"On September 29, 1780, Major John Andre, Adjutant-General to the British Army, was tried by a "Board of General Officers" appointed by General Washington, on a charge that he had come within the lines for an interview with General Benedict Arnold and had been captured while in disguise and traveling under an assumed name. The Board found that the facts charged were true, and that when captured Major Andre had in his possession papers containing intelligence for the enemy, and reported their conclusion that "Major Andre . . . ought to be considered as a Spy from the enemy, and that agreeably to the law and usage of nations . . . he ought to suffer death." Major Andre was hanged on October 2, 1780." (Footnote 9 of the ex parte Quirin decision.

George Washington established the first military commission to try a British officer who had violated the Laws of War. Andre was captured on Sept 23, tried on Sept 29, and hanged on Oct 2. There is no evidence that anyone worried about Habeas rights at the time.

It is ideological nonsense to attempt to connect Abu Ghraib with the MCA. Mistreatment of prisoners is a criminal offense and is not protected by limiting civil litigation.

George Washington's timetable may be a bit quick, but you certainly cannot use his memory to argue that what we really need is another five or six rounds of appeals stretched over years just to set the ground rules for a trial. If the current court system had been in place in GW's day, Andre might still be awaiting trial.
 

Mr. Horton:

You might want to stop trying to make comparisons with past Presidents like Lincoln and now Washington. The exercise has not worked out very well for you. As howard correctly observes, unlawful enemy combatants back then like Major Andre were executed almost without fail.

While I personally have some sympathy for adopting Washington and Lincoln's unlawful enemy combatant policies against al Qaeda, Mr. Bush has adopted a far more lenient (dare I say liberal) policy towards these captures.

As to the slander that Mr. Bush's policies are somehow responsible for the sexual abuse at Abu Ghraib, you are welcome to post any evidence you possess which proves the Mr. Bush authorized the military to sexually abuse their prisoners.
 

I'm not sure what howard's point is. It was common in the 18th Century for trials to take place soon after arrest. There were few prisons and their principal purpose was to hold the accused for the speedy trial which awaited. Trials themselves rarely lasted more than a day, even when the penalty was death (which it was for EVERY felony). The rights accorded to Andre exceeded those common to ordinary criminals. Nobody sought habeas for Andre because he didn't need it. He got a fair trial under the acknowledged law.

The fact that we today take greater care to secure the fairness of trials and the rights of defendants is cause for celebration, not criticism.

It is ideological nonsense to attempt to connect Abu Ghraib with the MCA. Mistreatment of prisoners is a criminal offense and is not protected by limiting civil litigation.

It is ideological nonsense to deny the connection. Among other things, the torture bill permits evidence to be introduced even if it was obtained by mistreatement (that's a euphemism) of the witness/prisoner. That's a criminal offense, not a foundation for evidence.
 

Bart,

While I personally have some sympathy for adopting Washington and Lincoln's unlawful enemy combatant policies against al Qaeda, Mr. Bush has adopted a far more lenient (dare I say liberal) policy towards these captures.

I've been wanting to ask that for some time. You have been continually reiterating that our policy before Vietnam was to summarily execute unlawful enemy combatants, I have wanted to ask if you favor returning to that policy. Your answer, as I understand it, is that you do not advocate returning to it, but would consider it morally justified
with respect to "al Qaeda."

Still, that leaves a lot of unanswered questions. If you consider summary execution of unlawful enemy combatants moral (even if you stop short of advocating it), does that apply to al-Qaeda only, or to all Iraqi insurgents? And what about sectarian militias? Or the Taliban? And would you apply it only to combatants captured in actual combat, or to ones taken under other circumstances? And, for suspected unlawful combatants not captured in actual combat,what quantum of proof would you require before considering summary execution justifiable?
 

Howard:

"On September 29, 1780, Major John Andre, Adjutant-General to the British Army, was tried by a "Board of General Officers" appointed by General Washington, on a charge that he had come within the lines for an interview with General Benedict Arnold and had been captured while in disguise and traveling under an assumed name. The Board found that the facts charged were true, and that when captured Major Andre had in his possession papers containing intelligence for the enemy, and reported their conclusion that "Major Andre . . . ought to be considered as a Spy from the enemy, and that agreeably to the law and usage of nations . . . he ought to suffer death." Major Andre was hanged on October 2, 1780." (Footnote 9 of the ex parte Quirin decision.

