>> marvin? >> i think we >> i think weal all agree that pakistan has to be at least involved if there was negotiations. while i have to recognize that there are some pakistan's interests here which are not compatible with u.s. interests and the interest of nato at this point. those will be a factor. the pakistani interestingly had come to recognize -- i think it has to be seen as part of this, that they don't trust the taliban. we assume we often simply put them together or they are their protectors and, therefore, the question of just whether they're speaking for them or they have coordinated their effort advanced. pakistani needs to be suspicious that they can control the taliban in power. but the pakistanis want out of

negotiations is they want a pastun force in kabul but they don't want it to have a free hand. they want to have that force in a way checked or diluted by the other groups and in that way, they can be sure that their basic interests are taken care of and that includes an indian influence and they would not have to face that blowback if the taliban were to gain great offense there where they might and i believe where they would then find that their interests really are far more akin to those of the pakistani taliban and that would have enormous affect on stability in pakistan. >> jeff, let me pick up your point about iraq because i think it kind of got lost. you know, one of the reasons we have such a problem in

afghanistan is we took all our eye off the ball and focused on iraq and and did not come through with the aid and everything that we promised. if, in fact, we tried to stay in iraq it would undermine the negotiations with pakistan -- i mean, in afghanistan, i agree you should not give it away in the beginning. but if you send a signal that you don't keep that agreement, particularly, there are people in iran -- i mean, in iraq who don't want you there, i think that's going to have an impact on the negotiations. i don't think anybody is focused on at this time. >> thank you, larry. the gentleman in the fourth row. >> yes. >> red supenders. >> i'm joseph and i'm a private citizen from chicago. my question regards the much vaunted and never heard about the northern alliance. i assumed they're armed. what is their role in any fighting, any conflict with the

taliban? and also what is the -- has there been any good effort or good success in creating the afghan security forces with a larger pastun element to them. >> okay. and then in the front row, please. >> my name is dan caldwell. i'm a professor of political political scientists. what were the biggest surprises were as a result of your service on this foundation commission >> and all the way in the back. >> one question i have -- >> i'm sorry, your name please. >> bill good dloofellow. what does the karzai government to negotiate a deal that would have the americans leaving?

they're getting extremely rich. dexter's piece on the kabul bank heist. it's staggering the amount of money these guys are stealing and it creates an enormous incentive it seems to me to keep going and about the last thing they want is the americans to wind down the war because this -- the gravy train stops. how do we change that dynamic. >> thank you, bill. why don't we start with larry and joe spriteluber on the northern alliance role, dan, biggest surprise and bill goodfellow -- >> on the biggest surprise was that this function on the miles an hour team, every place we went we got, you know -- you know, eikenberry doesn't get along and dick holbrooke was still alive and we wished mcchrystal was alive. it just looked like we did not have a common position over there. i mean, you heard about it but when you hear it, just remember

from the parliament, from members of the opposition, from everybody else, that was not only surprising but disheartening. >> i'll talk about the northern alliance. first of all, it's not that much of an alliance. it's a term which is carried over from the time when they were fighting the taliban. if you look at its composition here, you would find most of the elements of the alliance, the u.s.-backed many of them that i mentioned earlier they're heavily armed at this point. some of these groups, who played a large role in the ana, the afghan national army, and in the event of a civil war, 'cause that army will immediately break up and a large portion of it will be a large fighting force what we will be if we wish to call it the northern alliance.

but i don't hold out much hope for it because it's lacking one important element and that is it doesn't have a leader. certainly, the general who was the successor to the man who was the leader in the 1990s, massoud who, of course, is dead now, in no way commands the allegiance of the other elements and i wouldn't even trust him in the civil war on what side he's going to be because of his own holding. but ultimately because it is a fractured group, my guess is that eventually the taliban could prevail. and complete the job they failed to do in the late '90s and up until 9/11. so let me add so in the interim, we will have ethnic cleansing.

