Saturday, September 27, 2014

Energy, political terrorism and Twitter power

Bilawal Bhutto can yank himself from the uncles and aunties crowd and tweet #EnoughIsEnough and get his party to sponsor a no-confidence motion in parliament based on the Election Commission Report

A major event can hold public attention for a maximum of two weeks. After this point people get bored and irritated and tend to move on. Pakistanis have been held hostage to a staring contest that shows no signs of anyone blinking. For six torturous weeks now. 
In even small personal projects or efforts, people tend to have a plan B. Pros and cons, plan A and plan B get written down. It appears that Imran Khan and Tahirul Qadri went gung-ho with freedom and revolution with little other than their characteristic bluster and rhetoric. The age of technology gave them an audience of millions and their complaints against the Sharif clan resonate with a large segment of the population and a wave of furious discontent currently sweeps Pakistan.   

Within a week of the sit-ins the government was willing to set up a judicial commission for investigation of electoral rigging but Imran Khan had set out for the prize of Nawaz Sharif’s resignation and he ignored the offer. He probably thought that he had gotten to this point with such difficulty he might as well stay for the kill. But this, like so much of life, is a gamble which Kenny Rogers sang about so well: You've got to know when to hold 'em, know when to fold 'em, know when to walk away and know when to run”.  

Interestingly the same premise applies to the Sharifs. One expose’ after another, embarrassment after embarrassment, but the king and all his men just strut around in blissful ignorance. The electricity bill scandal is shocking in its stupidity. No meter readings were done, bills were simply written up with an over 500% markup, and the due date was written as the date that the bill was sent. Burning electricity bills is conduct unbecoming Imran Khan and sets up a bad example for his fans and other Pakistanis. But opening the envelope of the electricity bill and reading an amount that could be higher than 2 months of one’s salary is nothing short of terrifying. The electric supply corporations now say that people should pay their bills and their refund, after meter reading and correction, would show up after two billing cycles. Seriously? Have they heard of that saying: getting blood from a turnip?  

Nawaz Sharif’s private-jet journey, Islamabad-London-New York and his stay at the presidential suite of New York’s Waldorf Astoria at over $1000 per night financed by the Pakistani taxpayer and a nation of shelter-less millions may well be his last hurrah. I often wonder about how many sleeping pills it must take to quiet that wretched thing called a conscience.  

Kenny Rogers’ song is very instructive here. How long can Nawaz be the cloistered prime minister? That tiresome “go Nawaz go” is ubiquitous: chanted, written, painted, posted. His own party chanted it, instead of “go Imran go”! It followed him to London and New Yorkers will join in too.  

The sit-ins have changed the Pakistani mindset and awakened it to massive Sharif corruption and misrule. MPAs and senators removed from flights by angry passengers could be prefaces for a great deal worse. The careless display of power and wealth as well as uncompromising arrogance by the Sharif clan is actually asking for the public to unleash violence. Though this is the course of events in civil disorder, it is unwise for Tahirul Qadri and Imran Khan to scream about the potential of a bloody revolution. Hunger, unemployment, disease, floods, crushing poverty, rampant drug use and religious and sectarian intolerance is a ticking time-bomb. Responsibility and not rhetoric is what Pakistan needs.   

Video tapes of provincial law minister Rana Mashood and Chief Minister Shahbaz Sharif demanding money and allegiance from Asim Malik and his wife MPA Zubia Rubab Malik, leave you open-mouthed. Pretty terrifying to have to fork over Rs. 20 lakh, arrange for your children to quickly leave the country, completely lose your business and have your home with all its possessions occupied by Mashood’s lackeys.  

All that aside what we were arguing about arrived quite unannounced. The Election Commission of Pakistan released its report of the 2013 elections. According to the report the integrity and character of the candidates were not properly or completely verified and loan and bill defaulters slipped in. Trained staff at election booths was replaced with non-trained individuals. Ballots were stamped en bloc. Elections were conducted in a substandard manner and now UNDP, the Commonwealth and the European Union have also expressed their dissatisfaction.  

