Saturday, May 16, 2026

Bahrain Thread

 1/12 Bahrain is one of the gulf countries being hit with missiles, and as people follow the news, it’s important you understand the country, its context and history:

The indigenous population of Bahrain are the Baharna (بحارنة) – mostly made up of Arab Shia (it was one of the first countries to become Shia in the region in the 7th century). The Alkhalifa family (from the Bani Utbah tribe) occupied Bahrain by force in 1783 coming from Zubara (modern day Qatar) and have been ruling with violence since then. During the 2011 uprising one of the prominent chants was “go back to Zubara, your visit is over”, as the Bahrainis consider themselves occupied. This makes Bahrain the oldest ongoing occupation in the region. 
2/12 Around 30 years after their violent take-over, the Alkhalifas struck a deal with the British to become a protectorate (to protect them from the indigenous population). During their rule, the Alkhalifas depended on the UK and US to maintain full control, oppress the local population and one of their tools was to revoke citizenship and deport many indigenous Shia families to neighboring countries. At one point leaders of the uprising in the 50s were even sent to St. Helena Island where Napoleon was held. Bahrain has one of the oldest civil rights movements in the region, stemming back to the 1920s. There are uprisings almost every ten years in the country. In the 1920s the British were regarded as the de-facto rulers of Bahrain (see: the diaries of Charles Belgrave) to the extent that they could replace one emir with another when they wanted to secure their interest (see: replacement of emir in 1923). 
3/12 When the families who had been forced out of Bahrain to countries like Iran and Iraq returned to Bahrain after many years, sometimes decades, the regime tried pushing the narrative that these were Iranians coming to Bahrain that the regime was kind enough to allow. This doesn’t negate that there has also been immigration of Iranians to Bahrain. 
4/12 The British and US have always been seen as one of the main reasons the Alkhalifas have maintained absolute power in Bahrain; and Bahrain hosts the US fifth fleet as well as a British airbase. People in Bahrain have protested against the presence of these bases for decades, and in the short-lived lifespan of the legislative assembly in 1973, the AlKhalifas disbanded the assembly and imposed a state of emergency for 25 years because the assembly refused to renew the lease of the US base. 
5/12 After the uprising in the 1950s, which was led by Shia, Sunni and leftist leaders and put down by the British, a decision was made that they needed to implement the strategy of divide and conquer. The Alkhalifas very intentionally started a campaign of sectarianism in the country, in the hopes of separating the indigenous population along sectarian lines. What followed was the systematic marginalization and discrimination against the Shia majority in the country (see: the Bandargate report). 
6/12 There are unwritten laws in Bahrain about areas in which Shias are not allowed to rent or own, entire ministries (especially sensitive institutions like the military and police) where Shias are generally not allowed to work, Shia women married to non-Bahrainis are unable to pass citizenship to their children, and in schools students are forced to write that their Shia sect goes against Islamic teaching (I experienced this myself). And this is just the tip of the iceberg. 
7/12 Simultaneously, the regime started politically naturalizing tens of thousands of people from Pakistan, (specifically Baloch), Yemen, Syria (specifically from Deir Ezzor and Raqqa), and Iraq (specifically baathis post the war on Iraq), amongst other places. This was for two purposes: to change the demographics of the country from a Shia (indigenous) majority to a loyal naturalized Sunni majority; and to build a military and police force that was loyal to the regime (regarded as mercenaries by many locals). Those naturalized received citizenship upon arrival, government housing (which the indigenous population tend to wait decades for), and a job in the military or police. 
8/12 There’s an ongoing “joke” in Bahrain that you get beaten on the street by a Pakistani, arrested by a Yemeni, interrogated by a Syrian, tortured by a Jordanian, sentenced by an Egyptian, and the only Bahraini in the entire process is the victim.
The Alkhalifas also try to paintbrush the entire opposition with whatever they construe as being the threat-du-jour (threat of the day) for the West; Nasser-socialists, communists, Iranian, terrorists, etc. They believe by doing so, and by attempting to contain the movement within the indigenous Shia areas, they can better “justify” the oppression and crackdown to the West. 
9/12 In addition, corruption is insane in Bahrain; with rising poverty and unemployment. The ruling family has brought in hundreds of thousands of migrant workers who are treated badly and denied much of their rights (read: modern day slavery) – including access to citizenship regardless of how long they stay in the country. They’re underpaid and overworked and many live in dire conditions. 
10/12 On the other end of that are the “expats” (read: white westerners), who come to Bahrain, are overpaid for positions they’re not always qualified for, and treated better than the local population. They’re usually given high positions even when there are more qualified locals, and when in the exact same position as a local, they usually receive higher pay and more benefits. 
11/12 During the uprising in 2011, many western immigrants not only came out in support of the crackdown, but it was mired in racist and colonialist narratives. In the context of the Alkhalifas relationship with the West, it was not surprising to the indigenous population that this was their positionality in response to people wanting basic rights and freedoms. 
12/12 So when you see the reaction on the ground today, with over 30 people arrested so far since Saturday for protesting against the US and the Israeli occupation, understand the context. Bahrain is an old civilization, and quite different from the rest of the GCC in its social and political history.
This is just context - I haven't even touched upon the details of what the people of Bahrain have been subjected to in terms of repression (torture, killings, imprisonment, etc) by the Alkhalifas and their western allies.. 

