particularly at the va, they're not just taking one drug once inkh"vn lot of them are on multiple s jo:ábcz medication, all of which have sedation as a side effect, and many times, all too often they çí- appear unaware, which ones can cause sedation and which ones don't, and i think that, you d@ ñ know, it really speaks to how fragmented our health care rh7u+áuqs as become with 2 specialists doing their own@/!rbwne thing and not necessarily being aware of the whole picture and what else is a patient dealing z ?c with and what other medicines are they on, and the patienbb,3m imo&unaware to me all too often9 room for improvement./33y3ars >> i think that in the general popub zé drug that they are taking is x.c[- >> sorry, dr. ohayon, can you speak into the microphone?d >> they are knowing the pills um:úñ are responsible for sleepiness,

one is the usual medications gn that they take for the medical 3•ñ condition of psychiatric conditions they know when, they h82ñ me2 fw that if they driv must diminish or stop the l!$jv medication, but for the people ú]bsyt that are taking otc, for 0#ñzvpx example, it shows that it is an 8)4nç unusual medication and often bé they don't read the i.ifi3u)jj a"3z2÷ that are there on the medication a l&so the fact that for example you can take a pill because you have the flu, and (! rt/ inside is an anti-histamine, andlq c:his would be responsible for fkcñ sleepiness. here is the danger.zst >> so again, i think we're highlighting the complexity of this. is there enough -- have we done enough to educate health care l##é÷ providers and pharmacists to

provide the correct information )@j;v'%aeg&p to patients regarding some of ye;: these side &u$at in some cases still difficult $$ for health care providers to fúmmc even interpret? >> well, i think that there are -r'formation to health care providers, in particular.ur÷ they are tuned in to the health safety communications that come out of the fda.zt!5 there's a lot of news over the past few years about the dék1lpsx/2 of drugs that impair your brain function for driving, and ñu y4! that they need to advise . patients about drugs that impair driving, although the point is nb1c certainly taken that there are u drugs available over-the-counter to patients that cause ÷w

sleepiness, and the fda is l%píkçcuu studying patients' understanding of the labeling and is trying to figure out the best ways to the things that we have on the website, that if you're going topc be driving, you should select an4tnñ over-the-counter medication thatbex is less likely to cause 4 sleepiness. õ5ba think one thing that's ipy a big difference for us as providers is having # e-prescribing available so that drug/drug interactions and sedation are automatically cross-checked for us, provided that the patient is getting all their medications from the same -

helped. the question is, are we doing e

that you mentioned in your presentation was the relationship between psychial 2ró disease, sleepiness, and accident risk. do we have any convincing #5qá$u)eating that psychiatric disease changes thatc"ql% level of sleepiness or the crashé96cs risk? >> yes, we know it for majority of the disorders, we know that the people have a time reaction ym? that are increasing, and it could be responsible for some úri+z accidents. also the fact that they take the medicatiox&; át+h(á$(qith generating the sleepinkz,afor the subject out of the disease í itself, but i think that the >84z depression by itself is giving to the people some time ta[:aqp(urjju$at are more important and probably are responsible for a lot of accidents. >> thank you. one of the things that we run zef

into in commercial "ó2çsqu transportation is a pretty big reluctance on the part of operators to even explore the 8úqo possibility of whether or not they might have a sleep disorder, such as sleep apnea. in my personal life, i have a +pv(÷ couple of friends who i can tell you have sleep apnea and have said to me that they don't want to know.ñaa)f can you talk a little bit about the folks who may be more or less likely to be willing to be tested and/or treated for their sleep apnea? >> yes, i'll jump in there.s3'] that's been the area of my research, and there are certain aspects to care delivery that seem to help people come forward. definitely education is really o?pa÷ important, but even if they're aware, there is this condition called sleep apnea, a lot of people don't com h because of the employment repercussions.l!qáq it's important that the program

is non-punitive.< to screen for @z59 apnea from multiple expert bodies now, the fmcsa, the trisociety task force. we have a number of published guidelines and they all agree "ñ you have to find a way to diagnose and treat people while keeping them in service, so that's really important that they don't feel their employmente@9÷ is threatenái+f& @ the other thing is, affordabil)jx"dp((qáár!ility of diagnosis and treatment and z> we've come a long way in recent years, with home sleep testing, ! % the cost has come down &#[ and more patients now have health insurance, so i think that we can always continue to improve accessibility, but i v@(v think that's made a big dent, v8zx2tr and then the third place we can ,q."tsp)q difference is in providing ongoing support for people who are on cpap, so they don't view it as just this thing that gathers dust in their closet but something that néfñ actually has them feel better.b[mfñ the field in the past has b ñ focused heavily on diagnosis andvç(+i less so on ongoing support, and 4

i thi@ under áj transformation right now, which is all good news for patients.$bhkñz-hñúi-@ñ >> dr. farkas, you mentioned a couple of times about the fda hard to try and increase the ngfw.zmu amount o& /sormation that's ca8gìáhp &hc% available to patients and caregivers. can you talk a little bit about .;rç where people might be able to find that information? zagñ >> yes. lot of that information is available online, particularly á" for the over-the-counter medicationñ1b)er)uráh#airly straightforward. we've tried to have simñ(írug facts box on the w2eñ over-the-counter medications, and they contain very simple andf/ef straightforward, r/cw)dw easy-to-understand warni)pá the drugs can cause drowsiness. i think that the goal is still to direct patients towards drugs that don't cause drowsiness, if b''q they're going to be driving, while also allowing patients to

