Representative Loebsak Replies About Syria

September 11, 2013

Mr. Steve Greenleaf
345 Magowan Avenue
Iowa City, IA 52246-3515

Dear Mr. Greenleaf,

Thank you for contacting me about Syria.  I'm honored to represent you.  Your opinion is very important to me and my priority is to provide Iowa's Second District with the best representation possible.

As soon as discussions about possible use of military force in Syria began, I urged President Obama to make the case directly to the American people for involvement in the conflict and to seek authorization from Congress prior to committing U.S. military assets in Syria.   Any decision to use military force requires the public debate our Founding Fathers wisely prescribed in the Constitution. 

The use of chemical weapons against civilians and the humanitarian catastrophe in Syria is morally reprehensible and should be unequivocally condemned by the international community.  However, as a member of the House Armed Services Committee, I strongly believe that after more than a decade of war during which time our troops and military families have made great sacrifices on our behalf, we must exercise extreme caution in undertaking any military action.

The President must directly make the case to the American people for why military action in Syria is in our national interest.  This includes laying out the strategic reasoning behind military action, defining the national security reasoning for such action, and establishing an end goal and exit strategy for potential use of force, as well as laying out the broader implications of military action for the region and American interests there.  In a highly unstable area of the world, the implications of U.S. military involvement in the Syrian conflict requires significant debate and the support of the American people.  This is particularly true with our troops still deployed in Afghanistan and after our servicemembers and military families have made incredible sacrifices on our behalf over more than a decade of war.

I have received initial briefings by the White House and will continue to closely engage the Administration and our military, intelligence, and diplomatic leaders on this issue.  However, it is absolutely critical to me to know your thoughts on this issue, and I greatly appreciate you taking the time to share them with me. I also have a poll on this issue posted on my website, which I welcome you to take at http://loebsack.house.gov/syria if you have not already.

Please be assured that as a member of the House Armed Services Committee and the Congressional Human Rights Caucus, I will continue to closely monitor the ongoing situation in Syria and promote extreme caution in the use of military force. 

Thank you again for contacting me about this important issue.  My office is here to assist you with any and all concerns you have, so please do not hesitate to contact me whenever you feel that I can be of assistance.  I encourage you to visit my website at www.loebsack.house.gov and sign up for my e-newsletters to stay informed of the work I'm doing for you.  I am proud to serve the Second District, and I am committed to working hard for Iowans.

Dave Loebsak
Iowa's Second District

JFK’s Secret Doctor: The Remarkable Life of Medical Pioneer and Legendary Rock Climber Hans Kraus by Susan E.B. Schwartz

Two significant anniversaries are coming up soon. This November will mark the 50^th anniversary of the assassination of John F. Kennedy, an event that anyone born before 1958 likely remembers. The memory of this shock is seared into the consciousness of millions of Americans with feelings of loss, vulnerability, and thoughts of what might have been if Oswald had failed.

The other anniversary arrives in less than one year from now. In August 1914, triggered by another assassination, that of the Archduke Ferdinand, heir to the throne of the Hapsburg Empire, the First World War broke out. This marked the beginning of what some have labeled The Long War that ended only in 1989 with the capitulation of the Soviet Union in Eastern Europe. During this period, the Hapsburg Empire collapsed, Germany suffered defeat, Hitler and National Socialism arose, and Germany suffered another crushing defeat. Meanwhile, millions of lives were lost and many more were displaced.

I mention these two events because of their significance in the life of Dr. Hans Kraus, a medical pioneer previously unknown to me. Kraus came from a wealthy Hapsburg Empire family that moved from Trieste, a multi-ethnic city on the Adriatic, to Vienna, the capital of the Hapsburg Empire, and finally to New York, as refugees from the coming storm led by Hitler. The Kraus family had Jewish forbearers, but­ they had the wealth and foresight to escape the tide of war and genocide that washed over their native lands.

