We need to accept the seemingly obvious fact that a toxic environment can make people sick and that no amount of medical intervention can protect us. The health care community must become a powerful political lobby for environmental policy and legislation.

Interventions are really emotionally exhausting and I would never ever want to have one. In the same way I would never want to have a surprise birthday party. That would be horrible.

Global political conditions make a direct American intervention difficult but President Reagan's messianic and visceral attitude toward the Nicaraguan revolution could mean it will happen as an act of desperation.

Those who remember Washington's cold war culture in the 1980s will recall the shocked reactions to Reagan's intervention. People interested in foreign policy were astonished when in 1985 he met alone at Geneva - alone not a single strategic thinker at his elbow! - with the Soviet Communist master Gorbachev.