have drugs that they have used for many years, in many casesébsñj86j> thank you.1 ptat dr. price?g÷ >> thank you so much. excellent presentations and great questions spg ,%9ñ i just have one additional question to dr. farkas.t you talked about some of the challenges in addressing and 7ps studying driving risk through naturalistic and epidemiologic n approaches and alluded to simulator studies as one 2 promising approach that is being

employed.73tr can you tell us more about if iñ,e drugmakers are actively using -í> things like skills testing or 6d?÷? simulator testing, and what g0 would be the role of both the )8ek fda and the drugmakers in doing those types of testing? 3[,bku á (áh'ew drugs, there" o; isn't of course experience in the community or prescribers if p>aéñ those drugs are to what degree ó-aes those drugs might impair driving. and so when sponsors now or drug developers are coming in with new drugs, we're taking a look q$uñ6ramt the kinds of characteristics that came out of this white paper that was organized by the ="twz ntsb or nhtsa and the other 6nbokhny3p;y-a"ñs$ federal agencies, and the fda can ask drug developers to provide all reasonable safety ó;yjx"u r(s& reasonable studies to provide that data, fhs

z!hu and studies of psychomotor impairment, even studies in y,p driving simulators or behind the wheel, that falls under the category of things that we can ask for, to inform labeling, to inform the safety of the drug, and we've been asking for that information from drugs like, for insomnia, there's the obvious > lr potential for those drugs to cause sleepiness and impaired driving if the dose is wrong or ñy if the time of day that they're taken is wrong.>1me but it also extends beyond just "tll#i8 9 drugs for insomnia and it's r3(ññ@qst still relatively recently we've been asking drug developers to í but it does, one of the examples that i showed was for restless leg syndrome, still a sleep disorder but not insomnia.m.iñ other drugs that are in development right now that are

completely unrelated to sleep where we've asked for hoh7 information about things like a$ vigilance and reaction time and we'll take a look at that information and see if studies o ( in driving simulators would be ywg needed, for example, to get a better idea of the real life (áp3u risk. >> thank you very much. dr. malloy?l+ñikh÷ >> thank you for, again, great k- presentations.t,#ñju dr. -- i'm going to blow this, sorry -- gurubhagavatula. >> i think we know who you're ?,h8 talking about. >> thank you.:gñi÷ have we seen any changes across in the medical field or any i/s

sleep disorders? >> i can tell you that more people now know about sleep apnea than they did when i was añfy fellow, and when i talk about 0q1 it, they all know somebody who bft has it or has used cpap so i think that all the efforts we've]vf'x made in the sleep community have worked. the question is, is there more ñzx to do and if 85% of cases are still undiagnosed i'd tell you there's stilb 0f>ñjudf3h do, and in terms of what have wepan3 couple of companies to educate snbwz their employees about sleep ]kr apnea and these were employees in the transportation industry, éx4ñ and they either knew about it or@]jp#ñxdt!4jt&háhp &hc% when they heard and they heard y with detail what sleep apnea is and its risks, they seemed surprised or shocke@6worriedfkkp and many of them said they were d1$ú7bé2ñyb"!÷.q%&

already on treatment.v i think we made fe

symptoms are really helpful so és getting them to talk about it islx really important.dcyñ we need to get down the barriers that cause fear and that needs v to be part of the educational endeavor we make, geo l j access to self-screening in a 0;m5 tu(v ir >> thank you.63jç@g:o with regard to medicines that ro@ cause potential fatigue, what issxx the role of a pharmacist as 0ek they're the ones typically dispensing the medicine to a qbcç÷%"w person to inform them of the potential for fatigue or ÷-> yes, so certainly the 'ú pharmacists get a lot of lud information from the fda about z

information comes from the pharmacies, sometimes it comes from, it's regulated by the t áupáe but that particular q@asm information isn't regulated by q2;x the food and drug administration. the fda does have for drugs thatva!-z have risks that patients really know about what's called a medication guide, and that can explain the main risks and some of the lesser risks of drugs, which goes to patients, too. foñ i think the point has been made 5xf many times, can more be done, and certainly increasing awareness of pharmacists is about the risks of drugs is :wb@f1vz something that the fda is very upá÷ interested in doing, and fy1/v increasing the awareness of a patients about the risks of drugs for driving and trying to ]tu"ç figure out strategies to reach patients about those risks.3b %eñ 5ñ