George Washington established the first military commission to try a British officer who had violated the Laws of War. Andre was captured on Sept 23, tried on Sept 29, and hanged on Oct 2. There is no evidence that anyone worried about Habeas rights at the time.

Ummm, he was a spy And he was tried and convicted for that.

Lest you think that perhaps he ought to have had, say, a regular trial in a civilian court, or, perhaps access to habeas corpus, I might point out that this was well before the Constitution, much less the BoR, was even a gleam in Madison's eye....

If the current court system had been in place in GW's day, Andre might still be awaiting trial....

Your hyperbole is noted (and FWIW, much of the controversy recently has to do with whther they should be afforded a trial at all). But, as you have noted, the current court system was not in place. Which makes bringing up the Andre case a bit inapposite.

Cheers,
 

"Brave, Brave Sir Robi..." -- ummm, sorry, my mistake, -- "Bart" DePalma says:

You might want to stop trying to make comparisons with past Presidents like Lincoln and now Washington...."

Why? Because you don't like it?

... The exercise has not worked out very well for you.

"Come back here and take what's coming to you. I'll bite your legs off!"

Cheers,
 

Enlightened Layperson said...

I've been wanting to ask that for some time. You have been continually reiterating that our policy before Vietnam was to summarily execute unlawful enemy combatants, I have wanted to ask if you favor returning to that policy. Your answer, as I understand it, is that you do not advocate returning to it, but would consider it morally justified with respect to "al Qaeda."

If I were king, I would interrogate and then execute unlawful enemy combatants. POW privileges should be reserved for combatants who follow the basic laws of war and a modicum of civilization, not for terrorists. Extending POW rights to unlawful enemy combatants simply rewards barbaric behavior. However, modern society does not have the stomach for summary battlefield executions anymore.

Still, that leaves a lot of unanswered questions. If you consider summary execution of unlawful enemy combatants moral (even if you stop short of advocating it), does that apply to al-Qaeda only, or to all Iraqi insurgents? And what about sectarian militias? Or the Taliban?

Any combatant which meets the definition set forth in the Geneva Conventions should be extended POW rights. Everyone else is an unlawful combatant who should be treated as such. I would make an exception for enemy groups which enter into and follow agreements with us to treat our captured soldiers under the rules of the Geneva conventions.

And, for suspected unlawful combatants not captured in actual combat,what quantum of proof would you require before considering summary execution justifiable?

Interesting question. I am not sure what if any standard of proof has been previously applied in military status hearings. Under wartime conditions, I would probably settle for a preponderance of evidence.

For example, if the capture is a foreign Arab who claims he went to Afghanistan or Iraq to study the Quran or for work and was captured with terrorists and/or with bomb making materials on his person or in his apartment like Omar, he can be reasonably be considered an unlawful enemy combatant.
 

arne:

:::chuckle:::

You can be an ass, but anyone who is a Python can't be all bad.
 

JT Davis said...

From a new review in Ha’aretz:

Speaking of George Bush, with whom Sharon developed a very close relationship, Uri Dan recalls that Sharon’s delicacy made him reluctant to repeat what the president had told him when they discussed Osama bin Laden. Finally he relented. And here is what the leader of the Western world, valiant warrior in the battle of cultures, promised to do to bin Laden if he caught him: “I will screw him in the ass!"

It is amusing to see politicians in their unvarnished state like when Bush was caught telling Blair something to the effect that Syria needed to "stop this shit" in Lebanon.

However, I have a hard time crediting any account which begins by calling "The Bulldozer" Sharon "delicate." My heavens, Sharon was career IDF officer. I doubt Sharon's ears were burning if Mr. Bush made such a statement. Indeed, I imagine the old terrorist fighter, not to mention hundreds of thousands of New Yorkers, would share the sentiment.
 

Bart,

I am not sure what if any standard of proof has been previously applied in military status hearings. Under wartime conditions, I would probably settle for a preponderance of evidence.

Can I take it, then, that you are talking about some sort of summary in field court martial procedure?
 

Bart, howard,

How about this comparison.

Andre was captured, tried on the evidence, and then executed after being convicted.

The prisoners of Abu Grahib and Gitmo have been captured, tortured, incarcerated for years, and could be tried on evidence created while they were under torture.

Do you see why Washington could possibly be considered a better example of how to treat captured prisoners, even if, as Horton stated, he was also under pressure because his own troops who were captured were not given comparable treatment?
 

