Online Petition: Stop the DEA From Criminalizing Routine Geriatric Care in Nursing Homes

Go here to sign http://www.gopetition.com/online/32305.html

Background (Preamble):

The DEA in accordance with the controlled substance act (CSA), amendments to the CSA, and the DEA’s own internal interpretations of the act, regulate the prescription and dispensing of scheduled (controlled) drugs with the purpose of limiting abuse of these drugs. The intention of the CSA was geared toward limiting abuse in outpatient settings; the CSA itself does not mention nursing homes or hospitals.

When these DEA rules, which are originally designed for outpatient/office setting, are applied to inpatient settings, like nursing homes and hospitals, they create a logistical barrier to care and make the timely dispensing of medications prescribed by medical providers very difficult.

The DEA in 2009 initiated a strict enforcement of controlled substances rules in nursing home and have taken action against some nursing home pharmacies for what they deemed to be non-compliant practices. This “non-compliance” is not associated with any abuse issues but rather the nursing homes are being caught not following outpatient procedures set by the DEA.

This is a complicated issue but below are a few of the ways this DEA action is impacting nursing home providers’ practices and the care of nursing home patients:

1. If a new order for a narcotic drug is written in the nursing home chart, the provider has to write a hard script to go with that order.

2. If the medical provider writes an order to change a pre-existing order for narcotics, the provider has to repeat the same process and write a new script for the new change in dose or interval. This creates a disincentive to making appropriate order changes in patients with uncontrolled pain.

3. If the provider is not in the nursing home facility and gives a verbal order for a narcotic, he or she would have to fax a script to the nursing home before the pharmacy can dispense what he or she ordered. If a faxed script is not possible then a separate call is required to the pharmacist to authorize an emergency dispense. Hard scripts would then have to be written for the emergency authorization as well as the original order and be faxed to the pharmacy within 7 days. Of note, some pharmacies, like Waltz pharmacy in Maine, would not even take an emergency authorization unless the patient in the nursing home is having an “actual emergency” aside from the fact that they have a doctor’s order that shouldn’t wait till the next business day to be carried out. Ironically, CMS (Centers for Medicare and Medicaid) would consider such delay in care a violation in any federal or state survey of a nursing home. CMS expect nursing homes to carry out doctors orders without delay.

4. If the nursing home pharmacy can not deliver the ordered medicine in a timely fashion the staff at the nursing home are accustomed to using the “Emergency box” (E-box) in their facility to dispense the ordered medicine, while waiting for the pharmacy to deliver. The DEA’s position now is that the nursing staff can not use the E-box without a separate prescription (in addition to the original order and script), otherwise they are considered in violation of DEA regulations. Emergency script for each “Emergency box” use in this impatient setting is what the DEA is now mandating. With this DEA interpretation, some nursing home patients may be deprived of an important stop gap measure traditionally used by nursing staff to ensure the timely dispensing of medications legitimately ordered by licensed providers.

5. In addition to writing the orders for narcotics and providing hard scripts, nursing home providers are now expected to ask for a specific number of pills even though their patients are in an inpatient setting. This means that most providers would write for larger number of pills to avoid having to repeat this process over an over again. Larger scripts means more drug wasting in the nursing homes.

6. If the strict interpretation of the DEA regulations are applied then the above issues with schedule II narcotics would also be applicable to other scheduled drugs (III-V). In fact some nursing home pharmacies are already taking this strict stance as standard of practice.

7. Last but not least, assisted living facilities are in a worse shape than nursing homes as a result of the new DEA enforcement practices. Despite having a contracted pharmacy, like nursing homes, and having more or less the same checks and balances as nursing homes, these assisted livings facilities are now required to mail hard scripts (not fax) to the pharmacy for all narcotic orders. Some assisted living facilities are reverting back to using regular outpatient office practices for their patients rather than utilizing onsite geriatric medical services because it makes it logistically easier to meet the DEA requirements.

8. At no point does the DEA allow nursing home nurses to act as the agents of the providers in prescription matters. This is contrary to the realities of geriatric work in nursing homes where the medical team is made up of providers and nurses. Nursing home nurses have traditionally been the eyes and ears and the right hand of the providers in every nursing home in the nation.