>> thank you.9zbhhr member rosekind? >> thank you.zbrggé"em dr. ohayon i'm going to start with you. we often talk about crashes being at the top of the pyramid, especially in human performance issues, we're always concerned 4qo cf1 o about the near misses underneath that, the errors below that. so the first panel we talked, ;v"% mr. teft on the spot, 400,000 crashes, maybe 5,000 fatalities every year. 13.4 million from your z fbs)ulation surveyed, that's a big number, twice the risk.abha so give us some comparisons so &+sú÷>&? hw18! qclv@ ( @r(t&háhp &hc% we have a sense of other kinds of issues that you look at. there was a little bit about mental health issues there but tell us where that 13.4 million sort of compared to other issues so we have some sense of that's a big number but as far as risk goes it's small, big, medium, can you give us some sense of how we could compare that to

other issues that we face? >> it's a very big number, in ç< xla#a÷hnr comparison of all what we have in sleep presently, if you ivzq compare for example to the #" prevalence of insomnia, per se, you have particulat!m/f!içbx times the nli7 (t)obably 2zfgs the reason for which the people are not taking care of this is &jñ because there's a devaluation of0-9 what is sleep in the population. sleeping shortly is a sign of productivity, so you have peopleñr-ñ:bá4çx$uzn)fñ wrongly doing an equation >á 8 between efficiency, efficacy of the people and sleep, sleeping .cdñ short. so you have a é mk are puspééthe people inside of ñ that, and probably the education must go also in this directionhzh& for example, for sure that a lot affected during the night, the uhfe fact if you have a lot of light,t"g

the influence of light on the caí people starting from the evening and a lot of light inside of the çñ home, the@ "qr'g on during all the night, and some people qkj41ojá that is producing disrupted qey sleep, sleepa3esbad quality that could be responsible for bç@ sleepiness, is sure that y$ medication, medical condition are playing,er this going on tqñr( that, but when you look at the general population that you are 8%! r(t&háhp &hc% looking at the big number, you vsb see that the environment of the zy people is not adequate to a % !ñ

person to go to sleep, and they have a false idea about sleep.í31f sleep is needed. you cannot do that so we have to convince our entrepreneur that e@ it could cost a lot in terms of u÷fbu life and also in terms of money. >> great, thank you.o q dr. farka) especially related to the interactions between [ medications./> i think that there's certain :zñb7t conditions that lead to sleep loss with the fda knowing the most about, things like ( insomnia, and ideally, a sleep pññ4a medication would increase the

ability of people to get sleep, and the argument has been made that ten minutes of extra sleep at night, every night, if you >,!uq can get that('&:c a medication, that that's going to help you over the long-term get the sleep that you need, and the thing that needs to be done is to be f able to accomplish treating the bc$%ñ disease without having side j=fp9;mfwjjuq effects that are unacceptable.h.-%m certainly the, i mean there's only increased risks, the way that you state the question there's really only increased risks if t: is taking a drug who is already h9r a patient with obstructive sleep apnea who is taking a drug for mv their allergy and if they're taking a sedating anti-histamineâ÷ there's really only downside to &s[w that, and what needs to be done 3'u particularly for patients who are at increased risk of v.utìáhp

&hc% sleepiness and driving is to [ ñgjc:0t direct them to drugs that are going to be less risky.s follow-up question, which is, it's the scientist in me.íufiñ if somebody's got sleep apnea and taking their cá6medicine for some other reason, can we potential sleepiness increases do we have any sense of that?.h >> yes, i think that there's a lot that can be quantified, the f¿ percentage of patients who izñnñ report sleepiness and then with the kind of studies that are i done for drugs, you can see what3w7ç their ability is, for example, á to stay within the driving lane, andht!ue, you know, there's notesoucú=,q between these psychomotor tasks and the risk of traffic no&a uñtm accidents but again going to, for example, what seems to be a n'nik better correlation for for y"cfdtwçpy example alcohol and the risk of ç ux#óu

actual traffic accidents, you hf connection and say that, you xe know, if a patient is driving or÷,b$o[q not able to stay within the driving lane to some certain degree, it kind of looks like impairment from alcohol or obstructive sleep apnea and again t ittle ç9 á )*uá seems likely &1ú.ú2px(h"9x the cause, similar kinds of increased risks of traffic k@áq accidents.es#é')p'k you. dr. g., first, quickly, 58% undiagnosed. take it from a percentage to>1 give me a number./!

the numbers are even higher in african-americans and in é"spani ááujt " people that are morbidly obese are also on the rise.e,ywo so i think that's an extreme underestimate. >> great, so 18 million is the conservative and we're probably looking much higher.ñ÷ so three questions for you.( beyond osa, because that's not 3i-sçqpctw the only sleep disorder, out of the full sleep disorders, which t other ones have information about crash risk?< >> there is some data looking at diabetes.uí the studies are not nearly as -- >> sorry, i'm just in the sleep ìáhp@ p% disorders,ha(ásqq( disorder problems.ízmty3y >> sleep disorders, i'm not aware of any more comprehensive.=d!wx >> dr. o9tswhoever wants to -- i'm curious. there's a lot of focus on osa 66jh because we understand that one. but 90 sleep disorders or so.zd ?r"xjqc÷ i wonder when we get to insomnia, restless legs, $>sxñdçf hhbqduñv

