"DIRECT CONNECTION" IS MADE BY MPT TO SERVE ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

*] >> Jeff: GOOD EVENING AND WELCOME TO YOUR "DIRECT CONNECTION", JUST AHEAD TONIGHT, INSIGHTS ON THE WAR BETWEEN HAMAS AND ISRAEL.

WE'LL TALK WITH AN EXPERT ON MIDDLE EASTERN AFFAIRS COMING UP.

BUT WE BEGIN TONIGHT WITH YOUR HEALTH.

JOINING US TO ANSWER YOUR QUESTIONS DURING BREAST CANCER AWARENESS MONTH IS Dr. CYNTHIA DROGULA ASSISTANT PROFESSOR OF SURGERY AT THE MARYLAND SCHOOL OF MEDICINE AND MEDICAL DIRECTOR OF THE BREAST CENTER AT THE UNIVERSITY OF MARYLAND BALTIMORE WASHINGTON MEDICAL CENTER.

DrDOCTOR, THANK YOU FOR JOINING US DURING BREAST CANCER AWARENESS MONTH.

TELL US A COUPLE THINGS YOU WANT VIEWERS TO BE MOST AWARE OF?

>> .

>> SO I THINK BREAST CANCER AWARENESS MONTH IS A GREAT MONTH FOR EVERYBODY TO TAKE A MOMENT AND TAKE ASSESSMENT AND GET CAUGHT UP WITH OUR HEALTH.

EVERYBODY HAS GOTTEN A LITTLE BIT BEHIND SINCE THE PANDEMIC.

GETTING BACK ON TRACK WITH REGULAR SCREB SCREENINGS, GETTING REGULAR CHECKUPS FROM THE DAYS WHERE WE WENT MAYBE EVERY YEAR CLOSE TO OUR BIRTHDAY.

AND SO ONE OF THE THINGS IS MAMMOGRAPHY AND GETTING BACK INTO GETTING ANNUAL MAMMOGRAMS WHICH SHOULD BEGIN AT 40.

>> Jeff: ARE YOU SEEING -- >> EARLY DETECTION IS HELPFUL.

>> Jeff: SORRY TO JUMP IN THERE.

ARE YOU SEEING THE IMPACT IN YOUR SURGICAL PRACTICE PEOPLE WHO WEREN'T ABLE TO GET THEIR ANNUAL MAMMOGRAM?

>> I'VE SEEN A NUMBER OF WOMEN WHO GOT OFF TRACK.

WHEN YOU GO EVERY YEAR FOR YOUR MAMMOGRAM THERE IS A WHOLE SYSTEM OF REMINDERS.

SO THAT YOU KNOW, YOU WILL GET A HANDY NOTE FROM YOUR IMAGING FACILITY THAT SAYS HEY IT'S TIME TO SCHEDULE.

IT'S BEEN ALMOST A YEAR SINCE YOUR PRIOR EXAM.

SO I AM SEEING SOME WOMEN WHO CAME IN WHO ARE COMING IN WITH BREAST CANCER WHO GOT OFF TRACK.

SOME OF THOSE CLUES OR QUEUES THAT HELPED THEM REMEMBER TO SCHEDULE THEIR APPOINTMENT MAYBE THEIR LAST MAMMOGRAM WAS 2019.

MANY WOMEN ARE CATCHING UP.

BUT IT IS TIME TO DO THAT.

AND YOU SHOULDN'T WE BE ASHAMED NONE OF US ARE GOING TO SAY WHY HAVEN'T YOU BEEN HERE YET.

WE ALL WENT THROUGH THE PANDEMIC IT IS A PERFECT TIME TO GET CAUGHT UP.

>> Jeff: YOU KNOW, IT OF COURSE HAS A REPUTATION AS LET'S SAY AN UNCOMFORTABLE PROCEDURE FOR WOMEN.

AND MAYBE THAT'S PART OF THE REASON WHY SOMEBODY WOULDN'T ACTIVELY MOVE IT UP ON THEIR CALENDAR DURING THE PANDEMIC?

>> IT DOES.

AND I'M NOT GOING TO DISCOUNT THE FACT THERE ARE SOME WOMEN WHO ON A GOOD DAY HAVE SORE BREASTS.

FOR THEM TO GET A MAMMOGRAM THOSE WOMEN ARE GOING TO FIND IT'S MORE UNCOMFORTABLE.

THE MAJORITY OF WOMEN THEY WOULD DESCRIBE IT AS A SQUEEZE A PRESSURE, I MEAN THERE'S A LOT OF MISERABLE THINGS THAT WOMEN GET TO GO THROUGH FOR THE JOYS OF BEING A WOMAN.

