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Monday, November 21, 2005

CIA "Enhanced Interrogation Techniques" Revealed

Marty Lederman

On Friday, ABC News broke a very important story; and yet it seems that no one has noticed (or perhaps no one cares).

"Former and current intelligence officers and supervisors" described for ABC News six specific "enhanced interrogation techniques" that the CIA has approved for a dozen or so high-level Al Qaeda detainees incarcerated in isolation at secret locations on military bases in regions from Asia to Eastern Europe:

1. The Attention Grab: The interrogator forcefully grabs the shirt front of the prisoner and shakes him.

2. Attention Slap: An open-handed slap aimed at causing pain and triggering fear.

3. The Belly Slap: A hard open-handed slap to the stomach. The aim is to cause pain, but not internal injury. Doctors consulted advised against using a punch, which could cause lasting internal damage.

4. Long Time Standing: This technique is described as among the most effective. Prisoners are forced to stand, handcuffed and with their feet shackled to an eye bolt in the floor for more than 40 hours. Exhaustion and sleep deprivation are effective in yielding confessions.

5. The Cold Cell: The prisoner is left to stand naked in a cell kept near 50 degrees. Throughout the time in the cell the prisoner is doused with cold water.

6. Water Boarding: The prisoner is bound to an inclined board, feet raised and head slightly below the feet. Cellophane is wrapped over the prisoner's face and water is poured over him. Unavoidably, the gag reflex kicks in and a terrifying fear of drowning leads to almost instant pleas to bring the
treatment to a halt.

This story is notable for several reasons:

1. Confrmation that use of these techniques is formally approved at the highest level of the CIA: "According to the sources, when an interrogator wishes to use a particular technique on a prisoner, the policy at the CIA is that each step of the interrogation process must be signed off at the highest level -- by the deputy director for operations for the CIA."

2. The fact that several former and current CIA officers and supervisors are leaking CIA "methods" is newsworthy in and of itself. There's a very strong taboo against revelation of sources and methods within the CIA; such conduct could subject the leakers to severe discipline and even criminal exposure. Therefore it's virtually unheard of. These leaks -- together with recent leaks concerning the CIA's "black sites" where these interrogations occur, and about a CIA Inspector General report questioning the legality of these techniques -- indicate that there must be profound dissent within the agency on this issue, including on the question of the efficacy of such techniques: "[T]he debate among intelligence officers as to whether they are effective should not be underestimated." According to ABC News, the leakers "say they are revealing specific details of the techniques, and their impact on confessions, because the public needs to know the direction their agency has chosen."

3. The techniques were first approved in March 2002, at least four months before the infamous OLC "Torture Memo." This suggests that the CIA was willing to engage in such conduct before OLC signed off on it (in writing, anyway), and that OLC's advice was offered with respect to ongoing conduct. The general practice within OLC is not to opine on the legality of past or ongoing conduct within the Executive branch, because in such a case there could be an understandable inclination to skew advice so as not to conclude that Executive officials had been acting unlawfully. On the other hand, the Executive branch obviously needs to know if it has been acting unlawfully so that it can conform its practice to the law. Therefore it's often a tough call within OLC whether to give advice in situations such as this.

4. These techniques -- especially Nos. 4 through 6 -- would very likely be deemed conduct that "shocks the conscience," and that therefore would be forbidden by the McCain Amendment. (The CIA's own Inspector General apparently concluded that some of the techniques do shock the conscience.) I should caution, however, that there is no judicial precedent for applying the "shocks the conscience" standard in the context of interrogations of high-level international terrorism suspects, and therefore there is no way to know for certain whether the McCain Amendment would prohibit even such harsh techniques.

* * * *

I'm not going to discuss here whether these techniques are moral, or "effective," or worth the costs, or whether it was inevitable that they would "migrate" to less carefully monitored settings (e.g., Iraq), or whether they contributed to the confusion throughout the military about legal standards governing detainee treatment. Those important discussions are ongoing elsewhere (such as at Crooked Timber, on Andrew Sullivan's site, and in the comments to this Orin Kerr post), and I don't have any particular expertise to offer on such topics.

No one is discussing this question, however: Are such techniques currently legal?

In a series of posts here, I've tried to explain why the Administration concuded that the CIA, when acting against alien detainees overseas, is not bound by a whole host of legal restrictions, including (but not limited to) the Due Process Clause, the Geneva Conventions, Common Article 3 of the Geneva Conventions, customary laws of armed conflict, Article 16 of the Convention Against Torture, the Uniform Code of Military Justice, and the President's directive that detainees be treated "humanely."

