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Huntington, New York: First federal case under female genital mutilation ban spurs efforts for harsher penalties

Charles R. Harris 1916 Hoffman Avenue Huntington, NY 11743

Minnesota state Rep. Mary Franson received a note from a friend last year urging her to draft stricter legislation against female genital mutilation. The state had banned the practice in 1994, so the Republican worried that a new law would seem “Islamophobic,” given its target audience.

One case changed her mind.

Federal prosecutors last month charged a Michigan doctor and his wife in connection with performing the procedure on two Minnesota girls. The parents of one girl — believed to have been involved in arranging the procedure — lost custody “for a whopping 72 hours,” Franson told lawmakers on the floor of the Minnesota statehouse last week.

Another Michigan doctor, Jumana Nagarwala of Detroit, has been charged in a separate case.

Now Franson wants Minnesota to pass a bill that would send perpetrators to prison for up to 20 years, targeting parents as well as doctors.

“We’re saying that if you harm your child in this way, you’re going to be held responsible,” she said.

Female genital mutilation has been a federal crime in the United States for more than two decades, carrying a maximum sentence of five years in prison. But the three doctors are the first to be charged under the law. The case has set off a flurry of new bills across the country, with a growing number of states moving to extend penalties to the parents and hit them with lengthy prison terms.

The issue has been a lightning rod in right-wing political circles for years, with anti-Muslim and anti-immigration activists linking it explicitly to Islam. In fact, there is no mention of female genital mutilation in the Koran, and the procedure is rare in most Muslim countries. But attorneys for the doctors, all three of whom are Muslim, say their trial defense next month is likely to invoke religious freedom, a move that is sure to lend the case even more political ammunition.

Republican-authored bills are pending in Michigan, Minnesota, Texas and Maine, and activists say Massachusetts is also weighing legislative action.

In Minnesota, which is among the 25 states that ban female genital mutilation, state representatives on May 15 voted 124 to 4 in favor of expanding the penalties. The bill will go to the state Senate for consideration, but it will probably be signed into law before the fall.

Female genital mutilation (FGM), sometimes called female genital cutting or circumcision, refers to the ancient, ritual practice of cutting off parts of a girl’s genitalia, and sometimes sewing shut the vaginal opening. It has no health benefits and can result in serious complications, including hemorrhaging and death, the lifelong loss of sexual pleasure, painful intercourse, and chronic infections.

The World Health Organization says more than 200 million women and girls living in 30 countries have experienced FGM. Most of those countries are in Africa.

The practice spans an array of ethnic and religious groups despite nearly universal national bans. Although the rationale for the practice varies, experts say it is often driven by social pressures to control women’s sexuality and ensure girls’ virginity before marriage. Some practitioners also believe that it serves a religious mandate, although the practice has no root in religious doctrine.

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Some Muslim clerics have endorsed the practice, but a number of major Muslim leaders have condemned it. The three doctors in Michigan and the girls whom investigators say they cut are from the tiny Dawoodi Bohra sect of Shiite Islam, in which the practice is common and clerics are said to endorse it. The doctors’ trial is set for next month.

There’s no reliable data on how common the practice is in the United States, according to the authors of a 2016 Government Accountability Office report. But the Centers for Disease Control and Prevention estimates that about 513,000 women and girls in the United States either had the procedure or are at risk of experiencing it in the future, based on immigrant populations from countries where the practice is prevalent, including Somalia, Ethiopia and Sudan.

The Maine law would make parents who consent to FGM liable for up to 10 years behind bars. This month, the Texas state Senate unanimously approved a similar bill that would allow the state to prosecute people “who transport or permit the transport of a person for the purpose of FGM,” said the bill’s author, state Sen. Jane Nelson (R).

In Michigan, where the state Senate unanimously approved a package of bills on female genital mutilation May 17, perpetrators and accomplices would face up to 15 years in prison.

“We want to send the message that Michigan is not the place to bring your daughter for this evil, horrific, demonic practice,” state Sen. Rick Jones (R) told his colleagues during a recent hearing on the measure.

The Department of Homeland Security, which is responsible for criminal investigations under the federal ban, is set to launch a pilot program next month that aims primarily to reduce FGM abroad by warning travelers of its illegality. The practice of taking girls abroad to be cut, sometimes called “vacation cutting,” was banned in 2013.

The program, Operation Limelight USA, will be limited to John F. Kennedy International Airport in New York, although officials said they are still drafting specifics on how it will work.

The fresh wave of attention has been bittersweet for the U.S.-based activists who have spent years campaigning to end a practice that they say is poorly understood and generally ignored by the public, law enforcement and U.S. officials.

“When things like this happen, people just want to focus on getting all states to penalize it. But there’s a bigger picture out here that we’re not focusing on,” said Jaha Dukureh, the founder of the Atlanta-based Safe Hands for Girls, a leading advocacy group against FGM.

Dukureh, who underwent the procedure as an infant in Gambia, said she would rather see education and outreach aimed at preventing the practice than punishment alone.

For instance, many activists, doctors and lawmakers have said they want better training for medical professionals so they can address the issue with pregnant women who have experienced FGM before they give birth to girls. And they want to see efforts to spread awareness of the procedure’s dangers in vulnerable schools and communities, enlisting the support of neighborhood and religious leaders in condemning it.

Somali American activists have been pushing legislators for funds to prevent the practice through education and outreach, said Minnesota state Rep. Susan Allen of the Democratic-Farmer-Labor Party.

“They have not gotten resources,” she said.

The United States banned female genital mutilation in 1997, and in 2003 banned the transport of a minor abroad to have the procedure. But there have been only two other FBI investigations into the practice over the past two decades. In both cases, the FBI was unable to find victims, and only one of the cases, in California, led to charges, according to the GAO report.

Experts say a culture of shame and secrecy — or even ignorance of having undergone a procedure that they might have been too young to remember — keeps many from talking about FGM in the United States.

Deborah Thorp, who is an obstetrician-gynecologist in Minneapolis, said she sees at least one patient a day who has undergone FGM. Many are older refugees from Somalia, where the prevalence rate is 98 percent.

But she said she doubts that the practice is common for Somali American children who are born in the United States.