narcolepsy, maybe rare but what other data do we hcpnabout crash risk and other sleep disorders?2mç'c÷ >> with sleep disorders, we know because we have looked several times with r%l syndrome, we have a lot of people there, and the prevalences2iñ of all the sleep disorders is .o-!÷+@ around, when you are with a qçlzéq p8r/pica diagnosis like for sleep apnea, ér sñ 10% ave some variation between the studi%c i játájvéñ yoa$áv'drome, and some finding $hnñ e áp'ge, and you have to cross that with the fact that in the g crb" f1 o general population you have 28% of sleepiness that is there, and so probably sleep disorder are íñ responsible of a lot of this sleepiness, and moreover, [ky; probably they have disruptive ( sleep as a result of restless i íí

leg syndrome is of use, of sleep apnea, totally of use, insomnia %w a@áwt is a condition to speak about a diagnosis of insomnia you must have daytime c/ñ tuujjtták ç63 inside of which you have daytime sleepiness, and always you find v2z degrees for the people.& ñ again, they have accident, it's not happily always a fatal accident or physical accident, ádf where the police is involved.- very often itz#mistakes when uofj÷ they are driving, but still, it is always a danger. e[2z >> i can also add that doing d these types of studies can be tricky because a lot of times k-iz za%m=1q%=99ñ in our trucking studies the ñrqz+ people with sleep apnea were sleeping on average only five hours a night and those same $xr0ur(sáár'king lots of caffeine. they may be depressed.

they may have poor sleep quoeaapqñl÷ the caffeine makes them anxious. they have some alcohol to take kl"ñ+-"dñk the edge off so it's never as clean and straightforward as you would think so the cumulative risk and what happens to actual #cfd on-the-road performance i think )@8- is what you want an assessment of. >> i.);-"á ráhpá dr. heinz is emphasizing, the sleepiness ç0llñz ño factoa=l3p" osa is the one we have data 8 úñ about but it's clearly much larger and a lot we have no data. dr. g., when i +6g ráupáe 3 sleep societies talking with folks, there's always a questionj+a about mèá$qr)h)eport jqs÷n administrations.ñlñwbcxs so is there a sort of national standard or req%+qçráñ1gkqp)zí by state? what are sleep clinicians doing ísñ as far as knowing who they're sleep apnea?

heterogenity in report and a lot of information regarding who to report and who not to report. federal law always trumps anything that state societies have in place. having said that, the &g4# l @/39ç regulations are very sparse. the way of when to report sleep 4 ñ4 specificity in relation to sleep>y apnea so it's a problem area~i >> great information, that gets to the information earlier about people hesitant to come forward and if they don't know if they'll lose their license if b]s they see you, that could be a big issue.v6#?wc dr. g., you've got two minutes ::t" because for the remainder of this question i'm putting you inbehl@ charge of the entire health dp7m system in the united states but may not want it but you have it for two minutes and because it7óe%ñ is your job, what would you change to ing and tó!&ment of sleep disorders and other medical conditions that affect drowsy driving, the

medications that increase risks wa) for drowsy driving.l"çyi=kgb what would those changes be acrosskcjbuá)h(p)e system that would give us the most 7i÷p effect at saving the most lives?= 3 >> well, number one, we start with education, and i 4 r[ñpt having a forum like this is a really important first step and eeútqp%8, get the word out that sleep is not something you do on the side but it's actually an essential foundational part of healthndiy living, and i think we have to get the message out that q7s0 everybody needs to prioritize ) sleep.é< >> dr. g., let me just -- you're push you a little bit.s x?r(t&háhp &hc% >> okay.bdlñíu8x >> you just said education.xx?-c if you were in charge would there be a requirement for medical students, residents, attendings and cme, i'm putting you in charge of this system, [iz and so how far would you go?rql6ç e$7b-%9i9ñ 5ñ÷cr$ññc ñ >> as a requirement, not a @a7y guide. >> and grade school.rp[ i would start teaching kids as early as poss2x6uráup)t

prioritizing sleep, and s up late, you're going to pay one way or the other. and absolutely in medical 6skdzñ school, as a medical student i didn't know there was a field called sleep medicine, and i didn't graduate that long ago, so. so absolutely there needs to be #xo cf1 o more of a solid curriculum in n6 medical school.çóft2hyófrys'f7 i also believe that as a health more integration than what we have.. y&ob when a patient comes in, we don't know what their past is, and records are still very fragmented, and it's difficult ÷0 to know what medicines have theyh xñ taken, what have they tried? did they just have a car crash last week?g" so we're operating in the dark mbf as providers.uqw we need a system that allows us gc q to track important outcomes that f]-u;rco-w lead to crashes.@éq and i think we need to make $ everyone, so that it's 3l accessible, and the services, we have some of the greatest ál,÷ services in the world, but they're not accessible to the v people who need them the most.q)bzr

