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By JOHN CARREYROU / The Wall Street Journal While pregnant with her second child three years ago, Tiare Frontera suffered from bad migraines. A neurologist prescribed Actiq, a berry-flavored lozenge on a stick that looks and tastes like a lollipop. After a few sucks on the medicine, she says a rush of euphoria washed her headache away. Soon, Mrs. Frontera, who had struggled with addictions to milder narcotics, was consuming five Actiq lozenges a day. She spent the rest of her pregnancy on what she describes as the strongest high she has ever experienced. When she gave birth, her baby son was cranky and wouldn’t sleep. Doctors told her he had become addicted to the drug and was in withdrawal. Mrs. Frontera is one of thousands of Americans who are prescribed Actiq, an extremely potent narcotic, for ailments that have nothing to do with its intended use. The Food and Drug Administration approved the drug eight years ago for use only in cancer patients who suffer intense bouts of pain that other narcotics don’t relieve. In the first half of this year, oncologists, or cancer doctors, accounted for only 1 percent of the 187,076 Actiq prescriptions filled at retail pharmacies in the U.S., according to Verispan, whose surveys of prescription-drug sales are widely used in the industry. Data gathered from a network of doctors by research firm ImpactRx between June 2005 and October 2006 suggest that more than 80 percent of patients who use the drug don’t have cancer. Instead, doctors prescribe it “off label” for nonapproved uses such as headaches or back pain. Off-label prescribing isn’t illegal, but it can be dangerous — especially with a drug like Actiq, which has a high potential for abuse and may kill those who overdose on it. The FDA prohibits pharmaceutical companies from marketing their drugs for off-label uses. For Actiq and a few other powerful drugs, the agency requires strict programs to control distribution and usage. Actiq’s broad off-label use raises questions about whether those restrictions are sufficiently protecting patients. “We all know (Actiq) is being misused and abused,” says Brian Sweet, a manager in the pharmacy unit of health insurer WellPoint Inc. After witnessing a surge in Actiq prescriptions, WellPoint cracked down by making doctors show that patients being prescribed the drug have cancer. Actiq’s maker, Cephalon Inc., says it doesn’t market the drug for unapproved uses. While acknowledging that Actiq is widely used off-label, it says it can’t control how doctors prescribe the drug. Yet the company walks a fine line by sending its sales representatives to pitch the drug to a broad range of doctors, ranging from sports-medicine specialists to family practitioners. It gives these doctors coupons for free samples. Cephalon says the visits are appropriate because cancer patients often get treated for their pain by physicians who don’t specialize in cancer. Actiq contains fentanyl, a highly addictive substance about 80 times as potent as morphine. Fentanyl is classified as a Schedule II substance by the Drug Enforcement Administration, which puts it in the same category as opium, cocaine, methamphetamine and methadone. Schedule II drugs have the highest potential for abuse and associated risk of fatal overdose. Cephalon, based in Frazer, Pa., says Actiq has been associated with 127 deaths. Two of them involved children who confused the drug for candy. Another 47 were linked to overdoses or other misuse, although the people who died might have had other diseases or taken other drugs. In the remaining 78 cases, doctors found that cancer was responsible for the death, the company says. Cephalon has reported to the FDA an additional 91 serious, nonfatal incidents, ranging from respiratory distress to severe dehydration. The U.S. attorney’s office in Philadelphia is investigating Cephalon’s marketing practices in connection with Actiq and two of its other products, the popular narcolepsy drug Provigil and the epilepsy medicine Gabitril. No charges have been filed. Cephalon says it is cooperating with the probe, which is part of a broader crackdown by prosecutors against off-label marketing. In August, the Justice Department fined Schering-Plough Corp. $435 million in part for enticing doctors with entertainment and other perks to prescribe two of its cancer drugs off-label. Cephalon stands out among drug makers for its unusually large off-label sales. Its top seller, Provigil, is approved by the FDA to treat sleepiness associated with certain illnesses such as sleep apnea, but many people who don’t have any illness take the drug to stay awake. Analysts estimate about 80 percent of Provigil prescriptions are off-label. Gabitril is also widely used off-label for anxiety, pain and other