Even more interestingly election records stored in the basement of a school have been burned beyond recognition. Former law minister Babar Awan facetiously called this not the beauty of coincidence but the beauty of organization. And the report has also been burned off your computer screens, for it has been removed from the Election Commission website.  

Joint sessions of parliament witness much chest thumping in favor of democracy and self-righteous claims to strengthen it. Now’s the chance for every parliamentarian to do just that. The PPP, MQM and even members of the PML-N should latch onto the Election Commission report and demand a re-election under a caretaker government after a consensus on electoral reforms. We must drop this personality rather than processes culture. The Election Commission Report makes the current parliament unelected. The army will most likely stay out of this fiasco. Relying on the Supreme Court to intervene will be circuitous and protracted and serve to further bankrupt Pakistan; the economic cost of the sit-ins is massive.  

Bilawal Bhutto can yank himself from the uncles and aunties crowd and tweet #EnoughIsEnough and get his party to sponsor a no-confidence motion in parliament based on the Election Commission Report. You’ve worked on your Urdu and I was so proud to see you wade through knee deep water even though it was for a photo opp with the flood victims. This would give you a place in history. You will redeem the Bhuttos: Zulfiqar Ali Bhutto’s breaking of Pakistan, your mother’s mis-governance and your father’s massive corruption. A 24-year old and a simple tweet. How very awesome!


Corruption: comparison and consequences

Pakistanis love to ape America. What with the recent Valentine’s Day, Halloween and Mother’s Day celebrations. Would be so nice if America’s work ethic, punctuality, integrity, processes, legal recourse and fidelity to the state were also adopted. And most importantly what America does with corrupt members of government.


Recently former Virginia Governor Bob McDonnell and his wife were found guilty of accepting gifts, totaling $160,000, from the owner of a nutritional supplement company in return for promoting his products while they were in office. The U.S. Justice Department said the "convictions should send a message that corruption in any form, at any level of government, will not be tolerated." The charges carry a potential 30-year jail sentence.


Compare the corruption in the richest nation on earth with that of one of the poorest. Say the word “Zardari” and the mind’s synonym is corruption. The return of the PPP to power in 2008 resulted in the government withdrawing his corruption cases, which were at the threshold of being successfully filed. Zardari had spent eight years in jail. He was saved by ascension to power which opened the doors to further acquisition. It is alleged that Zardari has £740 million in Swiss bank accounts as well as an over £4 million mansion in Surrey and a $2.5 million manor in Normandy. No objections can be raised if this incredible accumulation was legal. Prior to marriage to Benazir, Zardari was a man of modest means, with the cleverness to calculate the power of 10%.


That Zardari got away with this massive corruption actually changed the psyche of the Pakistani nation. He took the sting out of the concept of corruption, made it romantic almost, and horror of horrors Pakistanis became immune to its illegitimacy and started to justify their own at all levels-consciously and unconsciously.


Rod Blagojevich was Illinois governor from 2003-2009. In March 2012, Blagojevich began serving a 14-year sentence in federal prison following conviction for corruption including the soliciting of bribes for political appointments. He was charged with several “pay to play” schemes in which he sold gubernatorial and legislative appointments to the highest bidder. He was impeached in 2009. Blagojevich’s “pay to play” schemes sound so Pakistani! Though, one must say, that Pakistani leaders give out business contracts and massive commissions to family members and cronies and the nation pays while they play!


It’s that magical kursi of Pakistan that turns saints to satan. Military rule in Pakistan has seen the personal aggrandizement of the army. Promotions are sweetened by gifts of plots of land. In her book “Military Inc.” Ayesha Siddiqa writes that the army's private business assets are worth around £10bn and it owns a handsome share of the country's business and land.


Kwame Kilpatrick was mayor of Detroit from 2000-2008. In 2013 he was sentenced to 28 years in federal prison for extorting bribes from contractors who wanted Detroit city contracts. He steered $127 million in contracts to his friend and business partner, Bobby Ferguson. The city of Detroit is the first in the nation to file bankruptcy. U.S. District Judge Nancy Edmunds granted the 28-year term sought by prosecutors, who claimed Kilpatrick's racketeering, bribery and extortion worsened the city's financial crisis as part of a conspiracy that spent millions of taxpayer dollars. The sentence was intended to send a message that corruption would not be tolerated and "that way of business is over," Edmunds said.