For now, however, I'd like to focus only on the question whether these techniques are federal crimes under two statutes: The federal anti-torture law (18 U.S.C. 2340A), and the federal assault statute (18 U.S.C. 113).

Torture

If our enemies used these techniques on U.S. military personnel, no one would, in public debate, deny that such techniques (especially Nos. 4-6) are impermissible forms of torture. Indeed, waterboarding and "cold cell" have often been used by repressive regimes, and have historically been thought of as standard forms of torture. And yet the CIA and OLC have concluded that they are not "torture" -- and, as I explained at the end of this post, OLC stuck to this conclusion even after it had, in December 2004, rejected all of the unconvincing statutory analysis of the August 2002 Torture Memo.

How could OLC possibly have concluded that waterboarding and "cold cell" are not necessarily torture? Well, we won't know for certain unless and until we see OLC's specific legal analysis. But surely, a large part of the explanation must be that the Senate (at the urging of the first President Bush) insisted upon adopting extremely restrictive readings of certain key terms of the Convention Against Torture as a condition of its ratification of that treaty -- restrictive terms that Congress itself adopted in the torture statute.

The criminal statute defines torture as an act "committed by a person acting under the color of law specifically intended to inflict severe physical or mental pain or suffering (other than pain or suffering incidental to lawful sanctions) upon another person within his custody or physical control"; and the statute in turn defines "severe mental pain or suffering" to require "prolonged mental harm."

I suppose the OLC theory must have been that although these techniques obviously inflict severe discomfort, severe agony, and, in the case of waterboarding, severe terror ("Unavoidably, the gag reflex kicks in and a terrifying fear of drowning leads to almost instant pleas to bring the treatment to a halt."), they do not necessarily inflict severe physical pain or suffering -- at least when applied under certain conditions and with certain "protections" (about which we still lack information). What about severe mental suffering? Perhaps OLC concluded that the mental pain is intermittant and short-lived, rather than "prolonged" -- say, if the water-boarding lasts only a couple of minutes, and is not intended to result in any lasting mental suffering.

Without seeing OLC's analysis, it's very hard to determine whether these legal conclusions were reasonable. I do think it's safe to say, however, that the conclusions are counterintuitive. If, for instance, one had asked the President and the 500+ representatives who voted for the torture statute whether waterboarding and "cold cell" and "Long Time Standing" constituted "torture" as they understood it, they all would have said "yes." And to the extent these techniques really aren't "torture" because of technical lacunae in the statute, perhaps that's a sign that Congress should consider amending its definitions.

At the very least, we can now understand that when the President indignantly repeats that "we do not torture under any circumstances," such an assertion of grand principle comes with an important footnote: "The following do not constitute 'torture': Being forced to stand, handcuffed and with one's feet shackled to an eye bolt in the floor, for more than 40 hours; being doused with cold water while standing naked in a 50-degree cell; and being bound to an inclined board, with one's feet raised and head slightly below the feet, and cellophane wrapped over one's face while water is poured over you, inducing a terrifying fear of drowning."

Assault.

Under 18 U.S.C. 113, simple assaults, or assaults by striking or beating, are misdemeanors if they occur "within the special maritime and territorial jurisdiction of the United States." The Administration concedes that this prohibition restricts our interrogations of detainees held "within the special maritime and territorial jurisdiction of the United States." Therefore, it plainly would make unlawful most or all of the six "enhanced" CIA techniques if they occur within the special maritime and territorial jurisdiction of the United States (SMTJ).

In late 2001, the PATRIOT Act amended the SMTJ statute (18 U.S.C. 7) so that the definition of SMTJ now includes "the premises of United States diplomatic, consular, military or other United States Government missions or entities in foreign States, including the buildings, parts of buildings, and land appurtenant or ancillary thereto or used for purposes of those missions or entities, irrespective of ownership."

According to the ABC News story, the locations at which the enhanced techniques occur "often . . . consist of a secure building on an existing or former military base." Regardless of current ownership, those buildings obviously are being "used for purposes of [the CIA]," and therefore would appear to be within the SMTJ, which would make the CIA's techniques there unlawful.

OLC must have concluded that these facilities are not within the SMTJ; but I have to confess that I have not yet figured out the basis on which the office might have reached such a conclusion, in light of the broad language of the statute.

Comments:

Seems that a lot of the mischief can be accomplished through a very narrow reading of specific intent. "Of course we didn't intend for Detainee X to die of a heart attack when we waterboarded him! Even though we knew he had a weak heart, that wasn't what we intended." Likewise with belly-slapping or long-time standing, which could clearly cause serious injury to an "eggshell skull" detainee.

