Balkinization  

Monday, September 17, 2007

Confirm Michael Mukasey

Scott Horton

The president has nominated former federal judge Michael Mukasey to serve as the next attorney general. The Senate will have plenty of questions to ask and issues to raise, and it should take this confirmation seriously. But it should move expeditiously to approval, recognizing that this is the first essential step towards taking the Justice Department off of life-support and making it a functioning agency once more.

I have known Michael Mukasey for over twenty years and I have a pretty good sense of his views on a great many issues. There are not many issues on which we agree, frankly. I am a civil libertarian and human rights advocate. Mukasey is driven by a concern for national security, and his many years on the bench tell him that our criminal justice system is inadequate to the task of trying terrorists. I recently parsed his op-ed in the Wall Street Journal looking for some important points I could agree with, and struggled to find them. Many of the civil liberties that Mukasey sees as vulnerabilities, I see as strengths.

Nevertheless, I consider Mukasey a highly qualified candidate and am prepared to support him with enthusiasm. Why? First, the president is entitled to nominate a candidate who represents his views on legal policy. I don’t think there’s room for a ray of light to pass between the Bush Administration and Mukasey, frankly. Mukasey has been close to Rudy Giuliani for many years, but those who know him also recognize that Mukasey is more of a traditional social conservative than Giuliani, which is to say he is actually closer to Bush than to Giuliani on a series of legal policy issues. Critics who argue that the next attorney general should turn from the Administration’s viewpoint are not being realistic. That is not the way our system works, and to hold to such a posture would only result in an administrative gridlock that would serve no one’s interests.

Second, Mukasey is not just a prominent judge, he is a judicious personality. That is to say, he has one much underrated quality in abundance: the ability to listen carefully, weigh facts and arguments and then form decisions. He does not rush to judgment. Having an attorney general who can listen carefully and deliberate will be a refreshing change. Mukasey will be a perfect person to lead a discussion of the current policy issues on the horizon—over extension and modification of FISA, military commissions, the national security court and similar matters. He will represent Bush faithfully and advise him well; but he will also listen carefully and insure a more effective effort to form a national consensus on these matters than we have seen up to this point.

Third, Mukasey is a lawyer’s lawyer. He actually cares a great deal about the law and what it provides; he approaches a question very carefully and with appropriate respect and deference for statutes and precedent. He knows how to separate and he does separate his own political views from what the law says. We haven’t had an attorney general like that in quite a long time. We’re past due. In fact having an attorney general who places emphasis on the traditional virtues of a great profession will be a very good thing for the Bush Administration and for the Justice Department.

Fourth, the Department of Justice faces a crisis of morale and confidence the likes of which it has rarely seen in American history. The only recent parallel was in the months following Watergate, when Gerald Ford chose Edward Levi as attorney general (and that nomination is certainly the closest in modern times to the selection of Mukasey). Mukasey is a man who first made his career as a prosecutor working for the Department of Justice and who was clearly moved, long into his later career, by love for the Department. That makes him a perfect person to address the internal problems of the Department. We face a number of pressing policy issues relating to law and the administration of justice, but they are all somehow dwarfed by the institutional troubles of the Department of Justice. This great ship has been tragically steered into a shoals and it is now in real danger. I think Mukasey is just the pilot to steer it clear again.

Civil libertarians will find no shortage of things to dislike about Michael Mukasey. But they should stop and recognize that he reflects the fundamentally conservative values which are essential to making our government work, and which have been often missing in a government that calls itself conservative, but really is not. Mukasey is a true conservative in much the same sense that Edmund Burke was a conservative. And perhaps that’s the strongest argument that can be mustered for his confirmation.

Cross-posted at Harper's Magazine

Comments:

I would only add that Mukasey has a better than average chance of remaining AG in a Giuliani Administration, proving the possibility of continuity.
 

Scott: I strongly disagree. Before any decision is to be made, the Senate must ascertain Mukasey’s views about torture and cruel, inhuman or degrading treatment. Any acceptable nominee for attorney general must clearly and publicly affirm that torture and ill-treatment are always and everywhere forbidden by law. This prohibition is binding on the US by virtue of the Geneva Conventions, the International Covenant on Civil and Political Rights (ICCPR), the Torture Convention, customary international law, jus cogens, the UCMJ and other relevant federal statutes.