ON A SCALE OF THOSE THIS ISN'T THAT BAD.

YOU KNOW, IT'S UNCOMFORTABLE, MAYBE.

TERRIBLE FOR THE MAJORITY OF WOMEN PROBABLY NOT.

>> Jeff: WHAT ARE THE OFFICIAL RECOMMENDATIONS?

THEY GET TWEAKED FROM TIME TO TIME.

WHAT SHOULD WOMEN KNOW ABOUT WHO NEEDS TO GET SCREENED?

>> IT'S AN EXCELLENT QUESTION BECAUSE THE GUIDELINES DO CHANGE AND WHEN THEY CHANGE IT LEADS TO CONFUSION.

WE DO RECOMMEND ANNUAL SCREENING FOR WOMEN WHO ARE AVERAGE RISK STARTING AT 40.

AND INCLUDING MAMMOGRAPHY AND IN THE STATE OF MARYLAND, YOU CAN JUST GO.

YOU DON'T NEED A DOCTOR'S ORDER FOR A SCREENING MAMMOGRAM IN THE STATE OF MARYLAND IF YOU ARE OVER THE AGE OF 40.

THERE ARE SOME WOMEN WHO ARE HAD EYER RISK EITHER THEY HAVE A STRONG FAMILY HISTORY THEY KNOW THEY CARRY A GENETIC MUTATION, PERHAPS THEY HAVE HAD AN ABNORMAL BIOPSY IN THE PAST AND THEY DO NOT FOLLOW THE GUIDELINES FOR AVERAGE RISK WOMEN.

THEY ARE SCREENING PROTOCOL IS TAILORED TO THEIR LEVEL OF RISK OF THE WE MIGHT RECOMMEND THEY START GETTING IMAGING EARLIER.

>> Jeff: LET ME REMIND OUR VIEWERS IF THEY HAVE A QUESTION FOR THE DOCTOR ABOUT BREAST CANCER SCREENING OR TREATMENT GIVE US A CALL AT THE NUMBER ON THE SCREEN.

OR YOU CAN SEND AN E-MAIL TO LIVE QUESTIONS@MPT.ORG/DONATE.

WHEN ARE THE DIFFERENT KINDS OF SCREENING TECHNOLOGY MRI'S FOR EXAMPLE, 3D STUDIES WHEN ARE THOSE RECOMMENDED?

>> SO, I THINK THE MAJORITY OF MAMMOGRAMS THAT'S ARE GOING TO BE DONE NOW ARE GOING TO BE 3D.

WE HAVE FOUND THE DETECTION FOR SMALLER CANCERS EARLIER CANCERS SNEAKY IFER CANCERS THERE IS NO PARALLEL.

THE 3D IMAGING PICKS THEM UP BETTER.

TECHNOLOGY HAS JUST IMPROVED IN LEAPS AND BOUNDS ANYWAY.

I LOOK AT OLD MAMMOGRAMS FROM THE 90s I CAN'T BELIEVE WE WERE EVER HAPPY WITH THOSE.

THE HIGH RESOLUTION IMAGES WE CAN SEE SO MUCH MORE.

IT IS A DIFFERENT STORY BECAUSE THERE'S NO STRONG RECOMMENDATION PER SCREENING MRI FOR WOMEN WHO DON'T HAVE CERTAIN MUTATIONS.

WE DO USE IT FREQUENTLY AS A DIAGNOSTIC TOOL WHEN WE WANT TO GET SOME MORE INFORMATION.

MANY WOMEN FIND IT CONFUSING BECAUSE THERE IS A MANDATORY STATEMENT ON THE BOTTOM OF THEIR MAMMOGRAM REPORT TALKING ABOUT THEIR BREAST DENSITY AND INDEED, MRI DOES SEE MORE CLEARLY THROUGH A DENSE BREAST THAN A MAMMOGRAM CAN.

>> Jeff: DOES BREAST DENSITY IMPACT SOMEBODY'S RISK OF BREAST CANCER OR IS IT JUST AN IMPEDIMENT TO GETTING A CLEAR MAMMOGRAM?

>> IT'S BOTH.

SO IT DOES INCREASE YOUR RISK SLIGHTLY.

AND THE REASON FOR THAT IS NOT WELL UNDERSTOOD THE DENSE BREAST TIRVE USE PERHAPS MORE BIOLOGICALLY ACTIVE OR MORE DENSE BECAUSE OF MORE CELLS PER GRAM LESS FATTY TISSUE.

BUT IT'S NOT COMPLETELY UNDERSTOOD WHY BREAST DENSITY INCREASES THE RISK BUT IT DOES VITALLY.

IT CERTAINLY MAKES BREAST CANCER MORE DIFFICULT TO DETECT.