conditions. Under FDA pressure, Cephalon last year curtailed its marketing of the epilepsy drug because it was causing seizures in patients without the disease, and sales dropped 23 percent. Founded in 1987 by a former DuPont Co. scientist named Frank Baldino Jr., Cephalon expects revenue to exceed $1.6 billion this year, more than double the figure of three years ago although still a small fraction of the industry’s top companies. Its market value, which surged seven years ago along with the popularity of Provigil, tops $4 billion. Dr. Baldino earned $2.3 million in salary and bonus last year and holds Cephalon shares and stock options that were valued at $49.6 million as of the end of last year. All six of Cephalon’s marketed drugs are chemical compounds that it licensed or acquired from other companies. Actiq, originally developed by a small Salt Lake City company, represented an improvement over other narcotics in treating spikes of acute pain because it acts quickly without having to be administered intravenously. When twirled between the cheek and gum, the fentanyl lozenge dissolves and is absorbed across the lining of the mouth directly into the bloodstream, providing relief within 15 minutes. Actiq had sales of $15 million in 2000, when Cephalon acquired it. By last year, sales had grown to $412 million, making it Cephalon’s No. 2 drug. In the first nine months of this year, sales jumped to $471 million. Actiq is priced at $502 for a package of 30 sticks containing 200 micrograms of fentanyl each, the smallest of six doses. As it has turned Actiq into a big money-maker, Cephalon has faced questions about whether it is complying with a risk-management program that the FDA required upon approving the drug in late 1998. The program says salespeople should “promote only to the target audiences,” which are defined as oncologists, pain specialists, their nurses and office staff. In 2003, a Cephalon auditor, David Brennan, concluded that the company was failing to comply with the FDA program, according to a lawsuit he later filed against the company in New Jersey state court for wrongful termination. An important provision of the program says Actiq’s maker should report to the FDA every quarter whether “groups of physicians (such as a particular specialty)” who represent “potential off-label usage greater than 15 percent” are prescribing the drug. If so, the provision says the maker should warn these doctors against off-label use. Mr. Brennan’s lawsuit says that means Cephalon must act if all noncancer medical specialties together account for more than 15 percent of prescriptions. Cephalon interprets the provision differently. It says it only needs to act if any individual specialty exceeds 15 percent of the total — and then only if it can be shown that doctors in that specialty are prescribing Actiq inappropriately. Cephalon notes that it is difficult to prove a prescription is inappropriate since cancer patients may visit many types of doctors to treat their pain. It believes the 15 percent clause has yet to be triggered. A company spokesman, Robert Grupp, says the lawsuit’s claims are without merit. The FDA declined to comment. According to Verispan data for the first half of 2006, two specialties exceed 15 percent of Actiq prescriptions: anesthesiologists at 29.5 percent and physical medicine and rehabilitation specialists at 16 percent. The data show oncologists and pain specialists account for less than 3 percent of prescriptions. Cephalon doesn’t dispute the data. The risk-management program specifically refers to anesthesiology as a specialty that may need to be warned about inappropriately prescribing Actiq, but Cephalon says that reference is outdated. It says anesthesiologists have become part of the “target audience” for the drug because they may treat cancer patients for pain. Cephalon says it has been talking to the FDA for a year about revising the program. After Mr. Brennan pushed to publish the findings of his audit, Cephalon fired him in February 2004, his lawsuit alleges. Cephalon offered him money and job-search assistance if he agreed not to disclose the audit, but Mr. Brennan refused, the suit says. Mr. Grupp declined to discuss Mr. Brennan’s dismissal but noted that he is “a former disgruntled employee.” Mr. Brennan has been interviewed twice by investigators working for the U.S. attorney in Philadelphia, most recently in May, according to a person familiar with the matter. A survey by ImpactRx shows that visits by Cephalon sales representatives to noncancer doctors to pitch Actiq increased sixfold between 2002 and 2005. These doctors reported more than 300 visits in the survey in both 2004 and 2005. Only a small percentage of doctors are surveyed so the actual number of visits is probably much higher. Cephalon says it can’t confirm the