The brothers Sharif and cronies’ corruption is as massive as Kilpatrick’s if not more. And for all intents and purposes Pakistan is bankrupt.


In a previous Sharif term, Salman Shahbaz imported a Siberian leopard and nurtured it in an air-conditioned cage. All while the students of Punjab studied in candlelight and numerous others died of gastroenteritis and dehydration, unable to even get potable water or basic medical care in hospitals.


True the Sharifs are businessmen. But doing business with taxpayer money is a bit egregious. Zardari at least kept the 10% commission premise to himself; the Sharifs have spread the goodness to members of the PML-N. And, keeping up with inflation, the commission on mega-government projects has risen to 30%. My fellow columnist Dr. Mansoor Hussain speaks of the Sharif “lifafa largesse”; envelopes stuffed with large bills are spread around to buy support and silence.


Pakistanis are treated, or tortured depending on your inclination, by the information or allegations in Imran Khan and Tahirul Qadri’s speeches. PPP’s Aitzaz Ahsan states that their words have irretrievably entered the hearts and minds of Pakistanis.  He acknowledges electoral rigging as well as the charges of massive corruption. If only he would drop the Pakistani staple of covering over illegality for some devious future personal purpose, Pakistan would be delivered of this climate of deceit, collusion and subterfuge.


Religion and state should be separated. But Nawaz Sharif is of the inshallah, mashaallah and subhanallah genre, so I must appeal to his religiosity. You have the nerve to go to the flood stricken areas and promise government help. What of their money that you and your cronies stole to finance your luxurious lifestyles and more-expensive-than-Rolex watches?


Infrastructure to combat flooding takes years to build. But tax-payer money was used to finance your mini-city Raiwind residence and satisfy your gluttony for numerous varieties of nihari and mithai. Perhaps a serious study of the early period of Islam and the scrupulous integrity of the four khalifas and their selfless service to their people would be instructive.


The PTI and PAT sit-ins have cramped your lifestyle and your 30-strong delegations’ world trips to garner more lucrative contracts. You and your coterie pay miniscule if any tax and pillage our treasury to go for Umra, again with plane-loads of friends and family.


The foundation of democracy is integrity and transparency. Khalifa Umar ibn Al-Khattab had to justify his use of two sheets when questioned by a woman. He also said “do your own accounting before it is done for you”. If there is a question of electoral rigging, if there is evidence of corruption that has broken Pakistan, take the moral high road, resign and submit to impartial investigation. According to the Islam that you love to tout, we must be forgiven by those we have wronged before we can be forgiven by God. Help yourself and your extended family; submit yourselves to investigation. It will be infinitely easier to remediate in this world. And way too late and unimaginable in the next.


Sunday, September 21, 2014

A sudden definite change in Pakistan

Long marches and sit-ins are the last thing an already chaotic and impoverished Pakistan needs. So I was indignant when the marches of Tahirul-Qadri and Imran Khan began. More than two weeks in, their demands remain unmet, but they have been dramatic catalysts in changing the mindset, opinions and expectations of Pakistanis.


We learned the importance of the FIR, First Information Report and how it is a charge with serious consequences. Two and a half months after the Model Town tragedy and much crying hoarse by Dr. Tahirul Qadri the FIR was finally lodged, naming the brothers Sharif in the murder, mayhem and terrorism of that sad day.


A person is only as good as his advisers are. Nawaz Sharif wouldn’t score well on an IQ test; but his political demise will be from the counter-intuitive advice he gets from his cabinet. Petrified of Dr. Tahirul Qadri’s arrival and agenda, they legitimized a man who was viewed pretty much as a crazy cleric. And they introduced the syndrome of “containeritis” in Punjab to prevent PAT and PTI fans from reaching Islamabad.  


The remarkable discipline of PAT workers and their heart-warming simplicity and dedication make it difficult to believe that they are Pakistani. The widespread support of Imran Khan was seen in the PTI protests and sit-ins across the nation.


