Philly.com: C is for caution: C-sections on the rise

C is for caution: C-sections on the rise
Or it may be for convenience, critics say. The surgery, once risky, now is used in about a third of U.S. births.
By Marie McCullough
Inquirer Staff Writer
For a peek into the future of childbirth, look to Puerto Rico.
Nearly half of all babies born in the U.S. protectorate are delivered by cutting open their mothers’ abdomens.
On the mainland, the cesarean section rate is not as high, but it has been climbing for a decade. In 2005, almost a third of the nation’s 4.1 million births were surgical.
New Jersey, which tops the charts with a 36.3 percent cesarean rate, had a few northern hospitals that matched Puerto Rico’s 47.7 percent rate. Pennsylvania, at 28.8 percent, was far behind, but some individual hospitals were not. Lankenau Hospital in Wynnewood hit 41 percent.
No one can explain why the United States keeps shattering its own cesarean records. Many experts say there is no “ideal” cesarean rate, but there is also no evidence that a vast, growing segment of the female population wants or needs major abdominal surgery to give birth. And while a dramatic decline in maternal deaths coincided with higher rates of cesarean, that trend ended 20 years ago. Today, ill effects such as life-threatening placental problems are being linked to C-sections.
Yet natural delivery is not enjoying a rebirth.
Pennsylvania Hospital high-risk obstetrician Harish Sehdev said, “If I look at Pennsylvania Hospital, we may say, ‘Sure, we’d like a lower rate.’ But when you review why an individual cesarean was done, I think it was appropriate.”
Groups that have demonstrated the will and the way to reduce cesareans – midwives, birthing coaches, lactation consultants, and other fans of natural birth – are far less influential than in the 1980s, when they led a modestly successful fight against rising cesarean rates.
“This is mostly about changes in culture,” said Eugene Declercq, an expert in maternal and child health at Boston University’s School of Public Health. “In all the gray areas of clinical decision-making, obstetricians have moved to cesareans. Mothers are more accepting, too.”
Cesarean critics worry that doctors are frightening mothers into the surgery.
“A woman who is given reason to be scared that something bad might happen to her unborn child will do anything to avoid it,” said Jose Gorrin Peralta, a University of Puerto Rico obstetrician. “If the doctor says, ‘Your baby could die unless I do a cesarean,’ what woman is going to say, ‘Don’t do it’? I call it obstetrical terrorism.”
In the spring, the deaths of two Barrington elementary school teachers gave maternity-care activists a sorrowful platform to lobby for a new law that would help pregnant women evaluate their risk of being cut open.
Valerie Scythes and Melissa Farah died, 15 days apart, after delivering healthy babies by cesarean section at Underwood-Memorial Hospital in Woodbury. Although no one has yet alleged that surgery caused the deaths, both families have hired lawyers.
Activists gamely staged a demonstration last month on the sidewalk in front of Underwood – a dozen women with children in tow – yelling over the noise of traffic and street construction.
“Right now, the whole country is looking at what we do here in New Jersey,” birthing coach Stacey Gregg proclaimed. “Pregnant women consumers in New Jersey need to have the cesarean rate statistics for each hospital and obstetrician so they can make informed health choices.”
Who’s choosing?
Through the 1940s, cesarean delivery was a rare, last resort to save the baby, often at the cost of the mother’s life. One in 16 women died.
With the advent of modern anesthesia, antibiotics, transfusions and surgical techniques, the procedure became truly lifesaving.
The doctor could perform a rescue within minutes if the mother’s blood pressure or blood sugar soared. If she hemorrhaged. If the placenta separated from her womb or blocked her birth canal. If the baby began suffocating because a shoulder got stuck after the head emerged.
Gradually, though, cesareans became more about caution and convenience than life and death. Most are done because labor has gone too long or at the first hint of trouble, such as a “nonreassuring” fetal heart rate on a monitor.
Two years ago, a few prominent U.S. obstetricians argued for a radical change. They contended that pushing a baby through the birth canal was inherently riskier for the mother’s pelvic anatomy and the child’s health than a cesarean. Surgery, they said, should be a woman’s choice, even for her first pregnancy, even if she didn’t need it.
This went far beyond the consensus that after a cesarean, a woman could choose surgery for subsequent pregnancies.
The American College of Obstetricians and Gynecologists decided to weigh in on the ethics of this controversial notion of “maternal choice” cesarean.
It concluded that data on the risks and benefits were lacking. Therefore, the group said, performing one is ethical if the physician “believes” it promotes the patient’s health – and unethical if the physician “believes” it doesn’t.
Before long, the media were reporting that growing numbers of women were demanding that they go under the scalpel for their first births because, well, they preferred to.
But efforts to quantify this demand have found it doesn’t really exist.
Healthgrades, a health-care ratings firm, used hospital discharge data to estimate that maternal-request cesareans rose from 1.6 percent of all cesareans in 1999 to just 2.6 percent in 2003.
Seattle public-health researchers pored over even more years of national hospital data, combing information on 459,000 women who gave birth, then narrowing the numbers down to those who had first cesareans without any medical reason or any labor. Between 1991 and 2004, they found only 309 such women.
Childbirth Connections, a maternity-care advocacy organization, sponsored a national survey of 1,500 women who gave birth in 2005.
“Only one woman met the criteria for maternal-request cesarean,” said Boston University’s Declercq, the lead author of the survey analysis. “We figured we’d have maybe 20 women.”
Plus-size fears
Study after study has found that obese women are more likely than thin ones to develop serious complications in pregnancy. They are also more likely to have babies born with debilitating spinal-cord defects, prematurely, or “macrosomic” – 10 pounds or more.
These factors give an obese woman up to a 50-50 chance of cesarean, which, because of her weight, will not be easy.