we will have a very bloody affair and something nobody is talking about. we lost 2 million refugees who will be making a beeline for pakistan which is ill-equipped to absorb any afghan refugee at this point. >> steve? >> well, i certainly, you know, worry about the unbalancing effects of the transition and even of the negotiations with the taliban because the civil war is certainly something that afghans themselves worry about from for good reason given their recent experience with it. i don't think it's likely, i don't. i do agree that the northern alliance -- what we used to call the northern alliance is fractured. marshall faheem has been pointed out has been more or less coopted by the president and other elements of his alliance stand in political opposition to the presidential palace. so the army is the most important way to measure this

question. and i do think that there's a lot of hedging going on and a lot of use of international investment in the ana to try to prepare against the possibility of being back in a civil conflict. and there the recruitment of pastuns of the officer corps, especially a general officer corps is a concern for the -- those leaders of the northern groups that are thinking about the possibility of having to fight another civil war against the taliban, which would be serving again as a proxy for the pakistan army. and that is that they don't want to build a coup in the army in advance of such a conflict so they're going to be very cautious about which pastun officers they allow to rise up inside the army and to build internal networks among officers. and i think -- that doesn't mean no pastun. if you're them, you want the

broadest possible front to defend against a second war against pakistan essentially which would be one way to think of it structurally. they're going to have partners in that war. india is going to be much better resourced than in the 1990s and russia and iran will be supportive. they have strategic depth that they didn't have in the 1990s and they have a pole politic including a young generation of afghans that are going to resist the taliban in such a setting. so they can build out a broader coalition if they're banded together to fight that war but it does require caution about building in officers from helmand and kandahar and other places where they would imagine that they're going to have trouble monitoring the loyalty of those groups. >> well, i don't think we have -- i mean, in terms of the northern alliance, i think a precondition in my view to having an eventual settlement in afghanistan -- it requires the

building up of a political consensus amongst the afghan political class at the moment as to what -- what are the objectives important to the taliban? what would be the outcome? what would be the red light? we saw that. it is going to be much more difficult. so in this period, while perhaps a special envoy is trying to work out the mechanics and the structure, there should be an effort led by pakistan and afghanistan and led by ngos or a consensus. at the moment it does not exist and bill was alluding to it, we need to ensure that at one point the afghan government end the u.s. government speak with the same -- from the same crib sheet when they're addressing the importance of talking to the taliban. now, how could -- i mean, i think the way to persuade the

government of afghanistan at the end of the day, as someone has suggested here, is not terribly interested in reaching an agreement here. another one is talking about talking. and another one is agree to a settlement. but i think that enough ways as we have seen now -- enough ways for the u.s. and for the europeans to say to the president karzai you will be on your own -- i don't like dates but 2014 since i mentioned but i think he needs to feel -- they would need to feel that there is -- that this is a position that will happen particularly if there is no -- there are no reforms within the afghan government. >> one last round of questions. oh, as for my -- to be the surprise was to find that omar, we so easily reached an

agreement on the conclusions of the report despite our disparate nature. >> let me follow up one question to marsh's point to the suggestion that you could see a splitting inside the forces of the afghan state right now and some who would from the northern alliance then go in opposition of a civil war scenario. who would be bankrolling them. right now we are bankrolling an afghan army far beyond afghan's ability to pay for it. where would a kind of rebel, you know, force that is not going to concede from the taliban get its funding? >> i don't think it will get that far. probably you would have this breakup long before you actually got a formal agreement. they wouldn't wait that long. so as far as the funding i think that's very clear. all of the other parties are prepared to fund them. if that's what it's going to

take. if that's what it's going to take to keep an ascendent taliban from emerging. i would anticipate a much larger role on india's part. even perhaps put in military advisors. now, as i say, the fragmentation of this ultimately is going to make -- make this still an uphill climb for the northern alliance. but i don't suspect that money is going to be the objective here. >> well, i would just point out that ourtors in india did explore precisely those questions. and grudgingly, reluctantly they seemed to recognize that if the choice is a settlement in which they get some guarantees against taliban control versus renewal of a war in which they're trying to support the anti-taliban

trusting all to the most fickle gods, the former is the better course. >> but they got to see what the terms are. >> that's right. on all sides to end this war. so i want to thank you very much for your participation in this program and thank you to the panel. [applause] [inaudible conversations]