Kraus was born at the beginning of the century, and his youth was marked by his time in the mountains, introduced to him by a domineering and demanding father. Kraus grew strong and developed a true love for the mountains: for climbing, hiking, and skiing, which provided him spiritual sustenance. But while Kraus grew up in a wealthy household, his youth was marked by two significant influences: his demanding father (similar in many ways to JFK’s demanding father) and the death of a friend during a climb they made as impetuous youths. Despite his father’s protests and derision, Kraus became a physician, and specifically, an orthopedist, in part as a way to atone after the shocking death of his friend.

Many an orthopedist that I know were athletes, and Kraus fits the mold, but his mountaineering hobby, which lasted nearly his whole life, provided him with experiences that would help change medical practice. For Kraus learned from the practical persons of the mountains, not fellow Viennese physicians, how to treat traumatic joint and muscle injuries. He learned to treat such injuries not by immobilization and bed rest, but by movement and muscular development. Over the course of a medical career spanning almost six decades, his treatment recommendations put him at odds with the medical establishment.

After emigrating to NYC, Kraus developed a very successful medical practice as well as establishing himself as a premier American rock climber. He developed a set of tests to measure susceptibility to back pain—a growing epidemic in the U.S.—and he pushed for better physical health among American children,  and by his efforts helping to create the President’s Council on Physical Fitness (for what little that was worth). However, his greatest claim to fame came from being asked to treat President John F. Kennedy for his famously bad back. Kennedy had undergone two back surgeries and extended periods of bed rest, and was nearly crippled by his back. Kennedy’s situation was aggravated by his Addison’s disease, a secret guarded as closely, if not closer, than his trysts. Kraus, at the invitation of a couple of JFK’s treating physicians, came in and took control of JFK’s back. Kraus palpated Kennedy’s muscles, tested his strength and flexibility, and then he prescribed the treatment: trigger point therapy, exercise, and relaxation. No surgery, no drugs, and no crutches. (Kraus also opposed JFK’s corset, but JFK held on to its use almost as a psychic crutch, which perhaps cost him his life (read the book).) After a couple of years of the Kraus treatment, people close to him described JFK as his healthiest in memory. JFK continued to have flare-ups of back problems, usually associated with time around family—strong stressors given his domineering father, the competitive family ethos, and his marriage—but his flare-ups were not associated with events like the Cuban missile crisis or other demanding presidential duties. Kraus, making his only exception to requiring patients to come see him in his NYC office, came when needed to help the President. By the time of JFK’s assassination, Kraus had developed a strong relationship with JFK and a high degree of admiration.

Kraus was slow to receive recognition in the medical community for his “old-fashioned” ways of palpating and manipulating patients, usually avoiding surgery, drugs, and hospital stays. In fact, the issue of the reception that Kraus’s insights and treatments received within the medical community is a great issue in this book that the author fails to fully explore. Kraus is quoted as saying “I’d be sued now” for using his ways of diagnosis and treatment, but that suggests that we lawyers are the problem. In fact, lawyers are the least important of three parties to a malpractice claim. The two most important players are patients, who, contrary to myth, are (in my experience) reluctant, frustrated by a lack of candor from treating physicians, and badly injured (or the surviving relatives). The other key players in any malpractice claim are fellow physicians, who offer opinions about the standard of care. Their opinions about the correctness of a course of treatment are the crucial element of any claim.

But step back from any consideration of outright malpractice, because an even greater issue is raised here, that of accepted practice (ortho-practice, if you will) that is actually iatrogenic—injury causing—such as bed rest and immobilization. One AMA president in the 1950s quoted in the book stated that smoking is actually probably good for you! Scientific ignorance, reasoning prejudices and biases, and economic incentives (surgery earns more money than prescribing exercises) all contribute to medical practices that can actually prove harmful, if not fatal. (See Nassim Taleb’s Antifragile for more about this.) I would like the author to have done more with this theme than simply noting Kraus’s battles for acceptance and the intransigence of the medical community toward his insights. I’m not sure that Kraus’s methods have been widely accepted—do you still use RICE (rest, ice, compression, elevation) for a sprained ankle? If so, read this book and think again!

Finally, this book is worthwhile because it can lead you to a better back. For most readers, this alone would prove the value of the book. A YouTube of a Kraus program can be found @ http://www.youtube.com/watch?v=UZziz64PNpY. (Enjoy the vintage workout clothes!)