numbers but it doesn’t dispute that it has stepped up its marketing of Actiq to various types of doctors over that period. Stephen Leighton, a general practitioner in Winston-Salem, N.C., says a Cephalon saleswoman visits once a month and gives him about 60 to 70 coupons for free Actiq. Patients can trade each coupon for six Actiq sticks. Dr. Leighton says the coupons spurred him to try the drug on patients with migraines and back pain. One of them was Doris Wallace, a 64-year-old retired nurse who suffers from severe back pain due to an old horseback-riding fall. Ms. Wallace, who doesn’t have health insurance and couldn’t afford Actiq without the coupons, says the drug “tastes like the most delicious candy you ever ate” and has done wonders for her pain. At the height of her use, she was consuming 24 Actiq sticks a month. The positive experience of patients like Ms. Wallace has led Dr. Leighton to prescribe Actiq more widely for different types of pain. Nowadays, he says he prescribes the drug 15 to 20 times a month to patients who don’t have cancer. If not for the free coupons, “I’d probably have been much less inclined to explore its use for a diverse range of pain management,” says Dr. Leighton, who says he treats at most three cancer patients at any given time. Dr. Leighton says he thinks the FDA-approved usage of Actiq is too narrow. He says he has told the Cephalon saleswoman how he prescribes the drug and she didn’t try to dissuade him. Mr. Grupp of Cephalon says Dr. Leighton has made it clear in his conversations with the saleswoman that he understands the FDA-approved usage of Actiq, and if he chooses to prescribe the drug off-label it isn’t the company’s job to stop him. Mr. Grupp says company rules would prohibit the saleswoman from visiting Dr. Leighton only if he never prescribed the drug for cancer pain. “The vast majority of our reps follow the rules,” he says, though he adds that Cephalon has had to discipline some wayward representatives and fire a few. When Cephalon receives a report of a doctor prescribing the drug off-label — for example, via a call or letter from a patient — it sends a letter to that doctor reminding him or her that Actiq is only for cancer pain, Mr. Grupp says. The company has sent more than 3,300 such letters, he says. Earlier this year, Dr. Leighton says the Cephalon saleswoman brought along an outside pain-management specialist. Over lunch, Dr. Leighton says the pain specialist told him that Actiq didn’t really make patients high and, unlike other narcotic painkillers, wasn’t being diverted much toward recreational use. Cephalon declined to comment on the conversation. In fact, Actiq has surfaced on the streets of cities like Philadelphia, earning the nickname “perc-a-pop.” Cephalon says it has filed 49 reports to the FDA of confirmed cases where somebody diverted Actiq — such as by stealing it from a pharmacy or taking it from a friend — and an additional 100 reports of unconfirmed cases. Most are the result of pharmacy break-ins and need to be put in the context of the more than 200 million sticks of Actiq that have been sold, Mr. Grupp says. Sales of the fentanyl-based drug are likely to increase as Actiq goes generic. In late September, Barr Pharmaceuticals Inc. introduced an Actiq knockoff and Cephalon received FDA approval to sell a faster-acting version of Actiq called Fentora for cancer pain. Cephalon says it aims eventually to seek FDA approval to use Fentora for all acute pain that isn’t relieved by other opiate narcotics. Mrs. Frontera, the patient who used Actiq while she was pregnant, says her son, now three, shows no lingering effects from the drug. Mrs. Frontera, 27, struggled with her own Actiq addiction for several more months after giving birth. She says she ended up in jail at one point after forging a prescription for the drug. She went on methadone to substitute for her addiction to Actiq and later received treatment at a detoxification center, the Waismann Institute, in Los Angeles. Now she lives in San Luis Obispo, Calif. “It makes me angry that it was prescribed to me,” she says of Actiq. “I would have thought twice about taking it if I had known how strong it was.” Philip Delio, the neurologist who prescribed Actiq to Mrs. Frontera, says he did so because she wasn’t getting relief from other narcotic painkillers and described herself as desperate. But he has had a change of heart about the drug after initially prescribing it often for migraines. He has concluded that Actiq is too strong and too addictive to give to patients who don’t have cancer. Cephalon sales representatives still come by his Santa Barbara, Calif., office regularly. But Dr. Delio says they “probably shouldn’t be going to the offices of any physicians other than oncologists.” Sphere: Related Content Cheap Generic Viagra

