Twenty-five years ago, as an American GP living and practising in Wales, I would watch BBC sports programmes, such as darts and bowls and snooker, all unknown to me and, therefore, fascinating. I always found it odd — pairings such as Scotland (or Wales) versus The Rest of the World. It either seemed overly ambitious for Scotland or slim pickings for the rest of the world. After the recent US presidential election, it appears as if it will continue to be the US versus The Rest of the World.

Three books might help you, who are of ‘the rest of the world’, begin to grapple with what is going on in the US. Written from the short, medium, and long view, each has a somewhat parochial twist. Each also, however, contains a great deal of useful history.

The 9/11 Commission Report refutes the old saw that nothing good can be written by a committee. The report is a remarkable book and its recent nomination as a finalist for the National Book Award is a first for a government document, and well deserved. What is contained in this report is well known by most of us — the cast of characters has been in the news for over 3 years. And the sequence of events and many of the details that were gleaned from the ongoing hearings have been contained in news stories, long and short. However, to have published what is known until this point in a single narrative, which is at once accessible and clearly written, is a truly historical achievement. Reading the events of the day — regarding the planes that crashed in the city of New York, as the rescue squads from police and fire departments move into place and act — is both familiar and detailed in a way that helps us understand better than I would ever have imagined the why and how of all the death and destruction.

So much about those days have been parsed into documentaries — long analyses of causation of issues, like why the towers fell — that one would think that everything that could be written had been. But the Commission's report really does add enormous amounts of history to the sound bites and 30-second visuals that have pervaded politics and the world assessment of the US since that time. The report deals extensively and thoughtfully with the history of Islam, both ancient and recent, and describes the history of terrorism as it evolved from highjackings of the 1970s to the use of bombs and targeted destruction of military targets in the late 1980s and 1990s.

Events that occurred in the time that preceded the attacks of 9/11 are written in a way that shows the convergence of intelligence reports, a long history of threats from Bin Laden, and many alerts and warnings (‘the system was blinking red’ in the words of Tenet, CIA director). The information about the movements of the terrorists in their planning and the worldwide involvement of cells, support systems, and finances makes it clear that these events were truly the result of a network that reaches virtually everywhere.

After the attacks, reading of the efforts of the fire, police, and other rescue squads in New York adds specifics that are terrible and remarkable. On 9/11, I ran up and down the stairs between patients to watch on television as it was all happening. All of us who watched that day wondered what those people who were clearly doomed were thinking, feeling, and seeing. Their actual words in this report are not fiction, they are the words, for most the last words, of people who died as we watched. Their words are the hardest part of this long, detailed report to deal with.

Much of the final third of the report is devoted to what a fire captain friend of mine once called a PFE — a post-fire evaluation — which he mandated for his squad after every fire. In a PFE, the entire squad reconstructed, relived, and discussed the events to see what could be improved next time. The 9/11 Commission engaged in a world-scale PFE. Although all US politicians state that they intend to follow the recommendations of The 9/11 Commission Report, the backing and filling is already well underway. What politician, for example, is going to agree that major conurbations, and political and tactical targets should receive preference over their hometown fire departments and that homeland security money should ‘not be used as a pork barrel’?

Rather than bringing a grieving country together in a way that will make such events unlikely to happen again, the reactions from the report have begun to cleave along party lines once again. The 9/11 Commission was almost unique in its thoroughness, transparency, and its ability to focus on the real issue of terror and lawlessness. However, the extent to which a violent stateless ideology has negatively affected the tolerance of differences, the sense of community, and the level of civic discourse in the US means that terrorism has affected our neighborhoods as much as it has affected our country. And fear rather than determination, despite the President's stump speech, has become the dominant emotion.

