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George W. Bush and the War in Iraq

Lawrence Freedman: The first- if the Americans had not responded to the Iraqi invasion of Kuwait, that would have left a permanent change, I think for the worse, in the regional balances of power. And the method by which Iraq took over Kuwait was clearly totally unacceptable. I mean, it was a basic breach of international law. And there was always an American choice not to, and if Saudi Arabia hadn’t wanted them to, it would have been very hard for the Americans to respond. If the Amir of Kuwait hadn’t escaped, it would have been very hard for the Americans to respond. But they had the choice and they took it, and I think, you know, at the time, I thought it was the right one then and I think in retrospect, I still would say that. I think the difficulty second time ‘round is that there was an untenable position in Iraq. I mean, I don’t- I find it very hard to believe they had a stable status quo that somehow was only destabilized by American action. At some point, something would have happened in Iraq. I don’t think the situation was durable. But the way that it happened and the timing that was happened and the reasons given meant that the regime was overthrown on what seemed to be at the time a contrived basis- and then, most catastrophically, without any real sense of what was gonna happen, so it was all done on the basis of the worst-case analysis of what would happen if you didn’t overthrow Saddam Hussein, that somehow they would build weapons of mass destruction, that they would go to Al-Qaeda, combined with the best case of what would happen if you did go to war- cheering crowds, cheerful liberation, beacon of democracy, help Israel- whatever- which is why it’s all been a crushing disappointment. Now, in the end, it may, you know- it may well be the case that Iraq would be far better off in the future because the Bath regime, Saddam’s regime, has gone. But it certainly happened in the most painful way possible, both for the Iraqi people and for the United States, as allies.

Question: Could Bill Clinton have done more to prevent blow-ups in the Middle East?

I mean, Clinton, to some extent, did the minimum. I think he was content with containment. He didn’t, probably correctly, see Iraq as a country that was going to suddenly burst out of its chains and suddenly cause major problems again. And if Saddam were still there, then that was the fault of his predecessor rather than him. And he also, for the first few years- he wasn’t very interested in foreign policy- took a while before he did. So I think the problems- I find, in some ways, the Clinton regime

quite hard- Clinton regime- Clinton Administration. It’s legitimate- you tend to use regime for illegitimate government. The Clinton Administration is the hardest to judge because he didn’t have strong policies on any of the issues. He was always trying to make the politics work, to produce the outcome that was most acceptable at home and most acceptable in the region, but was never really prepared to take very bold decisions to do anything about it. He had an opportunity with Iran, which may have been even greater than the one with Iraq. I think Iraq was a reasonably intractable problem which you would let rumble on until Saddam died, or there was a coup, or something happened there to give you an opportunity to move in. But when Iran had a change of regime, I mean, President Hatami came in, who was clearly interested to see whether something could be worked out with the United States. And it was very tricky, because Iran was/is very divided amongst its elite- some parts were amenable to dealing with the United States, some parts very hostile. But again, he never quite changed the framework of the debate on that, though he started to do so. Then, of course, it was the Arab/Israeli dispute, where you know, very belatedly, he had this big effort with the Palestinians. He had already tried with the Israelis and Syrians, and you sort of feel, looking back, that he never quite imposed American views or his views on what a proper outcome should be. He was always trying to work out how far could you push the Israelis without it making it too difficult for the Israeli government back home, or difficult for himself, with Israel supporters in the United States.

He never really was saying, “Well, this is what we think a good settlement would look like.” What he was saying is, “We think there should be a settlement- we wanna help you guys as much as we can to reach them. But in the end, it’s your responsibility.” And of course, in the end, it has to be their responsibility, but if the Americans are involving themselves that way, with the clout and the prestige and the influence the Americans have, you sort of sense that there was a clearer view from him about what was desirable- might have helped a bit, not left so many loose ends by the time his presidency came to a close.

Question: How will President Bush’s Mid East Policy be Judged?

Well, it’s hard to think there’s much at the end of it that’s better than there was from the start. I think there were some- history may take a different view- as things stand at the moment, there were some fundamental errors. I don’t think those errors were in chasing after Al-Qaeda in Afghanistan. I think any American President would have to have done that. And if I’d been talking about this in sort of late 2001, I’d have said- actually, you know, so far, this has been handled- all handled pretty well. The right things have been said, there’s a lot of American- there’s a lot of international support for the American position. You now need a more political period to build on that support, and start to create the conditions in which groups like Al-Qaeda can’t flourish. And two mistakes were made at that point- one was to exaggerate the success in

Afghanistan. Just because the Taliban had fallen didn’t mean to say that you had a stable country, in which all elements of Islamist influence were suppressed. You know, Afghanistan needed then, and needs still, a lot of work. But the eye was taken off that ball and went to Iraq, and there was no particular need to go to Iraq at that point. As I said before, at some point, any American President, I’m sure, would have found themselves dealing with Iraq again. But the- and I think a lot of people went along with the war because they thought this really was an awful regime and the world would be better off without it. But it was the least propitious conditions into which to take it off, and then to be so ill-prepared for what they then faced- so, you know, a flimsy case for the war itself, which I think, you know, was believed in good faith- I don’t think it was all made up, but it didn’t last very long, and therefore, drained some credibility from the American effort. But most of all, when you get to Iraq, not to begin to understand what it means to occupy a country of this sort- I think that- whatever happens to Iraq in the future, you know, tens of thousands of lives have been lost. Years have been lost. Iraq had the basis to be quite a strong, prosperous, even useful country, and at the moment it’s a drain on themselves and everybody else. The middle-class has fled- some are going back- sectarian conflict has been aggravated. You know, a whole generation has lost their education and health services are in disarray- they’re dependent on international aid. And things haven’t really improved

that much. Now, I think the policy now is more carefully tuned and is surer than it was before, but that’s an awful long way down the road. And you can’t re-wind- you know, you can’t say, “Well, we got it wrong that time. Let’s try it again a different way.” You can’t. You’re living with the consequences of those decisions that were taken in 2003.

Recorded on 5/19/08

Lawrence Freedman considers differences between the first and second wars in Iraq and how future generations may judge the current conflict.

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A new hydrogel might be strong enough for knee replacements

Duke University researchers might have solved a half-century old problem.

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  • Duke University researchers created a hydrogel that appears to be as strong and flexible as human cartilage.
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Image source: camillo jimenez/Unsplash
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  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.