The non-self-executing declarations attached to the ICCPR and the Torture Convention, and the unresolved debate whether the Geneva Conventions are self-executing, mean that (in practice, if not by law) judges are inhibited and perhaps blocked from enforcing treaty prohibitions on torture and ill-treatment. That places effective responsibility for enforcing executive branch compliance with treaty prohibitions on torture and ill-treatment almost exclusively in the hands of the attorney general. The attorney general will play a large role in determining whether torture and ill-treatment will be used.

The Senators need to ask Mukasey the following questions.

1. Is it ever legal to inflict torture or cruel, inhuman, or degrading treatment on any person?
2. Does the President ever have legal authority to order such treatment to be used?
3. Which of the "enhanced interrogation techniques" used by the CIA (*including* prolonged isolation, sleep deprivation, sexual humiliation, manipulation of phobias) are prohibited by law?

Unless the nominee can give clear and unequivocal answers to these questions ("no" to 1 and 2 and "all of the above" to 3), he should not be confirmed.

It is misleading to write that “the president is entitled to nominate a candidate who represents his views on legal policy.” The president is not entitled to nominate someone who will tolerate torture and ill-treatment.
 

I agree with Jamie Mayerfield that the interrogation policy issues need to be vetted. By saying that Bush is entitled to an attorney general who upholds his policies I don't mean to say that this can be done outside of the law. That indeed is fundamental.
 

"First, the president is entitled to nominate a candidate who represents his views on legal policy."

Presidents generally may be entitled to nominate a candidate who represents his views on legal policy, but this president is entitled to nothing but a fair war-crimes trial at the Hague. I express no opinion on Mukasey, but I do not think that our differences with Bush are differences on legal policy. They are differences in whether we accept the Constitution and the laws that used to govern this nation.
 

Even if Judge Mukasey isn't a fan of handling terrorism through the criminal justice system, I'm confident he'll at least insist that terrorism suspects are handled through SOME sort of legal process. He won't let things dangle in limbo until some Supreme Court decision forces the administration to actually come up with something.

Gonzales never had the credibility on terrorism issues to be any kind of policy-setter for the administration; he existed solely to rubber-stamp whatever the White House felt like doing. Judge Mukasey brings a genuine expertise to the position and thus has the ability to make credible proposals on this issue.
 

Jamie Mayerfeld said...

Scott: I strongly disagree. Before any decision is to be made, the Senate must ascertain Mukasey’s views about torture and cruel, inhuman or degrading treatment.

This line of questioning will be largely fruitless unless accompanied by a factual basis against which to apply the law. Everyone, including the Bush Administration, agrees that torture and cruel, inhuman and degrading treatment is wrong, but the rub is always what constitutes torture and cruel, inhuman and degrading treatment.
 

What does it suggest when, in order to get a principled Attorney General, we must first go through a calamity? This seems to be an argument against the mode of appointment we now have, and in favor of something else (a shadow cabinet?).
 

This comment has been removed by the author.
 

(reposting, typos)

OK we give up, we will give you something you want but there must something for us in it too, say Cheney's Patriot Act agenda. Deal?
---
The guy is clearly on a mission to expand the Patriot Act much further so this will have to be watched very carefully, but generally I agree with the author, given the desperate state of the DoJ we should take this "deal".

Two issues, however. His managerial skills and his religiosity. The first is important because this is a massive agency and judges typically have zero managerial skills. Any take on it?

Re his religiosity, I, like most of us could not care less whether he is an Orthodox Jew, devout Muslim, Hari-Krishna, Rastafarian or whatever as long as he keeps it private, is not too rabid about it and leaves it behind when he enters his office in the DoJ. Anything in his background suggesting we could have a problem here?
 

This line of questioning will be largely fruitless unless accompanied by a factual basis against which to apply the law. Everyone, including the Bush Administration, agrees that torture and cruel, inhuman and degrading treatment is wrong, but the rub is always what constitutes torture and cruel, inhuman and degrading treatment.

First of all, I don't think the Bush Administration and certainly not "everybody" does believe that.

Alan Dershowitz, for instance, doesn't believe it.

Rather substantial percentages of the American people don't believe it.

The producers of "24" likely don't believe it.

And I don't think the entirety of the Bush Administration believes it. Does Cheney believe it? Did John Yoo and Alberto Gonzales and Jay Bybee believe it?

Really, Bart, I think you would concede that in fact there are many people in this country and including in the administration who believe that national security concerns can trump the rules against torture and certainly the rules against cruel, inhuman, and degrading treatment. That, after all, is what the "ticking bomb" scenario we hear all the time is all about.