>> Jeff: LET'S TALK ABOUT THE TREATMENT SIDE.

AND WE'LL START WITH SURGERY BECAUSE THAT IS WHAT YOU DO.

AND THERE HAVE BEEN DRAMATIC ADVANCES IN SURGICAL TECHNIQUES.

>> YOU KNOW, HISTORY OF BREAST SURGERY GOES BACK TO HALSTED IN THE 1800'S.

AND IF YOU LOOK AT IT EVERY COUPLE OF DECADES WE'VE JUST HAD TREMENDOUS CHANGES IN HOW WE MANAGE THE DISEASE AND EACH STEP OF THE WAY IT GETS BETTER AND BETTER FOR WOMEN.

FROM THE RADICAL MASTECTOMY TO THE MODIFIED RADICAL AND THE BREAST OPTIONS WHICH THE MAJORITY OF WOMEN ARE CANDIDATES FOR KEEPING THEIR BREAST AND TRYING TO DESIGN INCISIONS AND DESIGN RECONSTRUCTIVE OPTIONS TO KEEP -- HELP THEM LOOK IN THE MIRROR AND STILL FEEL GOOD ABOUT THEMSELVES.

THAT'S JUST EVERY 10 YEARS THERE SEEMS TO BE A MAJOR SHIFT AND EACH TIME IT GETS BETTER AND BETTER.

>> Jeff: IS THAT WHAT'S CALLED A LUMPECTOMY AND IS THERE FEAR AMONG YOUR PATIENTS THAT IF WE'RE NOT TAKING THE WHOLE THING WE MIGHT BE LEAVING SOMETHING BEHIND?

>> RIGHT.

SO IT WOULD BE THE MEDICAL TERM IS A WIDE LOCAL INCISION.

BUT WE DO KNOW THAT FOR THE LAST 40 YEARS WE'VE KNOWN THAT SURVIVAL RATES BETWEEN MASTECTOMY AND LUMPECTOMY PATIENTS FOR THE SAME CANCER IS THE SAME.

WHAT SURGERY YOU CHOOSE WHEN YOU ARE PLANNING YOUR BREAST SURGERY DOESN'T IMPACT SURVIVAL.

AND SO IT REALLY BECOMES A QUESTION OF THE MECHANICS OF THE OPERATION AND HOW BIG IS THE TUMOR RELATIVE TO THE BREAST SIZE.

IS IT SOMETHING YOU CAN GET OUT AND LEAVE A PRESENTABLE BREAST.

OR IN SOME CASES A WOMAN MIGHT HAVE MULTIPLE TUMORS AND THEY MIGHT BE WIDESPREAD APART SHE MAY HAVE THREE OR FOUR TUMORS SIMULTANEOUSLY IN THE SAME BREAST AND IN THAT CASE MAYBE A MASTECTOMY IS A SAFER OPTION.

>> Jeff: WHAT TYPICALLY HAPPENS FOLLOWING SURGERY?

RADIATION, MEDICAL TREATMENT?

BOTH?

WHAT DO YOU GENERALLY RECOMMEND?

>> SO BREAST CANCER IS A MULTIDISCIPLINARY TREATMENT PLAN.

AND OUR PRACTICE WE HAVE WE ARE A CANCER CENTER AND WE HAVE A TEAM AND WE SIT TOGETHER EVERY WEEK WEDNESDAY MORNING AND I LIKE TO JOKE WE TALK ABOUT THE PATIENTS BEHIND THEIR BACK BUT I'M THERE FOR SURGERY.

WE HAVE RADIATION ONCOLOGISTS WE HAVE MAMMOGRAMS WE LOOK AT THE PATHOLOGY, OUR SOCIAL WORKER IS THERE, WE ARE GENETIC COUNSELOR AND WE BRING THE TEAM TOGETHER TO CREATE A CANCER PLAN FOR EACH INDIVIDUAL PATIENT.

AND SOME WILL NEED MOST NEED SURGERY.

SOME WILL NEED MEDICATION.

IT'S NOT ALWAYS CHEMO.

IT MIGHT BE HORMONAL THERAPY.

MANY PATIENTS NEED RADIATION THERAPY BUT THAT WAY EVERY SPECIALTY GETS TO WEIGH-IN AT THE VERY BEGINNING TO COME UP WITH THE BEST OPTION FOR THE PATIENT.

>> Jeff: WHAT YOU KNOW, PERSONALLY, YOUR JOURNEY FROM MEDICAL SCHOOL INTO PRACTICE, I BELIEVE YOU WERE TRAINED AS A GENERAL SURGEON.

WHAT LED YOU INTO THIS SPECIALTY?