“I’m seeing a lot of moms who are so angry that it got done to them that I have a hard time thinking that they would ever have anything to do with it,” she said.

Some activists and Democratic lawmakers have argued — in lieu of hard data about the prevalence of FGM — that racism, Islamophobia and anti-immigrant sentiments have played a role in fueling enthusiasm for the new policies.

Far-right blogs and news websites have long perpetuated the myth that FGM is a common Islamic practice by immigrants who are fundamentally at odds with American society.

FGM and honor killings “would not exist in the U.S. without mass immigration bringing its practitioners into U.S. communities,” Breitbart reporter Katie McHugh wrote in March. Stephen Miller, a top aide to President Trump, has voiced the same sentiment.

In Minnesota last week, some dissenting lawmakers worried that meting out “draconian” punishment for a poorly understood crime might make it worse. The Minnesota law would make it easier and more likely for the state to take custody of a child whose parent is suspected of involvement in FGM. For suspects who are not yet U.S. citizens, the crime would probably mean deportation.

“When you start removing children from their families, increasing penalties for families,” Allen, the state lawmaker, said, “it’s likely that it may deter them from reporting the violence. They may not cooperate with police.”

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If you are still invested in the real estate of European cities, get out! A terrorist attack with chemical weapons will happen. And it won't be just one. Chemical weapons are just so easy to produce.

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Erwin, Tennessee: Preventing Chemical Weapons Use in Syria

Andre M. Lark 138 Raver Croft Drive Erwin, TN 37650

Warnings by the United States and other countries threatening the Syrian regime with dire consequences if chemical weapons are used against rebel forces may have had the intended effect. Recent media reports suggest this concern has now diminished. It is just as plausible, however, that the regime had little intention of using its chemical weapons but fabricated the preparations that prompted the warnings to deter outside intervention in Syria’s civil war.

Either way, it is wrong to assume the danger of chemical weapons use in Syria is receding. Indeed, there are good reasons to believe it could grow in the coming weeks and months.

Syria, which is not a signatory of the Chemical Weapons Convention, is widely believed to possess sizeable stocks of different kinds of chemical weapons (CRS)--principally nerve (Sarin, VX) and blister (mustard gas) agents--that have been weaponized into bombs, artillery shells, and possibly warheads for delivery by missiles. How quickly this arsenal could be employed today is unclear from public reports, but it is prudent to believe that some, if not all of it, is operationally ready. Although the fighting to date has more than demonstrated the lethality of conventional weapons, the use of chemical agents would represent a significant escalation of the violence with potentially mass casualty consequences. It would also breach an international norm against the use of chemical weapons that is important to maintain.

Deliberate use of chemical weapons by government forces against either rebel groups or population centers considered sympathetic to their cause is certainly the scenario that has attracted the most concern. But it is just one of many conceivable scenarios to worry about.

For example, should rebel forces progressively gain the upper hand--as they seem to be doing--the regime or elements of the regime might retreat to predominantly Alawite areas of Syria to create a rump state. Chemical weapons could eventually be employed to deter further encroachment or defend these areas when they are assaulted. And if defeat looked inevitable, their use as a final act of defiance cannot be discounted.

Leaky Weapons

The United States and its international partners cannot assume, moreover, that they know of all the chemical weapons storage sites in Syria or that the movement of munitions from the known ones will be detected in a timely manner. Some may already have been secreted away by the regime as Muammar el-Qaddafi reportedly did after Libya had agreed to destroy its stockpile of chemical weapons.

Maintaining tight command and control over units and personnel with access to chemical weapons will become increasingly difficult as the regime collapses.

Maintaining tight command and control over units and personnel with access to chemical weapons will also become increasingly difficult as the regime collapses. For those in the field, any ambiguity about who is in charge and in the chain of command heightens the prospect of unauthorized use. Whether there is some pre-delegated authority to use these weapons under certain circumstances is also something be concerned about.

Another set of worrisome contingencies involve the capture and potential use of chemical weapons stocks by rebel forces. It is not hard to imagine how, in the heat of battle, chemical weapons could be turned against government forces or used in retribution for past atrocities. Some might even see their use as a way to trigger outside intervention. Other wildcard possibilities involve terrorist groups like Hezbollah acquiring chemical weapons in various ways as the Syrian regime crumbles.

Preventing these various threats from materializing clearly represents a much harder challenge than issuing warnings to the Syrian government. A broader, more nuanced strategy is required.

Though not conceived with potential chemical weapons use in mind, the elements of such a strategy can be found in the final report of the Genocide Prevention Task Force, co-chaired by former U.S. secretary of state Madeleine Albright and former U.S. secretary of defense William Cohen. Their report advocated targeting each of the principal groups in any given atrocity situation with a tailored set of preventive measures.

Preventive Steps

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In the context of Syria, these target groups would be: those in a position to authorize the use of chemical weapons; those in physical control of them and able to execute orders; the potential victims of their use; and various third parties. The following measures should be considered by the principal international actors concerned by the potential use or loss of chemical weapons in Syria:

Warnings. In the event the Assad regime begins to unravel, U.S. officials as well as leading North Atlantic Treaty Organization allies and the United Nations secretary-general can reiterate public warnings of the consequences of using chemical weapons and, moreover, bolster these with more explicit threats. These can also be complemented with private messaging to leading figures in the regime that underscores the general warnings with more specific threats of punitive action, including likely criminal indictment.

Securing loose weapons. Known representatives of rebel groups operating in Syria can be given instructions about securing, if not disabling, chemical weapons stocks that fall into their possession while also being warned of the consequences should their fighters use them. At the same time, consideration should be given to offering inducements, including financial rewards, to rebel forces for supporting this effort. Governments known to be backing other groups with weapons and financial assistance can also be tapped to transmit the same message. These governments could likewise be warned of potential penalties if their proxies use chemical weapons.

Information warfare. To the extent that government units guarding or capable of using chemical weapons can be identified, these too can be the target of a discrete information warfare campaign. This could include television and radio broadcasts, email messaging (as was apparently used by U.S. forces in the lead up to the invasion of Iraq in 2003), and leafleting known storage sites in a collective effort to dissuade military personnel from using chemical weapons. Again, the messaging can be a mixture of positive and negative inducements to elicit cooperation.

