Situation worsens in Pakistan; security increased for Asia Bibi

The assasination of Punjab Governor Salman Taseer has made political instability even more likely in Pakistan. Never far from collapse, the current government is facing multiple challenges from ongoing flood cleanup and relief to survivors to threats of violence from emboldened Islamic extremists.

New developments include:

500 Islamic “scholars” lauded the murder of Salman Taseer and praise his killer.

ISLAMABAD, Pakistan — The increasing radicalization of Pakistani society was laid bare Wednesday when the nation’s mainstream religious organizations applauded the murder of provincial governor Salman Taseer earlier this week, while his killer was showered with rose petals as he appeared in court.

Taseer, 66, the governor of Punjab, the country’s most heavily populated province, was assassinated Tuesday by one of his police bodyguards after Taseer had campaigned to ease Pakistan’s blasphemy law. Religious groups threatened to kill others who questioned the blasphemy statute, which is designed to protect Islam and the Prophet Muhammad from “insult.”

Security around Asia Bibi has been increased due to fears that a suicide bomber will take out the prison.

The death of Taseer has not mobilized moderates and civil society. If anything, according to Pakistani observer Fareed Zakaria , the situation is worsening in the direction of the extremists and Taliban.

Zakaria: This is a huge event in Pakistan. First of all it’s important to understand what Punjab is in Pakistan. Punjab is the most populous part of Pakistan, it is the most prosperous part of Pakistan, it’s also the heart and soul of Pakistan’s governing class. The officer corps of Pakistan’s military is largely Punjabi, there are some accounts that suggest as much as 80% of the officers corps comes from Punjab.

This man, Salman Taseer, was probably the most prominent liberal or progressive politician in Pakistan today. He was a very close ally of Benazir Bhutto, the Pakistani politician who was assassinated three years ago. He was a very powerful man in his own right and was famous as a crusading liberal — in particular against the forces of extremism and militant Islam.

Zakaria sums up why this issue is critical to our mission in the region. 

CNN: Why is this of concern to the United States?

Zakaria: For the United States, this issue is actually at the center of whether or not it will be able to succeed in Afghanistan. Let’s remember, the strategy in Afghanistan cannot succeed as long as there are sanctuaries for the Taliban and al Qaeda in neighboring Pakistan.

Right now what happens is the Taliban crosses the border from Afghanistan into Pakistan, regroups, gains support, logistics, resources in Pakistan, and then comes back to fight the U.S. forces or Afghan government forces. This has been the key to their ability to survive and thrive, so unless you can deal with the sanctuaries in Pakistan, you’re not going to make any headway in Afghanistan.

The entire leadership of al Qaeda and the leadership of the worst elements of the Taliban are all in Pakistan now. In order to deal with that, to destroy those terrorist groups, the Pakistani army has to be willing to go into the areas where these various groups have their strongholds, mostly in a part of Pakistan called North Waziristan.

So far, the Pakistani army has refused to do so. The most important reason is that they fear a backlash within Pakistan. They’re too nervous about the political consequences of having this frontal struggle against Islamic extremism. So if you can’t confront Islamic extremism with things like the blasphemy law, what hope is there that they actually go ahead and mount large-scale military operations in North Waziristan?

I suspect this line of thinking informs the Obama administration and may explain why the White House has made only general statements about blasphemy laws and to my knowledge not publicly condemned the plight of Asia Bibi. In some of the Pakistani rallies in favor of the blasphemy laws, “death to America” is also a rally cry.

We also have a multi-billion dollar investment in Pakistan but the elements which oppose us don’t care if we remove it – at least this is my take on it at this point. I suspect there are Islamic governments that would be happy to supply extremists with funds if they were in charge of the country. We have few carrots and seem reluctant to use our sticks.

And finally, here is an article with citations from my new British friend, Raza Anjum. Raza has been in Pakistan for weeks attempting to see Asia Bibi and win her release. I also provided his assessment of the situation with quotes from Taseer Salman just days before he was murdered.

The website that cried wolf: World Net Daily and death panels

Today, the far right website, World Net Daily, is accusing the President of using the Food & Drug Administration drug approval process as a way to ration health care via “death panels.”  As evidence for the claim, this front page story by Greg Koprowski states that “new drug approvals declined dramatically last year” citing a drop in such drug approvals from 25 in 2009 to 21 in 2010.

Although website claims the article is “breaking news,” the other evidence offered is a quote from a July 27, 2010 letter to FDA official Dr. Richard Pazdur from Senator David Vitter (R-LA) writing in support of the anti-cancer drug Avastin.  The FDA recently made a recommendation to remove the breast cancer indication from the Avastin drug label. In the letter, Senator Vitter worries that the approval process may signal the beginning of treatment rationing.