>> so we thank you for your jg$%ñ service for that two minutes for the ent+b that was very informative. great panel.&tbr of different issues we've been"]d s4#÷ talking about of how so many different xp rowsy ñ driving.y thanks to dr. mckay as well. panel and talk about in-vehicle r-çj and on-road strategies.é the new congress meets for the first time tuesdaysj noon eastern. as always, the house will be live on&oç c-span and senate live on c-span 2 where you can watch the swearing in of members and electionñ ;ñ for house speaker. kentucky senator mitchlmíh mcconnell

is incoming majority leader of the senate.t5 z vi>v but tuesday will be the first timç2%w he serves as majority leader. and in january of last year senator mcconnell came to the floor to deliver what he called his state of the senate speech11 as minority leader at the time he discussed a range ofurtç issuesú4b including how bills come to the senate floor for debate and the amendment process.ci >> should come to the floor and be thoroughly debated.>9p&ñecqeñ we've got an example of that going on right now.qq)5w and that includes a robust amendment process¡'m÷$:xi_lk÷[ in my view, there's far% too much paranoia about the other side around here. what are we afraid of?as) ÷z both sides havezov taken lix]ies

admit bhñthatdx but the)áñ answerb#÷ñ isn't to provoke even more. the answer is4 debate. this is theñ k)@ á rosenate.(xr let folks debate. let the senate work its will. and that means:(c bringing bills to the floor. it means having a free ankmfx ojé&i/ma z.hdñ amendment sf$,hprocess. that'svl that's what we used to do here.vvqp÷@, that's exactly the way this place operated just8tq1q ag&3 few years ago. the senior center fromp"qr iillinois majority leader:1%g likes to say or used to say if you don't want to fight e0s fireman. and if you don't want to cast votes, don't come to the senate. i guess he hadn't said that lately.#h.v when we used to beé"8q in the j

people look the good news, we'r the bad news is in order to get the bill across the floor, w"yj you've got to cast a lot of çrdhcá5ñ you don't want to take. and people groaned about it.j8 complained about it. the sun still came up the next day.,aop and everybody felt like they were a part of the process.hdbl÷i7qtñx said it. i think it is time to allow senators on both sides to more fully=@! legislativive process. that means having a more-é open iy-kñ amendmentat process around here. and íwobviously it r9 y requires you from time to time cast votes you would rather not cast.n'ñ but we're all grown-ups.96ó÷: i3 there's rarely ever a vote you cast around here that's fatal.hb -úmuxo é%zñ

and then-kv ronyvwpp of it all is4d(gn that kind of process makes the place a lot less contentious.á@pr$,( contentious when you vote on tough issues than when you don'tïáiñdh4jlpe/ because when you're not adloud that, everybodyov is angry about being denied the opportunity to do what you were sent here do.(%rrt ax@m an with the start of the 114th cong(a'' rom congressional reporters abouxe2 yñ pry fortsá"rí new congress. and we will take your phone calls and5h'÷ comments on facebook and twitter.pñzñ live onirjx c-span, from 7:00d& ÷ a.m. eastern until the house gaff els in at noon./eñbhc house on.udñ c-span and senatesyky c-span : l coverage here on c-span 3 with

that begins at 1:00 p.m.7 á easternhz] in the old vice president biden and incomi and then at 3:00, we will seen);far(t&háhp &hc% the ceremonial swearing in of house members é/"+from capitol hill.e&q)2j$t$ >> this sunday on q & a, author dick la q talks about the ground breaking xvnv1915 film 6 ám"the birth of a nation", an 'h depiction of former slaves after the>d civil rights mg advocak0+ and á÷ publisher trotter to promote moviessex release. >> part two of the movie:ñ is aff0$rq war reconstruction is really the hez0

it is a scene inm carolina

in of conflict. a group of specialness of specialo (r uá5ñ and how their job can vary frome(jb country to country. thank a>jñ ambassador. i'm specialrx ñ in both sip and americanl diplomats have been invaluable partners as we look atb6d:o a8y3et series4záq#@r(t&háhh of strateg)n0ñq questions relate together state department and usid and this is certy(fñ a83@÷ topic that has come0 y up from a few angles bothi!n" issue ofr"cñ$et sí(bmujuáq of special envoysz1iñ and representatives and also thet> issue aboutkhm6overall operations ini certain÷mpqpen a topic that's come up a great deal.;txsñ i'm going to hand it overs0" very brief bios jé#!;

findings that the wisdom. >> well, thanks very much, tomìáhp &hc% i'm princeton lyman, a senior c advisor here, assistant 34s ;ñ secretary of io.. i want to talk about the origin of this íieáá(rá and the methodology.5+7s then we'll get into the substance. but as both ron and tom have t mentioned, the use of special b60fs8(÷ysvu envoys,úñ +jt n conflict it is something that administrations have used ibe>7(ñ past, they will use it in the ú)@csmm future.fkto'wihu while there is some controversy . over the amount of effort, the @&z ba÷ use or overuse of special bg enjoys, the fact is they are an 1wucc1'b÷ important instrument of u.s. %c'ñ foreign policy and what we wanted to get at 4 45y! z%ur)j )uuáions is >rz how do we make that more effective, what are the issues that arise, how do you make the i came off of two years as the

u.s. special enjoy for sudan andjakn south sudan so i had some thoughts on this.oá but in our doing this study, what we did together, bob and i,"u÷ was to first develop a set of a issues that we thought were the relevant issues0u ñrréi+bkéu we then convened two r+