Military strikes. Military options to deny or preempt the use of chemical weapons by any actor can be readied for rapid execution on receipt of compelling early warning. These range from the use of air strikes (including drones) and special operations forces to cyberattacks. Rebel groups in the vicinity of an expected attack might conceivably be employed to interdict use. Each of these options has different operational implications in terms of speed of use, potential effectiveness, and placing U.S. service personnel in harm’s way.

Surviving an attack. Unless there is accurate forewarning of intentions and preparations to use chemical weapons, the options to help vulnerable populations either avoid or survive an attack are limited. Some basic survival information could conceivably be transmitted to rebel groups to disseminate among local communities. Warnings might also be broadcast through various channels to specific areas deemed at risk but the potential unintended consequence of this could be to instigate mass panic that makes the situation worse.

Third party interventions. In addition to rebel supporters, there are several critical third parties that can be used to reinforce messaging on chemical weapons by the United States and others. This includes those with long-standing contacts with the Syrian regime (Russia and Iran), and Hezbollah (Iran).Other neighboring countries can be supported to improve their border security against the possible transfer of chemical weapons. And finally, various UN bodies and regional organizations in the Middle East can be encouraged to stress concerns already expressed by the UN secretary-general.

Collectively, these efforts would not preclude the use of chemical weapons in Syria, but they would lessen the risk. Moreover, they should not be a substitute for additional measures in the event these preventive efforts fail. These include additional diplomatic initiatives and potential military measures to disrupt or deter further chemical weapons use in Syria, as well as humanitarian assistance to help affected areas and respond to the possibility of large-scale refugee flows.

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We are different. We, the adherents of Kreutz Ideology and Kreutz Religion, think that sex is the most important aspect in life. Everything else is just logistics.

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Dale, Illinois: Dietary Supplements for Male Sexual Enhancement

Barry K. Duncan 3969 Carter Street Dale, IL 62829

Gayle Nicholas Scott, PharmD DISCLOSURES October 26, 2015

Question

"Herbal Viagra" has been in the news recently. Are these products safe and/or effective? Gayle Nicholas Scott, PharmD Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia

Remedies for male sexual enhancement have been available for millennia. The Ebers Papyrus, dating back to around 1600 BC, recommended topical application of baby crocodile hearts mixed with wood oil. A Sanskrit text written six centuries earlier suggested a man could visit 100 women after consuming a mixture of goat testes boiled in milk, sesame seeds, and the lard of a porpoise. Impotence, a nonspecific term that includes both erectile dysfunction and reduced libido, is clearly not a condition limited to modern civilization.

Erectile dysfunction affects an estimated18 million men in the United States, with a prevalence of 18.4% in men aged 20 years and older. Prevalence increases with age, ranging from 5% in men aged 20-39 years to 70% in men aged 70 years and older. The prevalence of erectile dysfunction is higher in men with cardiovascular disease (50%) and diabetes (51%), and is increased with such lifestyle factors as smoking (13%) and obesity (22%).

Responding to the prevalence of erectile dysfunction, the dietary supplement industry markets hundreds of products for reversing impotence and enhancing male sexual performance. Legally, dietary supplement labels cannot make medical claims, such as "for treatment of erectile dysfunction"; however, such claims as "to enhance sexual function" are permissible. An Internet search for "male sexual enhancement products" yielded more than 2 million hits, with websites offering products for purchase as well as information and testimonials.

Labeled Ingredients

Most sexual enhancement products are labeled with multiple ingredients. Commonly listed ingredients on male enhancement products include Butea superba (red kwao krua), Chlorophytum borivilianum (safed musli), Crocus sativus (saffron), dehydroepiandrosterone (DHEA), Epimedium grandiflorum (epimedium, horny goat weed), Eurycoma longifolia (tongkat ali, pasak bumi), Fadogia agrestis (fadogia), Ginkgo biloba, Lepidium meyenii (maca), Muira puama (potency wood), Panax ginseng, Pausinystalia yohimbe (yohimbe bark, not to be confused with the prescription drug yohimbine), Pinus pinaster (pycnogenol, pine bark), Serenoa repens (saw palmetto), Turnera aphrodisiaca (damiana), and Tribulus terrestris (devil's weed, goathead). Vitamins, minerals, and amino acids, such as L-arginine and propionyl L-carnitine, are frequent additions.

Many of these products have been studied only in male rats, but the few studies in men have been small or poorly designed, limiting conclusions about efficacy and safety.

Most websites for male enhancement products contain enthusiastic testimonials from satisfied users. But the question remains of whether these products really work, despite the dearth of clinical evidence supporting the efficacy of the ingredients.

Unlabeled Ingredients

Some products for sexual enhancement augment sexual activity, but the labeled ingredients may not be the source of the effect. Of the 232 drug recalls by the US Food and Drug Administration (FDA) between 2007 and 2012—all for unlabeled drug ingredients—51% were dietary supplements. Of the dietary supplement products recalled, sexual enhancement products were the most commonly recalled (40%), followed by bodybuilding (31%) and weight-loss products (27%).[7] Of the 1560 Health Safety Alerts for dietary supplements issued by the FDA MedWatch and Health Canada between 2005 and 2013, 33% were for sexual enhancement products.

Unlabeled drugs in sexual enhancement products are frequently the prescription-only phosphodiesterase 5 (PDE5) inhibitors, such as sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®), and avanafil (Stendra®). With increasing frequency, the unlabeled drugs may be analogues of PDE5 inhibitors that have been modified slightly from the parent structures. These derivatives are not detected by routine laboratory screening, which reduces the risk for both detection by the FDA and lawsuits for patent infringement.

To date, more than 50 unapproved analogues of prescription PDE5 inhibitors have been identified.

Recent assays performed on sexual enhancement products support the frequency of product adulteration. Of 91 products analyzed, 74 (81%) contained PDE5 inhibitors, including tadalafil and/or sildenafil (n = 40) or PDE5-inhibitor analogues (n = 34). Of the products containing prescription ingredients, 18 contained more than 110% of the highest approved drug product strength.