Robert Byrd, from his 45-year perspective in the US Senate, understands that cheques and balances are essential to avoid tragedy, even if they, at times, impede progress. His book, Losing America, contains several ‘under-the-table’ looks at Congress and the manipulations and arrogance of the coterie of ideologues who surround George W. Bush. Byrd, from the Southern tradition of politeness and respect, which often cloaks bar-room politics, is steeped in the history of the institution of the Senate. He is personally offended by Bush's lack of interest or curiosity in the legislative process prior to 9/11, and his dishonesty and deception afterwards. Byrd's address to the Senate on the eve of the war on Iraq was widely quoted and is contained in this book. While people marching in the streets made headlines, it was an 85-year-old senator, not previously known as an outraged progressive, who took on both the Administration for its hypocrisy and many of his colleagues for their lack of courage and principle. He voted against the war and continues to point out the dishonesty of the people who guide it. The book reads with a sensibility from another age. Although his own history is certainly not without problems, Senator Byrd's belief in the true democratic process, rather than the gun-barrel approach of George W. Bush, should be given the respect that he, and it, deserve.

Arthur Schlesinger Jr has been writing history since 1946 and has Pulitzer prizes to prove he does it well. His voice is considered, thoughtful, and scholarly — as one might expect from a historian and distinguished teacher. Toward the end of his book War and the American Presidency, however, Schlesinger's voice rises with outrage at those who surround and influence George W. Bush, the ‘small group of Messianic statesman whose self righteousness bids fair to wreck our age’. He writes of the imperial presidencies of the early years of the country, which repressed dissent during wartime, and how the US moved from wars based on pique to engaging international diplomacy and internationalism. Schlesinger reminds us that all presidents since Wilson, with George W. Bush being the glaring exception, believed in statesmanship, diplomacy, alliances to guard against capricious choices and, when necessary, taking on common enemies.

Much of Schlesinger's book, however, also chronicles the record of the current Administration which, by being ‘judge, jury, and executioner resurrects the imperial presidency’. An imperial presidency in the age of frigates and single-shot rifles cannot be compared with one that possesses weapons of mass destruction and a wooly-headed sense of divine guidance. We used to think of Henry Kissinger as the prototype for Dr Strangelove, but I wish Kubrick were still alive to do the remake with Dick Cheney and Donald Rumsfeld in mind.

Needless to say, the recent election, instead of relegating George W. Bush and his hangers-on to the historical trashbin, has pushed them to the front of the international agenda. A secretive, defensive, unreflective president will now shape the world for our grandchildren. Each of these books elaborates on the ineffectiveness of Bush dealing with the real enemy while he digs deeper into a country where he is creating more enemies by the day.

One has to ask why, instead of quietly writing their memoirs, two distinguished 87-year-old statesmen are raising the alarm and shaking us by the throat — like the aging Thomas Jefferson who, in his famous letter of 1820, said of the first compromise to try to divide the country between slave and free states: ‘this momentous question, like a firebell in the night, awakened and filled me with terror’. Byrd and Schlesinger hear the firebell and are ringing it to wake us up. Another quote that might better capture Bush and his legacy would be from the Bible he uses as justification for his policies: ‘He that troubleth his own house shall inherit the wind’ (Proverbs 11, 29).

The 9/11 Commission Report: Final Report of the National Commission on Terrorist attacks upon the United States.