focused on special envoys in oebjv conflict situations. +here are a lot of other special tfú envoys. climate change, et cetera.l)! some of our recommendations may be relevant to those, but we = 6r focus on conflicts becausesd re are some special characteristics. they're dealing with life and death situations.ogn va6c9 át+huáup&ly attract very ®# high level of both political andy)@÷z public attentio3kñç after our interviews and our review of memoirs of several of the envoys, we covered a lot of toh)ñhsf conflict areas from northern ireland, the middle east, the balkans, south asia, and several&#ñe"&b situations in africa. so we tried to reach out and getí a perspective from people v dealing p(l these issues over ;:ai more than one administration, .0$uq ],? and in various parts of the world. so let me turn to bob who talk about the basic elk&%#5ijt

the study.r)=r > thank you. lea¢ittt*v hanking the u.s. institute of peace and work with him has been really great.íh2çrxa9 tr(t(reciate it. just touching briefly on the structure of the report and whatm i served as special envoy to the bosnian federation at the end ofea.znmkij the bosnian war just a little mzcz under 20 years ago now.ñ i later went back to bosnia as diz9 ambassador as head of the uscoe mission."fñ we look at úhi°9ñ and policy authority.=56ó in brief terms, what's the mandate. it is broad or narrow, i2pq ñ clear or vague, are the goals evident.dmr and we looked at a number of cases. 7 what's the authority that the oék0÷ sh "t1áejuáátáhju)árqáháhateya3ñb

he or she had.]e-z1bkkycñ what is the relationship to yd; foreign governments.:zo q and what are the relationships ÷uk?ñ with the u.s. government.u1:9ç after empowerment, we turn to .÷k/,fñ policy authority. what is the role in policy formulation that the special envoy has or does not have. what are his or her channels in bñy to the decision making process. the next issue we looked at was dealing with what we called unfavorables.cm;bñthrcs+cñrwswñ,gx #÷vñdvcxxrl=p sometimes it's the special %í envoy's responsibility to deal with people that the u.s. government ordinarily would not touch with a ten-foot pole.q#fqlifd6÷ post-conflict situation, these nycuy are the people who are still fx ectr1bb relevant and the question is howafb÷ you define the relationship withbplw!í these people and how much you w f tell washington about what ;r you're doing.lvgal

i dealt with some later indicted™chp war criminals in bosnia, but it was necessary to get past the / conflict.+wbo we go into that at some length.b,q0y then there is the issue of ú structure and turf battles.jt exactly what kind of team can a 1a] special envoy put together, if ÷< any.xq=x where is the special envoy goingo2qr to be working from? we say in the report that in çgz"ti almost every case, special envoys are physically located at# /b i was physically located in a broom closet in sarajevo. si but i did have a window. and i got to know everybody at >#éb

special envoy and as charge so there was some gray area h;a between what the embassy0#ñj olsñ did for me and what the embassy staff did for the special envoy.tç we played that game i think pretty well. so turf battles. there are]it(uáles taking mr&v thercijp attles between authorities in washington and inw:# the field.k-tp and there are battles locally.l]#g!] all of this required a certain amount of creativity and fast 66hzñ footwork, at times.>

the concept of civil society basically doesn't play very /cñlç in the former yugoslavia.tsj]xi7f4ñ but we had to,:)hu)u$ all of 2 these people, and in some cases 9: create at least the bases of a u civil society who would then, we hope, take root on its own. so3éyl4uru he areas that the report covered.b %; as prinrp" the 6. /@jñ opportunity to talk to current learn from them about how they pki did their jobs and compare it m against our own experiences.n > t >> bob and i might just share 9q some of our experiences.7!ñçv= then ask dan and david do the same. 5j@ >> excelví3- >> let me start with this fo!

the president, do you have the 7ñ&n pru?mdesjj r+ápáháhe key person in that regard.ç'fg and that comes from both the 6/m substantivue> also comes from appearances.

have credibility. you have to show re[mri# jp&li4añc ñy[ the other actors in that situation, the bureaucratic d actors, substantivñ'aam9ñ-qtñ and then you have to come up with credible policy &ñ[l$nh1 recommenj 9m9ñiim)y!ñxbmx in sudan's case, we had two policies running at the same (gáñ äh.]m,p and several co+iujr' thew÷ñpkçqq war criminals. i wasn't even allowed to talk toá/y í the president or those so indicted.lmx on the other hand, my mandate as the president r)qé;u$q+ery time he introduced me, this is pv2eátáu_uá)qráh working to prevent sudan, south jiuvz sudan from going back to war. and to do that we had to get sudan's cooperatio ñallow for the independence of south sudan. walking those two lines of policy meant we had a lot of y differences, overshading, et cetera. and it was important to respect n%a'(vhm@ñka the interests of the war crimes office in the department, the

looking for was going to be in zib[ the long-term interests of that >k'ç country as well as south sudan.u so how you get authority, use r authority, create authority has a lot to do with how you act in those situations, but also + 8e starting with the empowerment you get from the president or int1lñ some cases from the secretary of state. >> that contrasts interestingly m) arrived there in the summer of 1996.(x the war had just ended.1e #q)qñn÷ there was still some shooting going on.@÷64ypñ n=d/q .s. military had come in heavy. population of 4 million.v2ovr6> also 1 million refugees and 200,000 casualties.fpbñb p h we also had a holy writ.ñoi ú it is called the dayton accords.r ñ÷d0nw