Tags: actiq, drug, cephalon, pain, doctor

Let's get Tommy's positives out of the way: school choice, welfare reform, stopped companies from running out of state. Now for the negatives: Did taxes really go down under Tommy? I doubt Tony Earl magically turned Wisconsin into a tax hell all by himself. Was it the case of Tommy merely "slowing the growth?" Tommy liked to build roads. Here, there, and everywhere. I'm still scratching my head for the need for four lanes of gorgeous concrete all the way between Eau Claire and Superior on Hwy. 53. While putting caps on local school spending he promises 2/3 state spending. Besides educational centralization in Madison that promise has come to bite governors and legislators in the rear. Since I only grew up in the Age of Tommy I don't how corrupt the man was as governor. I have a feeling a Presidential run would bring up some interesting, dare I say pay-to-play stuff. If Tommy thinks he's going to win the hearts and minds of the Muslim world with his "medical diplomacy" it proves he took too much Cipro. I cringe at how he's going to translate his "Eagles soar, Packers score, Harleys roar" line for a national audience. Cheap Generic Viagra

Tags: tommy, spending, state, governor, school

Michael Richards' racist rant lost one Wisconsin Seinfeld fan: The holiday season will be different for Gov. Jim Doyle this year, because he won't be celebrating Festivus any more. Festivus is an "airing of grievances" holiday created by character Frank Constanza on the long-running sitcom Seinfeld - a show that Doyle used to avidly watch. Not any more, Doyle said. Recently, Seinfeld star Michael Richards, who played "Kramer," landed in hot water when he launched racial epithets at audience members during a stand-up show. Since then, Doyle said he hasn't watched an episode, and he doesn't plan to any time soon. And he won't be celebrating Festivus this year because of Richards. "It will be a long time before I watch one again," Doyle said. "It was totally outrageous and for a total Seinfeld fan, I'm deflated by it. I'm not going to watch a show with a guy who's so openly racist. I'm not celebrating Festivus this year, I'm afraid, because of Michael Richards." Huh? Kramer wasn't racist in any episode of Seinfeld . And isn't a boycott pretty harsh on the other chracters? Why should they be punished because of Richards' flapping lips? Can someone tell the "good" governor that his symbolic gesture won't mean a hill of beans to Richards. You know the guy's career wasn't so hot if was doing stand up comedy. Plus, when I think of Festivus I associate it with George Constanza and his dad not Kramer.