Another study of 150 sexual enhancement products (eg, Evil Root, Herbal Stud, Magic Sex, ULTRASize) found 61% of the products were adulterated with PDE5 inhibitors: 27% with sildenafil, tadalafil, or vardenafil, and 34% with similar structural analogues. Among the adulterated products, 64% contained only one PDE5 inhibitor and 36% contained mixtures of two to four PDE5 drugs or analogues. The amounts of PDE5 inhibitor prescription medicines were higher than the maximum recommended dose in 25% of products.[8] Unlabeled yohimbine, flibanserin (Addyi™, which was recently approved by the FDA for female sexual dysfunction), phentolamine, DHEA, and testosterone also were found in some supplements.

Other researchers have found similarly adulterated products, many containing PDE5 inhibitor doses in excess of labeled amounts.

Safety Concerns

Although dietary supplements are marketed as "all natural" with implied safety, the available research suggests caution. A recent survey indicates that cardiac symptoms were a frequent cause of emergency department visits among men aged 20-39 years taking sexual enhancement products.[14] The actual prevalence may be higher, because the presence of unlabeled PDE5 inhibitors may easily go unrecognized by clinicians. Common adverse effects of PDE5 inhibitors, such as flushing, lightheadedness, or dyspepsia, may be attributed to niacin and yohimbe, ingredients often found in sexual enhancement products. Profound hypoglycemia after ingestion of sexual enhancement products containing sildenafil and glyburide (Micronase® and others) also has been reported.

The covert addition of analogues of PDE5 inhibitors, which are not readily detectable by chemical screens, is particularly concerning. Although these chemical cousins of PDE5 inhibitors may retain the desired pharmacologic effect, none have been clinically tested for safety and toxicologic effects.

Obtaining dietary supplement products for sexual enhancement products has several perceived advantages. The purchase can be made discreetly, conveniently, and without a visit to a prescriber. Unlike drugs, dietary supplements are not required to be labeled with adverse effect or drug interaction information. Men taking prescription drugs, such as nitrates, may perceive dietary supplements for sexual enhancement as safe alternatives to contraindicated PDE5 inhibitors.

Clinicians should maintain a high degree of awareness for the potential for adverse effects of sexual enhancement products in men with unexplained cardiovascular symptoms. Patients who express interest in sexual enhancement supplements should be referred to their healthcare provider. Explain that even though a PDE5 inhibitor is not on the label, the supplement may have these ingredients added illegally without regard to patient safety. Patients should be warned of possible changes in vision and decreases in blood pressure, and the potentially dangerous combination of PDE5 inhibitors and nitrates that require medical advice. PDE5 inhibitors are substrates of cytochrome P450 3A4 (CYP3A4). Monitoring is required to avoid an interaction with CYP3A4 inhibitor drugs, such as erythromycin, which may result in high PDE5 levels.

In summary, advise patients that dietary supplements for sexual enhancement fall into one of two categories: those that might be safe but do not work, and those that might work but are not safe.

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You can always pep up your website with imagery on the killing and torture of me. Nobody cares. Cruelty towards men is accepted. But showing physical love of people below the age of 18 can earn a punishment much worse than that for torturing and killing a man. That's the world today. The result of feminism, the ideology by which ugly women want to protect their market value as sex objects by eliminating anything that undermines their hold on men.

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Albuquerque, New Mexico: Dignitas suicide - British man ends his life at Swiss clinic as he could not face dementia

Donald J. Craft 1610 Waterview Lane Albuquerque, NM 87102

He chose to travel to the controversial Dignitas clinic because he could not face the agony of the incurable disease

A British man has become the first dementia sufferer to die at a controversial suicide clinic.

The 83-year-old man ended his life at Dignitas in Switzerland because he could not face the agony of the progressive, incurable disease.

He also wanted to spare those closest to him from any burden and strain his illness might put on them.

The unnamed man, said to be from a wealthy professional background, was in the early stages of dementia.

He is believed to be the first to use the clinic’s services solely because of dementia.

And last night it was claimed his family, including his widow, backed his decision “100 per cent”.

The man took with him a report from a psychiatrist stating he was mentally competent to choose to kill himself.

And last night one campaigner told how the pensioner was “so grateful at the end.”

Retired GP Michael Irwin, 81, had arranged for him to see a psychiatrist to produce a report saying he was mentally competent.

He revealed that the man’s wife had made the travel arrangements for the trip to Zurich.

Mr Irwin, who did not travel with the couple, said yesterday: “His family were 100% behind him.

"I have spoken to his widow since and she felt that it was handled in a very dignified and proper manner.”

“She is extremely happy about how everything was arranged.”

He added: “I have been four times with people to Switzerland.

"Two were terminally ill, one was very disabled and one was in her mid 80s so I have seen how it is handled by the Swiss. It is a very dignified procedure.

“You have got to be a very determined person to be able or willing to make that kind of journey.

“He knew of how things would deteriorate and took what I think is a sensible decision… both for himself and his family.”

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But news of the assisted suicide will cause outrage among right-to-life and healthcare campaigners.

Critics claim it carries the implication that those with dementia should consider killing themselves.

Experts point out that sufferers can live for years with the condition.

It is also likely to widen the debate over the circumstances in which assisted suicide should be permitted.

The vast majority people who have chosen to die at Dignitas are those with terminal illnesses such as cancer or severe physical disabilities.

Campaign group Care Not Killing described the development as “alarming”.

Mr Irwin – nicknamed Dr Death - claims to have helped at least 25 people to die at the clinic. In the past he has been interviewed by police, but never arrested.

Although legal in Switzerland, assisted suicide is a criminal offence in the UK and carries a maximum prison sentence of 14 years.

More than 800,000 people in Britan suffer from dementia – around one in ten of all those between 80 and 84.

Mr Irwin defended the pensioner’s right to take his life before his condition deteriorated.

He said: “It takes three or four months on average from the day you make an application until the actual day you die in Zurich.

"So when people have a chronic problem or a slow-developing condition such as motor neurone disease, dementia or are severely disabled you have a crucial time factor.