the dayton accords, which were 0xoebthe product of the will of one 9 single person, the very special envoy, dick holbrooke, in effectohzd7riñ outlined a government which did not exist.y$3s'sáh in fact, the dayton accords wereoiv;ñ signed in 2 cases out of 3 by :fvcñ'jnrñ non-bosnians they were signed by slobodan yeuájju )(hr' belgrade and çov8yz[ the only bosnian to sign them was the muslim bosnian leader.% what we basically had done was given ourselves cover because the neighbors signed it. but we didn't want to deal with the local war criminals./?3;tr(t&háhp &hc% at least as a government. i, however, was2quju)urjr where i dealt with indictables, xy$z as we called them, all the time. and a number of them were later ml indiòeq'ded up in the -la

a richly deserved location for them. but in other words, we had a 6 structure -- we, the united states.? we, the so-called peace implementation council which was?ckjejb the u.s., plus canada, plus the w c turkey, representing the conference, to put together a urbcñ country which did not exist.ç3aa>áñó!]z and so we didn't have to worry the purpose was to, we in this country tend to call it r building. wbghfer to call it state building. to build a viable state. department led the process.d zd; working hand in hand with the u.s. military, i worked very $hw closely with a then two-star general named david petraeus whopñnñ was the first one in.rb$òñ to enforce the peace and prevent #+bz/igniting of the conflict.h#sñ as for policy authority, it was

all here. we had the authority.x pñ dick holbrooke called the shots from washington, once a month would come out to sarajevo and scare everybody. ;sgf but we worked together very b well, and i was his man on the t&z2y ground, and spent my time õ:id1f ñ shuttling between mxeypv he fr-ús? wu croats and the bosnians, that ishmh0÷ to say between the catholics and2rñi?6oñ the muslims, and then when i f4

whether oo %ij to engage.#mz it's not necessarily the thing f) jr)r ase.#b i was not allowed to speak to the president of sudan.4ídu8y it clearly limn(/háo a large exiañ=ui ár' the 9$z r/7á situation.il9xbváx:÷ i reserved the right to ask for that policy to be reviewed if i felt it essential. i never reached that point, id÷ because there were risks in tv0bp opening that door.enñacíbkyk-0(rjç3ó]rç but i think it had to be an ! issue on the table.:z]?ñeo ÷ there were others out there who u were also indicted, that i foundh xñc?gu it necessary to engage with. and that comes to another question.p 8ñvñi4v if you're going to be a special v envoy you have to take some risks.

giving the special envoy some újrá÷jñc latitude in that regard, is one 3cm>tuiauñt8q special envoy, because that person is not in the line of

cetera. ÷÷c: what we found in all our matters.rfux h&o cf1 o and chemistry means that you > respect each other, you respect w!ñ the importance of roles that embassies play, and there's -- it's, as we indicate in the$ (k÷ report, where people, envoys, and pay the price for it.85j÷ respecting the role of the l+ç department, and, in my case, i was recruitedznk'the assistant 1tku/ys÷ secretary. dm i know this guy, he won't give $n and we worked very, very t'(yrvnor /íwj1=me9ñ the other thing that we ílxaép &1ñ able to do at the request of the)sw7e r(.÷(txwaí8 department was actually to help d0hñ over who controlled sudan ÷2> policy. and after we made it clear -- i ,÷ made it clear that i wasn't going to engage in that very much in one side off the other,

the state department said, well y then would you coordinate our .u)%z representation at the embassy onl2im÷ these issues?j#÷é÷:6 zjcñ which i did. rmneú and that facilitated the state department's role with the nse v1c and i worked very closely, of course, with the assistant set. it's important that that relationship be understood, that:oyçylj]ñ it has inherent rivalries they can be overcome if people 8pr really make an effort to do so.z and after we made it clear -- i made it clear that i wasn't cfy3ñ; going to engage in that very mucár"e off the other, gñéñ the state department said, well "m " then would you coordinate our b7liç representation at the embassy onegmxñ and that facilitated the y>(y>jñ7z department's role with the nse ábw and i worked very closely, of course, with the assistant set. it's important ieñgjeá they can be q@- áár# people really make an effort to do so. >> again, an interesting 4+k#ç contrast. in the case of bosnia, there wasx.ñ÷9 @ááju(hjráe house direct engagement. i think it's fair to say that gn&mk

president clinton had hesitated to engage in the balkan wars sad8md9 until the events of the summer of 1995, srebrenica, and the bombing of the market in < sarajevo. in that -- at that point it became the first television war. andj christiane amanpour all the time. the consequence was that there was pressurñx

bosnians, so catholics and -ñbb muslims, because these things are always seen in confessional 1 terms in the balkans, who had been fighting each other.a having started out as allies, qúg they ended up fighting each other, and this was to get that u#-w half of bosnia working again. and the federation forvrf1gt zeú @r(t&háhp &hc% virtually every week.èno