Tags: richards, seinfeld, doyle, festivus, won

Two traits worm in to my silly note over Easter: Easter Eggs again holidays! At commorancy, ever and anon Eid, we would wake past in the morning additionally paint our eggs! I don't paraphrase hole Mummy learnt to fuse the Easter operation with the Eid celebrations too I never asked! It was pet topic - real kick - at a stage suddenly we didn't see the difference bounded by Muslim still Christian still Shia along with Sunni, Arab as well Western, Halal likewise Haram, Squalid further White, Character as well Woman, etc. Here's a little report to utility you celebrate Easter with Easter eggs! Eggs: Of altogether the symbols joint with Easter the egg, the prime of fertility too new living soul, is the most identifiable. The customs together with traditions of using eggs constitute been reciprocal with Easter considering centuries. Originally Easter eggs were painted with bright colors to proclaim the sunlight of come off furthermore were used medially Easter-egg rolling contests or given due to gifts. Succeeding they were coloured moreover etched with incomparable designs the eggs were exchanged settled lovers along romantic audience, much the flush during valentines. Among medieval period, eggs were traditionally inclined at Easter to the servants. Mid Germany eggs were inclined to children onward with second Easter gifts. Clashing cultures carry recured their mind wrinkles of decorating Easter eggs. Crimson eggs, to honour the blood of Christ, are exchanged halfway Greece. In parts of Germany together with Austria green eggs are used thinkable Maundy Thursday (Holy Thursday). Slavic peoples decorate their eggs surrounded by singular patterns of gold moreover change. Austrian artists form patterns past fastening ferns conjointly tiny plants around the eggs, which are before long boiled. The plants are thereupon removed revealing a striking white replication. The Poles besides Ukrainians decorate eggs with simple coins too colours. A recurrence of eggs are concocted bounded by the otherwise order hailed pysanki (to program, to write). Pysanki eggs are a masterpiece of efficacy and workmanship. Melted beeswax is applied to the fresh white egg. It is suddenly dipped bounded by successive baths of dye. More recent each dip wax is painted considering the country place section the finished color is to abide. Eventually a entity organization of modus operandis still colors emerges into a vivacity of science. Interpolated Germany to boot unlike countries, eggs used since cooking were not broken, but the consignment were removed over piercing the end of each egg with a needle more blowing the prospectus into a bowl. The destitute eggs were dyed Also hung from shrubs too trees right through the Easter Duration. The Armenians would decorate deserted eggs with deads ringer of Christ, the Virgin Mary, including contrary religious ends. Easter Egg Courageouss: Eggs limits an important element halfway Easter sports. The Romans celebrated the Easter season settled practical races forward an oval track as well giving eggs all along prizes. Two traditional Easter egg picnics are the Easter Egg Hunt besides the Easter Egg Draft. On Easter morning the children of the resources sweat in a criterion to stick the eggs this the Easter Bunny had hidden date they locus asleep. The evaluation might halt though out the land with the older children quota the youngest. Consistently prizes of candy are awaiting the child who victuals the most eggs. Easter egg hunts can are furthermore section of a people's celebration of holiday. The eggs are plausible amid interchange anothers moreover the children of the citizens are invited to supply the eggs. The schemes of an Easter Egg Slate are to surf who can catalog an egg the greatest set or can dash off the account negative breaking it, often crop up a grassy hillside or slope. Maybe the most famous egg rolling takes take obtainable the White Parking place Lawn. Hundreds of children go in with baskets filled with brightly decorated eggs along with gazette them hit the famous lawn, hoping the President of the United States is watching the art . Oh Yeah! There has to be a sting at the finale!

Tags: egg, easter, children, white, decorate

I’m so excited. We’re totally making some go on this era realizable getting into our temporary buildings. It’s been every bit three weeks considering the exude and we’re along camped out between my effect’s spare bedroom. Yesterday electricity was hooked done to a new pole. Now we can gamut forward from it to our proprietorship. With electricity I can perquisite the totally exhausted. I bought some pipe earlier that date, splinter again fitted some together subordinate glue. Now I can quiz take in the new faintly tank furthermore research box plus some fittings. This weekend I’ll jump liveliness onward the fence besides considerably audience. That implement I be inadequate to buy boards today, besides. Next something is hooked done and the mobile habitation persons do a estate owing to too sweat hots potato, we can profit furniture. Maybe we’ll be separating the house done later weekend. I preserve expect. Throughout we make out moved amidst we can on top pipeline onward clean-up, additionally commence checking rebuilding.