Metropolol and Propanolol

 Metoprolol is a prescription beta-blocker primarily indicated for treating hypertension (high blood pressure), angina pectoris (chest pain), and acute myocardial infarction (heart attack). It is also widely used to reduce cardiovascular mortality and hospitalization risks in patients with heart failure.

The exact clinical indications heavily depend on the specific formulation of the drug.

FDA-Approved Indications
  • Hypertension:
    • Lowers systemic blood pressure.
    • Reduces the risk of fatal and non-fatal strokes or heart attacks.
    • Approved for both Metoprolol Succinate (extended-release) and Metoprolol Tartrate (immediate-release).
  • Angina Pectoris:
    • Utilized for long-term management of chronic stable chest pain.
    • Improves overall exercise tolerance.
    • Decreases the frequency of painful angina attacks.
  • Heart Failure:
    • Indicated to reduce death and hospitalization risks.
    • Specifically targets stable, symptomatic heart failure with reduced ejection fraction (HFrEF).
    • Crucial distinction: Only the extended-release form, Metoprolol Succinate (Toprol XL), is approved for heart failure management.
  • Myocardial Infarction (Heart Attack):
    • Administered to hemodynamically stable patients within hours of a suspected or definite heart attack.
    • Significantly lowers the ongoing risk of cardiovascular death and repeat cardiac events.
    • Commonly initiated as an intravenous (IV) injection (Metoprolol Tartrate) in acute care before transitioning to oral doses.

Off-Label and Secondary Indications
In clinical practice, healthcare providers frequently prescribe metoprolol off-label for several other conditions:
  • Cardiac Arrhythmias:
    • Controls heart rates in fast rhythms like atrial fibrillation or atrial flutter.
    • Manages supraventricular tachycardia (SVT) and certain ventricular arrhythmias.
  • Migraine Prophylaxis:
    • Taken daily to reduce the frequency and intensity of severe migraine headaches.
  • Hyperthyroidism Symptom Management:
    • Acts as an adjunct therapy to mask physical symptoms like a racing heart (tachycardia), tremors, and anxiety during a thyroid storm.
  • Metoprolol is used off-label to treat Essential Tremor (ET). While it can be quite effective, it is not the first-choice beta-blocker for this condition.
    The primary choice for managing ET is propranolol, which is FDA-approved specifically for tremors. Metoprolol is generally reserved as a secondary alternative.

    Why Propranolol is Preferred Over Metoprolol
    The main reason for the difference in effectiveness comes down to how these two drugs interact with receptors in the body:
    • Propranolol is non-selective: It blocks both Beta-1 receptors (in the heart) and Beta-2 receptors (in the vascular and skeletal muscles). Tremors are heavily mediated by Beta-2 receptors in peripheral skeletal muscles, which is why propranolol is so effective at calming physical shakes.
    • Metoprolol is cardio-selective: It primarily targets Beta-1 receptors in the heart to lower heart rate and blood pressure. It has a much weaker effect on the Beta-2 receptors responsible for muscle shaking.
    Clinical trials show that while propranolol can reduce tremor intensity by roughly 41% to 55%, metoprolol typically achieves a more modest 32% to 47% reduction. Furthermore, metoprolol’s tremor-blocking effects can diminish during long-term use.
    When is Metoprolol Used for Essential Tremor?
    Despite being less effective, a neurologist or physician may prescribe metoprolol for ET in specific situations:
    • Asthma or COPD: Non-selective beta-blockers like propranolol can constrict the airways and trigger severe asthma attacks. Because metoprolol targets the heart rather than the lungs, it is a much safer option for patients with respiratory diseases.
    • Co-occurring Heart Conditions: If a patient already requires medication for heart failure or post-heart attack management, metoprolol can pull double-duty by protecting the heart while offering mild relief for the tremor.
    If you would like to explore the standardized medical guidelines for tremor management, you can review the recommendations published by the American Academy of Neurology or look up clinical study summaries on PubMed