Basically, no matter what happens to a detainee, as long as the injuries can be explained through linkage to one of these techniques, the interrogators can claim to be off the hook because they weren't specifically trying to achieve the result they got.

But my question is this: how is it legal to transport a prisoner outside of the geographic jurisdiction of US law with the specific intent of engaging in acts against that prisoner that US law prohibits?
 

"On Friday, ABC News broke a very important story; and yet it seems that no one has noticed (or perhaps no one cares)."

92 links here, actually, and Technorati misses a lot of stuff. See also here and here, where people were discussing it on Saturday.
 

Julie, this is the same crowd that thinks you don't intend to blow a CIA operative's cover if you call her "Joe Wilson's wife" instead of "Valerie Plame."

They just aren't very bright.

And while I'm commenting, you'll all be relieved to know that Marty is alarmed over nothing, because Porter Goss says the CIA doesn't torture people. (Pardon the self-linking, as NYT links go bad faster than fresh milk.)
 

some of the important news in the world is now ccunted by number of links..so its hard to see the latest important news nowadays,,so you see the most intersting news in the world not important news.
 

I can just imagine a non-com assigned to this task with his/her clipboard handy with the DoD list of the steps to be taken in the interrogation, checking them off, to make sure of strict compliance with the sanctioned interrogation protocol - at least the first few times - before improvisation takes over if and when the sanctioned steps fail to get the desired results. Since such improvization seems to be foreseeable, then those added steps could also be deemed sanctioned by the non-com's superiors.
 

http://www.weeklystandard.com/Content/Public/Articles/000/000/006/400rhqav.asp?pg=2

Charles Krauthammer has a very well thought out article on the subject. Waterboarding is torture. I think step five (hypothermic treatment) is actually worse than waterboarding (it is apparently far more life threatening and dangerous). But it does not "shock my conscience" for the CIA to use coercive force to get high level al Qaeda leadership to give up information to thwart future terrorist attacks. Certainly step four is legitmate--unless you want to see more innocent people die at the hands of al Qaeda murderers. If you think no coercive force is allowed against high ranking al Qaeda--why even capture them. We are better off just killing them.
 

And Krauthammer agrees (as do I) that we should not have the DoD engaging in any coercive interrogations. Lead that to professionals and only to high level/high value al Qaeda and terrorist threats. If you think it is moral to fight al Qaeda with your hands tied behind your back, remember that will almost certainly result in innocent people getting killed as a result.
 

I don't normally resort to name-calling, but Charles Krauthammer does nothing but carry water for the Bush Administration 24-7. He's one of these guys who the media pretends to be a great conservative intellectual thinker but who actually simply says whatever Karl Rove wants him to say.

That said, his specific argument is, of course, bunk. First, he ignores the fact that torture is already illegal. It is true, as Marty Lederman points out, that we ratified the Torture Convention with reservations and understandings. Nonetheless, we ratified it, and the Torture Convention is very specific that there can be no justification for torture. That's right, NO justification. Doesn't matter if someone's going to blow up the entire world with antimatter weapons. Actual torture is illegal. (The argument, as noted by Lederman, is as to what constitutes actual torture.)

So Krauthammer's central point-- that everyone accepts torture in the ticking bomb scenario-- is not only incorrect, but precisely contrary to the settled understanding of international law and the official position of the United States government for three administrations, as reflected in a signed, ratified, and statutorily executed treaty. This, by the way, is why Bush 43 swears we do not torture. He knows if he argues the ticking bomb scenario he will be admitting that the US is violating the treaty.

If you support allowing torture in the ticking bomb situation, you may ask "how could this have happened?". Simple. EVERYONE who wants to torture asserts the ticking bomb scenario. It's the standard excuse given. And invariably, it comes to light that the ensuing torture did not involve a ticking bomb.

And I might add, that has happened here. We may well be torturing Khalid Sheikh Mohammed. But we know we tortured at Abu Graib, and at Guantanamo, and elsewhere, and we know that many of the people we tortured were either completely innocent or did not identify the location of anything analogous to a ticking bomb.

We signed a treaty banning torture in the ticking bomb situation because this is exactly what happened when Israel tortured, and when Argentina tortured, and when everyone else tortured. It was never controlled. It always went down the slippery slope. Unsurprisingly, we went down it too.

