The West faces a significant dilemma; increasingly vocal extremist groups are advancing an agenda and winning the hearts and minds of many of our youth. As in most Western cultures, physicians typically transcend political rivalries. Similarly physicians often transcend factions among Islamic extremists. A physician can also travel about freely with significantly less scrutiny than the average citizen. Physicians, especially academics, are expected to present research internationally; with bona fides, ease of cross border movement is all but assured. The same is true in the US. Extremist health care workers can position themselves innocently into vulnerable, i.e. recruitable populations, as well as infiltrating the more â€˜diplomaticâ€™ and â€˜sophisticatedâ€™ arenasâ€“ raising funds, creating foundations, and interacting with the media and politicians.