The argument against the DEA actions:

1. Doctor’s authorization in nursing homes equals doctors orders in the chart. Mandating a hard script is simply a duplication of the providers’ orders in another format and serves no purpose whatsoever.

2. Nursing homes are inpatient facilities and patients residing there are inpatients. Nursing home residents should not be treated as community dwelling outpatients who get their prescripts during outpatient office visits and have minimal changes in medications between visits. Modern Geriatric standards mean more frequent intervention and orders to meet the needs of the nursing home population. This includes frequent, sometimes daily, nursing calls to providers to address changes in patients’ status that often require new orders. The DEA requirement that these frequent orders be coupled with prescriptions is bringing this dynamic system of care to a halt.

3. Nursing homes maintain contracts with house pharmacies that follow the same checks and balances as hospital pharmacies. These checks and balances already account for the appropriate use of the nursing home “Emergency box”. As it is, two nurses are required to sign off on each access of the “Emergency box”, in addition to having a doctor’s order in the chart. These pharmacy services, and protocols are already mandatory for all nursing homes in the United States and have been proven very effective.

4. Nursing homes and hospitals follow the same protocols and have similar checks and balances, yet the DEA doesn’t apply the scheduled drugs rules to hospitals but does so in nursing homes. The explanation is that the hospitals are inpatient; We say so are the nursing homes.

5. The DEA, by applying rules designed for outpatient setting to nursing homes, are creating problems without solving any. It is widely accepted that the only major DEA related problem in nursing home is “drug diversion” by staff, not “drug abuse” by nursing home patients. The documentation and checks and balances in nursing homes, just like in hospitals, are geared to dealing with the issue of drug diversion and preventing it. The DEA’s current actions divert attention from this very real DEA related problem and focuses attention on a self created issue of paperwork compliance that does nothing to prevent drug diversion.

6. The DEA is creating unnecessary hardship for nursing home patients and providers alike in a field of Medicine where there is a real shortage of qualified medical providers. Geriatric recruitment and retention is already suffering as the unnecessary paperwork mounts. The DEA actions are exacerbating a chronic geriatric recruitment issue in nursing homes.

7. Drug wasting in nursing homes can be expected to increase as the DEA is providing an incentive for providers to write larger scripts to minimize their paperwork. When there is a change in orders, the pharmacy is not allowed to take back the unused drugs, so they are routinely wasted at a huge cost to the system.

8. The increased bureaucracy increases the chances of medication errors as the potential for providers giving slightly different instructions multiplies when orders and scripts are done in separate steps and in duplication.

9. The DEA is creating a new potential abuse issue in nursing homes that never existed before, as the new mandates are resulting in increasing number of hard prescription that the providers give to facilities only to sit in charts after being faxed to pharmacies. These signed hard scripts can be sold or used illicitly to get narcotics from outpatient community pharmacies. Most providers are genuinely concerned that the hard scripts they provide to nursing homes serve no purpose and are a liability for them and their practices.

10. CMS (Centers for Medicare and Medicaid) has long been pressing nursing homes to improve pain management for their residents. This new DEA action is a barrier to meeting that goal, and it can potentially disrupt the quality of care related to pain management.

Petition:

We petition our government to instruct the DEA and CMS to take the following actions:

1. The DEA should use the same standards for all inpatient facilities, including nursing homes. Nursing homes (NF and skilled facilities) and assisted living facilities should be treated the same as hospitals and inpatient rehabilitation facilities, provided they maintain the same pharmacy checks and balances as hospitals. This should include the ability of nursing home nurses to use the “Emergency box” to fill doctors orders until the pharmacy can deliver the ordered medications.

2. Allow nursing home nurses to act as the agents of medical providers to implement and carry out doctors’ orders in their facilities. This should apply to the DEA as well as Medicare Part-D issues i.e. assist with prior authorization issues and conveying doctors’ orders to pharmacies.

3. Allow nursing home pharmacies to act as the agents of medical providers in processing prior authorizations with Medicare part-D plans for nursing home patients when providers order drugs not covered by Part-D formularies.

4. Allow nursing homes to have a less restrictive system for partial fills for PRN (as needed) as well as scheduled narcotics to decrease drug wasting and associated cost.

Go here to sign http://www.gopetition.com/online/32305.html

It's the economy stupid, Even in Iran

Many following Iranian politics are waiting and hoping for some sort of major political event that would push the Green revolution over the hump and lead to the collapse of the Iranian regime.