Further, with respect to cruel, inhuman, and degrading treatment, there has been a great reluctance among Congress, the courts, and the Bush Administration to apply to it the full set of sanctions that apply to torture. First, it is defined narrowly under a reservation and understanding to the Convention Against Torture to mean only that conduct which shocks the conscience. Then, it is unclear to what extent the Torture Act bars it. And the Bush Administration has argued that the reservation and understanding exempts foreign detainees altogether from any protection against cruel, inhuman, and degrading treatment.

So, no, the only issue is not "how is it defined?". There's plenty of questions to be asked about if there are situations where the rules don't apply, whether the cruel, inhuman, and degrading treatment prong applies to foreign detainees, whether it is limited to actions that shock the conscience.

With respect to how is it defined, it is also the case that while the Bush Administration can attempt to avoid discussing whether particular techniques are illegal (as it has done in the past), the Democrats are under no obligation to confirm the attorney general either. This is a very different ballgame than the oversight hearings that have occurred in the past.
 

dilan:

The President's appointees have been frequently been asked if they oppose torture and they all say yes.

The question is meaningless because every single one of us has different ideas of what constitutes "torture."

The definition of "torture" as "severe pain" does not provide much assistance because we all have different ideas of what constitutes "pain."

The examples of given here of what posters believe constitute "torture" have ranged from sensory deprivation by blindfolding to beatings.

In order to get a substantive answer, you need to provide a factual basis by describing the act and then ask the respondent whether they think that act is torture.

Anything else is useless political posturing.
 

I am a very liberal Democrat, and think Judge Mukasey is as excellent a choice as we (the country) are likely to get. My wife clerked in the SDNY for four years while I taught at Cardozo Law School (I haven't seen it mentioned anywhere, but the judge attended an Orthodox Jewish day school, Ramaz), while the judge's son was a student there. I have a number of good friends, liberal and moderate Democrats, who are district judges in the SDNY and on the Second Circuit. I can't imagine any of them not supporting him, as do I.
 

"Bart" DePalma says:

[Scott]: I strongly disagree. Before any decision is to be made, the Senate must ascertain Mukasey’s views about torture and cruel, inhuman or degrading treatment.

This line of questioning will be largely fruitless unless accompanied by a factual basis against which to apply the law.


Well, hell has frozen over. I agree with "Bart". Yes, we should have a "factual basis" against which to evaluate the law. We need to know what our gummint has done to people (renditions, stress positions, sensory deprivation, waterboarding, torture, beatings, homicides, whatever), and under what authority. Yes, I'd welcome some "factual basis" here. The gummint should come clean about what it's done, and then we can sit around and discuss if that's the kind of thing we think our gummint should be allowed to do. Hmmmm ... the word "Nuremburg" rings a bell....

Cheers,
 

The opportunity costs here are worth considering: for example, getting a candidate into the position to restore some modicum of functionality to the DC DoJ; getting someone even halfway competent into position before the Administration runs out the clock; on the other hand, risking putting a shadow-nominee sycophant into position who will allow them to run out the clock; whether they will delay and leave the position unfilled regardless; or, perhaps most salient, whether anything could possibly be worse than Alberto Gonzales or a Bush-appointed interim lackey.

If the White House doesn't change hands in 2008, this is all moot, because the torture issue and all the rest won't get fixed under another GOP President; thus it seems to me that the priority right now isn't reversing the Administration's policies as fast as possible, but merely holding the door open long enough to fix the institutional damage and perhaps hold some of the worst offenders accountable.

Also, the fact that the usual suspects are kvetching about the appointment does bring a little bit of warmth to my heart. Not at all sure what to think about "Bart"'s backhanded endorsement, though -- that more than anything else gives me pause.

Put him up there and ask some hard questions about Administration policy and the mess at the DoJ, and see if he waffles. If he hesitates, toss him out and ask for the next one. At the very least, we might be able to fix the public eye on these issues, and the fact that they've put one nominee out there means it's going to be much harder to stonewall from here on out.
 

Scott,
You focus on the torture/civil rights aspects of our current crisis. In your opinion, can Judge Mukasey be an honest broker in getting down to the bottom of the US attorney firing scandal?

Also, it seems to me that if I am reading you correctly, a Mukasey AG tenure would lead to more situations similar to the FISA bill that was passed earlier this summer. Mukasey will root out the Bush administration policies that are illegal (or extralegal), and will work with the congress to try to pass legislation that will make the policies legal.