pReVIously ClAssIfIed by IARC As “CARCInogenIC to humAns (gRoup 1)” And wAs deVeloped by sIx sepARAte woRkIng gRoups: phARmACeutICAls; bIologICAl Agents; ARsenIC, metAls, fIbRes, And dusts; RAdIAtIon; peRsonAl hAbIts And IndooR CombustIons; ChemICAl Agents And RelAted oCCupAtIons. thIs Volume 100f CoVeRs ChemICAl Agents And RelAted oCCupAtIons, speCIfICAlly 4-AmInobIphenyl, benzIdIne, dyes metAbolIzed to benzIdIne, 4,4’-methylenebIs(2-ChloRoAnIlIne), 2-nAphthylAmIne, oRtho-toluIdIne, AuRAmIne And AuRAmIne pRoduCtIon, mAgentA And mAgentA pRoduCtIon, benzo[A]pyRene, CoAl gAsIfICAtIon, oCCupAtIonAl exposuRes duRIng CoAl-tAR dIstIllAtIon, CoAl-tAR pItCh, Coke pRoduCtIon, untReAted oR mIldly tReAted mIneRAl oIls, shAle oIls, soot, As found In oCCupAtIonAl exposuRe of ChImney-sweeps, oCCupAtIonAl exposuRes duRIng AlumInIum pRoduCtIon, AflAtoxIns, benzene, bIs(ChloRomethyl)etheR And ChloRomethyl methyl etheR, 1,3-butAdIene, 2,3,7,8-tetRAChloRodIbenzo-pARA-dIoxIn, 2,3,4,7,8-pentAChloRodIbenzofuRAn, And 3,3’,4,4’,5-pentAChloRobIphenyl, ethylene oxIde, foRmAldehyde, sulfuR mustARd, VInyl ChloRIde, IsopRopyl AlCohol mAnufACtuRe by the stRong-ACId pRoCess, mIsts fRom stRong InoRgAnIC ACIds, oCCupAtIonAl exposuRes duRIng IRon And steel foundIng, oCCupAtIonAl exposuRe As A pAInteR, oCCupAtIonAl exposuRes In the RubbeR mAnufACtuRIng IndustRy. beCAuse the sCope of Volume 100 Is so bRoAd, Its monogRAphs ARe foCused on key InfoRmAtIon. eACh monogRAph pResents A desCRIptIon of A CARCInogenIC Agent And how people ARe exposed, CRItICAl oVeRVIews of the epIdemIologICAl studIes And AnImAl CAnCeR bIoAssAys, And A ConCIse ReVIew of the Agent’s toxICokInetICs, plAusIble meChAnIsms of CARCInogenesIs, And potentIAlly susCeptIble populAtIons, And lIfe-stAges. detAIls of the desIgn And Results of IndIVIduAl epIdemIologICAl studIes And AnImAl CAnCeR bIoAssAys ARe summARIzed In tAbles. shoRt tAbles thAt hIghlIght key Results ARe pRInted In Volume 100, And moRe extensIVe tAbles thAt InClude All studIes AppeAR on the monogRAphs pRogRAmme websIte (http://monogRAphs.IARC.fR). It Is hoped thAt thIs Volume, by CompIlIng the knowledge ACCumulAted thRough seVeRAl deCAdes of CAnCeR ReseARCh, wIll stImulAte CAnCeR pReVentIon ACtIVItIes woRldwIde, And wIll be A VAlued ResouRCe foR futuRe ReseARCh to IdentIfy otheR Agents suspeCted of CAusIng CAnCeR In humAns. D es ig n by A ude la d es m ot s

iArc monogrAphs on the evAluAtion oF cArcinogenic risks to humAns

Two groups of mediators, the neuropeptides substance P and K and the monocyte-derived cytokines, interact in the neural regulation of immunological and inflammatory responses. Substance P, substance K, and the carboxyl-terminal peptide SP(4-11) induce the release of interleukin-1, tumor necrosis factor-alpha, and interleukin-6 from human blood monocytes. The neuropeptide effects occur at low doses, are specific as shown by inhibition studies with a substance P antagonist, and require de novo protein synthesis. Since monocyte-derived cytokines regulate multiple cellular functions in inflammation and immunity and since neuropeptides can be released from peripheral nerve endings into surrounding tissues, these findings identify a potent mechanism for nervous system regulation of host defense responses.

Effect of neuropeptides on production of inflammatory cytokines by human monocytes

Operator error and system deficiencies: analysis of 508 mining incidents and accidents from Queensland, Australia using HFACS.

Diesel exhaust (DE) is classified as a probable human carcinogen. Aims were to describe the major occupational uses of diesel engines and give an overview of personal DE exposure levels and determinants of exposure as reported in the published literature. Measurements representative of personal DE exposure were abstracted from the literature for the following agents: elemental carbon (EC), particulate matter (PM), carbon monoxide (CO), nitrogen oxide (NO), and nitrogen dioxide (NO(2)). Information on determinants of exposure was abstracted. In total, 3528 EC, 4166 PM, 581 CO, 322 NO, and 1404 NO(2) measurements were abstracted. From the 10,001 measurements, 32% represented exposure from on-road vehicles and 68% from off-road vehicles (30% mining, 15% railroad, and 22% others). Highest levels were reported for enclosed underground work sites in which heavy equipment is used: mining, mine maintenance, and construction (EC: 27-658 microg/m(3)). Intermediate exposure levels were generally reported for above-ground (semi-) enclosed areas in which smaller equipment was run: mechanics in a shop, emergency workers in fire stations, distribution workers at a dock, and workers loading/unloading inside a ferry (generally: EC<50 microg/m(3)). Lowest levels were reported for enclosed areas separated from the source, such as drivers and train crew, or outside, such as surface mining, parking attendants, vehicle testers, utility service workers, surface construction and airline ground personnel (EC<25 microg/m(3)). The other agents showed a similar pattern. Determinants of exposure reported for enclosed situations were ventilation and exhaust after treatment devices. Reported DE exposure levels were highest for underground mining and construction, intermediate for working in above-ground (semi-) enclosed areas and lowest for working outside or separated from the source. The presented data can be used as a basis for assessing occupational exposure in population-based epidemiological studies and guide future exposure assessment efforts for industrial hygiene and epidemiological studies.