The main problem this Iranian revolution has had is that the educated elite are the only ones revolting, while the majority of other Iranians are still on the sidelines.

There is one event that might motivate the other socioeconomic classes to join the green revolution and it happens to be the brainchild of the government itself. Facing a budget deficit and impending sanctions, the Iranian government just approved a measure to take away subsidies on some basic commodities, like gasoline.

The gas prices in Iran are about to increase by at least 350%. Imagine if Gas prices in the US went from $2.7 to $9.45 overnight. The amazing thing is that if the Iranian government is doing this at a time when the political future of the regime is in jeopardy. They think their plan to pay qualified families a stipend will lessen the devastating psychological impact of such a jump in inflation.

Like other dictatorships in history, the dictators are the last to realize that their time is up. East Germans had a military parade a month before the Berlin wall fell, and in similar fashion the Iranians are increasing the cost of commodities for the poor during a major political turmoil. This political suicide will be put into action within the next 12 months; I can't wait!

The greatest thing about the dictators of Iran is that they seem to be more arrogant than they are stupid, which suits me just fine.

Iranians are posting info on individual Riot police officers

Facing an increasingly brutal crackdown, and with no way to fight back, Iranian revolutionaries are fighting back by taking the battle to the individual riot police. The Green movement is posting photographs of the riot police officers as they beat up young demonstrators, most of whom are girls. What really caught my attention was that they also included the individual officers' name, rank, unit, as well as their home address and phone number.

This is their way of trying to hold their oppressors accountable. Some of the riot police officers can no longer go home and forget about their rough day at work anymore. Sooner or later they will have to answer for their actions to their families, neighbors, friends, and most likely future courts, if and when the regime is overthrown.

This revolution is evolving in many ways:

-When the government refused to grant permits for public gathering, the greens used government events to make their voice heard. The latest example was Nov.4 when they went to a government sanctioned anti-American demonstration, commemorating the hostage taking of American diplomats, to chant slogans asking the American president Obama to support them in their struggle against the anti-American Iranian regime. They walked over the picture of the supreme leader instead of walking over the american flag, as is customary in such events.

-When the government started using the online video footage to track down demonstrators, the Greens started taking clips showing the backs of people rather than filming while facing the demonstrators, many of whom now waring masking for good measure.

-When there was no opportunity to express dessent on state television, some brave soles confronted the leadership, including the supreme leader, in the government's own TV covered events and the government to task publicly. They held the regime accountable for its actions and oppression on state media, even if it was only for a moment to be censored later.

The future is now more unpredictable than ever but with the government squashing peaceful demonstrators it's a matter of time before some of these demonstrators decide to arm themselves and exercise whatever version of self defense they deem appropriate. We will then have a full blown civil war that will only end after much loss of life.

Lets hope this regime expires before this stage of the revolution.

Iran and President Obama, time to take a stand

Iranian demonstrators in Tehran are chanting "Obama, Obama, either with them (the government) or with us". I wonder if he is aware of the gravity of this sentiment on the streets of Iran. What if the people of Iran conclude that the united states would rather play it safe and be content to watch as the Iranian regime tries to crush them. What if they won despite the lack of moral support from the US and it's president?Isn't that a political risk for Mr. Obama?

It is hard to imagine how Mr. Obama can avoid taking a chance and stand with the Iranian people despite what some overcautious politicians think. I hope his advisers are pointing out the fact that it is politically wise for the united states to abandon talks with a government at this time considering that the current regime will never be a true friend to America, in favor of cultivating a better relationship with Iran as a country down the line.

Even if the government of Iran doesn't change the US can pick up were it left off months or years later when the political atmosphere is different and the US won't appear to be appeasing a brutal regime.

The continuation of overtures towards Iran despite the savage crackdown against the defenseless civilians is undermining the future relationship between the two countries. The risk of siding with the demonstrators is much less than the risk of appearing obtuse about the cause of freedom and the wants of the Iranian people.

The current government of Iran blames the US for all ills whether they support the democratic movements or not so why not show some initiative and go all out in support of the peaceful demonstrators.

President Obama is not immune from missing a historical opportunity to do good, just as president Hoover, with his strong financial background, was an unlikely president to miss a historical chance to confront the great depression.