Second, neither Krauthammer nor anyone else actually knows whether we have obtained any good intelligence from torture. I would argue that both given the Bush Administration's demonstrated penchant for lying its butt off (something Krauthammer will never admit) and given the fact that they love trumpeting their alleged successes (remember Ashcroft's press conference on Jose Padilla), the governing inference should be that we HAVEN'T stopped any terrorist plots through torture. But the point is, even if we have, Krauthammer has no idea. His argument is completely theoretical-- "if we stopped a ticking bomb, this would be OK", but his conclusion-- that it IS OK, doesn't follow unless he can actually pointed to something that we thwarted.

Finally, I have to say one other thing-- it is the height of duplicity that Bush has his surrogates like Krauthammer and Limbaugh make an argument that he doesn't have the guts to make himself. If he really thinks that torture is OK, he should say it, and suffer the consequences. But of course, George W. Bush never has little actual courage in his life, so why start now?
 

We had better keep in mind that, if we accept the "ticking bomb" (aka the "doomsday") scenario, we had better define just what its limits are. Torture of POWs was flatly illegal, uner all circumstances, in the only two previous wars in which the US ws actually fighting for its continued existence: the Civil War and WW II. It was kept illegal for Japanese POWs during the latter war despite the fact that Japan not only refused to reciprocate but routinly subjected our POWs to hideous atrocities -- and despite the fact that the American public would unquestionably have approved its use. Why? because the Roosevelt Administration wanted postwar Japan to be an unoccupied but non-hostile country, and knew damn well that this would be hugely more difficult if we had tortured Japanese POws. Now consider how much more important this latter factor is in the case of the Moslem world, which we can't occupy even temporarily, and in which the opinion of individual Moslems is more important than if we were in a war only against a dictatorial government.

So: that "ticking bomb" had better be a goddamn big one for torture to be allowed in this war. Is there anything short of an attack that would kill thousands of Americans -- or tens of thousands -- that would possibly qualify? Not that I can see. At an absolute minimum, the decision as to whether torture (or semi-torture, or whatever the hell you call it) should be used must be made by not just one man -- including the President -- but by a supermajority of a group of men, not all of them appointed by the same President.
 

I see nothing here that approaches Torture, you do?
 

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mesothelioma Mesotheliomais a form of cancer that is almost always caused by exposure to Asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart the pericardium (a sac that surrounds the heart or tunica vaginalis.
Most people who develop
mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing Mesothelioma Unlike lung cancer, there is no association between mesothelioma and smoking but smoking greatly increases risk of other asbestos induced cancer.Compensation via
Asbestos funds or lawsuits is an important issue in
mesothelioma The symptoms of
mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis, which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural
mesotheliomaSymptoms of peritoneal
mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal
mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
chest wall pain
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up hemoptysis
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
abdominal pain
ascites, or an abnormal buildup of fluid in the abdomen
a mass in the abdomen
problems with bowel function
weight loss
In severe cases of the disease, the following signs and symptoms may be present:
blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation a disorder causing severe bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
A
mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs
Diagnosing
mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for
mesothelioma A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of
mesothelioma A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude
mesothelioma it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of
mesothelioma A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
There is no universally agreed protocol for screening people who have been exposed to
asbestosScreening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for
mesotheliomaThe level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[ Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
asbestos
is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
asbestos
has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and
asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer bronchial carcinoma). The Kent brand of cigarettes used
mesothelioma in its filters for the first few years of production in the 1950s and some cases of
mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with
asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of
asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for
mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with
asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related
mesotheliomaExposure to
asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of
asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to
asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial
asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with
asbestos workers have an increased risk of developing
mesothelioma and possibly other asbestos related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to asbestosMany building materials used in both public and domestic premises prior to the banning of
asbestos may contain
asbestos Those performing renovation works or activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue
asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to
mesothelioma radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although
mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation Therapy when given alone with curative intent has never been shown to improve survival from
mesothelioma The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for
mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural
mesothelioma showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer.
mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The
mesothelioma tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs.
cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk o f asbestosrelated disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to
asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis
How is
mesotheliomadiagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the
cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is
mesotheliomatreated?
Treatment for mesothelioma depends on the location of the
cancerthe stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for
mesotheliomaThe doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesotheliomaa lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Stereo Tactic Radiation Therapy also called radiotherapy, involves the use of high-energy rays to kill
cancercells and shrink tumors Radiation therapy affects the
cancercells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the
cancercells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat
mesotheliomaare given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation Therapy and surgery may also be helpful in relieving symptoms.
 

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Mesothelioma is certainly such an ill-fated sickness, and in actual fact might well have been preventable had most people known back then what we know now. It is furthermore a waste that many men and women get annoyed about the asbestos cancer commercials on tv, but those affected ought to be recompensed fairly IMO. Mesothelioma
 

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