>> YEAH, SO BLOO BELIEVE IT OR NOT WHEN I WENT TO MEDICAL SCHOOL MY PLAN WAS TO WORK IN THE LAB.

I WORKED AT THE NIH AND I DID MY SURGICAL ROTATION AND I WAS SOLD.

AND I'VE BEEN IN THE FIRE DEPARTMENT AS A MUCH YOUNGER PERSON SO I GRAVITATED TOWARDS EMERGENCY SURGERIES.

BUT OVER THE YEARS I DID MORE AND MORE BREAST SURGERY, TOO.

AND I THOUGHT IT WAS IMPORTANT WORK TO DO.

CERTAINLY THERE IS A NEED.

FOR GOOD BREAST CARE.

ONE IN EIGHT WOMEN GET BREAST CANCER THERE IS ALSO A LOT OF WORK TO DO.

WOMEN ARE BUSY.

THEY TAKE CARE OF EVERYBODY ELSE FIRST.

AND WHEN THEY GET THIS KIND OF DISKS SIS THEY NEED SOMEONE TO BE THERE TO NOT HASSLE THEM AND TO UNDERSTAND THEM AND GET THEM THROUGH IT.

>> Jeff: YOU ENCOURAGE PATIENTS TO HAVE A POSITIVE ATTITUDE.

TALK ABOUT THE POWER OF POSITIVITY AND ALSO THE INCREASING LIST OF GOOD REASONS TO BE POSITIVE ABOUT BEING ABLE TO TREAT THIS CONDITION?

>> SURE.

WELL, I THINK THE FIRST REACTION A PATIENT FEELS IS FEAR.

YOU HEAR THE CANCER WORD AND IT'S SCARY.

AND THERE ARE SOME WOMEN YOU KNOW WHO COME OUT IMMEDIATELY OUT OF THE GATES AND THEY ARE READY AND THEY BLOW US AWAY WITH THE POSITIVE ATTITUDE.

THEY ARE READY TO FIGHT.

SOME WOMEN ARE REALLY FRIGHTENED AND THEY NEED HELP GETTING THERE.

SO IT'S IMPORTANT TO HAVE A TEAM INCLUDING SOCIAL WORKERS AND YOU KNOW, SUPPORT GROUPS TO HELP THEM WITH THAT POSITIVITY.

BECAUSE YOU ARE HAVING A STRONG SPIRIT HAVING AN OPTIMISTIC OUTLOOK IS GOING TO HELP YOU GET THROUGH IT.

BECAUSE THIS STUFF IS HARD.

AS FAR AS THOUGH, A REASON TO HOPE, SURVIVAL RATES ARE BETTER THAN THEY WERE 30 YEARS AGO.

AND 30 YEARS AGO WE THOUGHT WE WERE PRETTY MODERN AND WE WERE DOING PRETTY WELL.

AND TO THINK WHAT HAS IMPROVED AS FAR AS MEDICATIONS, TARGETED THERAPIES, IMMUNOTHERAPIES, BETTER SURGERIES BETTER RADIATION IT'S REALLY STARTING TO MANIFEST IN IMPROVED SURVIVAL RATES.

SO WOMEN ARE NOT ONLY DOING BETTER, THEY ARE GETTING THROUGH IT MORE EASILY THEY ARE LIVING.

AND WE WANT THEM TO DO THAT.

WE HAVE A SURVIVORSHIP PROGRAM TO MAKE SURE THAT WE KEEP THEM ON TRACK.

THAT WE PREP FOR SUCCESS BECAUSE THEY REALLY DO HAVE A GOOD REASON TO HOPE.

I TELL MY PATIENTS I NEVER SUGAR COAT EVER.

IF I TELL YOU I THINK YOU WILL BE FINE IT'S BECAUSE I REALLY DO BELIEVE IT.

AND I END UP SAYING THAT A LOT NOW.

>> Jeff: THAT IS GREAT.

ONE OF THE THINGS WE HEAR LESS ABOUT THAN MAYBE 30 YEARS AGO, IS BREAST SELF EXAMS FOR WOMEN AND MAYBE MEN.

MEN OCCASIONALLY GET THIS.

HAVE THE RECOMMENDATIONS ON THAT CHANGED?

>> THEY HAVE.

AND IT'S COUNTERINTUITIVE.

ONE MIGHT THINK IF YOU STAYED ON A SCHEDULE AND CHECKED EVERY MONTH THAT IT WOULD IMPROVE SURVIVAL RATES.

AND YOU KNOW THERE WERE SEVERAL GOOD TRIALS LOOKING AT IT AND FOR SOME REASON IT JUST DOESN'T SEEM TO BE THE CASE.

AND THE WOMEN ALSO FELT A LOT OF GUILT IT WAS HARD TO DO.