The president is facing a choice and he should know that he can't have it both ways, either stand with the Iranian people in their fight with the regime or pursue an illusive reconciliation with an untrustworthy regime that still celebrates taking American diplomats hostage after 30 years of that shameless act.

I hope he throws caution to the wind and do the right thing. Mr. Obama and The united states shouldn't be on the wrong side of history in this crucial time for Iranians.

Khamenei's mistake could end his Regime

Khamenei did not need to antagonize all the grand Ayatollahs in Iran and Iraq, for no reason what so ever, but yet he did.

Khamenei issued a decree, on Sat the 19th of september, "ordering" all Iranians to stop fasting and celebrate the Eid on Sunday, rather than Monday, contrary to the decrees of all the other Ayatollahs.

In Shiite Islam individuals are required to select a senior clergyman, an Ayatollah, to be their spiritual guide in religious matters, such as when to start and end the fasting month of Ramadan. Ayatollah Khamenei, like the other Ayatollahs, has his own religious followers, inside and outside the country. He is also the only Ayatollah who is the head of state for all Iranians. This political title does not change the fact that most Iranians, regardless of their political allegiance, look to Ayatollahs other than Khamenei for spiritual guidance when it comes to religious matters.

As a religious leader Khamenei is expected to exercise his purgative in issuing edicts for his own religious followers on issues such as what day to start and end of the fasting month of Ramadan. Such religious edicts are expected to be directed at his religious followers and not be forced on others.

The aforementioned command is a major leap even for a supreme leader and effects all Iranians and not only Khamenei's own religious followers--It is an intolerable mixing of politics and religion even in a theocracy. This blatant action is tantamount to countermanding the religious advice of all other Shiite Ayatollahs in Iran and Iraq, including the grand Ayatollah Sistani in Najaf, who has the greatest religious following among Shiites around the world.

By this action Khamenei is forcing all Shiite Iranians to ignore their own spiritual guides and follow his religious instructions as the political head of state instead. Most people would see this as a step too far and an abuse of power by the supreme leader--needlessly interfering in the most basic of religious matters. The Grand Ayatollahs in Qom and Najaf are likely to see this as a direct challenge to their authority over their flock, and may do the unthinkable and consider the Iranian theocracy a threat to the Shiite religious establishment.

With the exception of the student organizations, the religious establishment in Iran is the only non government entity with grass roots that could be tapped into to organize the opposition movement and give it a reasonable chance of success. If all the Ayatollahs brake their silence and put their weight behind the Green revolution then this regime is history.

Khamenei may believe himself to be the new Khalif or Shah of Iran with power over all people, in both religious and political maters, or he could be simply inadvertently over reaching, either way he may have just made his biggest mistake yet.

Iranian women ministers, yeah right

Mr. Ahmadijejad may think that the women of Iran who are eager to depose him will be satisfied with the gesture of selecting two women to be the first women ministers in the Islamic republic. Never mind the fact that the proposed minister of health is a hardliner who once called for the segregation of women into separate hospitals. Never mind that the proposed minister of welfare is a staunch defender of polygamy and is a two time Parliament member in the hardliners' block.

Mr. Ahmadijenad is either arrogant, stupid, or both, for believing that the brave girls and women who walk in front of their men in the street demonstrations would be that gullible. It doesn't seem likely for these women to risk arrest, torture, and rape only to fall for such empty gestures.

Radical women in ministerial positions does not advance the cause of women's rights, rather it is likely to serve as a cover for more limitations on women.

Some blacks may have once thought that the selection of the black Judge Clarance Thomas to the united states supreme court would mean more support for minority rights, but he proved that a person's beliefs are more important than gender or ethnicity.

Iran will one day be free and so will its women and minorities; the only way Mr. Ahmadinejad is going help in this process is by fueling the flames of the green revolution by being the stupidly arrogant sun of a bitch that he is.

Mr. Ahmadinejad does not realize this but he is like a frog enjoying the slowly boiling water that is the Iranian green revolution. He will one day be tried for his actions and the judge might well be one of the women that he subjected to imprisonment and rape.