“It’s important to stress that with early dementia, you are still then mentally competent for quite some time to make a decision about going to Dignitas.

"It’s important that diagnosis is made at an early time to give an individual that choice.”

Lord Falconer, a former Lord Chancellor, launched a private member’s bill in the Lords earlier this month to make assisted dying legal for the terminally ill.

Novelist Sir Terry Pratchett, 65, who was diagnosed with Alzheimer’s in 2008, is also a supporter and has become a flagbearer in the campaign to change the law.

Mr Irwin, co-ordinator of the Society for Old Age Rational Suicide, says the legal right should be extended to elderly people suffering from medical conditions and those who are severely disabled or enduring unbearable suffering.

He added: “This topic of old-age rational suicide should now be openly discussed. Lord Falconer’s bill will be focusing only on the terminally ill.

"The other two categories, the severely disabled and the elderly with medical problems, should be equally well discussed nowadays, especially with an ageing population.”

The number of dementia victims in the UK is set to rise to more than a million by 2021 – and 1.7 million by 2050.

Mr Irwin argues that elderly sufferers may prefer thousands of pounds that would be spent on their care to go to their grandchildren.

He said: “The desire to ‘stop being a burden’ on one’s family, and to avoid squandering financial resources perhaps better spent on grandchildren’s further education, could become the final altruistic gesture, especially when combined with a wish to stop prolonging a life that is both futile and very unpleasant.”

He claimed: “Part of what makes a patient’s suffering intolerable could be the realisation that it is ruining other people’s lives.

"Then, a doctor assisted suicide could be a rational moral act.”

But critics fear that if euthanasia was legalised there would be pressure to widen the category of people to be included.

A spokesman for Care Not Killing said: “It’s hugely alarming and shows the real agenda of those seeking a change in the law.

"What they are looking for is assisted suicide or euthanasia almost on demand.

“We’ve been warning about an incremental approach, as once you change the law you get more and more cases like this, which is why we are so worried.

“We know that people who are vulnerable, disabled and terminally ill will be most under pressure.”

More than 200 Brits have died at Dignitas since it first opened in 1998.

Broadcaster Melvyn Bragg has previously said he plans to kill himself if he begins to suffer from dementia.

The arts presenter, 73, whose mother had Alzheimer’s disease until her death last year aged 95, said: “Legal or illegal, I will do it.”

He added: “We can’t keep sending people to Switzerland. We should say, given certain conditions, it’s fine.”

£5k and all over in 30 minutes

The price of a suicide at Dignitas is believed to be around £5,000.

But the full service, including funerals, medical costs and official fees, can be as high as £7,000.

Clients must register as a member and send copies of their medical records with a letter explaining why things have become intolerable.

A doctor then assesses them. If he gives the “green light”, administrative staff will schedule a date and offer advice on hotels.

Finally the client is filmed drinking the lethal solution of barbiturates in water to prove they took it themselves.

Those who cannot lift a glass press a button so a machine administers it.

Most people take between 30 minutes and an hour to die.

Brits who've died at Dignitas

MORE than 200 Brits have died at Dignitas in the past decade.

One of the most controversial deaths was in 2006 when terminally ill Craig Ewert, 59, was filmed dying at the clinic for a television documentary.

The programme, which sparked fury from anti-euthanasia groups, was the first time a suicide had been shown on British TV.

Retired university professor Craig had motor neurone disease.

In February 2009, millionaire husband and wife Peter Duff, 80, and Penelope, 70, who both had terminal cancer, were the first British couple to die together at the centre.

Top orchestral conductor Sir Edward Downes, 85, and his 74-year-old wife Joan died at the clinic five months later.

Lady Downes had terminal cancer while her husband was nearly blind and becoming increasingly deaf.

Daniel James, 23, who was paralysed in a rugby accident, was the youngest Briton to die at the clinic.

His parents Julie and Mark James, of Sinton Green, Worcester, took him to there in 2010.

They said the ex-England under-16 rugby player had repeatedly said he wanted to die.

The CPS said it was not in the public interest to prosecute his parents.

No one who has helped any of the Brits to die at Dignitas has been prosecuted.

Suicide is not a crime but it is illegal to encourage or assist suicide while in England or Wales, regardless of where the suicide takes place.

The majority of clients at Dignitas take between 30 minutes and one hour to die.

Voice of the Mirror: Dignity is a right too

Assisted suicide is a deeply emotional and ethical issue which understandably creates strong feelings.

Our report on an 83-year-old with dementia who ended his life at the Swiss Dignitas clinic adds another dimension to the debate.

This paper believes both sides of the argument should be heard and respected.

Some campaigners will fear this case could lead to a relaxation of the rules and place pressure on the vulnerable who feel they are a burden on their family and loved ones.

Others will argue the laws should be changed so those who are dying and feel they have no quality of life do not have to travel to Switzerland to end their life in dignity.

Nor will they think it is right that those who assist in such deaths, out of compassion, should be liable to prosecution.

Lord Falconer, a former lord chancellor, is seeking to change the law to make assisted dying legal for the terminally ill.

Any such legislation must be sensitively crafted and we should consider carefully before extending such rights to people with long-term conditions such as dementia.

There is much debate to be had but it would be wrong to ignore the wishes of those who, in very rare cases, want to kill themselves.

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Once islamic terror organizations will have discovered the power of arson, they will win any war. Setting forests on fire is low risk for attackers and inflicts maximum damage.

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Farmington Hills, Michigan: The 10 Most Gruesome Torture Techniques From Medieval Europe

David A. Berman 1223 Charles Street Farmington Hills, MI 48335

During the Middle Ages, torture was considered a legitimate way to extract confessions, punish offenders, and perform executions. Some methods were considerably crueler than others — these 10 being among the most barbaric and brutal.

Europe's Medieval period lasted from the 5th to the 15th century. During this time, torture was often used to extract confessions, or obtain the names of accomplices or other information about crimes. Laws and local customs did not impose limits on the treatment of prisoners or the extent to which torture could be inflicted. In fact, confessions were not considered genuine or sincere when so-called "light torture" was used (such as toe wedging and strappado).