>> in a few moments a news conference on new rules at aiming

>> the obama administration announced new requirements yesterday aimed at cushing prescription drug abuse. according to a report from the national drug control policy office, the number of people who unintentionally overdose on prescription drugs now exceeds the number of people who overdose during the crack cocaine of the 1980s. this is less than an hour. >> this is what people expect of government. they expect us to come together. they expect us to work across all these different jurisdictional and bureaucratic lines and they expect us to do

what's right to solve a problem. i'm delighted to be here with dr. hamburg, the commissioner of the food and drug administration, administrator michelle lynhart and dr. howard cowe from the department of health and human services someone who has been working on this issue for quite a while, as everyone is here and a special thanks also to karen perry. karen is the executive director of the narcotics overdose prevention and education task force. she traveled with us from -- or up here today to be with us from south florida. she has a very powerful story and she has been just absolutely focused on this effort as you'll hear. seated in the front row also dr. janet woodcock, director of fda's center for drug evaluation and research and the doctor we

have worked on this issue also. and is director of the fda center of drug evaluation and research. well, thank you to all the people here but probably more importantly to their staff members who have worked so long and so tirelessly on this particular issue. i want to mention, too, the head of the cdc dr. tom friedan. he could not be with us here today, but when we have met, whether it's in atlanta or here, i can tell you that he is also, as is everyone else is here been absolutely focused and committed to reducing this problem that we're going to talk about for a few minutes. tom, of course, as you know is the director of the center for disease control and prevention. he is represented here today of the cdc is represented by the director of the cdc's national center of injury prevention

control. let me start by talking about what i think is a startling fact and as a long-time police chief in what caused harm in my city in seattle was one that was startling to me and i think it's startling still to a lot of people in this country. and that is that america is in the midst of a public health epidemic driven by prescription drug abuse. prescription drug abuse is our nation's fastest growing drug problem. according to the cdc, it is an epidemic. and that is not a word that i or the nation's public health community use lightly. well, the facts are devastating. in 2007, and that's the last year in which we have data available, 28,000 americans or about 1 in every 19 minutes died from an unintentional drug overdose and it was driven to a large degree by prescription drug abuse. more recent data show 7

people -- die from an unintentional drug overdose and to put this tragedy in perspective, the number of people who have overdosed on prescription drugs now exceeds the number of people who have died as a result of gunshot wounds. it is a significant problem. the overdoses that we have talked about in the past, historically, crack cocaine and others, are not at the same level of problems that we are seeing with prescription drugs today. well, today also in 17 states and here in the district of columbia, in fact, it's the leading cause of accidental death. what does that mean? it means it's ahead of car crashes from taking lives well, from day one the obama administration has been focused like a laser on this particular

problem. we've increased funding for drug prevention, for treatment, enforcement programs by millions of dollars and in september of last year, the des hosted the first ever national prescription drug takeback program collecting over 121 tons prescription drugs in one day alone. in october of last year, the president signed into law historic federal legislation that will make it easier for the communities to collect dangerous and unneeded or expired drugs. and we set a goal of reducing prescription drug abuse by 15% over the next five years. but the severity of the public health epidemic requires a sustained national effort that will build upon what we have already done. and to build upon our response today we're releasing the national prescription drug abuse plan and i think many of you have been provided the plan, if you haven't seen it, this is it right here.

prescription drug abuse is an unbelievably complex drug problem. and the plan is a culmination of months of collaboration across the federal government. not just the people represented here, the departments of justice and health and human services. veterans affairs and the department of defense all of these are significant players in dealing with this issue. and the plan outlines an unprecedented strategy to save lives and reduce the mammoth burden prescription drug abuse places on our community by focusing on four key areas of action. the first and the most critical part of the action plan requires a significant expansion of efforts to educate health providers. and citizens and the research community about the scope of this threat while too many americans are still not aware of the misused or abuse prescription drugs and how dangerous they can be and

especially particular prescriptions that will get a lot of attention. we have to aware of the awareness of patients, youth and health care providers and today's announcement by the fda which will require manufacturers to pay for education for long-acting opiates is a problem. and the doctor will work in concert with this plan knowing on dcp will work on this plan that would amend the controlled substances took require mandatory education on the sale and the appropriate use of open eighties for all prescribers of controlled substances. second, and also a significant part of the action plan, we are expanding efforts to work with and monitor prescription drugs and to help accomplish this, we are calling on every state in this nation to implement a prescription drug monitoring program and to establish the ability to share data and interoperability between them.