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Mousavi needs to act

Brave people deserve brave leadership, and so the besieged people of Tehran deserve to have their leaders share in their risks and sacrifices.
I know that Mr. Mousavi is under house arrest but if the few thousand people manage to get through the armed militias and police maybe he can try harder to join them.
Such a brave act would force the government's hand into arresting him, which would add another spark to this revolution.
Mr. Mousavi may turn out to be like Mr. Gorbachev, a catalyst for change but not destined to be the leader in the new age. Either way he needs to act and leave the rest up to the Iranian people. I hope he gets it that this is no longer about a desputed election--it's about regime change.

Iranians should be proud, Persian or Not

Most in Iran know that not all Iranians are Persians but most Iranians abroad insist they are. Perhaps it is because people might like them a little better if they associated them not with Iran but with ancient Persia.

Even as Iranians from all ethnic backgrounds fight and die on the streets of Tehran and other cities, some supporters insist on over emphasizing the persianhood of the people of Iran. This old inferiority complex was exaggerated by the bad reputation brought on by 30 years of the Islamic republic. In this day and age such thinking, regardless of its root causes, is at worst racist and at best narrow minded.

After the sacrifices and the extraordinary bravery of the Iranian men and women in the past few week it should be easier for most Iranians to use the word "Iran" without being ashamed anymore. Let us stop insisting on reminding everyone of our Persian heritage in order to entice them to respect us despite us being Iranaian.

Again, We are all Iranian but not all Persian. Afterall Mr. Moussavi himself is an Azeri Turk, and the young student who took a bullet to the head on the 20th of June was an Arab Iranian from Ahwaz; sadly he also happens to be my sister's brother in law.

Lets be proud of being Iranian again and stop pushing the "Persian" phrase all the time. Lets just pray that our brave country men and women in the front lines will keep on fighting for all of us, Persians and non-Persians.

Did I also mention how we need to distribute some DVDs to the masses and inform ordinary Iranians about our struggle?

DVDs maybe the key to Iran's Green Revolution

There is no doubt that the students and the facebook members of Iran are predominantly behind the fledgling green revolution. What is in doubt is the awareness and support of the millions of poorer Iranians with no access to alternate media. It is not clear if they are aware of the extent of oppression and killings by the government security forces on the streets. If the Media black out in Iran holds, the revolutionaries may remain cut off from the majority of the poor Iranians. Without those masses in southern Tehran and the provinces the revolution can not succeed.

In 1979 ayatollah khomeini, faced with a simillar Iranian media black out, spread his message from France through smuggled cassette tapes. The hope of the new Green revolution may lye in DVDs and CDs as even the poor with no facebook accounts have access to DVD players. Lets burn some DVDs and get the word out. There is security in numbers and this might help bring more people out to support the thousands of brave Iranians already on the street.

I was touched last night as I watched a clip of young demonstrators being charged by the police. As the crowd saw tear gas and smoke rising ahead of them they chanted "be brave, we're all together". With no one to help them and surrounded by so many security forces they are indeed brave as they only have each other.

Iran's Green revolution, Is it finally happening?

When I last left Iran 18 years ago not only had I given up on the idea of traveling back to visit, but I had also given up on the possibility of regime change in Iran in my life time. There were many more Iranians who looked at Iran from afar hoping that they would return some day but most, if not all, had given up hope.

When the latest election came, I greeted it with my usual skepticism knowing that the so called reform movement is just a faction of the ruling regime and can not be an instrument of real change.

What happened next caught me off guard and did not fit into the familiar Iranian political equations. It seems that the Iranian regime was not content to have the people chose the inconsequential post of president but decided to deny the people that privilege as well. And so the hardliner Ahmadijenad who trailed his opponents in the poles wins unexpectedly, in a landslide no less.

The sequence of events that followed were an expression of multitudes of frustrations by the people and was spontaneous and not politician driven. What the government saw as post-election demonstrations were actually anti-government demonstrations. In the early days the reformist leaders even called for the cancellation of rallies in an attempt to remain on the good graces of the supreme leader, only to see the people show up on the streets anyway. People power is driving the leaders and they're trying desperately to catch up.