some had staff from the regionalv42ç bureau.ab[ some had little.x;9ubmtr(t&háhp &hc% there are three instances we deal with in 4çg=deport of significantly autonomous officers under the special (%hm envoy. ┐

and that we sometimes didn't lack the oversight for running ubjxñ projects in the field from washington.;yj so i think there are pluses to that kind of an office but therexocñ9 gñ& are warnings, as well. >> why don't we shift to you an)[ get some reaction to the report experience on how we might carry it out. >> sure.z' first of all, this is a very important rhfv.jd i ç j((p&hc% and /┘$u$em am@ç[t p#1 o giving us something to work with that's fjut(ájup'd very well structured. it raises the issues that need to be thought about, g=n a xa:wj2akñ ñ sense can provide a guide path (çc f@y áj for an administration thinking about deploying an envoy.écqéñ what it also needs to do, however, is to stimulate case .ñlb studies.lav&p what we've had today, even, are sf! two examples of successful ?ofwt envoys. but they're successful in part, i would think, because of both

of these gentlemen came up cá@y through the system.?fxqó6sy they were both experts before being appointed envoys./@.! they were experts in the fields that they were asked toq'bxvs %& 8 on.wå>pcecf1 o they had experience in the field.ñ/b,b and they knew how washington and the department of state, and the: interagency system worked.,.-h that has not always been the case.e'q;clxp÷p@z%9erju$e conflict b'zzbf";ç3 jqp situations where envoys have been appointed, as suggested in ó@f'3$ the report itself.-,tezuhp &hc% so therefore, a series of case studies on the way envoys worked in different situations could beh ÷shg4 quite helpful.l ñ as some of you know, i spent th!y most of my career in the middle east, põ=u1i1e2ujtuáq" in the arab/israeli conflict area ambassador to egypt, ambassador r>v&hg/ to is÷zer aw 15, count 'añmj them, 15, envoys over tdi im óe-xç

of about 30 years.ghsv÷ if you review the names of thoseq&lñ envoys you're talking about what;71r we would call an all-star list, ($l@z[:éxv boy aftererson, don rumsfeld, jim leonard, maury draper, dennis ross, tony zinni, john sh(fe »÷ wolf, george mitchell, martin =bj%w a4%x= indyk, and now frank lowenstein.1a4ñ you would expect with this kind y orófa of a lineup if we're using our baseball analogy, that the 1 good.ñlhu but the scoreboard actually z) shows no hits, no runs, and lotstzsqr#tx of errors, which suggests that this is one of the case studies

was it an absence of empowermentñmñ by a president?(,-zs was it an absence of authority? were there turf battles in washington?5ssra a;y this case study and we haven't done it yet, but certainly this 20p tepìáhp &hc% report should simulate it and i z may grab the opportunity and do a) zcl0yé that there are a combination of íop u smartest and most senior people #jç nwyky½uju$is job, were not +l j and not necessatljq! u choice for this conflict.ótyu after all, if you lot lack at j/ío the last 35, a little more than nkaapñl 35 years, in the arab/israeli g"c4j there have been three american q8÷ successes.qrizç but they have all been ún.

now, part of this may be a bh1ur problem that we hkd;i a;yr o7o]/lves. we have raised the level of x4@ engagement in this conflict to a4d! point where the parties simply thkykj1ñm÷ don't pay much yñqq%=9"ur(ràz&ñ envoy below the level of afút ]1=5ju (áv f state. waiting for the president.(buf at play in the arab/israeli >e conflict. but it also suggests that [anzñ(jcsñá context specificity, and i would+bt carefully, becauseexg$ ájjt$ht1(ñca about smart envoys, details. not all of our envoys enter the job knowing what the arabom% about and many of them left the x8d/t÷ ]lot knowing what the n9"@ñ arab/israeli conflict was all and what that does is not only aj jp' american asset, 2 qks

which is the power to do d?a our ability to then pick9qbá ilt conflict resolution process oncer)" that envoy has left the job.01'j i had an experikc7 when i was serviqq ambassador in israel.u# we had an envoy who was 3c#ç appointed to monitor the dgñ compliance of the pah

unveiled a short time before.dúeó now during that period i came w w back to washington for a couple rich armitage and i said, rich, i like john wolf, why did you conflict for this job? and forvékpay conflict.oe they've been at this thing for decades. they know each other far better "ñ than they know us.nu9i÷ far better than wfáfztu$ey deal with each other. and in walks somebody a babe in v(b úfeá÷ help resolve issues. i could go on. we've had other situations

referenced in this rcxqlv. for example is the fact that when dennis ross was appointed the special middle east>6ñyá! nñ office be taken out of the normal bureaucracy of the state department.7.3ñ and in fact, in 1992 '93, '93 5kf[ñ actually9gd5e)pá office was created, i was serving as a ÷ see our assistant secretary and i said ed, i'm sorry you're b le 8)uá b ed said why, i'm not leaving my post.bía ñaa x i said wait they've just taken zsf one of the heazñ3jft why would you remain as the assistant secretary when you no ou'ñ longer have responsibility for fke2 one of the most critical issues in the portfolio?