these state-based programs are already successful in 35 states around the country. and they are saving lives by tracking prescriptions and immediately alerting prescribers to those who may be engaged in doctor-shopping. not only do they successfully prevent abuse and prevent so-called pill mills from operating but they are also designed to have strict protections on patient privacy and they are tailored to the unique challenges of the individual states. and third, in the action plan it will make it easier for americans to dispose unused or expired or unneeded prescription drugs. 7 out of every 10 people who abuse the prescription drug or pain reliever got them from friends or relatives. and to help prevent the diversion, the action plan requires the dea and other federal agencies to conduct more takeback programs, distribute information to local community organizations and to create new federal rules that will make it

easier for communities to host their own local takeback programs safely and effectively dispose of these pain killers. finally, the action plan will shut down pill mills and it will aggressively crack down on those who contribute to the suffering of citizens by illegally prescribing and dispensing prescription drugs. although it's a very small number of doctors who abuse their prescribing privileges, they're responsible for an immense amount of the addiction, the suffering, and the death. and we have a responsibility to do everything we can to bring these criminals to justice. and as a result, this action plan increases resources, training and support for federal agencies and state medical boards to take action against these rogue pain clinics. the prescription painkiller epidemic is not going to be a problem that will be solved overnight but like any other problem there are commonsense steps and some of which we just outlined that we can take to

address it and today's prescription drug plan does just that. well, i want to thank our partners at the fda, hhs, cdc and the dea and the other agencies that i mentioned and the many that i actually did not have time to mention for all of their work, all of their contributions and all of the efforts that they put into this plan. i look forward to the progress that we are going to make in the days and weeks and months ahead on the prescription drug abuse problem in this country. dr. cowe is going to be speak and he'll be followed by dr. hamberg, administrator lenhart and ms. perry and then we will have questions. thank you very much. >> thank you so much, director, for your leadership. you have been an incredible leader forever all of us in these critical public health issues and we're just absolutely

delighted to join you for the relief of this plan. i also want to thank the leadership of administrator lenhart from dea and my colleagues from the department of health and human services, commissioner hamburg, who you'll be hearing about from a couple minutes and dr. woodcock and throcmorton, samhsa, pam high who's the administrator of samhsa could not be here today but she and i have the pleasure of cochairing a broad coordinating committee across the department of health and human services that's addressing these very critical issues around mental health and substance abuse, particularly, prescription drug abuse. i want to acknowledge or senior public health drug policy director and our deputy assistant secretary and our special thanks and admiration to karen perry and the nope task force. the heroism that she has

displayed to turn personal pain into power is really extraordinary and ms. perry we want to thank you for being here and sharing your story. you've heard from the director that abuse prescription drugs represents an alarming public health public crisis and i can add that this growing public health crisis is suffocating our society. you've heard several startling facts and let me add to those facts. we know that the abuse of legal drugs, prescription drugs or over the counter medications now account for 1 million emergency department visits a year, matching the number of visits attributable to illegal drugs. we know that nearly a third of people who use illicit drugs for the first time begin by abusing prescription drugs.

and as the director has noted, 7 out of at the point of these people get the drugs from the medicine cabinet. so these facts alarm all of us. they alarm me as a father, as a physician and as the assistant secretary for health. as a father of three children, i know that all parents try to protect our kids and create safe, healthy environments for them to promote health and healthy choices. we may think that prescription drugs can be used only for good but they are beneficial only when used appropriately. as a physician who has spent over 30 years caring for patients, i'm also very aware that we physicians and we providers have had too little opportunity for education on proper prescribing and dispensing of opiate medication. until now