As the supreme leader drew a line in the sand on Friday, asking for demonstrators to go home or there will be bloodshed, a ghost from the past appeared on the political scene to challenge him directly. Political junkies may recall that In the months before the late Ayatollah Khomeini's death there was a change in the succession plans. Up to that time the Iranian regime had widely presented the people with grand Ayatollah Montazeri as the chosen successor to Khomeini. The regim soon discovered that the more he expressed his views the more it became apparent that he is likely to allow the clerics to lose power to the people and so he quietly disappeared from public view. When Khomeini died there was another man chosen by the clergy elite to be supreme leader, Khamenei. The only thing he had in common with the late supreme leader was the similarity of name. Khomeini vs Khamenei. Even the slogans can stay the same they must have thought. There was a slight problem however, Mr. Khamenei was not high enough in the religious hierarchy to qualify for the post, he wasn't even an Ayatollah. No problem. In a few weeks he emerged with the title of ayatollah and even managed to develope a grayer beard to emphasis seniority.

Ever since that swift change of the guards Mr. Montazeri has kept to himself and thought to be under house arrest. His timing to brake his silence and come out in support of the demonstrators couldn't have been better. As the supreme leader Khamenei demanded an end to the uprising, Grand Ayaltolah Montazeri expressed the opposing religious and political view that "it would be anti-Islamic for the government to oppose people's will". Instead of calling for an end to demonstrations he called for 3 days of moaning practically inviting more demonstrations. This direct challenge to the supreme leader is unprecedented and removes a psychological and political barrier for others to follow suite.

The previously unthinkable is actually happening. The government including the supreme leader is under siege. The state media is reporting calm where there are riots. There is total black out on filming or reporting on the demonstrations. The pro government militias are on the lose attacking demonstrators. As horrible as this is, it offers a glimmer of hope as the government is now reactionary and is losing control. If the people of Iran sense that they can actually overthrow the regime they might do just that. Demonstration against election fraud can easily turn into demonstrations for the overthrow of the regime.

Ironically, at this stage the greatest threat to this uprising movement comes from its reformist leaders. They may decide that this is going too far and seek to restrain people's ambitions in order to save the Islamic theocracy.

We are in uncharted territory but as the government moves in to crackdown there is more likelihood for a shift from demonstrations to an all out green revolution. And so I find myself, and for the first time in 18 years, hopeful about the future of Iran. I'm even starting to dream about travelling freely to see my family one day.

Until then I pray that regime change will not have a high toll in blood of the Iranian people.

Iran, A dirrect challange to the supreme leader

There is a new twist in the unfolding political struggle in Iran. An old foe of the supreme leader, Ayatollah Montazeri declared his support for the demonstrators and contradicted the supreme leader directly by saying that the government needs to respect the will of the people. Ayatollah Montazeri was the original heir apparent for the late Ayatollah Khomeini but he was removed from that position before Khomeini's death and later replaced with Khamenei. Ayatollah Montazeri was then forced to maintain a low profile ever since.

A couple of decades later Mr. Montazeri is probably one of the few people who can draw support from a wide segment of the population including those who support the current regime. His words of defiance go beyond the political, his challenging the supreme leader on religious grounds too. He called for 3 days of morning and for the government to respect of people's right to protest as a religious duty of the government, while the supreme leader is calling for people to leave the streets and is threatening them with blood shed if they don't. The undermining of the supreme leader's religious and political authority was unthinkable in the past and it is a turning point for the people's struggle with the regime.

This a lose lose for the government, if they allow the demonstrations to go on they lose face and risk an eventual loss of power, on the other hand if they crack down they risk a full blown revolution now.

The best part of this is that Montazeri can be the spiritual leader of a transitional government in case of a regime change. This would minimize the chances of civil war.

I am personally encouraged to the point that I feel the end of the regime is finally possible. Lets hope it can happen with the least of blood shed.

Iran's battle lines are drawn

After Khamenei's hard line speech on Friday there should be no more confusion about what it would take for the demonstrators to effect real change in Iran. Sooner or later everyone will realize that there can only be one final authority in Iran, either the will of the people or the will of the unelected supreme leader, not both.

Ironically, all the candidates in the recent election, including Mr. Mousavi, officially support the supremacy of Mr. Khamenei over the wil of the people. If Iranians have the courage to stand to the government for a few more weeks other elements in society and regime will have to take sides between these two competing interests, and that includes the Iranian military.

Help comes from within not from without so lets hope that this time all the internal elements will align to ensure that the sacrifices by the people of Iran are rewarded with real freedom.

Last but not least, lets not forget the large segment of society that depends on the current government for their livelihood. Once the revolution is underway, if that's what this really is, there need to be a general amnesty issued for all who worked for the regime, including the security agencies and revolutionary guards. Without such amnesty we risk an all out civil war.