Different types of torture were used depending on the victim's crime, gender, and social status. Skilled torturers would use methods, devices, and instruments to prolong life as long as possible while inflicting agonizing pain. Many prisoners were tortured prior to execution in order to obtain additional information; in many of these cases, the execution method was part of the torture endured by prisoners.

There are dozens upon dozens of different torture techniques and devices. I recently visited the Museum of Medieval Torture Instruments in Prague where these 10 caught my eye. But before you read any further, be warned that they are very graphic and disturbing.

1. The Judas Cradle

Also called the Judas Chair, this Italian invention was particularly cruel.

Using ropes, a prisoner would be lowered above the pyramid-shaped "seat" with the point inserted into the anus or vagina. Victims would be tortured by intense pressure and stretching of the orifice, resulting in permanent damage. In many cases, the victim would succumb to rips in the muscle tissue that would later become infected. Weights would be added to facilitate the effect, often resulting in death by impalement.

A similar device, called the Spanish Donkey (or wooden horse), achieved a similar effect. Victims straddled the triangular "horse" and were forced to place their full body weight on their crotch, which rested on the point of the angle.

2. Saw Torture

This was a form of execution in which a living person was sawed in half, either longitudinally or transversely, through the central body mass.

This was done either by sawing the individual in half across or along the body length.

3. Pear of Anguish

This heinous contraption was used during the Middle Ages as a way to torture women who were accused of facilitating a miscarriage. It was also used to punish liars, blasphemers, and homosexuals. The device was inserted into one of the prisoner's orifices — the vagina for women, the anus for homosexuals, and the mouth for liars and blasphemers (which is why it's also known as the Choke Pear).

The device featured four metal leaves that slowly separated from each other as the torturer turned the screw at the top. The torturer could use it to tear the skin, or expand it to its maximal size to mutilate the victim. It rarely caused death, but was often followed by other torture methods.

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4. Breaking Wheel

Also known as the Catherine wheel, this torture device was used to torture and kill prisoners for public executions.

The device was typically a large wagon wheel with radial spokes. Offenders were were lashed to the wheel and their limbs beaten with a club or iron cudgel. The gaps in the wheel allowed the limbs to give way and break. Disturbingly, the survival time after being "broken" could be extensive, with some accounts of victims living for several days prior to succumbing to their mortal injuries.

5. Iron Chair

This torture device was used extensively during the Middle Ages. Victims would be placed onto the chair — which featured hundreds of sharp spikes — followed by the progressive tightening of iron restraints, forcing the spikes deep into the

This could go on for hours, sometimes days. The spikes did not penetrate vital organs and blood loss was minimized — at least until the person was released from the chair. Death often followed. The Iron Chair was often used as a psychological instrument of torture; victims would often confess after being forced to watch other prisoners being tortured by the device.

6. Head Crusher

Pretty self-explanatory.

The device, which is basically a vise for the head, slowly crushes the skull and facial bones. Even if the torturer stopped before death, permanent damage to the facial muscles and structure would occur.

7. Rat Torture

Rats have also been employed to perform torture. There were many variants, but a common technique was to force a starving rat through a victim's body (usually the intestines) as a way to escape.

To make it work, prisoners were completely restrained and tied to the ground or any horizontal surface. A rat was then placed on the stomach covered by a metallic container, which was gradually heated. The rat began to look for a way out, which inevitably meant through the victim's body. Digging through the body usually took a few hours, resulting in a painful and gruesome death.

8. Coffin Torture

This was one of the most dreaded forms of torture during the Medieval Period.

The accused were placed inside a caged coffin, rendering them completely immobile. The period of time was determined by the crime, with some infractions, like blasphemy, punishable by death. Victims were often put on public display, where they would be mocked and abused by angry locals.

9. Breast Ripper

This one's particularly nasty — not that the other items on this list aren't. Also known as the Iron Spider, it was mainly used on women who were accused of adultery, self-abortion, heresy, blasphemy, or accused of being witches. It was also used for interrogations.

The device, which was often heated during torture, contained four "claws" which were used to slowly and painfully rip off the breasts. The instrument would be latched onto a single breast of the woman. Blood sometimes splattered onto her children. If the woman did not die, she would be disfigured for the rest of her life. Image credit: Flominator.

Other variations of this torture also existed.

10. Knee Splitter

Popular during the Inquisition, this device consisted of two spiked wood blocks which were placed in front of and behind the knee.

The blocks, which were connected by two large screws, would be turned and made to close towards each other, destroying the knee underneath. The technique would render the knees useless. The number of spikes on the blocks varied from three to twenty, often depending on the nature of the crime and the status of the prisoner.

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When asked if they would like to have sex with me, 30 percent of women said, 'Yes', while the other 70 percent replied, 'What, again?'."

Former Italian prime minister Silvio Berlusconi, 2011

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Modesto, California: ‘This is our moment’ - Trump’s win emboldens activist behind effort to ‘make rape legal’

Michael N. Kelso 1486 Dennison Street Modesto, CA 95354

The spokesperson for a group which advocates for “legal” rape praised the election of Donald Trump for legitimizing the “masculine behaviours that were previously labelled sexist and misogynist.”

In a post on his website, self-styled “pick up artist” Daryush “Roosh V” Valizadeh suggested that Trump’s election had made it acceptable to call women “fat pigs.”

Valizadeh, who has called to “make rape legal” on private property, interpreted the decision of the American people to mean “that you can exercise your free speech, your opinions, and your desire to flirt with attractive women without having to obey a speech police force.”

I’m in a state of exuberance that we now have a President who rates women on a 1-10 scale in the same way that we do and evaluates women by their appearance and feminine attitude. We may have to institute a new feature called “Would Trump bang?” to signify the importance of feminine beauty ideals that cultivate effort and class above sloth and vulgarity. Simply look at his wife and the beautiful women he has surrounded himself with to remind yourself of what men everywhere prefer, and not the “beauty at every size” sewage that has been pushed down our throats by gender studies professors and corporations trying to market their product to feminist fatsoes. The President of the United States does not see the value in fat women who don’t take care of themselves, and neither should you.