IF YOUR DOCTOR ASKED YOU ARE YOU DOING YOURSELF EXAMS AND YOU HAVE TO BE SHEEPISH AND MAYBE I MISSED A FEW.

IT DIDN'T SEEM TO HELP SO MUCH.

WHEN WE ASK WOMEN TO DO IS TO BE AWARE OF WHAT IS NORMAL FOR THEM.

BECAUSE BREAST TISSUE CAN BE LUMPY THERE'S LOTS OF TEXTURES LIKE HAIR.

AND ALL THE DIFFERENT VARIETIES WE HAVE.

AND SO IF A WOMAN IS AWARE OF WHAT IS NORMAL FOR HER, SHE MIGHT BE MORE ALERTED TO SOMETHING THAT IS BEING -- IS A NEW CHANGE AND THAT IS THE TYPE OF STUFF WE WANT TO BRING TO OUR ATTENTION.

>> Jeff: Dr. CYNTHIA DROGULA JOINING US FROM THE UNIVERSITY OF MARYLAND BALTIMORE WASHINGTON MEDICAL CENTER AND THE EYELE LOW BREAST CENTER WE APPRECIATE YOUR TIME.

THANK YOU VERY MUCH.

>> MY PLEASURE, THANKS.

>> Jeff: AND NOW TO THE WAR BETWEEN ISRAEL AND HAMAS.

WE SPOKE TODAY WITH NATHAN FRENCH PROFESSOR IN THE DEPARTMENT OF COMPARATIVE RELIGION AT MIAMI UNIVERSITY.

PROFESSOR THANK YOU FOR JOINING US.

YOU STUDY ISLAMIC LEGAL THEORY AND THEOLOGY AND CONTEMPORARY MIDDLE EAST HISTORY.

WITH THAT BACKGROUND, DO YOU THINK HAMAS HAD A PURPOSE IN THIS ATTACK?

>> WELL, AS I TELL MY STUDENTS WHEN WE STUDY THIS CONFLICT WHEN WE STUDY THIS NOW WAR, THIS IS A DEEP HISTORY.

WE COULD SPEND OVER A SEMESTER.

BUT IT'S IMPORTANT RIGHT NOW TO FOCUS ON THE SPECIFIC MOTIVATIONS THAT HAMAS MAY HAVE HAD LEADING INTO THIS CONFLICT.

AND I THINK WE COULD BROAD LEE SEE THESE IN FOUR WAYS, FOUR SEPARATE POSSIBLE MOTIVATIONS.

THE FIRST OF THESE, A SENSE AMONG HAMAS' LEADERSHIP THAT ISRAELI SOCIETY HAS NEVER BEEN MORE DIVIDED.

FOR THOSE WHO MAY HAVE BEEN WATCHING NEWS OVER THE LAST YEAR OR SO, WE KNOW THERE HAVE BEEN MASSIVE PROTESTS AGAINST THE GOVERNMENT OF PRIME MINISTER ANNETTE BURKE REGARDING JUDICIAL REFORMS IN ISRAEL.

AND HAMAS SOUGHT TO EXPLOIT THOSE POLITICAL DIVISIONS.

I ALSO THINK THAT HAMAS THEY MAY THINK THAT PARTIES INTERESTED IN ISRAELI AND PALESTINIANS HAVE TURNED THEIR ATTENTION ELSEWHERE THERE MAYBE A SENSE THERE WAS A DISTRACTION BY THE EU AND NATIONS IN THE EU BY THE UNITED STATES, TURNING ITS ATTENTION ITS SUPPLIES AND MATERIAL TOWARD THE CONFLICT IN UKRAINE.

AND THEY THOUGHT PERHAPS THIS WAS AN OPPORTUNITY TO TAKE ADVANTAGE OF THAT LACK OF ATTENTION.

THREE, HAMAS MAY HONESTLY HAVE SOUGHT TO DISRUPT THE ONGOING THREE PARTY NEGOTIATIONS BETWEEN THE U.S., SAUDI ARABIA AND ISRAEL THAT MAY HAVE RESULTED IN THE NORMALIZATION OF TIES BETWEEN THE UNITED STATES, ISRAEL AND THE KINGDOM OF SAUDI ARABIA TOGETHER.

A CONTINUATION PERHAPS OF THE TRUMP ADMINISTRATION'S ABRAHAM ACCORDS AND NOTED FOREIGN POLICY OBJECTIVE OF THE BIDEN ADMINISTRATION.

THE KINGDOM OF SAUDI ARABIA AS WE SHOULD NOTE HAS ALREADY SAID THEY CONSIDER THOSE NEGOTIATIONS ON HOLD PENDING THIS CONFLICT.