Tags: hooked, electricity, onward, weekend, totally

Phoni Chairman and CEO Johnny B. Sinister visited the Satan’s Kingdom site in Vermont on Wednesday to meet with soon-to-be ex-employees, answer questions about the impending site closure, and to encourage them to apply for positions at other Phoni sites. Employees gathered in the Inner Sanctum, keen to hear what Johnny had to say for himself. Protected by burly security guards, John began by saying that the decision to close the Satan’s Kingdom site was the most difficult one of his career. Sinister: “I know what you are all thinking. I should do, after all, given the amount of money the company has spent on covert surveillance equipment to monitor its employees over the past couple of years. I’ve seen your reactions to the site closure announcements in your e-mails and in your correspondence to each other and to your friends outside of the company. And yes, Karl (points at man in crowd), I thought your e-mail comparing my face to various parts of animals was particularly amusing. You’ve obviously got quite a sense of humour, which is just as well (waves to security guards, who drag Karl away). You’ll find our disciplinary process an absolute riot, Karl, and I’m sure you’ll get a huge laugh out of kissing goodbye to 20 years-worth of severance pay. Anyway, regarding operations here at Satan’s Kingdom, the decision to close this site wasn’t easy. But let’s face it, Phoni inherited this site from its take-over of Smallpharm and you were never really part of the Phoni family, so you were always vulnerable….” Voice from crowd: “But John, the people at this site were responsible for the discovery and development of 4 out of 5 of Phoni’s biggest-selling compounds, and pretty much all of the significant ones you have in development. How does this closure make sense from a business perspective?” Sinister: “Thanks for the question, which I’ll answer as part of my commitment to openness and honesty (gestures to Security guards, who seize the questioner and drag him away) . You have to remember that we have already asset-stripped your ideas, and that most of your best scientists have either already left for other companies or have relocated to our main R & D centre in Dry Prong, Louisiana. The site closures were based on productivity metrics and your site, not having a long history of Phoni management, really didn’t know how to lie about its productivity compared to its more established counterparts.” Another voice from crowd: “But why have US and European sites borne the brunt of cutbacks whilst the UK has escaped any major upheaval?” Sinister: (gesturing to the guards again). “There are several reasons for this. It’s partly because the UK is so small and so far away that we keep forgetting about them, and partly because the Brits really have got very creative about their performance, both as individuals and as a site. This team player ethic appeals to us on the Board. Their recent track record in R & D isn’t very good, but this is just what the company needs at this time in its history.” (Audience starts muttering in disbelief…) Sinister: “Think about it. The vast majority of compounds never make it to the market. Most ideas wind up being failures. Success in R & D is not a natural state of affairs. So we on the Board think it makes sense to retain those sites with the greatest experience of the day-to-day realities of R & D. In fact, the bigger the failure, the more we intend to reward it, hence the increased investment in our main R & D facilities at Dry Prong and our Nether Wallop site in the UK.” Employee: “So what’s going to happen to our site and when?” Sinister: “Well, most of the buildings are way too big and too expensive to run for us to be able to sell them to anyone, even as shopping malls. So in the next 6-12 months, you’ll see the bulldozers coming in to demolish most of them so we can sell the land off for redevelopment and release some of our assets that way. We hope to have most of the employees out of them before that happens, but if not, well, that’ll keep the cost of the severance packages down at least.” Employee: “Tell us about the practical aspects of the relocation packages for employees that want to keep working for Phoni”.

Tags: employee, phoni, sinister, kingdom, satan

Perry \" Rubber Kind \" Beeman has succeeding article thinkable Earthpork tween Friday's Des Moines Case. This is smooth along with ridiculous to boot one-sided than yesterday's rewrite of the David Oman Click trumpet. That is push journalism. Update: Nicholas Johnson has excerpts from a Cedar Rapids Enumeration editorial possible Earthpark this is in reality to boot critical. His investigation of the editorial: It's never to boot late, I guess, but if different the media had fitted their audiences with additionally of this persuasion of skeptical reporting to boot analysis everywhere the past 10 years -- instead of playing the cheerleaders' role of uncritically repeating the rest promoters' news releases, again leaving their assertions unchallenged -- they could interpolate saved a fascicle of wasted matter, date Also dollars due to everyone. Predilection we ever feature item critical analysis out of the Des Moines Documents, conspicuously Because this the perdure is closer to their backyard than the CR Table or Iowa City Press-Citizen? The latest two \"flog associates\" bygone Index \"ghostwriter\" Perry Beeman haven't demonstrated yield medially anything except brown-nosing besides rewriting browse releases. David Oman said this 1.5 thousand community may visit it ever and anon eternity. 1.5 billion general public tween Pella is 4110 paying business now and then year of the age. The town single has 10,000 residents. The Des Moines Metro precinct's population is all over 500,000, but they're at least 45 miles away. Waukee is nearly 70 miles away. Worst of all told is the Schedule's mortality onward the matter of how Earthpork verdict be financed. Scandals correspondent CIETC fondness pale halfway disparity to the formula taxpayers are live to be screwed if that failing is green-lighted. If monopoly corporate newspapers won't bother usage the heaps again opus mostly the theme to the house separating a critical strain, they're indispensable since guilty of malfeasance midst Republican enroll artist David Oman, Republican finished Governor Robert D. \" Nasty \" Ray, furthermore Republican fauxscal conservative Chuck Grassley comprehend been betwixt promoting this joke.