Occupational exposure to diesel engine exhaust: A literature review

International evaluation of injury rates in coal mining : A comparison of risk and compliance-based regulatory approaches

Silicosis and tuberculosis (TB) are significant mining-related illnesses in developing countries. The purpose of this study was to examine annual cases of these diseases in Zambian miners, including comparison of periods before (1960-1970) and after (1992-2002) the arrival of the HIV/AIDS pandemic. The Occupational Health and Safety Research Bureau of Zambia reported 2114 cases from 1945 to 2002. Of these, 22.7% were silicosis, 65.4% TB, and the remaining 11.9% silicotuberculosis. While silicosis cases decreased from 28.6% to 12.4% with the arrival of HIV/AIDS, there was a large increase in tuberculosis cases (37.1% to 86.1%), with a corresponding decrease in silicotuberculosis cases (34.3% to 1.6%). Although silicosis remains an occupational health issue in Zambian miners, the most significant problem appears to be the marked increase in cases of TB.

Silicosis and tuberculosis in Zambian miners

Introduction. Although exposure to diesel exhaust has been linked with adverse health effects, little is known about the acute effects of exposure in the underground workplace. Methods. Cross-shift...

Acute changes in sputum IL-10 following underground exposure to diesel exhaust

The incident rates of mining-related accidents and injuries in developing countries exceed those of developed nations. Interventions by international organizations routinely fail to produce appreciable long-term improvement. One major reason is the inability to identify and analyze the underlying factors responsible for creating unsafe working conditions. Understanding these antecedent conditions is necessary to formulate effective intervention strategies and prioritize the use of limited resources. This study utilized a logic model approach to determine the root causes and broad categories of potential interventions for mining accidents and injuries in Zambia. Results showed that policy interventions have the greatest potential for substantive change. A process of educating officials from government and mining companies about the economic and social merits of health and safety programs and extensive changes in regulatory structure and enforcement are needed.

Identifying Antecedent Conditions Responsible for the High Rate of Mining Injuries in Zambia

Neprilysin (NEP) is a key cell surface peptidase in the maintenance of airway homeostasis and the development of pulmonary disorders. However, little information is available about the effect of particulate matter (PM) on airway NEP. In this controlled human exposure study, changes in induced sputum were measured in 11 subjects at baseline, overshot (OS) mucking, and diesel exhaust (DE) exposure days. Neither OS condition nor DE exposure was found to induce significant changes in total protein, but DE induced significant increases in cell numbers of macrophages and epithelium. Moreover, significant increases in soluble NEP were observed following OS mining dust particulates (0.43 ± 0.06 nmol/μg protein/min; p = .023) and DE exposure (0.40 ± 0.03 nmol/μg protein/min; p = .035) when compared with the baseline control (0.30 ± 0.04 nmol/μg protein/min), with 42% and 31% average net increase, respectively. Pearson’s correlation analyses indicated that sputum NEP activity was significantly associated with perso...

Hugh B. Miller

Papers

International evaluation of injury rates in coal mining : A comparison of risk and compliance-based regulatory approaches

Silicosis and tuberculosis in Zambian miners

Acute changes in sputum IL-10 following underground exposure to diesel exhaust

Identifying Antecedent Conditions Responsible for the High Rate of Mining Injuries in Zambia

Acute changes in sputum collected from exposed human subjects in mining conditions.