And undoubtedly Dr. Tahirul Qadri is an orator. With complete control over history, theology, politics and the Constitution, he is adept in building an argument and bringing it to a skillful climax.


Anxious to see a resolution to the political crisis, millions of Pakistanis at home and abroad have been captive audiences to Dr. Tahirul Qadri’s and Imran Khan’s speeches. Pakistanis had become accustomed to the corruption of its recent democratically elected rulers. But learning of the alleged magnitude of the Sharif clan corruption makes one angry. Former president Zardari was infamous for being Mr. 10%; the corruption within just one year of the Nawaz government has raised the commission in mega government projects, allegedly, to 30%.


The rebellion of the Islamabad police was also stunning. First SSP Mohammad Ali Nekokara refused to use force on PAT and PTI workers. So they called in SSP Ilyas who also declined. Finally Asmatullah Junejo agreed to clean out the Red Zone. Over 780 police officers refused to use force on the protestors and over 2000 police officers went to the Pakistan Institute of Medical Science and Polyclinic hospital urging doctors to grant them medical leave.


Who would want to tear-gas unarmed civilians and shoot at them with supposed rubber bullets, killing two and injuring 500? The horrific police brutality on personnel of seven television channels was nauseating. Minister Saad Rafeeq said police brutality was unjustifiable and he didn’t know why it was happening. How about it happened because the order went out by the government and was caught on wireless? More jaw-dropping was Nawaz Sharif reminding Chaudhry Nisar during a parliament session to specifically mention Geo in the government’s apology. Nisar had the good sense not to. Geo personnel were the only ones that were not attacked. Nawaz Sharif exposed his Geo affiliation and his IQ, or the lack of it, further.


Yazidi tactics were seen as well. The supply of water and food to the protestors was stopped, cars bringing them in were damaged and the food and water were consumed by the police!


Nawaz Sharif asking Chief of Army Staff Raheel Sharif to mediate the crisis and then lying about it, story-book style, on the Parliament floor is egregious. ISPR issued a statement that Nawaz Sharif had asked for the mediation.


The word democracy is bandied about by the government to hold onto power. The charge of murder and terrorism in the Model Town tragedy and violating the sanctity of the Parliament by blatantly lying are more than sufficient to be cause for an automatic resignation under the most basic premise of democracy.


That the Parliament passes resolution after resolution supporting Nawaz Sharif means nothing when one member can vie with another in the magnitude of their respective looting of taxpayer money and self-enrichment, and providing cover to each other. The Urdu aphorism really sticks: iss hammam mein sab nangey hain-in this public bath they are all naked.  


The day the crisis reached a head and the protestors moved toward the Prime Minister’s House almost everyone was convinced of an army intervention.  And this is the most important change in Pakistan’s politics. What was reflexive previously did not happen, and is unlikely to in the future.


Imran Khan is correct in demanding institutional rather than cult-oriented perversions of democracy. He gives the example of Switzerland where the prime minister’s name is not well known; Swiss institutions and processes run the country democratically.


Demanding the resignation of Nawaz Sharif does not destroy democracy; it strengthens it. For the longest time Pakistan has been hostage to personalities rather than creating processes and building institutions. Pakistan’s kursi is magical; it can turn a Sufi into Satan.


The brothers Sharif and sycophantic parliamentarians painted PTI and PAT as terrorists violating the sanctity of the parliament. Video evidence, beamed across the world, of Chaudhry Nisar and PML-N workers scaling the walls of the Supreme Court exposes their hypocrisy and is irretrievably incriminating.


Quite the parliamentary metamorphosis was members vehemently condemning Nawaz Sharif. The 2013 elections were rigged and the government is involved in massive corruption was the chorus by PPP’s Aitzaz Ahsan and MQM’s Khalid Maqbool Siddiqui. Had the dharna and their demands not happened, Parliament would not have recorded this.


The brothers Sharif are desperate now. The old British maxim of divide and rule is being employed. PTI members are being enticed to jump ship and Imran Khan’s situation is also getting difficult. Dr. Tahirul Qadri has asked for school and entertainment supplies for the children in the sit-in, suggesting a long haul, but his negotiations with the government are said to be promising.