All in all, an interesting and worthwhile book about a very interesting and little known character. A big shout-out goes to Tanta Rose for bringing this book to my attention.

About Syria & U.S. Intervention

If I’d been in the U.S. on Monday, I would not have attended a rally against U.S. airstrikes on Assad’s regime in Syria. Not because I favor such strikes, but because I don’t want to delude myself or others about what we’re doing or not doing if the U.S. were to act. For instance, the mailer from CREDO stated:

The use of chemical weapons is morally reprehensible, and it should be punished. The International Criminal Court should immediately start war crime tribunals and proceedings against those responsible for the use of chemical weapons in Syria. And the U.S. can take evidence that Assad’s regime used chemical weapons to the UN Security Council and seek a resolution against Syria. Both acts would make it far more difficult for Russia to continue defending the regime and open the door for international action to broker a ceasefire -- the only way we will stop the massacre of civilians.

Gee, why hadn’t anyone thought of these actions before? To call this attitude “spittin’ into the wind” would be an apt cliché, except that we’re talking about life and death here. We’re not talking about a simple choice of war or peace. There is no peace in Syria, nor will there be for some time, regardless of U.S. actions. Whatever we do, let’s not delude ourselves. By not acting, we may embolden the regime to use chemical weapons in the future, assuming the regime—with Assad’s knowledge and consent—did make the decision to deploy the poison gas (a likely but by no means certain proposition). By not acting, we and the rest of the world may have allowed the use of chemical weapons without consequence, to the detriment of a bright line that has for the most part been recognized (although we looked the other way with Iraq when Saddam was our enemy’s enemy in the war with Iran). Finally, the President drew a bright line and if we don’t back up his word, we may reduce the credibility of the U.S. and the Obama administration. While I’m generally an Obama administration supporter, the issue isn’t whether it would hurt him and his administration (the David Gergen argument), but it’s a larger issue, larger than all of the factors that I’ve listed so far: what’s in the vital interest of the U.S. in the long haul?

Based on my perception that we do not have a compelling national interest in acting by direct military attack on Syria, we should not. It will come at a cost, as I hope that I’ve made clear above, but politics always revolves around choices, often tragic choices, life and death choices. The leader of our nation has to decide whether a compelling national interest merits the lives of those in our armed forces, the cost to our treasury, and the effects on our long-term standing in the world. I believe our (sort of) hands-off approach to Syria has been the correct stance, the despicable character of the Assad regime notwithstanding. In fact, it may be a case of the devil we know is better than the one that we don’t. If you think that you can forecast accurately the future of any potential change in regime, then I expect that you forecast the sequence and turn of events in Egypt successfully as well. Please call the President immediately with your credentials! Like Egypt, Syria has no oil and no reason (or ability) at this point to cause its neighbors further harm. The Israelis and Saudis may be nervous, but that should be their problem first and foremost, and a secondary concern (at most) to the U.S. We have to act in our national interest, not in accord with any other nation’s interest except to the extent that it accords with our own.

We have a polity will have and express different ideas about what constitutes a compelling national interest, but to me, we have to have some tangible reason for action, not merely our revulsion of murder and genocide (important as those are) nor some sense of national prestige or credibility.

At this point, I don’t see how our national interest compels us to act. The reasons for action—which I take seriously—do not outweigh the reasons to avoid taking the course of active military intervention. Let’s hope that the Russian proposal, if real, works and saves us from having to make a tough decision.

I’ll be sending this to Congressmen Loebsak and Braley along with Senators Grassley and Harkin. A “no” vote to strikes isn’t a vote against “war” or to “give peace a chance”, but a calculated decision to protect the vital national interests of the U.S. and to commit to making the world a better place in the long run, even when it hurts.  

P.S. Nicholas Kristoff wrote compelling in favor of intervening. Stephen Walt argues articulately (and convincingly, to me) against intervention, and Graham Allison provides some thoughts about alternative courses of action that seek to punish and deter without the use of airstrikes. See my Twitter feed for citations if you care to check these out.