Am I correct? Is this the best we can hope for right now? Make the war on terror illegalities legal?
 

(some secondary and somewhat cynical observations)


We keep hearing left and right from members of the legal profession how fair Mukasey tend to be to everybody in the courtroom.

That's real nice of him but isn't being fair to both sides in the courtroom a basic requirement in any legal system, including ours?

So are we to infer from this that fairness in our courts is so unusual that rare judges who practice it deserve special brownie points for it?

---
Fair he may be, but by far the more defining characteristic of this fine jurist is him being a paragon of Draconian justice.

35 years for thinking about doing things as opposed to actually doing something? It follows that actually doing things would force Mukasey to order drawing and quartering, putting to stake, burning alive or something equally nice.

The concept of proportionality, a bedrock of fair judicial systems everywhere is apparently totally foreign to him, so all you defense lawyers out there brace yourself for new potentially interesting era in federal courts.

---
Also that reported fairness to defendants doesn't seem to extend to protecting them from brutality when held in pretrial detention on his orders. Per WSJ when the attorney for one terror defendant complained about his client being beaten in jail, he refused to intervene on grounds that the defendant look fine to him.

That's a judicial irresponsibility of highest order for he surely must know that the art of beating prisoners w/o leaving traces is a standard skill among guards in prisons all across the country.

Besides any allegations of abuse when a citizen is sitting totally helpless and at the mercy of prison guards need to be investigated and acted upon immediately, if that judicial system of ours is to have any integrity to it.

---
And finally I'm growing a bit suspicious of all those people heaping tons of praise on him. The tone is a little bit too laudatory, too saccharine, too sycophantic to be real. Maybe he really deserves it but with all those unfilled positions in the DoJ I'm thinking ...


---
He may turn the department around, the question is how draconian this new department will become in the process.
 

The praise for Judge Mukasey from those who know him (and who like me have different politics) reflects how he actually functions. Its not that he should get special brownie points for being what we expect of judges, it is that we have a record upon which we can, to the extent possible, predict how he mightbehave int he future. That was possible with the last AG which is why he was put there and he functioned just as Bush wanted him too. The fact that Mukasey was passed over by Bush for 5 vacancies on the court of appeals and retired rather than wait around for a possible appointment in a Guiliani administration says a lot too in the real world, not a fictional one.
 

-wq- wrote:

We keep hearing left and right from members of the legal profession how fair Mukasey tend to be to everybody in the courtroom.

That's real nice of him but isn't being fair to both sides in the courtroom a basic requirement in any legal system, including ours?

So are we to infer from this that fairness in our courts is so unusual that rare judges who practice it deserve special brownie points for it?


That's my take on it too.

First point that needs to be made is that it is the job of a judge to attempt to be fair and non-partisan (and their actions need to stand up to public scrutiny). In addition, judges are independent of the executive, and for the most part their own boss. They don't have to deal with political pressures, and can afford to stand up to the executive when the executive is one party to the dispute at bar. When his job becomes one of being the chief law enforcement officer owrking for the maladministration, he may well follow a different course (and think it's just 'doing his job')....

Second point is that Mukasey's ruling that Padilla needed to be afforded legal counsel shouldn't be taken as an encouraging sign; this is really the bare minimum that you should expect as a matter of course from a jurist. The fact that Mukasey thought that Padilla could be held indefinitely as an "enemy combatant" without charges or trial doesn't bode well.

Cheers,
 

arne langsetmo said...

Yes, I'd welcome some "factual basis" here. The gummint should come clean about what it's done, and then we can sit around and discuss if that's the kind of thing we think our gummint should be allowed to do. Hmmmm ... the word "Nuremburg" rings a bell....

Be careful what you wish for, arne.

If what should be done to KSM was put to a popular vote, I would not be surprised if racking to gain information followed by the old English treason punishment of near hanging followed by disembowelment was approved by a majority.

The average American voter is not nearly as squeamish about interrogation as many who post here.

As I posted before, the concept of "torture" is largely in the eye of the beholder. That is why elections matter.
 

"Bart" DePalma:

If what should be done to KSM was put to a popular vote, I would not be surprised if racking to gain information followed by the old English treason punishment of near hanging followed by disembowelment was approved by a majority.

Of course. You, similarly to many of the RWA contingent, happen to think that everyone thinks like you.

But FWIW, I didn't say that torture ought to be put to a "popular vote", even if it were true that it might be 'popular'. Nor do I think that it's possible to "put [it] to a popular vote" to any legal effect. The U.S. federal gummint isn't run by referendum, and the Constitution is not amendable via that route.