AND FOURTH, HAMAS HAD GROWN UNPOPULAR IN RECENT YEARS IN THE GAZA STRIP.

GAZAIANS DO NOT HAVE FREEDOM OF MOBILITY AS WE'RE SEEING RIGHT NOW AS THE CONFLICT UNFOLDS BEYOND THE BORDER WALL.

ONE IN 10 ENJOYED SAFE ACCESS TO CLEAN WATER BEFORE WATER SUPPLIES WERE CUTOFF BY THE ISRAELI GOVERNMENT.

FOOD SUPPLIES WERE LIMITED.

MEDICAL SUPPLIES WERE LIMITED AND HAMAS WAS BEGINNING TO FEEL THOSE PRESSURES.

THIS WAS A CHANCE FOR HAMAS TO PIVOT THE CONVERSATION TOWARD FIGHTING TOWARD WARFARE TO PUT THE GAZA STRIP ON A WAR FOOTING.

>> Jeff: IS IT SURPRISING THAT THE PRESIDENT OF THE PALESTINIAN AUTHORITY ABBAS CONDEMNED THE HAMAS TERRORIST ATTACKS?

>> NOT AT ALL.

HAMAS AND THE PALESTINIAN AUTHORITY HAVE HAD A FRAUGHT RELATIONSHIP SINCE 2006.

THOUGH HAMAS IS STILL DEPENDENT LARGELY ON OUTSIDE REMIT TANSES COMING IN FROM FUNDING SOURCES IN TERMS OF THE POLITICAL CONFLICT HAMAS BELIEVES THE ONLY WAY TO PREVENT THE CONTINUED OCCUPATION OF WEST BANK TERRITORY OF PALESTINIAN TERRITORY IS THROUGH ACTIVE VIOLENT RESISTANCE INCLUDING THE USAGE AS TERRORISM AS A TACTIC AS WE'VE SEEN SO TRAGICALLY OVER THE LAST WEEK.

THE WEST BANK AND LEADER ABBAS BELIEVE IN CONTINUED ONGOING NEGOTIATIONS, TRYING TO POLITICAL SETTLEMENTS AND ARRANGEMENTS WITH THE ISRAELI GOVERNMENT.

ABBAS IS FACING A CHALLENGE FROM VARIOUS AND DEVELOPED MILITANT GROUPS SUCH AS THE LION'S DEN AND I WOULD ANTICIPATE WE'LL HEAR MORE ABOUT THAT IN THE WEEKS AHEAD.

>> Jeff: WITH YOUR EXPERTISE IN ISLAMIC THEOLOGY, HOW DOES HAMAS SQUARE THAT WITH TERRORISM AND ATTACKS ON CIVILIANS?

>> WELL, HAMAS IN THEIR INTERPRETATION OF JIHAD AND ISLAMIC LAW ARGUE THAT ISLAMIC LANDS NAMELY THE LAND OF PALESTINE HAS BEEN INVADED BY THE ISRAELI GOVERNMENT AND BY WHAT THEY ARGUE ARE THE WESTERN COLWILL NATIONAL SUPPORTERS.

AND THEY TRY TO INTERPRET A LINE OF ISLAMIC LEGAL THINKING THAT ARGUES IN A TIME OF INVASION OF MUSLIM CONTROLLED TERRITORY, THE RULES OF WARFARE CHANGE.

THEY SHIFT.

WARFARE BECOMES AN INDIVIDUAL OBLIGATION UPON ALL MEMBERS OF SOCIETY.

AND THIS THEY ARGUE MEANS THEY ARE FIGHTING A DEFENSIVE STRUGGLE TO DEFEND THEIR TERRITORY.

AN ARGUMENT WE SHOULD NOTE THAT MANY, MANY MUSLIM JOURNALISTS AROUND THE WORLD CONDEMNED AND ARGUE IS A MISINTERPRETATION OF ISLAMIC LAW.

>> Jeff: AS YOU SAY A COMPLEX SITUATION HOW WELL UNDERSTOOD DO YOU THINK IT IS WITHIN THE UNITED STATES GOVERNMENT?

THE WHITE HOUSE MEMBERS OF CONGRESS, IS THERE ANYTHING THAT YOU THINK AMERICAN LEADERSHIP SHOULD BE PAYING CLOSER ATTENTION TO?

>> WELL, I COME FROM A GENERATION OF SCHOLARS AND NOW IN WASHINGTON D.C. A GENERATION OF POLICYMAKERS, INTELLIGENCE OFFICIALS MILITARY PERSONNEL WHO CAME OF AGE AND STUDIED AT UNIVERSITY AND DONE A TREMENDOUS MOUNT OF WORK IN THE SHADOW OF THE GLOBAL WAR ON TERRORISM DECLARED UNDER THE BUSH ADMINISTRATION.