I spoke with Sandy Walsh at the FDA who called the claim that the FDA was using cost as a measure of approval “absurd.” She also noted that recent approvals are in line with past years.  As a review of FDA data demonstrates, she is correct.  For perspective, here are numbers of new medicines approved by the FDA from 2000 to the 2010 estimate.

2010 – 21 (estimated)

2009 – 25

2008 – 24

2007 – 18

2006 – 22

2005 – 20

2004 – 36

2003 – 21

2002 – 17

2001 – 24

2000 – 27

Mr. Koprowski called the drop from 25 new drugs in 2009 to a “mere 21 new drugs in 2010” a dramatic decline. Not at all. An examination of the approvals over time tells a different story. Clearly, Obama’s FDA is keeping pace with the record of the Bush administration.

Regarding Avastin, the maker of the cancer fighting drug is appealing the decision but it is simply wrong to assume that the FDA decision was based on cost considerations. The FDA panel that voted 12-to-1 to recommended the action consisted of physicians and patient advocates. FDA spokesperson Erica Jefferson told me that “no political appointees were involved in the decision-making” adding that “most of the reviewers have been with the agency close to 15 years.” Moreover, the decision was endorsed by the National Breast Cancer Coalition, which said about the action, “We applaud the FDA for responding to the scientific evidence in the face of significant political and public pressure.”

By reading WND, one would never know the rest of the story. Selective reporting is just one reason to question crying wolves at WND. Enter the Medicare death panel scare.

In late December, World Net Daily published an article that said the Obama Administration was slipping death panels back into Medicare via a regulation defining patient-physician discussions of advance directive planning. Yesterday, the Obama administration rescinded that rule, in part because of the misinformation campaign waged by social conservatives.

Judie Brown of the American Life League was quoted as saying:

Nothing good can come of this,” said Judie Brown, the president of American Life League. “This will affect everybody’s parents and grandparents and preborn babies, and it will not affect anybody for the good.

She added ominously:

Congress must step up to cancel the regulation, Brown added. “If not, a death certificate is written for an awful lot of elderly people.”

Ratcheting up the rhetoric, Liberty Counsel’s Mat Staver told WND that the Medicare regulation was not just a death panel, but a “super death panel,” saying

When you have the government mandating this end-of-life counseling, they’re conscripting doctors to do end-of-life counseling on a massive scale. It will be the equivalent of a super death panel. Elderly patients will get confused and will end up signing documents without having a clue what they’re signing, and they will sign away care they might really want.

As I noted in a previous post, claims that the just rescinded Medicare regulation required doctors to persuade senior citizens to refuse care are just false. The new regulation was an extension of a definition of advance care planning which remains a part of the initial Medicare visit, a provision that was added by Congress in 2008. That bill was passed via override of a President Bush veto. The veto however, had nothing to do with end-of-life counseling, but rather concerns over cost. As far as I can find via search engines, there was no outcry from conservatives then over the end-of-life provision. No one cried death panels then.

As an administration official told me yesterday, Medicare does not prescribe any conversation between patients and physicians about end-of-life issues. Patients are free to use pro-life resources and advance directives to plan their end-of-life care. The only reason the definition was included was to alert physicians that these conversations are important. There is neither a separate reimbursement for advanced care planning now nor would there have been if the rule, rescinded yesterday, would have remained viable.

In the case of the advance care planning regulation, the scare tactics worked. The Obama administration backed off of a reasonable definition of advanced care planning, a practice that pro-life groups actually recommend to their constituents. However, hysteria and spin won out over good policy. In the case of FDA approvals, it is clear that there is no trend specific to this administration. At what point, do readers realize that those crying death panels are crying wolf?

Obama Administration rescinds voluntary advance care planning rule

Just about an hour ago, the Health and Human Services Department rescinded the Medicare rule on voluntary advance care planning that had been misrepresented as the return of “death panels” by some social conservatives. I will comment more on this story but for now here is a link to the Federal Register and relevant portions of the order.

II. Provisions of the Amendment

In the July 13, 2010 Federal Register (75 FR 40039), we published the proposed rule entitled “Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011.” In response to this publication, we received comments from health care providers, and others urging us to add voluntary advance care planning as a specified element of the definitions of both the “first annual wellness visit” and the “subsequent annual wellness visit.” The commenters stated that their recommendations were based upon a number of recent research studies, and the inclusion by the Medicare initial preventive physical examination (IPPE) provisions of a similar element in the existing IPPE benefit.

CMS agreed with the commenters that voluntary advance care planning should be added as a specified element in the definitions of both the “first annual wellness visit” and the “subsequent annual wellness visit” based on the evidence provided and the inclusion of a similar element in the IPPE benefit (also referred to as the Welcome to Medicare CMS-1503-F2 3 exam) since January 1, 2009, and incorporated it into the final rule.