And from the do as I say, not as I do side, Reuters quoted Bush today as saying:

"And as we work to advance the cause of freedom around the world, we remember that the father of our country believed that the freedoms we secured in our revolution were not meant for Americans alone."

Except, apparently, if you dare to oppose the way we seek to advance the cause of freedom.
 

"Bart" DePalma says:

If I were king, I would interrogate and then execute unlawful enemy combatants....

If pigs could fly, we'd carry cast-iron umbrellas.

.. POW privileges should be reserved for combatants who follow the basic laws of war and a modicum of civilization, not for terrorists.

POW privileges should only be extended to people who don't try and kill the "good guys". The others, they're "bad guys" and dontchaknow they're trying to kiiilllllll uuuusssss, and of course they need to be killed as quickly as possible.

Cheers,
 

"Bart" DePalma:

You can be an ass, but anyone who is a Python can't be all bad.

Oh, I'll take being an "a$$" any day ... say, compared to being an eedjit. You have my sympathy. And my derision, but the latter comes free ("Die Gedanken sind frei").

Cheers,
 

Enlightened Layperson said...

Bart: I am not sure what if any standard of proof has been previously applied in military status hearings. Under wartime conditions, I would probably settle for a preponderance of evidence.

Can I take it, then, that you are talking about some sort of summary in field court martial procedure?

Historically, the commander of the capturing military unit determined the status of the prisoner and took the appropriate action. This could range from a formal hearing like that given to Major Andre to a quick and dirty determination on the battlefield. There really were no established rules.

I am unaware of the courts martial process being used for a status hearing. Courts martials are for the discipline of our own soldiers.
 

"...I would interrogate and then execute unlawful enemy combatants. POW privileges should be reserved for combatants who follow the basic laws of war and a modicum of civilization, not for terrorists. Extending POW rights to unlawful enemy combatants simply rewards barbaric behavior."


This statement looks like it might have come from a third George...namely King George III.

The insurgents in Iraq are resorting to guerilla warfare for the same reason we did during the American Revolution: it had the best odds at succeeding. And as our forefathers experienced, the current insurgency is growing due, in part, to the tales of mistreatment at the hands of the "empire" they are fighting.

One can't help but think that if our post-invasion planning had gotten farther than trying to figure out how many troops we would need to sweep up all the flowers the Iraqis were going to shower on us upon our triumpant parade into downtown Baghdad, we could have avoided a lot of this mess.
 

JT Davis says:

That's probably unfair to KGIII. Have you ever taken the LGF Quiz?

Thanks, JT. Puts "Bart"'s 'experts' into perspective. Let's see if he addresses this. Doubt it.

Cheers,
 

Invoking the memory of some hero of the past will nearly always fail to take on their strengths and nearly always succeed to take on their failings.
 

My major problem with this is how their enemy combatant status is determined. If I understand right, some, if not a majority of these detainees weren't captured on any battle field or in a terrorist stronghold or in the process of making IUD's and the like. Many of them were rounded up during broad sweeps or based on tips from dubious sources such as a rival clan.

Designating them as unlawful enemy combatants on what seems like nothing more than executive say-so seems antithetical to the basic principles of justice. Its circular logic: the detainees aren't entitled to any rights to challenge their detainment because they are guilty of being unlawful enemy combatants, but they are unlawful enemy combatants because they can't challenge their pre-determined guilt. Its all based on executive say-so, including the proposed tribunals: the judges, prosecutors, defenders, sentencing and evidenciary rules are all, ultimately, at the whim of the executive. Haven't dozens if not hundreds of detainees been set free after years when it was (finally) determined they were detained by mistake? Doesn't this provide evidence that assuming the guilt--and thus enemy combatant status--of all those at Gitmo and similar facilities is unjust?

Its ashame that questioning our actions in this situation has become so bitter and partisan--as if I'm a terrorist sympathizer, or its only liberals that have a problem with what's going on. I want those guilty to pay the harshest penalties under the law. But detaining people (not on any sort of battlefield), stripping them of any fundamental rights, such as Habeas Corpus (which predates our constitution), all by executive fiat seems counter to any sort of democratic ideals, not to mention true, original conservative ideology.
 

Attention Comrades,
Sorry, but we're back.
Please visit http://ministryoflove.wordpress.com to learn more about our creative protest of the Military Commissions Act.
Or watch our spiffy video at http://www.youtube.com/watch?v=uOq5yHDkQgY
Links to either URL are doubleplushelpful.
Regards,
O'Brien
 

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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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