IRAN, glimmer of hope and lessons unlearned

Contrary to conventional wisdom, the re-election of Mr. Ahmadinejad offers a glimmer of hope for an eventual regime change. Instead of a new president, popular with the elite and the educated, we got the ignorant radical back. Instead of pacification of the masses we have anger and unrest in the big cities. There is no guarantee that this would create a momentum for bigger change but there is no denying that an influential segment of the population is denied its choice of pretend president. The demonstrations that follow can be the ice breaker for a nation frozen in fear for 30 years. Grass root leadership may still emerge from this but its still a long shot.

The reason for the unfavorable odds for change can be found in the election results themselves. If we believe the election results, Mr. Ahmedinejad appears to have support among those living in rural areas, the less educated, the more religious, and the traditional segments of the Iranian society. Of note, these same segments of society were at the core of the Iranian revolution in 1979. Even though the students and merchants are credited with toppling the Shah, the reality is that the poorest in Iran were the ones that made the revolution possible by coming out in their thousands and millions to demonstrate their dissatisfaction with the Shah's regime.

The elite of years ago didn't get it and the elite of today apparently don't either. They can not make a drastic change, or even a small one, without addressing the needs of the poor and the less fortunate in Iran.

As a result of having an entrenched "dictatorship lite" for 30 years is that more than half of the population in Iran works for the government one way or the other. Their biggest fear is that with any kind of change comes a loss of the very little they have. They not only fear for their livelihood but they also fear for their lives, baring in mind the executions that followed the last regime change.

If the elites of Iran want to effect change they need to treat the poor and traditional majority of Iran with some deference and convince them that their lives and livelihood will be protected if the regime does eventually change to a more pro-western regime. Chanting "death to the dictator" in rallies certainly doesn't help allay these fears. In the mind of many, Death to the dictator could easily mean "death to the dictator and his past and present supporters".

IRAN, the fake democracy

Watching the news coverage of the Iranian presidential elections I am getting the impressions that the world, including the Iranians themselves, are starting to believe the notion that there are actually democratic elections in Iran.

The minor details are easily forgotten, such as the, never mentioned, vetting process in place for presidential candidates that excludes anyone who disagrees with the current form of government in Iran. There is also the minor matter of the supreme leader oversight. The Iranian constitution stipulates that all elected officials in the Iran, including the president, are subject to the veto power and guidance of the unelected "supreme leader". The Iranian presidential election could easily be called the "sidekick election" for selecting the sidekick to the supreme leader.

Looking at the presidential candidates over the years the names are starting to look familiar, that because all the candidates are from within the current regime. A select few are simply changing roles within the same government. Their commitment to the regime has already been tested over and over again making the vetting easy.

The news media divides the presidential candidates into conservatives and moderates but they really should be divided into ultra-conservatives and moderate conservatives as any candidate to the left of that never gets past the vetting process.

The Iranian younger generations are made to believe that they are actually electing their government, and worse, that the past failures in Iran are a consequence of their previous votes. Those who are truly responsible are never blamed or punished as they are never elected. They quietly supervise those elected and let them take the blame for the government failures, in the process allowing the public to vent their anger by electing new sidekicks once in a while.

The first election in the Islamic republic was the election to establish the form of government after the 1979 revolution. Even then there was only one choice on the ballet, an Islamic Republic (a theocracy) or nothing. The ballot read "Yes or No to the Islamic republic". That election sat the stage for future elections where Iranians got to choose, provided that government decides what or who can be on the ballet. The People get to vote but only for select posts and from a pool of select people.

Despite all the hoopla the reality in Iran is that Iranian can't even vote for their city mayors or the governors of their provinces as those government posts are deemed too sensitive to be opened to people's vote. The government in Tehran appoints every provincial governor and every city mayor.

In the next few days some Iranians will be celebrating the fake victory of their fake representative government while the real, unelected, government of Iran gets another 4 years of breathing room to rule. They will even throw in an occasional drama of power struggles over some inconsequential post in the government.

The Iranians best hope lies in the remote possibility that one of these so called presidents would have the balls to lead a grass root reform movement that would change the Constitution and get rid of the unelected supreme leadership of the republic--peacefully of course.