“I have huge anxiety for these women,” said Laura Riley, an high-risk obstetrician-gynecologist at Massachusetts General Hospital in Boston. “On one hand, I applaud them for wanting a vaginal birth. But I’m fearful because not only do you labor a long time, it’s a big baby, it’s hard to establish how big the baby is, then you end up with a failed vaginal delivery. And then the C-section is harder, there’s greater blood loss, greater danger of infection in the incision. In addition, there’s greater risk for a DVT [deep-vein blood clot] or pulmonary embolism than with someone who’s thinner and up and out of bed faster.”
Prodded by Riley, the American College of Obstetricians and Gynecologists two years ago issued guidelines that say obstetricians should warn patients about these risks and encourage weight loss “before attempting pregnancy.”
“We need to fess up that this is a medical problem,” Riley said. “It’s not about passing judgment on women who don’t look like they belong on the cover of Cosmo.”
Yet for plus-size women, that’s too often exactly what it seems like.
Maria Barroso, 23, of Queens, N.Y., is 5-foot-5 and 325 pounds. When she got pregnant in 2004, she and her husband were thrilled.
Her doctors were nervous. They warned her, she said, that she was likely to develop gestational diabetes. And even though estimates of fetal weight are notoriously inaccurate and don’t justify a cesarean, “they kept telling me I was going to have a big baby, and that many plus-size women can’t have a baby naturally.”
She wound up with a cesarean she thinks could have been avoided.
In 2005, newly trained as a birthing coach and under a different doctor’s care, Barroso gave birth to her second child vaginally. She labored for 26 hours.
“I stuck it out ’cause I didn’t want the recovery I had had the year before,” she said. “I knew that unless my life or my son’s life was in danger, I was going to give birth vaginally.”
Barroso’s experience raises the question: Are changing demographics fueling first-time C-section rates?
Declercq and his Boston University colleagues used birth-certificate data to examine two periods: 1991 to 1995, when first-time cesareans decreased slightly, and 1996 to 2002, when they shot up like uncorked champagne. The researchers looked at maternal, fetal and labor-delivery factors – incompetent cervixes, dysfunctional placentas, diabetes, genital herpes, breech position, macrosomic size, and much more.
The fall and rise of first-time cesareans “were not related to shifts in maternal risk profiles,” they concluded.
A similar analysis in Puerto Rico also found no link between risks and rates.
Specter of lawsuits
In Chinese tradition, July is the “ghost month,” when spirits come out from the lower world to visit earth.
Because many Chinese believe July is an inauspicious time for any type of surgery, researchers at Taipei Medical University looked at cesarean rates.
Sure enough, in a study published last year, they found cesareans were unusually low in July – and unusually high in June.
While the United States doesn’t have a ghost month, the specter of lawsuits heavily influences the use of cesarean.
At Lankenau, for example, the cesarean rate rose from 28 percent in 2001 to 36 percent the very next year. The jump was largely triggered by a lawsuit contending that a child was born with cerebral palsy because a cesarean was not performed. The parents won a $24 million verdict.
“You can imagine there is that fear of what can happen,” said Nancy Roberts, the chief of obstetrics.
A Pennsylvania State University College of Medicine study of 31 hospitals found that the more physicians perceived they were at risk of being sued, the more cesareans they did.
The fallacy behind this phenomenon is that a cesarean is a guarantee against unhappy outcomes. It isn’t.
“It’s not going to get you out of anything,” said Raymond Brown, a longtime Temple University Hospital obstetrician-gynecologist who said his cesarean rate was about 15 percent. “But at least they aren’t going to say, ‘You could have prevented this by doing a cesarean.’ ”
Many obstetricians argue that their patients are the ones who have developed an extreme, almost unreasonable, aversion to the tiniest risk. This pushes doctors to do more just-in-case cesareans. For example, to prevent one 10-pound baby from shoulder nerve damage during vaginal birth, they have to surgically deliver 3,700 macrosomic babies, according to a March editorial in the New England Journal of Medicine.
These debates would not matter so much if it were clear that the surge in surgery was good for patients.
But it is not clear.
While studies find that a woman’s risk of death from cesarean is remote – not to say as low as with vaginal birth – the recovery time is much longer, and hemorrhage, infections, dangerous clots and rehospitalizations are more common.
Cesarean also poses risks to future pregnancies. Evidence is growing that uterine scarring can cause placental abnormalities that endanger mother and baby, and that the risk of these abnormalities increases dramatically with each subsequent cesarean.
Life-threatening situations have become so common, “you’d be hard-pressed to find an obstetrician who doesn’t know the terror of these near-misses,” said Carol Sakala, director of programs for Childbirth Connection.
Newborns, meanwhile, are more likely to have temporary respiratory difficulties after a planned cesarean.
Planned cesareans may even be contributing to the mysterious, dramatic increase in premature births. That’s because a baby who is estimated to be full term may actually be weeks younger.
“We are foreshortening gestational age . . . with a giant social experiment,” Sakala said.
So far, though, there is little to stop the trend, even in places that have jaw-dropping cesarean rates.
In New Jersey, Charles Denk, an epidemiologist with the state Department of Health and Senior Services who has analyzed cesarean data, said the Garden State was “riding the same wave as everybody else” – albeit with a faster surfboard.
“Physicians decide the benefits outweigh the risks,” he said. “As long as there is that perception, the rates will continue to go up.”
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View a slideshow and hear an interview on the risks and benefits of cesarean delivery with obstetrician Jeffrey Ecker via http://go.philly.com/health
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Contact staff writer Marie McCullough at 215-854-2720 or mmccullough@phillynews.com.
I thought this article was one of the best I have ever read about the cesarean birth issue.
Jenny Hatch

SF Gate: Adult Psychiatric Drug OK’d for Kids

Adult Psychiatric Drug OK’d for Kids
risperdal.jpg

“The Food and Drug Administration on Wednesday approved a widely used adult psychiatric drug for the treatment of schizophrenia and bipolar disorder in children and adolescents.

The action permits use of Risperdal for schizophrenia in youths aged 13 to 17 and for bipolar disorder in those aged 10 to 17, FDA said.

It was approved last fall for treatment of irritability in autism.

Risperdal, manufactured by Janssen, L.P. of Titusville, N.J., is the No. 3 anti-psychotic drug, with $2.3 billion in sales in 2005, according to the pharmaceutical data company IMS Health. Janssen is a unit of Johnson & Johnson.

Risperdal was approved for use in adults in 1993.
Until now, FDA said, there has been no approved drug for the treatment of schizophrenia in youths and only lithium is approved for the treatment of bipolar disorder in adolescents.
The dose approved for youths is slightly lower than the adult dose, FDA said.

Drowsiness, fatigue, increase in appetite, anxiety, nausea, dizziness, dry mouth, tremor, and rash were among the most common side effects reported, the agency said.”

Most common Risperdal Side Effects:
Abdominal pain
Vomiting
Constipation
Diarrhea
Dry mouth
Sore throat
Abnormal walk
Agitation
Aggression
Anxiety
Chest pain
Coughing
Involuntary movements
Nasal inflammation
Decreased activity
Decreased sexual desires
Lack of coordination
Impotence
Dizziness
Dry skin
Difficulty urinating
Heavy menstruation
Tremor
Weight gain
Lethargic feelings
Join pain
Difficulty ejaculating
Tremor
Respiratory infection
Some Risperdal patients may want to consider alternate treatment methods due to the evidence of increased risk and lack of adequate safety studies.
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Those Risperdal Legos are really something. Does that mean the child who is about to be treated is sent the message, “Hey, taking psychiatric meds is sort of like playing with Legos, see how fun it is to take our pills!!! Just like playing with your toys!!!”
Good job Big Pharma Drug Pushers. Why not put the drug in a lolly pop and sell it with helium baloons? And give away a Barney Video with each sale? “I love you, you love me, we’re a druggy family!!! With a great big hug and a kiss from me to you….won’t you take my drugs instead of sue?”
Sue, as in lawsuit for pushing yet another toxic chemical on the children of America.
Sick, very very sick.
Jenny Hatch

Hugh Hewitt: Will 10,000 Terrorists Killed Or Captured In Iraq In 2007 Lead The MSM News Tonight

Will 10,000 Terrorists Killed Or Captured In Iraq In 2007 Lead The MSM News Tonight
Mr. Hewitt shares an ironic ABC news picture with misleading and negative sub titles of the presidents speech. I wonder how much longer they think they can get away with this sort of yellow, dog eared journalism?
Jenny Hatch

Huff Po: Stressed Opera Singers Turn to Drugs

Stressed Opera Singers Turn to Drugs
This is one of the reasons I love being an amatuer singer. If I were under all of that professional pressure, it would take the joy out of singing. The definition of the word amatuer
Jenny Hatch

George Bush Speech to the Veterans of Foreign Wars (VFW)

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President Bush Attends Veterans of Foreign Wars National Convention, Discusses War on Terror
Kansas City Convention and Entertainment Center
Kansas City, Missouri


9:46 A.M. CDT
THE PRESIDENT: Thank you all. Please be seated. It’s good to be with you again. I understand you haven’t had much of a problem attracting speakers. (Laughter.) I thank you for inviting me. I can understand why people want to come here. See, it’s an honor to stand with the men and women of the Veterans of Foreign Wars. (Applause.) The VFW is one of this nation’s finest organizations. You belong to an elite group of Americans. (Applause.) You belong to a group of people who have defended America overseas. You have fought in places from Normandy to Iwo Jima, to Pusan, to Khe Sahn, to Kuwait, to Somalia, Kosovo, Afghanistan, and Iraq. You brought security to the American people; you brought hope to millions across the world.
As members of this proud organization, you are advocates for the rights of our military veterans, a model of community service, and a strong and important voice for a strong national defense. I thank you for your service. I thank you for what you’ve done for the United States of America. (Applause.)
I stand before you as a wartime President. I wish I didn’t have to say that, but an enemy that attacked us on September the 11th, 2001, declared war on the United States of America. And war is what we’re engaged in. The struggle has been called a clash of civilizations. In truth, it’s a struggle for civilization. We fight for a free way of life against a new barbarism — an ideology whose followers have killed thousands on American soil, and seek to kill again on even a greater scale.
We fight for the possibility that decent men and women across the broader Middle East can realize their destiny — and raise up societies based on freedom and justice and personal dignity. And as long as I’m Commander-in-Chief we will fight to win. (Applause.) I’m confident that we will prevail. I’m confident we’ll prevail because we have the greatest force for human liberation the world has ever known — the men and women of the United States Armed Forces. (Applause.)
For those of you who wear the uniform, nothing makes me more proud to say that I am your Commander-in-Chief. Thank you for volunteering in the service of the United States of America. (Applause.)
Now, I know some people doubt the universal appeal of liberty, or worry that the Middle East isn’t ready for it. Others believe that America’s presence is destabilizing, and that if the United States would just leave a place like Iraq those who kill our troops or target civilians would no longer threaten us. Today I’m going to address these arguments. I’m going to describe why helping the young democracies of the Middle East stand up to violent Islamic extremists is the only realistic path to a safer world for the American people. I’m going to try to provide some historical perspective to show there is a precedent for the hard and necessary work we’re doing, and why I have such confidence in the fact we’ll be successful.
Before I do so I want to thank the national Commander-in-Chief of the VFW and his wife, Nancy. It’s been a joy to work with Gary and the staff. Gary said, we don’t necessarily agree a hundred percent of the time. I remember the old lieutenant governor of Texas — a Democrat, and I was a Republican governor. He said, “Governor, if we agreed 100 percent of the time, one of us wouldn’t be necessary.” (Laughter.)
But here’s what we do agree on: We agree our veterans deserve the full support of the United States government. (Applause.) That’s why in this budget I submitted there’s $87 billion for the veterans; it’s the highest level of support ever for the veterans in American history. (Applause.) We agree that health care for our veterans is a top priority, and that’s why we’ve increased health care spending for our veterans by 83 percent since I was sworn in as your President. (Applause.) We agree that a troop coming out of Iraq or Afghanistan deserves the best health care not only as an active duty citizen, but as a military guy, but also as a veteran — and you’re going to get the best health care we can possibly provide. (Applause.) We agree our homeless vets ought to have shelter, and that’s what we’re providing.
In other words, we agree the veterans deserve the full support of our government and that’s what you’re going to get as George W. Bush as your President. (Applause.)
I want to thank Bob Wallace, the Executive Director. He spends a lot of time in the Oval Office — I’m always checking the silverware drawer. (Laughter.) He’s going to be bringing in George Lisicki here soon. He’s going to be the national commander-in-chief for my next year in office. And I’m looking forward to working with George, and I’m looking forward to working with Wallace, and I’m looking forward to hearing from you. They’re going to find an open-minded President, dedicated to doing what’s right. (Applause.)
I appreciate Linda Meader, the National President of the Ladies Auxiliary. She brought old Dave with her. (Applause.) Virginia Carman, the incoming President. I want to thank Deputy Secretary of Veterans Affairs Gordon Mansfield for joining us today. I appreciate the United States Senator from the state of Missouri, strong supporter of the military and strong supporter of the veterans, Kit Bond. (Applause.) Two members of the Congress have kindly showed up today — I’m proud they’re both here: Congressman Emanuel Cleaver — no finer man, no more decent a fellow than Emanuel Cleaver — is with us. And a great Congressman from right around the corner here, Congressman Sam Graves. Thank you all for coming. (Applause.)
Lieutenant General Jack Stultz, Commanding General, U.S. Army Reserve Command, is with us today. General, thanks for coming. Lieutenant General Bill Caldwell, Commanding General, Fort Leavenworth, Kansas, is with us today, as well. General Caldwell, thank you for your service. (Applause.)
Thank you all for letting me come by. I want to open today’s speech with a story that begins on a sunny morning, when thousands of Americans were murdered in a surprise attack — and our nation was propelled into a conflict that would take us to every corner of the globe.
The enemy who attacked us despises freedom, and harbors resentment at the slights he believes America and Western nations have inflicted on his people. He fights to establish his rule over an entire region. And over time, he turns to a strategy of suicide attacks destined to create so much carnage that the American people will tire of the violence and give up the fight.
If this story sounds familiar, it is — except for one thing. The enemy I have just described is not al Qaeda, and the attack is not 9/11, and the empire is not the radical caliphate envisioned by Osama bin Laden. Instead, what I’ve described is the war machine of Imperial Japan in the 1940s, its surprise attack on Pearl Harbor, and its attempt to impose its empire throughout East Asia.
Ultimately, the United States prevailed in World War II, and we have fought two more land wars in Asia. And many in this hall were veterans of those campaigns. Yet even the most optimistic among you probably would not have foreseen that the Japanese would transform themselves into one of America’s strongest and most steadfast allies, or that the South Koreans would recover from enemy invasion to raise up one of the world’s most powerful economies, or that Asia would pull itself out of poverty and hopelessness as it embraced markets and freedom.
The lesson from Asia’s development is that the heart’s desire for liberty will not be denied. Once people even get a small taste of liberty, they’re not going to rest until they’re free. Today’s dynamic and hopeful Asia — a region that brings us countless benefits — would not have been possible without America’s presence and perseverance. It would not have been possible without the veterans in this hall today. And I thank you for your service. (Applause.)
There are many differences between the wars we fought in the Far East and the war on terror we’re fighting today. But one important similarity is at their core they’re ideological struggles. The militarists of Japan and the communists in Korea and Vietnam were driven by a merciless vision for the proper ordering of humanity. They killed Americans because we stood in the way of their attempt to force their ideology on others. Today, the names and places have changed, but the fundamental character of the struggle has not changed. Like our enemies in the past, the terrorists who wage war in Iraq and Afghanistan and other places seek to spread a political vision of their own — a harsh plan for life that crushes freedom, tolerance, and dissent.
Like our enemies in the past, they kill Americans because we stand in their way of imposing this ideology across a vital region of the world. This enemy is dangerous; this enemy is determined; and this enemy will be defeated. (Applause.)
We’re still in the early hours of the current ideological struggle, but we do know how the others ended — and that knowledge helps guide our efforts today. The ideals and interests that led America to help the Japanese turn defeat into democracy are the same that lead us to remain engaged in Afghanistan and Iraq.
The defense strategy that refused to hand the South Koreans over to a totalitarian neighbor helped raise up a Asian Tiger that is the model for developing countries across the world, including the Middle East. The result of American sacrifice and perseverance in Asia is a freer, more prosperous and stable continent whose people want to live in peace with America, not attack America.

At the outset of World War II there were only two democracies in the Far East — Australia and New Zealand.
Today most of the nations in Asia are free, and its democracies reflect the diversity of the region. Some of these nations have constitutional monarchies, some have parliaments, and some have presidents. Some are Christian, some are Muslim, some are Hindu, and some are Buddhist. Yet for all the differences, the free nations of Asia all share one thing in common: Their governments derive their authority from the consent of the governed, and they desire to live in peace with their neighbors.
Along the way to this freer and more hopeful Asia, there were a lot of doubters. Many times in the decades that followed World War II, American policy in Asia was dismissed as hopeless and naive. And when we listen to criticism of the difficult work our generation is undertaking in the Middle East today, we can hear the echoes of the same arguments made about the Far East years ago.
In the aftermath of Japan’s surrender, many thought it naive to help the Japanese transform themselves into a democracy. Then as now, the critics argued that some people were simply not fit for freedom.
Some said Japanese culture was inherently incompatible with democracy. Joseph Grew, a former United States ambassador to Japan who served as Harry Truman’s Under Secretary of State, told the President flatly that — and I quote — “democracy in Japan would never work.” He wasn’t alone in that belief. A lot of Americans believed that — and so did the Japanese — a lot of Japanese believed the same thing: democracy simply wouldn’t work.
Others critics said that Americans were imposing their ideals on the Japanese. For example, Japan’s Vice Prime Minister asserted that allowing Japanese women to vote would “retard the progress of Japanese politics.”
It’s interesting what General MacArthur wrote in his memoirs. He wrote, “There was much criticism of my support for the enfranchisement of women. Many Americans, as well as many other so-called experts, expressed the view that Japanese women were too steeped in the tradition of subservience to their husbands to act with any degree of political independence.” That’s what General MacArthur observed. In the end, Japanese women were given the vote; 39 women won parliamentary seats in Japan’s first free election. Today, Japan’s minister of defense is a woman, and just last month, a record number of women were elected to Japan’s Upper House. Other critics argued that democracy — (applause.)
There are other critics, believe it or not, that argue that democracy could not succeed in Japan because the national religion — Shinto — was too fanatical and rooted in the Emperor. Senator Richard Russell denounced the Japanese faith, and said that if we did not put the Emperor on trial, “any steps we may take to create democracy are doomed to failure.” The State Department’s man in Tokyo put it bluntly: “The Emperor system must disappear if Japan is ever really to be democratic.”
Those who said Shinto was incompatible with democracy were mistaken, and fortunately, Americans and Japanese leaders recognized it at the time, because instead of suppressing the Shinto faith, American authorities worked with the Japanese to institute religious freedom for all faiths. Instead of abolishing the imperial throne, Americans and Japanese worked together to find a place for the Emperor in the democratic political system.
And the result of all these steps was that every Japanese citizen gained freedom of religion, and the Emperor remained on his throne and Japanese democracy grew stronger because it embraced a cherished part of Japanese culture. And today, in defiance of the critics and the doubters and the skeptics, Japan retains its religions and cultural traditions, and stands as one of the world’s great free societies. (Applause.)
You know, the experts sometimes get it wrong. An interesting observation, one historian put it — he said, “Had these erstwhile experts” — he was talking about people criticizing the efforts to help Japan realize the blessings of a free society — he said, “Had these erstwhile experts had their way, the very notion of inducing a democratic revolution would have died of ridicule at an early stage.”
Instead, I think it’s important to look at what happened. A democratic Japan has brought peace and prosperity to its people. Its foreign trade and investment have helped jump-start the economies of others in the region. The alliance between our two nations is the lynchpin for freedom and stability throughout the Pacific. And I want you to listen carefully to this final point: Japan has transformed from America’s enemy in the ideological struggle of the 20th century to one of America’s strongest allies in the ideological struggle of the 21st century. (Applause.)
Critics also complained when America intervened to save South Korea from communist invasion. Then as now, the critics argued that the war was futile, that we should never have sent our troops in, or they argued that America’s intervention was divisive here at home.
After the North Koreans crossed the 38th Parallel in 1950, President Harry Truman came to the defense of the South — and found himself attacked from all sides. From the left, I.F. Stone wrote a book suggesting that the South Koreans were the real aggressors and that we had entered the war on a false pretext. From the right, Republicans vacillated. Initially, the leader of the Republican Party in the Senate endorsed Harry Truman’s action, saying, “I welcome the indication of a more definite policy” — he went on to say, “I strongly hope that having adopted it, the President may maintain it intact,” then later said “it was a mistake originally to go into Korea because it meant a land war.”
Throughout the war, the Republicans really never had a clear position. They never could decide whether they wanted the United States to withdraw from the war in Korea, or expand the war to the Chinese mainland. Others complained that our troops weren’t getting the support from the government. One Republican senator said, the effort was just “bluff and bluster.” He rejected calls to come together in a time of war, on the grounds that “we will not allow the cloak of national unity to be wrapped around horrible blunders.”
Many in the press agreed. One columnist in The Washington Post said, “The fact is that the conduct of the Korean War has been shot through with errors great and small.” A colleague wrote that “Korea is an open wound. It’s bleeding and there’s no cure for it in sight.” He said that the American people could not understand “why Americans are doing about 95 percent of the fighting in Korea.”
Many of these criticisms were offered as reasons for abandoning our commitments in Korea. And while it’s true the Korean War had its share of challenges, the United States never broke its word.
Today, we see the result of a sacrifice of people in this room in the stark contrast of life on the Korean Peninsula. Without Americans’ intervention during the war and our willingness to stick with the South Koreans after the war, millions of South Koreans would now be living under a brutal and repressive regime. The Soviets and Chinese communists would have learned the lesson that aggression pays. The world would be facing a more dangerous situation. The world would be less peaceful.
Instead, South Korea is a strong, democratic ally of the United States of America. South Korean troops are serving side-by-side with American forces in Afghanistan and in Iraq. And America can count on the free people of South Korea to be lasting partners in the ideological struggle we’re facing in the beginning of the 21st century. (Applause.)
For those of you who served in Korea, thank you for your sacrifice, and thank you for your service. (Applause.)
Finally, there’s Vietnam. This is a complex and painful subject for many Americans. The tragedy of Vietnam is too large to be contained in one speech. So I’m going to limit myself to one argument that has particular significance today. Then as now, people argued the real problem was America’s presence and that if we would just withdraw, the killing would end.
The argument that America’s presence in Indochina was dangerous had a long pedigree. In 1955, long before the United States had entered the war, Graham Greene wrote a novel called, “The Quiet American.” It was set in Saigon, and the main character was a young government agent named Alden Pyle. He was a symbol of American purpose and patriotism — and dangerous naivete. Another character describes Alden this way: “I never knew a man who had better motives for all the trouble he caused.”
After America entered the Vietnam War, the Graham Greene argument gathered some steam. As a matter of fact, many argued that if we pulled out there would be no consequences for the Vietnamese people.
In 1972, one antiwar senator put it this way: “What earthly difference does it make to nomadic tribes or uneducated subsistence farmers in Vietnam or Cambodia or Laos, whether they have a military dictator, a royal prince or a socialist commissar in some distant capital that they’ve never seen and may never heard of?” A columnist for The New York Times wrote in a similar vein in 1975, just as Cambodia and Vietnam were falling to the communists: “It’s difficult to imagine,” he said, “how their lives could be anything but better with the Americans gone.” A headline on that story, date Phnom Penh, summed up the argument: “Indochina without Americans: For Most a Better Life.”
The world would learn just how costly these misimpressions would be. In Cambodia, the Khmer Rouge began a murderous rule in which hundreds of thousands of Cambodians died by starvation and torture and execution. In Vietnam, former allies of the United States and government workers and intellectuals and businessmen were sent off to prison camps, where tens of thousands perished. Hundreds of thousands more fled the country on rickety boats, many of them going to their graves in the South China Sea.
Three decades later, there is a legitimate debate about how we got into the Vietnam War and how we left. There’s no debate in my mind that the veterans from Vietnam deserve the high praise of the United States of America. (Applause.) Whatever your position is on that debate, one unmistakable legacy of Vietnam is that the price of America’s withdrawal was paid by millions of innocent citizens whose agonies would add to our vocabulary new terms like “boat people,” “re-education camps,” and “killing fields.”
There was another price to our withdrawal from Vietnam, and we can hear it in the words of the enemy we face in today’s struggle — those who came to our soil and killed thousands of citizens on September the 11th, 2001. In an interview with a Pakistani newspaper after the 9/11 attacks, Osama bin Laden declared that “the American people had risen against their government’s war in Vietnam. And they must do the same today.”
His number two man, Zawahiri, has also invoked Vietnam. In a letter to al Qaeda’s chief of operations in Iraq, Zawahiri pointed to “the aftermath of the collapse of the American power in Vietnam and how they ran and left their agents.”
Zawahiri later returned to this theme, declaring that the Americans “know better than others that there is no hope in victory. The Vietnam specter is closing every outlet.” Here at home, some can argue our withdrawal from Vietnam carried no price to American credibility — but the terrorists see it differently.
We must remember the words of the enemy. We must listen to what they say. Bin Laden has declared that “the war [in Iraq] is for you or us to win. If we win it, it means your disgrace and defeat forever.” Iraq is one of several fronts in the war on terror — but it’s the central front — it’s the central front for the enemy that attacked us and wants to attack us again. And it’s the central front for the United States and to withdraw without getting the job done would be devastating. (Applause.)
If we were to abandon the Iraqi people, the terrorists would be emboldened, and use their victory to gain new recruits. As we saw on September the 11th, a terrorist safe haven on the other side of the world can bring death and destruction to the streets of our own cities. Unlike in Vietnam, if we withdraw before the job is done, this enemy will follow us home. And that is why, for the security of the United States of America, we must defeat them overseas so we do not face them in the United States of America. (Applause.)
Recently, two men who were on the opposite sides of the debate over the Vietnam War came together to write an article. One was a member of President Nixon’s foreign policy team, and the other was a fierce critic of the Nixon administration’s policies. Together they wrote that the consequences of an American defeat in Iraq would be disastrous.
Here’s what they said: “Defeat would produce an explosion of euphoria among all the forces of Islamist extremism, throwing the entire Middle East into even greater upheaval. The likely human and strategic costs are appalling to contemplate. Perhaps that is why so much of the current debate seeks to ignore these consequences.” I believe these men are right.
In Iraq, our moral obligations and our strategic interests are one. So we pursue the extremists wherever we find them and we stand with the Iraqis at this difficult hour — because the shadow of terror will never be lifted from our world and the American people will never be safe until the people of the Middle East know the freedom that our Creator meant for all. (Applause.)
I recognize that history cannot predict the future with absolute certainty. I understand that. But history does remind us that there are lessons applicable to our time. And we can learn something from history. In Asia, we saw freedom triumph over violent ideologies after the sacrifice of tens of thousands of American lives — and that freedom has yielded peace for generations.
The American military graveyards across Europe attest to the terrible human cost in the fight against Nazism. They also attest to the triumph of a continent that today is whole, free, and at peace. The advance of freedom in these lands should give us confidence that the hard work we are doing in the Middle East can have the same results we’ve seen in Asia and elsewhere — if we show the same perseverance and the same sense of purpose.
In a world where the terrorists are willing to act on their twisted beliefs with sickening acts of barbarism, we must put faith in the timeless truths about human nature that have made us free.
Across the Middle East, millions of ordinary citizens are tired of war, they’re tired of dictatorship and corruption, they’re tired of despair. They want societies where they’re treated with dignity and respect, where their children have the hope for a better life. They want nations where their faiths are honored and they can worship in freedom.
And that is why millions of Iraqis and Afghans turned out to the polls — millions turned out to the polls. And that’s why their leaders have stepped forward at the risk of assassination. And that’s why tens of thousands are joining the security forces of their nations. These men and women are taking great risks to build a free and peaceful Middle East — and for the sake of our own security, we must not abandon them.
There is one group of people who understand the stakes, understand as well as any expert, anybody in America — those are the men and women in uniform. Through nearly six years of war, they have performed magnificently. (Applause.) Day after day, hour after hour, they keep the pressure on the enemy that would do our citizens harm. They’ve overthrown two of the most brutal tyrannies of the world, and liberated more than 50 million citizens. (Applause.)
In Iraq, our troops are taking the fight to the extremists and radicals and murderers all throughout the country. Our troops have killed or captured an average of more than 1,500 al Qaeda terrorists and other extremists every month since January of this year. (Applause.) We’re in the fight. Today our troops are carrying out a surge that is helping bring former Sunni insurgents into the fight against the extremists and radicals, into the fight against al Qaeda, into the fight against the enemy that would do us harm. They’re clearing out the terrorists out of population centers, they’re giving families in liberated Iraqi cities a look at a decent and hopeful life.
Our troops are seeing this progress that is being made on the ground. And as they take the initiative from the enemy, they have a question: Will their elected leaders in Washington pull the rug out from under them just as they’re gaining momentum and changing the dynamic on the ground in Iraq? Here’s my answer is clear: We’ll support our troops, we’ll support our commanders, and we will give them everything they need to succeed. (Applause.)
Despite the mistakes that have been made, despite the problems we have encountered, seeing the Iraqis through as they build their democracy is critical to keeping the American people safe from the terrorists who want to attack us. It is critical work to lay the foundation for peace that veterans have done before you all.
A free Iraq is not going to be perfect. A free Iraq will not make decisions as quickly as the country did under the dictatorship. Many are frustrated by the pace of progress in Baghdad, and I can understand this. As I noted yesterday, the Iraqi government is distributing oil revenues across its provinces despite not having an oil revenue law on its books, that the parliament has passed about 60 pieces of legislation.
Prime Minister Maliki is a good guy, a good man with a difficult job, and I support him. And it’s not up to politicians in Washington, D.C. to say whether he will remain in his position — that is up to the Iraqi people who now live in a democracy, and not a dictatorship. (Applause.) A free Iraq is not going to transform the Middle East overnight. But a free Iraq will be a massive defeat for al Qaeda, it will be an example that provides hope for millions throughout the Middle East, it will be a friend of the United States, and it’s going to be an important ally in the ideological struggle of the 21st century. (Applause.)
Prevailing in this struggle is essential to our future as a nation. And the question now that comes before us is this: Will today’s generation of Americans resist the allure of retreat, and will we do in the Middle East what the veterans in this room did in Asia?
The journey is not going to be easy, as the veterans fully understand. At the outset of the war in the Pacific, there were those who argued that freedom had seen its day and that the future belonged to the hard men in Tokyo. A year and a half before the attack on Pearl Harbor, Japan’s Foreign Minister gave a hint of things to come during an interview with a New York newspaper. He said, “In the battle between democracy and totalitarianism the latter adversary will without question win and will control the world. The era of democracy is finished, the democratic system bankrupt.”
In fact, the war machines of Imperial Japan would be brought down — brought down by good folks who only months before had been students and farmers and bank clerks and factory hands. Some are in the room today. Others here have been inspired by their fathers and grandfathers and uncles and cousins.
That generation of Americans taught the tyrants a telling lesson: There is no power like the power of freedom and no soldier as strong as a soldier who fights for a free future for his children. (Applause.) And when America’s work on the battlefield was done, the victorious children of democracy would help our defeated enemies rebuild, and bring the taste of freedom to millions.
We can do the same for the Middle East. Today the violent Islamic extremists who fight us in Iraq are as certain of their cause as the Nazis, or the Imperial Japanese, or the Soviet communists were of theirs. They are destined for the same fate. (Applause.)
The greatest weapon in the arsenal of democracy is the desire for liberty written into the human heart by our Creator. So long as we remain true to our ideals, we will defeat the extremists in Iraq and Afghanistan. We will help those countries’ peoples stand up functioning democracies in the heart of the broader Middle East. And when that hard work is done and the critics of today recede from memory, the cause of freedom will be stronger, a vital region will be brighter, and the American people will be safer.
Thank you, and God bless. (Applause.)
END 10:29 A.M. CDT
Paul and I listened to this speech live this morning. I believe it was one of the finest I have ever heard during President Bushs Presidency!
Jenny Hatch
UPDATE: Next day:
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Photo courtesy of Palomino
Radio Blogger has the Knee Jerk democrat response to the Presidents Speech:
“Here’s Hillary’s comment.

“The surge was designed to give the Iraqi government time to take steps to ensure a political solution to the situation. It has failed to do so.”

Now we go to Ted Kennedy.

“…political reconciliation continues to elude Iraq’s leaders.”

Now let’s hear from Harry Reid, a national political leader so feckless he makes al Maliki look positively Jeffersonian.

“It is time to change direction in Iraq, and congress will again work to do so in the fall.”

Read the Radio Blogger Commentary, it is really good.
Jen