The average American voter is not nearly as squeamish about interrogation as many who post here.

That may be so, but there wasn't a lot of "Hosannahs" and "atta-boys" when the Abu Ghraib pictures came out.

As I posted before, the concept of "torture" is largely in the eye of the beholder. That is why elections matter.

True, and that's why I'll do everything I can to get the RWA neocon/social-'conservative' Republicans turned into the sad historical footnote they deserve to be.

Cheers,
 

There appears to be lower expectations here. This pick is good since ... the guy's a professional that won't embarass us. In fact, he might actually do a good job as to the mechanics of the situation.

[There are such people in the Bush Administration. Some left it for that very reason ... they couldn't take the rest any more. Or, were kicked out by those who didn't like competency.]

Somewhat depressing. Comments from various lawyers suggest, yes, the bona fides expressed here as to his fairness is sadly notable.

I'm willing to accept he is a decent choice given what we are likely to get. Horton clarified the limits to administration discretion. But, I fear a quick confirmation will let the administration off the hook.

We saw other credible choices get in and little changed occurred. A full vetting and some hope that investigations will continue (and continual pressure from the Congress ... noises suggests people like Schumer don't agree this is necessary) is necessary.

BTW, the bait and switch on the acting AG must be noted.
 

Looks like the Dems are going to hold Mukasey hostage to their demands for privileged Executive documents. It doesn't appear that the Dems have much confidence in prevailing on the executive privilege issue in the courts.
 

joe:

I'm willing to accept he is a decent choice given what we are likely to get. Horton clarified the limits to administration discretion. But, I fear a quick confirmation will let the administration off the hook.

We saw other credible choices get in and little changed occurred.


Powell --> Rice
Ashcroft --> Seedy

Actually, I think the second round has not been noticeably better and in some cases much worse (and its a rare day I say that about the likes of Ashcroft, just to show how low the bar has gotten).

Cheers,
 

"Bart" DePalma:

Looks like the Dems are going to hold Mukasey hostage to their demands for privileged Executive documents. It doesn't appear that the Dems have much confidence in prevailing on the executive privilege issue in the courts.

That's not very astute, "Bart". Going through the courts is time-consuming, and the maladministration just wants to run out the clock. This is one way to bring the issue to a head in a timely manner.

Cheers,
 

Scott:

"First, the president is entitled to nominate a candidate who represents his views on legal policy."

First, just because the president nominates somebody, that doesn't mean that they are should be confirmed. Two entirely separate things.

Second, after six years of unprecedented criminality,Bush doesn't *deserve* anything. His last attorney general set new lows, and he had to beat out Nixon's guy to do that.

Scott, in your professional career, is there *anybody* with a job record even one-fourth as bad as Bush, about whom you've written that his or her judgement is worth one iota of respect?

Could you please name for us such a law student whom you said deserved a job? The law professor so bad whom you recommended as a colleague?
 

By the way, Bart, I've been around this with you before, but there is actually rather extensive law, both domestic (28 USC 1350 cases as well as various torture statutes) and international, as to what constitutes torture.

It's a common right wing spin tactic to say that nobody really knows what it is (but of course, inconsistently, whatever the Bush Administration is doing cannot be torture). That simply isn't true.

And that gets us back to my point-- there are plenty of people who indeed believe that torture-- i.e., the type of thing that clearly violates international and domestic law-- is perfectly permissible in certain scenarios of terrorist interrogation.
 

Dilan:

And that gets us back to my point-- there are plenty of people who indeed believe that torture-- i.e., the type of thing that clearly violates international and domestic law-- is perfectly permissible in certain scenarios of terrorist interrogation.

And my point too, albeit underappreciated by at least some here. Let's see what they're doing, and see if it comports with the law. And if the laws are being violated, but enough people (or at least legislators) think they need changing nonetheless to allow the illegal practises, so be it, but let's do so within the law and aboveboard so people can see what we do and why. And I'd reiterate my position on the "nuclear option": If you think you need to violate the law, then I guess it's up to you to do it ... but then be a responsible person and own up to what you did and take the punishment (if any). Civil Disobedience 101. None of this dodging behind a "state secrets privilege".

Cheers,
 

How come no one cares that the Constitution says, with the "advice and consent of the Senate?"

Just a response to First, the president is entitled to nominate a candidate who represents his views on legal policy.
 

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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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