Whether PTI’s and PAT’s demands are met or not Pakistanis must applaud Dr. Tahirul Qadri and Imran Khan for suddenly transforming Pakistan’s socio-politics. We have been empowered in demanding pristine elections, removal of corrupt legislators, absolute personal integrity in the government and the smooth carriage of justice. And the brothers Sharif should go. Better to leave with grace than unceremoniously. Your political careers are over.

Friday, September 12, 2014

One call for opiate help is what addicts need

Chasing an opiate high, hundreds of Americans die of overdoses every day. The despair I feel that we are not doing enough — urgently — to treat the opiate epidemic has become overwhelming.
The first dose of an opiate in a genetically predisposed individual can cause euphoria. Addicts generally progress from Vicodin to Percocet to heroin. The first snorting or injection of heroin can leave an indelible feeling of intense exhilaration.
As heroin use continues, the brain develops tolerance and more is needed to produce the same rush. Often, the patient miscalculates and the result is death.
Almost every day, I walk into an examination room and find a patient either sobbing or stunned at the overdose death of a family member or friend. It has never been this bad in the 20 years that I have practiced addiction medicine.
Our attention is riveted when a celebrity becomes an overdose victim, and we focus for a bit on the ravages of addiction. But the thousands of nameless, faceless victims whose obituaries euphemistically say that they “died suddenly” become mere statistics that are growing at an alarming rate.
Research shows that heroin overdose deaths decline among patients in methadone maintenance. The same effect is available through the use of Suboxone, which is a combination of an opiate (buprenorphine) and an opiate-antagonist (naloxone).
Suboxone doesn’t just take away the craving for opiates; it also prevents the rush from opiate use. A patient who injects heroin while on Suboxone is less likely to die.
Attorney General Eric Holder’s approach to the opiate epidemic — education, enforcement, and treatment — is good. But while we see efforts in the first two areas, the most urgent response to the epidemic is getting the least attention.
Social bias blames the addict for poor choices. Instead, we need to understand that addiction is a chronic disease, like diabetes and hypertension. It has the same treatability, response, and relapse rates.
It’s a familiar maxim of addiction that a patient must hit bottom before he or she achieves sobriety. In my experience, the downhill slide of opiate addiction has many ledges from which a patient cries out for help. The abyss below is either an overdose death or a catapult to recovery.
It is estimated that only one out of six addicts nationwide gets treatment. Imagine what a patient who is ready for sobriety must go through, anywhere in the country:
A patient who is in a drug-induced fugue state or in withdrawal — with the attendant anxiety, sleeplessness, sweating, diarrhea, and vomiting — fumbles through the Internet and starts to call Suboxone providers. Many providers do not have openings, do not accept the patient’s insurance, or offer an appointment many weeks away. The patient hangs up and reaches for his or her drug of choice.
We urgently need a government hot line that would provide opiate help with one call. It would operate 24/​7. Trained staff would determine which treatment program is right for each patient.
One treatment option would be detoxification, followed by abstinence, counseling, and 12-step programs. Another is Naltrexone, which is not an opiate but prevents craving for opiates; it is available in pill form for daily use or via a monthly injection. A third option is Suboxone. A fourth is methadone maintenance.
A minority of patients will require residential treatment. The goal should be to reintegrate most patients into the routine of life as soon as possible.
Office-based opioid treatment provides myriad life-changing stories. The knowledgeable prescription of Suboxone is one of the most gratifying experiences in medicine.
All patients who need opiate treatment, regardless of insurance coverage, should be eligible for the appropriate program. Ohio can be a pioneer in developing a program of one call for opiate help, with workable templates and their mandatory enforcement in all towns, cities, and suburbs.
As we controlled AIDS and eradicated smallpox, we can control the opiate epidemic and limit the havoc it wreaks every day. Education highlights the dangers of addiction; charging drug dealers with murder in overdose deaths can also be a deterrent.
But more than anything else, heroin and painkiller addicts need treatment — urgently and free of roadblocks. The desire for treatment among opiate addicts lasts only as long as the phone call they make for help. We must make that call count.