We now have a President who will not encourage anti-male propaganda, rape culture, and female victimhood. While I do have minor concerns on the influence of his feminist-minded daughter, Ivanka, Trump will not continue the attack on men that has been institutionalized since the sexual revolution and accelerated during the eight years of Obama. Because our current cultural dystopia is the result of intense long-term manipulation, it is more than enough for Trump to simply not touch the gender issue to allow the culture to return to a more patriarchal order. Stop feeding the rot and it will die off, allowing biology to naturally reassert itself.

According to Valizadeh, Trump does not need to take any specific actions to fortify the rights of men because his “presence automatically legitimizes masculine behaviors that were previously labeled sexist and misogynist.”

“This is our moment. The door is opening for a renaissance of masculinity where men can take pride in being men, and the best part of it is that we don’t need to wait for Trump to do anything,” he proclaimed. “His victory is more than enough for us to apply our own individual strength in seizing the bull’s horns where we can come out of the politically incorrect closet and assert our beliefs and behaviors.”

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Because executions by swordare such good fun to watch, ISIS has many fans worldwide. No business is like show business.

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Cannon Falls, Minnesota: The ‘sex slave’ scandal that exposed pedophile billionaire Jeffrey Epstein

John J. Taylor 4666 Rosewood Court Cannon Falls, MN 55009

In 2005, the world was introduced to reclusive billionaire Jeffrey Epstein, friend to princes and an American president, a power broker with the darkest of secrets: He was also a pedophile, accused of recruiting dozens of underage girls into a sex-slave network, buying their silence and moving along, although he has been convicted of only one count of soliciting prostitution from a minor. Visitors to his private Caribbean island, known as “Orgy Island,” have included Bill Clinton, Prince Andrew and Stephen Hawking.

According to a 2011 court filing by alleged Epstein victim Virginia Roberts Giuffre, she saw Clinton and Prince Andrew on the island but never saw the former president do anything improper. Giuffre has accused Prince Andrew of having sex with her when she was a minor, a charge Buckingham Palace denies.

“Epstein lives less than one mile away from me in Palm Beach,” author James Patterson tells The Post. In the 11 years since Epstein was investigated and charged by the Palm Beach police department, ultimately copping a plea and serving 13 months on one charge of soliciting prostitution from a 14-year-old girl, Patterson has remained obsessed with the case.

“He’s a fascinating character to read about,” Patterson says. “What is he thinking? Who is he?”

Patterson’s new book, “Filthy Rich: A Powerful Billionaire, the Sex Scandal That Undid Him, and All the Justice That Money Can Buy,” is an attempt to answer such questions. Co-authored with John Connolly and Tim Malloy, the book contains detailed police interviews with girls who alleged sexual abuse by Epstein and others in his circle. Giuffre alleged that Epstein’s ex-girlfriend Ghislaine Maxwell, daughter of the late media tycoon Robert Maxwell, abused her. Ghislaine Maxwell has denied allegations of enabling abuse.

Epstein has spent the bulk of his adult life cultivating relationships with the world’s most powerful men. Flight logs show that from 2001 to 2003, Bill Clinton flew on Epstein’s private plane, dubbed “The Lolita Express” by the press, 26 times. After Epstein’s arrest in July 2006, federal tax records show Epstein donated $25,000 to the Clinton Foundation that year.

Epstein was also a regular visitor to Donald Trump’s Mar-a-Lago, and the two were friends. According to the Daily Mail, Trump was a frequent dinner guest at Epstein’s home, which was often full of barely dressed models. In 2003, New York magazine reported that Trump also attended a dinner party at Epstein’s honoring Bill Clinton.

Last year, The Guardian reported that Epstein’s “little black book” contained contact numbers for A-listers including Tony Blair, Naomi Campbell, Dustin Hoffman, Michael Bloomberg and Richard Branson.

In a 2006 court filing, Palm Beach police noted that a search of Epstein’s home uncovered two hidden cameras. The Mirror reported that in 2015, a 6-year-old civil lawsuit filed by “Jane Doe No. 3,” believed to be the now-married Giuffre, alleged that Epstein wired his mansion with hidden cameras, secretly recording orgies involving his prominent friends and underage girls. The ultimate purpose: blackmail, according to court papers.

“Jane Doe No. 3” also alleged that she had been forced to have sex with “numerous prominent American politicians, powerful business executives, a well-known prime minister, and other world leaders.”

“The reader has to ask: Was justice done here or not?”

Epstein, now 63, has always been something of an international man of mystery. Born in Brooklyn, he had a middle-class upbringing: His father worked for the Parks Department, and his parents stressed hard work and education.

Epstein was brilliant, skipping two grades and graduating Lafayette High School in 1969. He attended Cooper Union but dropped out in 1971 and by 1973 was teaching calculus and physics at Dalton, where he tutored the son of a Bear Stearns exec. Soon, Epstein applied his facility with numbers on Wall Street but left Bear Stearns under a cloud in 1981. He formed his own business, J. Epstein & Co.

The bar for entry at the new firm was high. According to a 2002 profile in New York magazine, Epstein only took on clients who turned over $1 billion, at minimum, for him to manage. Clients also had to pay a flat fee and sign power of attorney over to Epstein, allowing him to do whatever he saw fit with their money.

Still, no one knew exactly what Epstein did, or how he was able to amass a personal billion-dollar-plus fortune. In addition to a block-long, nine-story mansion on Manhattan’s Upper East Side, Epstein owns the $6.8 million mansion in Palm Beach, an $18 million property in New Mexico, the 70-acre private Caribbean island, a helicopter, a Gulfstream IV and a Boeing 727.

“My belief is that Jeff maintains some sort of money-management firm, though you won’t get a straight answer from him,” one high-level investor told New York magazine. “He once told me he had 300 people working for him, and I’ve also heard that he manages Rockefeller money. But one never knows. It’s like looking at the Wizard of Oz — there may be less there than meets the eye.”

“He’s very enigmatic,” Rosa Monckton told Vanity Fair in 2003. Monckton was the former British CEO of Tiffany & Co. and confidante to the late Princess Diana. She was also a close friend of Epstein’s since the 1980s. “He never reveals his hand .?.?. He’s a classic iceberg. What you see is not what you get.”

