emotional needs and provides some hope for a cure, but moves us forward only a few yards at a time.n

By arrangement with LA Times-Washington Post

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