AND I HAVE FRIENDS, COLLEAGUES WHO ARE VERY FAMILIAR WITH THIS CONFLICT ON BOTH SIDES OF THIS CONFLICT, THE PALESTINIAN AND THE ISRAELI SIDES.

I WOULD IMAGINE THE CONVERSATIONS OCCURRING IN WASHINGTON D.C. ARE BENEFITING FROM A GENERATION OF SCHOLARS AND POLICYMAKERS WHO HAVE BEEN LIVING, WORKING, STUDYING AND DEVELOPING POLICY IN THIS REGION NOW FOR OVER TWO DECADES.

>> Jeff: WHAT ARE RELATIONS LIKE AT THE MOMENT BETWEEN HAMAS AND EGYPT?

GAZA BORDERS ISRAEL BUT IT ALSO BORDERS EGYPT?

>> WELL, I THINK THE PRESIDENT AND THE EGYPTIAN GOVERNMENT ARE CONCERNED ABOUT THE EMERGENCE OF A HUMANITARIAN CRISIS ON THEIR BORDERS.

IN RECENT NEGOTIATIONS WITH THE U.S. GOVERNMENT, BORDER CROSSING BECOME A WAY IN TO EGYPT FROM THE GAZA STRIP FOR U.S. CITIZENS.

THE EGYPTIAN GOVERNMENT DEMANDED HUMANITARIAN CONCESSIONS.

THEY HAVE KEPT THAT BORDER CLOSED.

THEY ARE CONCERNED IF THE BORDER OPENS GASSIANS WILL COME INTO EGYPT AND PERHAPS NOT LEAVE EGYPT A SIMILAR SET OF CIRCUMSTANCES THAT OTHER PALESTINIAN REFUGEE COMMUNITIES FACED IN THE 70-YEAR WAR AND CONFLICT.

TAKE FOR EXAMPLE, THE PALESTINIAN REFUGEE COMMUNITY NUMBERERRING OVER TWO MILLION IN JORDAN TODAY.

THE CC GOVERNMENT DOES NOT CONSIDER HAMAS AN AS ALLY THEY VIEW HAMAS SKEPTICALLY LIKE THEY HAVE CRACKED DOWN ON THE MUSLIM BROTHERHOOD, THE GOVERNMENT SOUGHT TO LIMIT HAMAS' ABILITY TO SMUGGLE WEAPONS AND MATERIAL THROUGH TUNNELS AND MEANS OUTSIDE OF THE BORDER CROSSING IN THE SINAI.

THE GOVERNMENT HAS FOUGHT A DOMESTIC JIHADIST INSURGENCY IN THE LAST FEW YEARS.

AND I CAN ONLY IMAGINE THEY ARE CONCERNED ABOUT WHAT WOULD HAPPEN TO THOSE REFUGEE COMMUNITIES FROM GAZA IF THEY WERE ALLOWED IN AND THE SECURITY AND HUMANITARIAN QUESTIONS THOSE WOULD POSE.

>> Jeff: IT'S IN THE INTEREST OF ISRAEL AND EGYPT TO KEEP GAZA CONTAINED AND WALLED OFF FOREVER.

BUT THE POPULATION OF GAZA'S BEEN EXPLODING OVER THE DECADES.

AT SOME POINT, SOMETHING HAS TO GIVE.

I MEAN IS THERE AN OBVIOUS SOLUTION THERE?

>> ISRAEL AND EGYPT BOTH HAVE ENJOYED A PEACE TREATY AGREEMENT FOLLOWING THE 1973 YOM KIPPUR WAR THE 50TH ANNIVERSARY WE RECENTLY PASSED.

ISRAEL AND EGYPT HAVE A DEDICATED SERIES OF CONVERSATIONS TO THIS QUESTION.

I THINK EGYPT WE WILL SEE IN THE WEEKS AHEAD WILL CONTINUE TO MAINTAIN A VERY FIRM LINE ON PROVIDING ACCESS TO HUMANITARIAN AID, MEDICINES, WATER AND FOOD.

BUT I DON'T KNOW THAT THE EGYPTIAN GOVERNMENT IS GOING TO AGREE WITH THE ISRAELI GOVERNMENT TO TAKE IN LARGE COMMUNITIES OF REFUGEES WITHOUT MAJOR CONCESSIONS FROM THE ISRAELI GOVERNMENT.