It has since become apparent that we did not have an opportunity to consider prior to the issuance of the final rule the wide range of views on this subject held by a broad range of stakeholders (including members of Congress and those who were involved with this provision during the debate on the Affordable Care Act). Therefore, we are rescinding the provision of the final rule that includes voluntary advance care planning as a specified element of the annual wellness visits providing personalized prevention plan services, and returning to the policy that was proposed, which was limited to the elements specified in the Act. We are revising our regulation at §410.15(a) to remove voluntary advance care planning as a specified element from the definitions of “first annual wellness visit providing personalized prevention plan services” and “subsequent annual wellness visit providing personalized prevention plan services” and to remove the definition of “voluntary advance care planning.”

And the rule is now amended to read:

For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR part 410 as set forth below: 

PART 410–SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

1. The authority citation for part 410 continues to read as follows:

Authority (42 U.S.C. 1302, 1395m, 1395hh, and 1395ddd). Secs. 1102, 1834, 1871, and 1893 of the Social Security Act Subpart B–Medical and Other Health Services § 410.15 [Amended]

2. Section 410.15 is amended as follows:

A. In paragraph (a), in the definition of “First annual wellness visit providing personalized prevention plan services” removing paragraph (ix) and redesignating paragraph (x) as paragraph (ix).

B. In paragraph (a), in the definition of “Subsequent annual wellness visit providing personalized prevention plan services” removing paragraph (vii) and redesignating paragraph (viii) as paragraph (vii).

C. In paragraph (a), removing the definition of “voluntary advance care planning”.

Let me note here that in 2008, the same concept was included in the Medicare Improvements for Patients and Providers Act of 2008 and remains a part of Medicare regulations for the first visit by a Medicare enrollee to a physician. George Bush vetoed that bill in 2008 but not because of the end-of-life counseling was included in the bill. He did so because he was concerned that the bill was too costly. I have looked in various search engines for record of opposition to the end-of-life provisions by social conservatives at that time. I found none.

World Net Daily hearts the Pink Swastika

In a given month, World Net Daily numbers page views in the millions; I number mine in the thousands. So I know that repeating the critique of the Pink Swastika will not reach the number of people now misled by WND but here goes anyway…

WND has a superstore with an apparently spanking new edition of Scott Lively’s The Pink Swastika in it. WND site owner Joseph Farah gives a shout out to TPS without addressing any of the criticisms. He says he has read all of the criticism, but he attributes it to “homosexual bloggers.” Well, I am not a homosexual blogger; Grove City colleague and historian Jon David Wynekin is not a homosexual blogger and we spent lots of time and detail demonstrating the flaws in the book. Campus Crusade for Christ is not a homosexual blogger organization and it removed an exerpt of The Pink Swastika from one of their websites. Exodus International is not a homosexuality affirming organization but they removed the link to The Pink Swastika. NARTH is hardly a gay affirming bunch but they removed all references to Scott Lively and The Pink Swastika.

Maybe Joseph Farah didn’t know that; maybe he doesn’t care, having already made up his mind.

Slain Pakistani Governor had received death threats

As is being widely reported, the governor of Pakistan’s Punjab province, Salman Taseer, was assasinated earlier today by his own security guard. The guard apparently heeded the fatwa issued by Islamic extremists who were angry about Taseer’s advocacy for Asia Bibi, a Christian mother of five who was recently sentenced to death for allegedly insulting Islam. Taseer had petitioned the government for her pardon.

Over the past several weeks, I have had contact with Raza Anjum, a city Councillor from the UK, who is in Pakistan trying to win freedom for Asia Bibi. Just hours after the shooting, Anjum (on left below) issued a statement describing a meeting he had with Governor Taseer less than a week ago.  In that meeting, Taseer (on the right in the picture below) said that a fatwa had been issued on him due to his support for Asia Bibi and his opposition to the nation’s blasphemy laws.         

Anjum said that Taseer spoke strongly against religious extremism, saying that  “one needs to be determined and brave in standing up for human rights,” adding that “the extremists aim to install fear in the minds of the people.” According to Anjum, Taseer said he was “prepared to stand up to them to help bring about a progressive and peaceful Pakistan.”

That peaceful Pakistan now seems elusive. 

On New Year’s Eve, thousands went on strike warning of violence if the government amended the blasphemy laws or freed Asia Bibi. On Sunday, the second largest political party in Pakistan pulled out of the coalition goverment citing corruption and economic differences.   

About the tragedy, Anjum said, “The assassination of Salman Taseer is a huge blow to all those who are working for an enlightened and progressive Pakistan. His death has left the country in shock at a time when it faces an imminent political crisis.”

On Taseer’s Twitter page, an associate posted “R.I.P. Lion of the Punjab Salmaan Taseer (31 May 1944-04 Jan 2011)” According to Mr. Anjum, the Pakistan People’s Party said it would observe two weeks of mourning over Taseer’s death. Prime Minister Syed Yusuf Raza Gilani “strongly condemned” the incident, according to CNN.

Here is a Wall Street Journal news report that fills in additional information: