Evening Exchange; 2202; Famine in Africa / Weekly News Analysis / Hormone Replacement Therapy

The primary election and the changing political landscape should she or shouldn't she. The debate over hormone replacement therapy. And famine in Africa. Why it's recovering. All next on evening Xchange. Hi I'm Cojo and welcome to evening exchange. We see the pictures on television all the time starving children in Africa. Please help. Maybe you also read the headlines. Food Crisis in Malawi. Famine in southern Congo. Humanitarian crisis in Zimbabwe. And you say did I hear that same story a year or two ago. Is this the same famine or is it a new one.

Has the drought in southern Africa stretches into its second year and famine spreads. The people of Africa continue to suffer as the food supply which is a dangerous low. Lines like this one in Zimbabwe stretch for blocks with people who wait for hours for a chance to buy sugar. On this day much like every day less than half of the people on line went home with food. This woman that no sugar. The sugar donation like all other donations didn't stretch far enough she had to eat Maroulis nuts. People in Zimbabwe usually eat these Only when all other food is extremely scarce and scarce it is hundreds of thousands of acres of corn wheat and sugar have long dried up. And farmers like Niccolo macaronis say that without the government's help people will continue to starve. No food and no blood.

At last a deal we get booted as to how the government does it. It is something for us certainly. Kevin Farrell is The World Food Program Director for Zimbabwe. Now donors need to get pledges immediately so that we can get food into the country before the situation deteriorates. But until then the people of Zimbabwe and the millions of people of southern Africa will have to get by. The best way they can. So then you read that they had a conference on sustainable development in South Africa last month with more than a hundred heads of state from around the world. But who could be against something so noble a sustainable development. So it all seemed pretty boring and the only thing you remember is someone suggesting that your SUV is somehow part of the problem. So you say to yourself why don't they solve that famine problem down there instead of play or hating me for my SUV play or hating for the uninitiated means being jealous of me.

So let's see if we can help to connect the dots here. Our guests are Charles Cobb Jr. of all Africa Lainey. Gabourey Mahin of the International Food Policy Research Institute and George economist in residence at American University. Melanie let me just start with you because I know you've studied the food crisis in Malawi. Most people believe these are just conditions brought on exclusively by nature. There was no rainfall there was drought this famine starvation. End of story is that it or the other internal and external factors that lead to situations like this. Well Cojo the answer is absolutely not. Nature of course plays a part but famine and the hunger that obviously implies is really a function of bad policy of weak governance of weak capacity the capacity in this case to even monitor and forecast in a timely fashion. The trends in

production is also a function of weak institutions. Markets are failing. And the distribution systems not being adequate to get food from it to to those people that need it to the hungry. It's also a very important part of the stories we can structure the road situation the very high transport costs. An interesting situation in the particular case of Malawi that we found in our own work in Malawi is that following the structural adjustment programs that were undertaken over the period of the 80s and 90s there was an assumption that the private sector would be would have the capacity to undertake food distribution. Obviously the current situation has shown the contrary. And some of our work looking and talking to the trade traders and the market situation in Malawi shows a very weak capacity. Only a quarter of the traders

that we interviewed had a bank account or access to finance. You find that with a 600000 ton shortfall in production. Very little private sector activity occurred in the earlier part of 2002 despite a 300 percent tripling of prices. There was very weak a capacity to import food into the country. So these kinds of things are clearly something that governments and donors need to pay far more attention than what I hear you saying also is that there's a relationship between famine and poverty. You're talking about a population that is not very wealthy and does not have a great deal of resources. Absolutely. Absolutely. On on both sides you find that on one side it's very important that those who are hungry need access the market to obtain food and that was part of the problem in Southern Africa. But the other side of it is that in order to get the income and purchasing power smallholder farmers need to access markets in order to sell their produce on markets

and on both sides. There's obviously a very important gap. Which brings me to Charlie Kobs trip to the World Food World Summit on Sustainable Development because it is my understanding that one of the objectives of that United Nations conference was to address the needs of poor people and the environment. Let's talk about poverty for a second. And poor people how could such a conference on Sustainable Development. Take a look at poor people in the world in general but in Africa in particular and try to address that what do what does international and foreign policy and trade policy have to do with poverty. Well if you're talking about from the point of view of developing nations African nations then there are certain barriers that African nations would like to see or there is access to capital and other resources have been difficult for nations to receive that would contribute to

developing the very things that the lady has been talking about this is this particular sustainable development conference was supposed to at least at one point in the conceptualization of it was supposed to actually establish some concrete targets in this direction which it did not do. I think largely for political reasons that have to do with the broad tensions between developing. And developed nations or this North-South tension. However you want to characterize it in short I think what was talked about in Johannesburg was these broad macro kinds of approaches. Are quite quite removed from the practical day to day needs of the villages and farms in places like Malawi.

Nevertheless George this is one of the things that the conference tried to address the issue of poverty and environmental issues like access to clean water because everything we read indicates that famine crises are heightened if there is not proper access to clean water. To what extent do you see the internal policies in and of governments and the economic infrastructure and countries having a relationship to what takes place that these international conflicts could you I was very very disappointed in this particular conference. And it's like it nobody needs to be told that what is important for development. Nobody needs to be told about access to clean water education health care. You do need a conference for one thing not one. OK. No there is. You know we've had these so many of these conferences in Africa. Nothing really comes out of these conferences. To me it's it's it provides the government's leaders opportunity to divert attention

from their own domestic economic failures. Look at this farming crisis for example in the case of Malawi for example of course we've had drought in Zimbabwe of course there's been drought. But look I do know the violent land CS's has contributed a great deal to the shortage of food in Malawi for example last December green stalks reserves of green stalks were mysteriously sold by the government is sending all the funds were misappropriated even the Danish government and threatened to suspend aid to Malawi. But let me look at me. You don't provide the broader picture the broader picture is that look we've had periodic droughts in Africa. That's not anything new. But the most important factor is that since 1960 is agricultural production per capita has really been declining to the extent that they are. There were lot of countries in the 1960s which were exporting food and produce more than enough to feed himself and export surpluses.

Nigeria was one of them certainly was one of them my dear Kenyan Zimbabwe Malawi. Not anymore. Today all of Africa we import fourteen point nine billion dollars in food. We can't feed ourselves anymore. What it is not just drought but a lot of other manmade factors. And I think you also pointed out some of them bad agricultural policies civil war we just uproot people because most of the peasant farmers in Africa are women. You know there's a lot more to talk but I don't like to have this opportunity to go on because I'm really going to ask any question that Charles asked you in a previous interview having to do with the fact that maybe between 80 and 90 percent of the population of Africa is involved in agriculture. Why. As George pointed out is the aquaculture product Prodgers declining so much. Well I think part of that answer is population growth. And part of

it is inappropriate or technology or adoption of technology. If you look at the Asian green revolution or the Asian miracle and agricultural growth that came along in Taiwan for example there was a 13 fold increase in fertilizer application on farm. Underlying that there was a very systematic support of small farmers through research through extension through investments in infrastructure such as irrigation and roads in Africa at present if you compare road density in rural Africa to India in the 1950s there were five times road density in India in the 1950s then in all of sub-Saharan Africa at present a staggering statistic to me is the fact that it costs. Three times as much to transport food grain in

land for example from the port to an England site than it does from Kansas to to Africa. And these are facts. So essentially Africa is becoming increasingly landlocked if you will are increasingly archaic. The point has been made is. Certainly with independent Africa regardless of the problems of say structural adjustment with the IMF. Or regardless of the ideological diversity that can be found on the continent. I think it's safe to make the point that the bias of governments without exception in Africa has been to urban populations. Resources have been directed almost entirely in that direction at the expense of agriculture particularly small farmers and it seems to me as an observer that that governments still for the most part have not made up their minds whether they want to abandon this you know you

to get into some of that fact to see if you look him at you know of course sustainable development. You've got to ask what government is doing in know to have sustainable development in agriculture. All these factors one she pointed out complete lack of breakdown of infrastructure roads network and so forth. If the farmers produce How do they get their produce to market. Number two in the Independent is that been a bias or neglect of Agriculture. I want to have anything to do with agriculture because agriculture was an inferior form of occupation. They want to emphasize industry endlessly ization. So that neglect was there. Number three even when they turned their attention to agriculture government issued misguided policies towards agriculture to be impose price controls and also ordered the peasant farmers to sell their produce to stick it in boats. All this discourage production. And furthermore you see they couldn't even improve agricultural production because we believe we knew nothing about prison or agriculture or that we knew about agriculture was textbook

European type of agriculture mechanized agriculture. We don't even know how the person farm is you know get their land from the land. What I think that both my colleagues here are correct in stating that there that obviously there was a bias against agriculture but I think that the last decade in particular we've seen a dismantling of those policies the taxing of Agriculture has been very much reduced and this urban bias is also I think being corrected. But what you don't see and we were just now coming out with a book on the reform experience with the reforms about the culture of markets in Africa and what you find is even with good policy. This too is very weak response. The economy. There are two issues I want to discuss when you talk about good policy the emphasis of course of United States foreign policy is theoretically the advancement of democracy in these countries I don't know the extent to which democracy has a significant impact on economic policy but before we go there let's talk about what took place in the in the Summit on Sustainable

Development it's my understanding that when you talk about structural or restructuring and the IMF and the World Bank a lot of governments can no longer provide subsidies for farmers. And at this conference at this point I doubt that while the developed countries of the world the United States and Western Europe in particular and the IMF and the World Bank are telling these countries no you should not have subsidies for your farmers. We are providing almost 300 billion dollars worth of subsidies to farmers in the industrialized west and we're making it virtually impossible for the farmers in Africa and in other third world areas to effectively compete. What's going on here. Well I think this is something and perhaps the others would also like to comment on this. That really has become a very very clear issue that 10 years ago when I was working on the org way around the U.N. and we were calculating the fact that what types of subsidies there were on European sugar beet or Japanese rice and you find that the Japanese farmer gets 500 percent five times the world price. And now in Africa there's

virtually very very little subsidy at all if any of any smallholders. I think this point is being made and I think there is a reluctance to face up to it and the current U.S. farm bill in fact has increased subsidies to American farmers at a time specifically when the whole world is crying out for liberalization. So yes we have talked about the internal pressures on farmers and agricultural workers from their own club policies of their government. How about the international pressures. Oh yeah. I mean this blocks the export of agricultural products from Africa particularly to something like free trade. It's not free trade but such policies are not particularly new in either the economic or political relationship between African nations and the Western or the European world. I would argue though that despite this this is not central. To the needs of the continent as a nation it's it's it's an interesting illustration.

Said of a certain kind of hypocrisy but it's not central to the problem of agricultural production. You mean I wasted my outrage on a peripheral issue I'm afraid. You know see there is a hypocrisy involved in terms of know trying to promote free trade and all those who despise them. You know I'm anti American. You know the 2002 farm security didn't pan out. You know two billion in three you know over 10 years were two American families and that's you know patently hypocritical. But the subsidies really the effects on African agriculture has been somewhat exaggerated. It will affect Latin America or Asian countries. Look we are not even producing enough to food ourselves. How can the subsidies hurt us. You know low prices hurt us. So that is really a non issue for us. Let's go to the other issue I mentioned and that is the relationship between democracy and economic policy. Well it's a lot about structural adjustment. Look no country

no government can't overspend more than it takes in in revenue. All right. Look at Argentina for example. All of us many of us by name do not have the tax revenue. All right. So any economist would tell any government all right to bring down these expenditures. That's exactly what the World Bank does. I am on air. You know I find myself uncomfortable you know sort of a project in the world. But I just have to be cut. But with the African governments right now guess where they cut the expenditures on the issue. The military is they don't want to cut the military budgets. I mean they don't want to cut the budgets for the civil service or it would be shifting the burden if I just went onto social programs and then D.C.. All right look this marginal adjustment isn't working because it is hurting the poor. Of course it will hurt hurt the poor. If you shift the burden of adjustment onto the poor Susie there is some chicanery involved here. Right. Prior to recession.

Absolutely. But I think it's not just the African governments to blame here. I think if you look at World Bank lending to that it 20 years ago 40 percent of lending was to agriculture. Now it's only 7 percent. It's very sharp to the rest of it going to other sectors and health education and and things which no one would dispute I put in. But the fact is that agriculture research has pretty much dropped off the map. The crisis really in African National Agricultural Research Systems and this is the core of where you're going to get any and technological gains and productivity increases and an eventual green revolution in Africa. We're very far from that and the capacity is that we're actually regressing rather than advancing in Africa. This is obviously a discussion we'll have to continue because we're out about just about out of time right. Thank you very much for shedding some light on what is sometimes a very difficult situation to understand we're going to take a short break. When we come back the primary elections the 9/11 memorials the rock the Middle East. Nothing escapes the focus attention of our weekly news and.

We'll be right back. This past week Americans went to the polls for the primary election in several parts of the country but

it was an election somewhat overshadowed by a media saturation of 9/11 revisited as Americans viewed listening to read and sometimes participated in ceremonies commemorating victims and heroes of September 11th 2001. The terrorist attacks. Joining us to talk about the memorials the election results and now the clearly divided American attitude toward war with Iraq. Todd LENNEBERG of the Hoover Institution. Brenda Wilson of National Public Radio. Asking Muhammad of the Washington informer the final call and Mark Plotkin of WTOP Radio. Allow me to start with what's latest President Bush's address to the United Nations on the necessity in his mind to take action against Iraq. He told the United Nations essentially you'd do something about this violater serial violator of UN resolutions if you don't we will. And if we have to do it alone then we will do it alone. Do you think that this had any significant effect on the United Nations. I think it had a very dramatic and rapid effect. I think what Bush managed to do

was use the momentum of you've got to go to the U.N. which had been building particularly by those who have questions about attacking Iraq and put it to his end which is to say the U.N. has got to go. The U.N. has to do something for the sake of its own credibility and having passed these resolutions about enforcing them. I think it's made a big difference to the political case. I think that was immediately apparent and some international reaction and also in the very respectful if still cautious reaction from Democrats in Washington. And now I suppose in a sense is a form of due process that. The U.S. was submitting to to some degree. I don't know it looked like a ritualize sort of thing to me with everyone presuming that the U.S. is going to do whatever it wants to do anyway and the U.N. still seeming like pretty much a rubber stamp of what the United States wants to do. So it was a kind of a ritualized. Essentially this is what we're going

to do. And so therefore we've got to go through this process or else you know it will. I don't know it won't be it won't be legal so to speak but. Ask it legal. Well I think the United States has positioned itself as if it's above international law and even above moral law because if this war takes place with UN approval or without it becomes the first time ever in American history when the war is preempted that is not a just war it was not caused by an attack against the United States and and righteous retaliation but rather a regime change kind of notion we contain the Soviet Union for 30 years. They had thousands of nuclear weapons and weapons of mass destruction aimed at the United States and faced them down. And now here's someone who doesn't have one and hardly a missile or a window that pisses off the pitch it out of and we're going to attack and destroy that kind of Archilochus. But what I'm interested is the Democratic senators and actual presidential contenders.

Everybody said including Trent Lott that watch what Daschle does. He's Senate majority leader. He's I think Todd is right in terms of his language seems to have softened from before. Also John F. Kerry who is probably the most prominent dove who is a war hero in Vietnam I would differ with you Aski in terms of the Gulf of Tonkin resolution which was really supposedly wasn't an attack. Two senators Gruening God I always know this and I blame who is the other senator. And I'm going to tell you had a trivia question. If two senators voted against it but that was used as an authorized thing and also timing. The cynical among us would say they want this resolution and they want to debate it and they want to approve it before the November midterm elections and they don't want the midterm elections to be focused on domestic issues because that's where the Republicans

would be weakest it seems and might lose a second Senator. Well listen let's keep focusing on Iraq for a second because we've been hearing a great deal that what President Bush needs to do is present evidence to the American people and present evidence to the international community. Instead what the president did was to reiterate what the international community basically already knows about Saddam Hussein and says you know this he's in violation. Let's take action. No new evidence presented. Do you think there is more. That's why I say it was essentially a sort of legal brief case essentially. I mean he focused primarily on the fact that there had been no inspections it was and presumably if there have been no inspections that means that he's over there creating and building weapons of mass that is what one has got to assume since he does not allow the inspections. But it isn't even if you found them I mean you know it's those who are opposed to you know a war with Saddam Hussein or with Iraq. You know do not believe that the finding of those weapons

necessarily presumes that. Why don't we have free emptive strike against the comfortably Neph this out. He wants to go to war and he wants a resolution where before and he feels that at least he had to appear before the U.N. It's just a question of when. Well the question I was going to raise with Todd is whether or not you feel there's been the kind of sea change in the political equation in the world that when the United States now says look we are going to do something if you don't do something that that is what is persuasive to the rest of the world. Yeah. In fact this is reminiscent of the way in which Bush's father used the United Nations without being used by the United Nations in 1990 91 during the start of the first Gulf War the first war with Iraq. He came in a determined leader. He said we have we feel very strongly about this. You brought people on board he got U.N. Security Council resolutions passed the by the way the U.N. Security Council has never passed those resolutions and there was an invasion going on at the time there

is no invasion at this point. And a lot of problems are really but one of the things is to take that Saddam actually said he was going to do it such as eliminate entirely his pursuit of weapons of mass destruction chemical biological So he agreed to a lot of the question a lot of legal action. Do you think that President Bush will find significant support in the U.N. enough for the U.N. to authorize this. Well I guess he needs the U.N. Security Council. China is still not onboard. The Russians have not yet committed. And so it's still problematic. And you know you've you've got other countries in the world who have violated U.N. resolutions who do have weapons of mass destruction in their arsenals now and who are not being called on the carpet to do it. I don't think so and I don't think you don't think the U.N. is going to back them up on it. We do have to move on this of course was the week in which there were the memorials for the September 11 terrorist attacks that took place in New York City and in

Washington D.C. And well there was a great deal of media coverage about it but there was not. It would appear a great deal of talk about how this has affected us as a country significantly. A year later there was the assertion that it has. But how has it you know I was overseas last year and the feeling I got then among people and I felt it myself was a sense of guilt that I hadn't suffered more. You know in South Africa we were looking for bags and we were not wandering the streets and I think about people wandering the streets with pictures of relatives I mean they are in absolute shock. They were mortified. You're not going to find this person this person is not lost. This person is dust. And so there was a sense of of guilt that people that these people are in jumping out of windows on 104 first floor the people who didn't suffer like that felt a sense of guilt and I think we're still feeling that sort of almost like

why do you celebrate the 25th anniversary of Elvis's death. Why do you. You know let's not celebrate morbid things let's celebrate celebratory things and let's rally around those things. And and this is this is the sense that I got of the coverage that we're still there we're still sort of wallowing in our guilt and those who didn't feel pain are trying to act as though they really. But this is those appeals to embark on a new period both of understanding our vulnerability and of being involved in a prolonged war against terrorism as a result of this. And some of the columnists that I've been reading say this is not characterized by the kind of sacrifice that one usually associates with being on a war footing or with folks that it is simply historically inaccurate. Most wars that this country has fought are not like World War II or World War One. They do not involve massive mobilizations farewell. You know what used to be known as small wars and that's rather annoying you know in the old and elegant way of putting it.

But but it's professional troops sent to dispatch dispatch to do a particular kind of job in a far away place. Most of the news of it comes know in the newspapers that's what that's what people hear. But I think the thing that differs even you know in this particular situation from past situation which makes it look terribly suspect is the kind of fury and everything that gets whipped up around it and it does seem incredibly manufactured. You know the all the all day coverage. In a sense the media kind of cop cooperating and something that does not appear genuine. While you may feel for the people who lost family members and you know in these incidents there's something about constantly the constant flag waving the whole ritualized aspect of it which doesn't have anything to do with being on a war footing. It has to do with manufacturing some sort of atmosphere to either deflect attention from what ever this

really is or is not about. It doesn't so that you people can't even explain it. So they've got someone reading you know President Lincoln's words because there are no words to explain what in fact you are in fact talking about. You can't perpetually more angry on from this to politics. Was also a political week around the nation and in the District of Columbia. Mark Plotkin you have been calling it seems like for months for somebody to oppose the incumbent mayor in the primary election. Somebody finally came along and that's somebody you got trust. Are you satisfied. Well I. I did. I thought somebody would come along in the conventional sense not wait till thirty two days before the election how to be a candidate that had a possibility of actually winning and that means appealing to white voters who are 40 percent of the Democratic Party turned out version of Marion Barry 78 a biracial that's who he was he won because he won one word one two and three and six which had white major

white populations Willie Wilson was a candidate of the dispossessed the have nots. He had no. And I found him to be a warm and engaging human being and a very likable person. But he had no political history with 40 percent of the population. He had not been in their homes. He didn't have a political tradition. It didn't surprise me one bit that he lost. You know as heavily as he did. Well Mayor Williams is not alone. This is a wider wealthier city and a prosperous place. And white voters voted their property values. They said we don't have to fall in love with them. That's what's so disturbing. It's one of them is the exploitation wasn't just white voters. Even a lot of people who had complained about the disconnected. Anthony Williams When it came down to it sort of said you know. Yes. Willie Wilson is a warm genuine and I really think it's very important what he's saying but in the meantime most of the things Williams has done

aside from the whole business the political he's utterly incompetent politically. But hey I can I can live with it. And it wasn't just white voters who said that what was in Lambesis seems to show is that there was not major maybe a major but certainly some class breakdown. Oh absolutely. And that is black and white people over a certain income tend to favor Anthony Williams and black people who are make up the majority of the poor in the District of Columbia tended to support Willie Nelson. I agree and I hope that in this sense I've never been a fan of Mayor Williams starting with the UDC debacle and then go on to the General Hospital the D.C. General Hospital. I was almost glad that the Olympics wasn't coming here because it meant that that whole confiscation of land along the Anacostia River might stop. So I've never been a fan of him but I hope that now that he's won and won convincingly that he gets the political props that he deserves. He won. He's the victim. I mean he didn't eke out a victory he won convincingly

in a political sense. And so now as he got he has a mandate as a politician. But what does he do with the man. And I want to say statistically he got 22000 more votes as a write in than he got four years ago when his name was on the ballot. But I don't understand these numbers. I mean how many people actually participated in this. About the same amount as did four years. In a way people are writing it. Right. I think what you have to do is have to balance the budget which is going to be a very serious problem. So all governors I would like him to do I'm not going let this conversation with go out to stop being a colonial demonstrator just deliver city services challenge our colonial status get us voting representation let us appoint our own judges and do away with the congressional interference not just the big issues in this election and this person is not interested in this. You're absolutely right. And his constituency is not asking him to be that he is a trend a self inflicted transitional figure. That is very popular because this the population both black and white is rational a transitional

transition to a leader who will change who will challenge your colonial status. Why I'd like it to go out like you and me hear what I ask you the last time. Who is that person going to be. I don't know who it is but I don't want to be this person I take. Williams said that he might get some of those. I mean I've seen the Iranian much you know like when you talk about in Prince George's County State's state's attorney Jack Johnson won with almost twice as many votes as his nearest competitor Jim ISTEP. Johnson of course is the only official in that race who had been elected countywide before and people who observed this and say he has basically been campaigning for the last four years eight years but most of the publicity that Jack Johnson has gotten has had to do with his tense relationship with the Prince George's County police a tense relationship. I might add that is shared by significant numbers of the African-American community. It seems as if this election was a referendum on the Prince George's County Police Department when Wayne Curry said Can you imagine that in the most affluent

African-American county in the country in which things are still going very well. You look at this election and you would think that this whole county was going to hell in a handbasket. How can you explain if that's the case the jury nullification that appears to take place whenever this same now nominee to be county executive prosecutes police officers for these egregious crimes that they commit against the same black population. All seven of the trials he's brought they've got an acquittal and probably the worst case involving the Howard University student Jones didn't even get to trial. They didn't even bring charges Mitchell Johnson in defense and I'm now an instant Prince George's County expert says that it's because judges decided and they weren't able to get jury trials if they had jury trials he would have gotten convictions. Jack Johnson was a full time politician he's not the most polished or well spoken but they knew him and they liked him. And in terms of the police he went so far as to say that the ballot boxes should not have police.

What's the word protection. Because he thought he was implying that they were going to fool around with the ballot boxes. That's the trust level. Let's go from the Heriot's and ask them what the heck happened in Florida. Ask again and again. Sadly there's very little what is coming up to in this we thought they might be learning or Apparently that was not the case. So we have yet another mini fiasco not quite as great a fiasco this time just because just because the race between the governor's race was not as close as Bush was. Well let me ask you about this film because it's one of those strange states and it looks one way if you're down there you know you know the line and it looks different when it's right across the border from Alabama. And you know what's the name of Gilmer right. McBride I mean that's where he went. He went north looking for those conservative Florida voters because he knew that Janet Reno already had essentially you know the South Florida folks.

No victory would be sweeter for the Democratic Party than to knock off the present president's brother who happens to be from the state of Florida which has a very significant memory for the Democratic Party and they are so worried about now. Bill McBride central Florida resident former football player for read as a lot of his own money that Jeb Bush two weeks before the election was even over they were taking out ads against McBride. They don't want to run against. Right. They think because right. You know she still might conceivably still not conceded. Former Florida secretary of state Katherine Harris won the Republican primary. Talk about a bad as probably a lot in the election this is probably going to come to town. Right. I mean this is the same for Republican. It's almost like deja. Well there are lots of examples of these are all over again. It's a beautiful thing. Would you be interested in her sitting on the District of Columbia. No I don't. They don't even get me started. Now that Bob Barr is gone you know there's always one that replaced anchors.

So that is likely to happen. That's OK. The the the Palestinian legislature seems to be in something of a revolt against Chairman Yasser Arafat. Arafat hurriedly fired his cabinet. But it would appear that there's some shaking up going on and the legislative council at first thought of as a rubberstamp going to accept the chairman's proposal to sack five new members said no we're really in rebellion and we're close to a no confidence vote and the president himself and so he decided to sack the entire cabinet. The troubling thing to me is the Israeli reaction which was well we need a genetic change in the code the DNA code of the Palestinian Authority which almost sounds like regime is worse than regime change. It sounds almost like the racial makeup of the Palestinian mind is inadequate for self-government and perhaps that is a portent of things to come. What is happening been other areas of development and the Palestinian legislator later unfortunately we're just about out of

time in this segment. Thank you all for joining us. When we come back hormone replacement therapy. No easy choices. Is. About 17 million women in the United States. Take hormones to relieve menopausal symptoms

which include hot flashes sleep disturbances and vaginal dryness. But two major studies released in July led to an ongoing search for answers. W T. Correspondent Jane Walton has this report. It's not crying women or do I wear this dress or that dress this dress. I thought I was losing my mind. My my I to complain about hot flashes lashes lashes lashes. I felt like I was bouncing off the walls. I walls. You just heard different women from different walks of life with the same issue. Menopause when the symptoms of menopause hit women typically find themselves in a doctor's office feeling some relief when they're faced with a decision should they take a traditional medical treatment such as hormone replacement therapy or seek an alternative holistic route. I feel like I'm living testimony. I've been on this. Right. Twenty minutes into the race. And I've had no problem with.

Every day Phyllis Hayes pops appeal to control her menopausal symptoms. After consulting with her doctor she chose HRT hormone replacement therapy. It's a form of drug therapy in which women are given estrogen to replace what the body stops making during menopause. Dr. cure on methadone has prescribed HRT for years. Estrogen is given to women who don't have a uterus and so they therefore don't need a protection against cancer of the uterus. Estrogen and progesterone combination is given to women who still have a uterus. And so we don't want to just continually give estrogen stimulates the lining of the uterus without giving a hormone the counterbalances the stimulation of estrogen in the past HRT was thought to have wonderful side benefits like preventing osteoporosis. R&B star Patti LaBelle took HRT and promoted it heavily. But recently these treatments have come under attack. New reports indicate estrogen progestin combos may increase the risk of heart attack stroke blood clots

and breast cancer. This news has some people calling their doctors and switching to more natural holistic treatments. My spirit is just leading me to be more in harmony with. My true self. And I just think that perhaps natural pathic medicine just helps me to facilitate that process. Angie McCarley chills alternative treatments often called naturopathic medicine because she believes it's always safer to stick with nature. Her holistic doctors prescribe a healthier diet more exercise and a combination of vitamins liquid calcium and a tincture made of various herbal extracts. Stephanie Becker is a naturopath doctor naturopath like medicine that we try to do. The key is to accomplish and to increase a woman's improve her quality of life without placing her at greater risk for things such as endometrial and breast cancers. Dr. Mustin is quick to point out that the recent publicity surrounding HRT

applies to only a small percentage of women particularly those with a family history of heart disease and breast cancer. She always counsels her patients about both traditional and holistic treatments. I have women who are on lower doses of estrogen therapy and complimentary medicine because what happens is they can stay on a low dose but it's not enough to keep them from having symptoms. But they use the alternatives. Menopause is not about turning back the clock. It's a natural part of aging. So they aren't experiencing symptoms. The kind of treatment should be to optimize their quality of life while decreasing the chances. Of cancers and coronary heart disease and bone disease despite negative reports. Hayes believes HRT helps to keep her life balanced and peaceful. No more mood swings sleepless nights or hot flashes. Arafat never said that's wrong because when another group of women end up changing ring again. So what works. I'm OK but I'm

broke don't fix it. And what works for Coralee is her holistic medicine. That was reaffirmed when she didn't have her tincture for nearly three weeks. One day I started getting hot and it felt like my body was on fire from my head to my toes. I had absolutely never ever felt anything like that before in my life. She's never run out again. Both Hayes and Coralee are happy with the relief they get from their treatments. Experts advise that women make their decisions with the help of a trusted physician for even an exchange. I'm Jane de Walten. Joining us now to discuss this issue are Dr. Monique Rainford she is with the Washington Hospital Center. Dr. Andrea Williams who is associate clinical professor at Georgetown University and naturopath physician Andre Sullivan she's a Ph.D.. Good to see you again. Andreas You always good. Allow me to start with you

because you are one of the coal investigators on one of these studies by the Women's Health Institute. Tell us about that. OK so the ones who designed this. It started in 1993. Basically they recruited several women for this study that were published about over 16000 women or in that study approximately equal numbers in either part. And what they followed from the study that basically the risk of cardiovascular disease was increased. A woman who used hormone replacement therapy. The preparation they used was Prempro as it's called as preparation they use. They found that they had increased risk of breast cancer but decreased risk of color rectal cancer and decreased risk of fractures hip fractures and other fractures as well. Is that the study that was called off. Yes that was what it was called off because they have something called a global index where they look at the risk or benefits of this study and they see the risk profile. So

basically they knew about the cardiovascular side effects or risks from before. But in the last six months before they called it off or the analysis they found that there was increased risk of breast cancer. And because of that the risk see the benefits of continuing the study and they're very they're very carefully studies so for the safety of the women they called off this study after five point two years. And it seems as if risks and benefits are what we're talking about here unrelentingly not so how do you advise your patients. I think that my approach should be a little replacement therapy really has not changed that much even though since this study has actually come out with replacement therapy has been around for a number of years and there's been controversy associated with the medication for years. I'm looking at a lot of things that the study was looking at and also some other issues. I think that when I talk with a patient I make sure number one that they realize that menopause is a very natural process for women to actually go

through. And therefore all women do not go to menopause do not need hormone replacement therapy initially when it was initially we learned about replacement therapy we were taught that it was a wonder drug when you can I went to my residency together and we were taught that it helped with the skin changes with aging to cardiovascular disease. And I think the risk of defining a medication or anything as being a drug that will take care of everything is something that we need to avoid. So one of the things I find that I do was if a patient is perimenopausal meaning she's going into a menopause. If she's menopausal if she comes to me with the menopausal symptoms that I educate them about newborns and then if I do feel that that person is a candidate for hormone replacement therapy go with the risks and benefits associated with it. But as was mentioned on the screen that diet I find is very important exercise and I find it very very important to him replacement

therapy is not for everybody. And Andrew Sullivan It seems that one of the first things. That Andre Williams said was that. Menopause is a natural phenomenon. Absolutely. Absolutely. It's just like adolescence. Although I'm sure there are some parents that would think adolescence is a disease it is not a disease it is part of life as is menopause and we all have gone through it or go through what our grandmothers went through it. They didn't suffer in the ways that we do now. Menopause has to be treated as a multi-disciplinary kind of situation it's not just one pill as Andrea said nothing is one pill unfortunately in Western medicine you know we take one pill and everything goes away. As a natural passing physician and we're slowly but surely educating patients to how to take care of themselves and take charge of their lives. And it's not just about taking HRT or any one thing. Homeopathic medicine is very very important when you're talking about menopause because each woman is an individual. So we're treating not just the menopausal symptoms but also the person as a whole. The person is weepy versus irritable if the person is depressed versus

anxious. All of those are different homeopathic pictures. Then you add to that diet then you add to that some herbal preparations and you add to that exercise and you've got a total package not just one individual isolated pill that's going to create this wonderful experience called Wellness that doesn't work like that because menopause is not just one isolated situation it's affected by our stress levels. Stress management is very important when you're talking about menopause. So we have to look at it as a complete picture and not just something that's in a vacuum Carol mustn't refers patients to me all the time and I to her Dr. Becker a colleague of mine and we all would agree that certainly there are women who can tolerate some amount of hormone replacement therapy and use complementary medicine also. Some women come to me however and they don't want to use any HRT they only want to use complementary medicine. So it's a matter of choice. They have to make different choices. What seems to be driving the fear among a lot of women is that we turn to

HRT because we were looking for relief from symptoms and then we discover that this if we're taking it at a certain stage of our lives in particular and if we've been taking it for a particularly long period over 10 years can be much more dangerous than the symptoms that we came to do it for. So how do you advise people in that situation for the people who have taken it for a long time. You know basically we're advising them to taper off me or discuss it with their physician but probably taper off because if they're been on the medication for like 10 years and we would try to see how they do without the medication terms of menopausal symptoms if you are feeling better if that's the case. You know if that's not a problem because some of the women who are taking it before we're taking it full cardiovascular protective effects. So basically they don't need to take it for that. So if they stop the medication then they can see how they do in terms of menopausal symptoms. So probably the best thing that people have been taking it for a long time.

There was some surprise expressed that despite the fact that women have been taking hormone replacement therapy for such a long time that only now have definitive studies been coming along and the suggestion there is that if this were men that would have been studies a long time ago indicating that there's gender bias in these studies. And that's true. I definitely agree. You know I definitely agree. The other thing that was said in the back is that we saw as I don't know what to do because I'm a mother of two or three years somebody is going to come up with another study that tells me something absolutely different. What do you tell people on that. That that's a very difficult thing and I am. What's interesting is there are some patients who've come to me who you know they haven't placed on all on home replacement therapy for various reasons and we've reviewed the risk with the most recent review and some women have actually opted to go off the replacement therapy. Some women I find however have gone off the replacement therapy and then have a resurgence of the hot

flashes for instance that they had before and you know then we end up putting them back on the hormone placement therapy and again review the risk and go over a lot of things making aware of the fact there probably will be something coming down the line that you know we are aware of with the medication. And more research definitely does need to be done and I think that's the great thing about this study that find that we do have a large study that has been done really looking at the medication and hopefully again from that. More studies will I got to tell you one of the things that I have observed is that a lot of women have done more reading on this issue during the course of the past 30 days and I guess that's who for that because we should all be reading more about our own conditions. But Andrew Sullivan they want to know if in fact I go to a naturopath physician what kinds of solutions do you recommend. Well as I said at first diet is clearly important. You've got to get so flavonoids in your diet phytoestrogens which are big words for things like just

replace estrogen you're seeking to to fill the estrogen receptors side so to speak. Calcium is important not in the form of milk. Milk is for baby cows. I love to say the calcium in the form of green leafy vegetables kale collards chard things like that spinach you do places that have the highest amounts of osteoporosis drink the highest amounts of milk. So there's something wrong with that scenario that milk is the key to osteoporosis. No putting one foot in front of the other is the key to osteoporosis. The whole exercise taking in a diet that is wholesome in whole grains and vegetables is the key to osteoporosis as well as cardiovascular disease as well as the whole complication with sleep deprivation or hot flashes. So exercise diet herbs. Black Cohosh is so popular now because it's an estrogen phyto estrogen. That's what it does. It acts like estrogen in the body. Also licorice Glycerium. But I want to say that licorice can be potentially harmful for people that have hypertension. So I

wouldn't just go out and start taking licorice root if you are a person who is going through menopause as well as having hypertension that is not a good suggestion. But other herbs that are definitely used for phyto as phyto estrogen as well as progesterone like substances. Is there a level of discomfort that is tolerable a level of discomfort that you can tell to a patient. This is not that bad. You don't really need any HRT or any treatment at all. I think that the individual decision the patients will know can they tolerate or not. I would ask my patients can you tolerate these symptoms and if they say they can. Well I said I do I will recommend you know HRT or anything else. If they can't tolerate it then we have to discuss something further because it's really you know I myself as a physician I can't tell a patient Oh that's OK if they're telling me doctor I can take this. You know. So that's definitely in the video. But on the other hand as it was pointed out earlier we've become a society in which we feel that any kind of discomfort at all we pop a pill that goes away. Right. And is there some question to Monique a level of

discomfort that if the patient tells you. Well I feel something that I can live with it. You simply advise the patient you don't have to do anything. I don't think I can come up with and completely understand and understand your question. I think that just they don't come to you that they don't have if they won't come to you if they didn't have this level of discomfort that they find it difficult to do. Well I think a lot of patients as I mentioned earlier a lot of patients come to the gynecologist for their annual gynecological exams and it's during that time. But I find is paramount to educate if someone's going into my palms to educate about the menopausal period and what things should and should be done as a preventive measure. What everyone seems to agree on here you speak to your medical professional and on the basis of your individual situation. Thanks to all of you for joining us. But most of all our thanks to you for watching. Stay well. Us.