IT MAY BE POSSIBLE THAT THE EGYPTIAN GOVERNMENT AND THE SAUDI GOVERNMENT WITH OTHER LIKE MINDED GOVERNMENTS PRESSURE THE ISRAELI GOVERNMENT TO MAKE COMMITMENTS ON ENDING OR LIMITING THE ANNEXATION AND OCCUPATION OF THE WEST BANK WHICH MANY INTERNATIONAL OBSERVERS CONSIDER TO BE ILLEGAL.

>> Jeff: YOU TALKED ABOUT HAMAS' STANDING AT HOME WITH THE CITIZENS OF GAZA.

THEY WON THE ELECTION AFTER THE ISRAELIS WITHDREW IN 2005.

IF THERE WAS A NEW ELECTION, HOW WOULD THAT GO?

>> THIS IS A VERY BIG QUESTION.

AND IT IS A DIFFICULT ONE TO ANSWER IN PART BECAUSE WE NEED TO UNDERSTAND THAT HAMAS ISN'T SIMPLY JUST A MILITANT GROUP WHICH USES TERRORISM AS A TACTIC.

HAMAS PROVIDES SOCIAL WELFARE.

IT'S PROVIDED EDUCATION.

IT'S PROVIDED MEDICAL SUPPLIES AND FOR MANY GAZAIANS THIS HAS BEEN THE ONLY STRUCTURE ABLE TO FOLLOW THROUGH ON PROMISING THOSE MATERIALS.

SO THE QUESTION OF A VOTE FOR HAMAS MAYBE A QUESTION FOR A VOTE OF TRUST.

WHOM DO YOU TRUST IF YOU ARE IN THE GAZA STRIP?

DO YOU TRUST OUTSIDE POLICYMAKERS WITH BROAD IDEAS OF HUMANITARIAN AID?

OR DO YOU TRUST THOSE MOVEMENTS YOU LIVE CLOSEST TO THAT HELPED YOU SECURE, FOOD, MEDICINE AND MATERIAL?

THE MOST DIFFICULT QUESTION RIGHT NOW AND ONE WE WILL CONTINUE TO TRY TO RESEARCH IS HOW MANY GAZAIANS HOLD HAMAS ACCOUNTABLE FOR WHAT IS OCCURRING AND HOW MANY WHILE THEY MAY HOLD HAMAS ACCOUNTABLE FEEL COMPLETELY TARGETED IN A HOPELESS SITUATION BY THE ISRAELI DEFENSE FORCES AND THE ISRAELI GOVERNMENT.

>> Jeff: LASTLY, I SAW AN INTERVIEW WHERE YOU DRAW A PARALLEL BETWEEN HAMAS AND GAZA AND THE TALIBAN IN AFGHANISTAN.

WITHOUT GOING TOO DEEPLY INTO THAT HOW CLOSELY DOES THAT HOLD?

>> THE PURPOSE OF THAT PARALLEL IS TO UNDERSTAND THE TALIBAN BELIEVE THEY ARE RESTORING JUST ISLAMIC GOVERNANCE TO AFGHANISTAN.

AND WHEN THEY CAME TO POWER IN 1996, THERE WERE MANY AFGHANS WHO DID NOT SUPPORT THE TALIBAN'S IDEOLOGY THEIR INTERPRETATION OF ISLAM.

BUT THEY SUPPORTED THE IDEA THAT THE TALIBAN WAS GOING TO REMOVE GOVERNMENT CORRUPTION WAS GOING TO RESIST OUTSIDE INVASION AND END WHAT HAD BEEN A LENGTHY CIVIL WAR.

WHEN HAMAS CAME TO POWER IN THE GAZA STRIP THE PALESTINIANIAN AUTHORITY WAS SEEN AS CORRUPT, WAS SEEN AS AN AUTHORITY THAT ABANDONED THE NEEDS OF PALESTINIANIANS AND GAZAIANS WITH FRUITLESS PEACE AND POLICY TALKS WITH THE ISRAELI GOVERNMENT AND HAMAS PROMISED TO DELIVER STABILITY AN ANTICORRUPTION CAMPAIGN.

TO HELP RESIST OUTSIDE INVASION AND OCCUPATION.

>> Jeff: OUR THANKS TO PROFESSOR NATHAN FRENCH OF MIAMI UNIVERSITY.

THAT IS "DIRECT CONNECTION" FOR THIS WEEK.

WE'RE BACK FRIDAY WITH "STATE CIRCLE" AND THE LATEST ON MARYLAND POLITICS.

JOIN US FOR THAT FRIDAY EVENING AT 7:00 P.M. AND REMEMBER YOU CAN SEE PAST EDITIONS OF OUR PROGRAMS ON-LINE AT VIDEO.MPT.TV.

PLEASE FIND US ON SOCIAL MEDIA AFT MPT NEWS.

THANK YOU FOR WATCHING AND HAVE A GOOD NIGHT.

TIONDZ