Author + information
- Spencer B. King III, MD, Editor-in-Chief, JACC: Cardiovascular Interventions⁎ ()
- ↵⁎Address correspondence to:
Spencer B. King III, MD, Editor-in-Chief, JACC: Cardiovascular Interventions, Saint Joseph's Heart and Vascular Institute, 5665 Peachtree Dunwoody Road, NE, Atlanta, Georgia 30342
“It is as clear as night and day.” Or is it? The night and day, black and white, with us or against us philosophy is, unfortunately, prominent in the U.S. and throughout the world. We cannot afford it!
I just returned from Lebanon, a country created about 90 years ago, but a land that contains cities of Byblos and Tyre that are among the oldest in the world. These Mediterranean fishing villages were organized over 4,000 years ago. The Phoenicians sailed from this coast to establish civilizations throughout the Mediterranean, and the minds of these people invented the first alphabet. Today, Beirut is a beautiful city, with the sea that was the “middle of the world” (medi-terranean) at its front door and majestic mountains in the backyard. It is thriving, as evidenced by the boom in construction. At $1,500 per square foot, a 2- to 3-bedroom flat of 1,200 feet would run you approximately $1.8 million, making it some of the most expensive real estate in the world. The conflict this city is so well known for, however, is not extinct. As I entered the city on the expressway from the airport, I was greeted by giant billboards with the photo of Mr. Ahmadinejad of Iran, who was to arrive as I was leaving. However, as we drove further I saw banner-like posters spanning the highway depicting the Lebanese leaders who have been assassinated by terrorists. Despite these visible expressions of dichotomy, the center of the city, destroyed during the civil war, is now almost completely rebuilt with gleaming towers, broad boulevards, Paris-designer boutiques, and a 10-mile long corniche along the sea where people walk and ride bicycles in the soft Mediterranean breezes. It is truly a spectacular city. But also along this seaside boulevard is a massive sculpture marking the spot where Rafic Hariri was assassinated by a suicide bomber, whose truck was carrying so much explosive material that the crater it produced in the road led to early speculation that there was a subterranean explosive device. The tribunal of the United Nations is still investigating the murder of this prime minister who was largely responsible for rebuilding the city after the civil war. The pictures of the man throughout the city and the hospital and airport that bear his name are little solace for the loss of this man who was a voice of reason that imagined what could be and set about to make it happen.
I was fortunate enough to know Mr. Hariri—he was my patient. In 1995, he began to have exertional angina and was found to have anterior ischemia on exercise perfusion scanning. His personal physician was a former fellow in cardiology at Emory University, and one of my colleagues who had also been a fellow with us was then my associate. Intervention on a calcified left anterior descending stenosis resulted in alleviation of the angina, and preventive therapy resulted in no cardiac events or recurrent symptoms throughout his life. The conversations I had with him were mostly about his health, but I was aware that on each visit to Atlanta, Georgia, he had also visited President Bill Clinton and subsequently President George W. Bush in Washington, DC. In 1995, this multibillionaire had begun deploying his fortune to the rebuilding of the city. I do not recall any conversations about the first Gulf War, when the U.S. came to the aid of Kuwait and then left Iraq intact, although ruled by a despotic dictator. However, after 2001 he expressed clearly what would happen if the U.S. diverted its attention from capturing or killing the perpetrators of the attack on September 11 to an attack on a surrogate enemy, Iraq. The destabilization of the region and the radicalization of a generation were accurately predicted. Lebanon is a defenseless state with a homegrown militia (Hezbollah) supported and directed from Syria with economic and military supplies furnished by Iran. This force is more potent than the Lebanese army, which is not allowed to develop adequate muscle to ensure security for the country.
Few in the West understand the central role of the status quo in Israel and the Palestinian-occupied areas in the radicalization of young Arabs. This seemingly intractable problem was abandoned by the U.S. when President Bill Clinton left office, and now President Barack Obama and Secretary of State Hilary Clinton are attempting to re-engage. Critics of attempts at conciliation point to broken promises on both sides. Each time a high-level peace process is proposed, one side or the other throws up a road block. It was Yasser Arafat who rejected a plan to establish a Palestinian state in order to maintain his own power, and now Benjamin Netanyahu capitulates to conservative elements in Israel and continues to build settlements on Palestinian land, which will lead to another stalemate. The strategy of doing what it takes to win no matter what is right might work for a hockey match, but if the only outcome given credence is how many points a team can gain over the opposition, a real outcome that could be beneficial to all parties will never be discovered.
We in the U.S. are not so credible when giving advice to the Middle East. Our political blood sport has been so disabling to the process of finding real solutions that it has become more important to demonize the opposition than to govern. The terms “we” and “they” permeate American politics. Still, the security of the U.S. and the world demands a different approach. Leadership shown by Begin and Sadat during the Oslo Accords have been sorely lacking since. Lebanon's shadow government, Hezbollah, could not exist absent the Israeli-Palestinian conflict. A prosperous Lebanon could be a positive influence on largely secular Syria. Lebanon is often used as an example of the dichotomous division into opposing sides. The Green Line through the center of Beirut marked the Muslim and Christian neighborhoods. Today, there are still predominantly Christian and Muslim areas, but the beautiful church and the rebuilt mosque that sit side by side give hope. The American University of Beirut School of Medicine's fellows-in-training are one-half Christian and one-half Muslim, a ratio that was completely accidental as religious affiliation is not a criterion for acceptance. Black and white? Night and day? Distinctions such as these serve a purpose, but they mostly help those who benefit from demonizing others and seldom lead to lasting solutions.
I was chairing a meeting in Jerusalem about 10 years ago when someone asked me if Shimon Peres could come over from the Knesset to welcome the cardiologists in attendance. I thought it was a joke until the door opened and in he came, and he asked me if he could greet us for 5 min. About 20 min later, as he was concluding his remarks, he related a story told to him by a Palestinian. A rabbi instructing 2 students posed the question, “How can you tell when the night has ended and the day begins?” The first student said that when he can see a tree and tell if it was a cedar or pine that night had ended and the day had begun. The second responded that when he saw an animal moving and he could distinguish if it was a dog or a lion, then the night had ended and the day had begun. The students asked which answer was correct. The rabbi responded, “When one sees a person walking down the road toward them and cannot tell whether it is an Arab or a Jew and it doesn't matter, then the night has ended and the day has begun.” It is unlikely that the wounds of mistrust and anger will heal in a generation, but the common interest of different people dictates a new approach for all of us that does not cast every issue as being as clear as night and day.
- American College of Cardiology Foundation