Both profiles intimated that Epstein had a predilection for young women but never went further. In the New York magazine piece, Trump said Epstein’s self-professed image as a loner, an egghead and a teetotaler was not wholly accurate.

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“I’ve known Jeff for 15 years,” Trump said. “Terrific guy. He’s a lot of fun to be with. It is even said that he likes beautiful women as much as I do, and many of them are on the younger side. No doubt about it — Jeffrey enjoys his social life.”

Three years after that profile ran, Palm Beach Police Officer Michele Pagan got a disturbing message. A woman reported that her 14-year-old stepdaughter confided to a friend that she’d had sex with an older man for money. The man’s name was Jeff, and he lived in a mansion on a cul-de-sac.

Pagan persuaded the woman to bring her stepdaughter down to be interviewed. In his book, Patterson calls the girl Mary. And Mary, like so many of the other girls who eventually talked, came from the little-known working-class areas surrounding Palm Beach.

A friend of a friend, Mary said, told her she could make hundreds of dollars in one hour, just for massaging some middle-aged guy’s feet. Lots of other girls had been doing it, some three times a week.

Mary claimed she had been driven to the mansion on El Brillo Way, where a female staffer escorted her up a pink-carpeted staircase, then into a room with a massage table, an armoire topped with sex toys and a photo of a little girl pulling her underwear off.

Epstein entered the room, wearing only a towel, Mary said.

“He took off the towel,” Mary told Pagan. “He was a really built guy. But his wee-wee was very tiny.”

Mary said Epstein got on the table and barked orders at her. She told police she was alone in the room with him, terrified.

Pagan wrote the following in her incident report:

“She removed her pants, leaving her thong panties on. She straddled his back, whereby her exposed buttocks were touching Epstein’s exposed buttocks. Epstein then turned to his side and started to rub his penis in an up-and-down motion. Epstein pulled out a purple vibrator and began to massage Mary’s vaginal area.”

Palm Beach assigned six more detectives to the investigation. They conducted a “trash pull” of Epstein’s garbage, sifting through paper with phone numbers, used condoms, toothbrushes, worn underwear. In one pull, police found a piece of paper with Mary’s phone number on it, along with the number of the person who recruited her.

On Sept. 11, 2005, detectives got another break. Alison, as she’s called in the book, told Detective Joe Recarey that she had been going to Epstein’s house since she was 16. Alison had been working at the Wellington Green Mall, saving up for a trip to Maine, when a friend told her, “You can get a plane ticket in two hours .?.?. We can go give this guy a massage and he’ll pay $200,” according to her statement to the police.

Alison told Recarey that she visited Epstein hundreds of times. She said he had bought her a new 2005 Dodge Neon, plane tickets, and gave her spending money. Alison said he even asked her to emancipate from her parents so she could live with him full-time as his “sex slave.”

She said Epstein slowly escalated his sexual requests, and despite Alison’s insistence that they never have intercourse, alleged, “This one time .?.?. he bent me over the table and put himself in me. Without my permission.”

Alison then asked if what Epstein had done to her was rape and spoke of her abject fear of him.

An abridged version of her witness statement, as recounted in the book:

Alison: Before I say anything else .?.?. um, is there a possibility that I’m gonna have to go to court or anything?
Recarey: I mean, what he did to you is a crime. I’m not gonna lie to you.
Alison: Would you consider it rape, what he did?
Recarey: If he put himself inside you without permission .?.?. That, that is a crime. That is a crime.
Alison: I don’t want my family to find out about this .?.?. ’Cause Jeffrey’s gonna get me. You guys realize that, right? .?.?. I’m not safe now. I’m not safe.
Recarey: Why do you say you’re not safe? Has he said he’s hurt people before?
Alison: Well, I’ve heard him make threats to people on the telephone, yeah. Of course.
Recarey: You’re gonna die? You’re gonna break your legs? Or?—
Alison: All of the above!

Alison also told Recarey that Epstein got so violent with her that he ripped out her hair and threw her around. “I mean,” she said, “there’s been nights that I walked out of there barely able to walk, um, from him being so rough.”

Two months later, Recarey interviewed Epstein’s former house manager of 11 years, documented in his probable-cause affidavit as Mr. Alessi. “Alessi stated Epstein receives three massages a day .?.?. towards the end of his employment, the masseuses .?.?. appeared to be 16 or 17 years of age at the most . . . [Alessi] would have to wash off a massager/vibrator and a long rubber penis, which were in the sink after the massage.”

Another house manager, Alfredo Rodriguez, told Recarey that very young girls were giving Epstein massages at least twice a day, and in one instance, Epstein had Rodriguez deliver one dozen roses to Mary, at her high school.

In May 2006, the Palm Beach Police Department filed a probable-cause affidavit, asking prosecutors to charge Epstein with four counts of unlawful sexual activity with a minor — a second-degree felony — and one count of lewd and lascivious molestation of a 14-year-old minor, also a second-degree felony.

Palm Beach prosecutors said the evidence was weak, and after presenting the case to a grand jury, Epstein was charged with only one count of felony solicitation of prostitution. In 2008, he pleaded guilty and nominally served 13 months of an 18-month sentence in a county jail: Epstein spent one day a week there, the other six out on “work release.”

Today, Jeffrey Epstein is a free man, albeit one who routinely settles civil lawsuits against him, brought by young women, out of court. As of 2015, Epstein had settled multiple such cases.

Giuffre has sued Ghislaine Maxwell in Manhattan federal court, charging defamation — saying Maxwell stated Giuffre lied about Maxwell’s recruitment of her and other underage girls. Epstein has been called upon to testify in court this month, on Oct. 20.

The true number of Epstein’s victims may never be known.

He will be a registered sex offender for the rest of his life, not that it fazes him.

“I’m not a sexual predator, I’m an ‘offender,’?” Epstein told The Post in 2011. “It’s the difference between a murderer and a person who steals a bagel.”

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30 percent of all Chinese men suffer from a certain medical condition which actually is a birth defect, and which is called a micropenis (less than 1 inch). This is why the Chinese are so good in making money. They have to be good for something.

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