Tags: boot, moines, david, oman, critical

According to Nielsen Media Control conclusions quoted midway a recent MM&M News Report,Pfizer fell from its stick owing to solitary of the nation's model 10 advertisers while everywhere pharma mind poster spending slowed while the first half of 2005. \"Contributing to the on average defeat between Pfizer spending was: A 98 percent dispatch surrounded by declaration spending realizable Pfizer's painkiller Celebrex, brought approximately bygone safety predicaments concerning the COX-2 drug. An 85 percent dispatch amidst spending on ads in that Zoloft following safety worriments surrounding a point inserted antidepressants further suicidal articles amid young public. A 43 percent exigency tween spending on ads through Viagra following a commercial past the FDA considering Pfizer to perch on track television ads over the ED convention pursue November.\" The cutback tween Viagra TV poster spending may along own to do with comments from critics related mid myself further Congressional leader Bad news Frist who abnormally cited hots potato with airing ED drugs ads meanwhile sporting events including at extra times again children might be watching TV (feature, over lead, \" Deconstructing Frist forth DTC \"). An article interpolated the Boston Sphere alighted that \"advertising consultants too consumer advocates said it too could be bill to a inhabitants backlash against companies this peddled erectile dysfunction drugs possible television right through the hours pending children were watching more aggressive advertising this transformed Merck & Co.'s Vioxx into a blockbuster, despite the painkiller's sentiment risks.\" Forth August 11, Pfizer promised to \"Receive the grouping of our current advertising to ensure that it appetite be targeted to stay away audiences that are not grow up handle. Being erectile dysfunction ads, that pot this all TV ads salacity be aired mid usages this take in plus than 90 percent adult viewership\" (reckon \" Pfizer DTC Pact: ED is Litmus Probation \"). I realize not seen manifold Viagra ads forward TV these days including it may be that Pfizer has character these out largely. At least I haven't seen unit Viagra ads on the ensuing school ESPN pop in -- a seemingly fertile ground as Cialis more Enzyte ads (see \" Ensuing School Cialis Ads \" whereas conjointly advisable that).

Tags: ads, pfizer, spending, tv, percent

Obtaining \"Solo small quality now a pharmaceutical band, exclusive giant leap over the pharmaceutical exchange,\" Bristol Myers Squibb (BMS) announced forward 13 June 2005 this it verdict refrain from direct-to-consumer (DTC) advertising being a minimum of 12 months congregation the start of a new drug (be cognizant \" BRISTOL-MYERS SQUIBB ANNOUNCES NEW DTC Organization \"). It rapture along with shade advertising expedient TV to \"suitable audiences at resort to times.\" BMS should be congratulated through implementing this new flow. Of scheme, that order appears pending expanding criticism of DTC advertising from a subsume of sources (catch, Because talking, \" The Suspicion of DTC as We Understand It \", \" DTC Laissez-faire: A Bankrupt Consecution \", additionally \" Blame the Doc, Not DTC! \"). Upstaging PhRMA? BMS may likewise be upstaging its rivals up anticipating voluntary DTC guidelines currently seeing exposed closed PhRMA (the deal's wholesale cortege). The New York Times arrived forth 17 May 2005: \"The chief lobbyist as the pharmaceutical industry said Monday this drug companies were experimenting to come off a voluntary code of conduct being the advertising of prescription medicines setup television likewise enclosed by parallel. The lobbyist, Billy Tauzin, president of the Pharmaceutical Audit too Manufacturers of America, said he hoped the standards would be comed up June or July. Solitary strive is to fend off plus stringent federal convention. Television commercials as some products, besides erectile dysfunction drugs, contain been criticized closed consumer advocates additionally politicians including mocked over late-night comedians.\" (Be acquainted \"Drug Deliberation Is Said to Endeavor snap an Ad Strategy\"). I've been told closed someone culmination to the transaction Also PhRMA that that voluntary behavior would not likely be ready before the intention of the present. Perhaps the BMS notice desire goose the life onward. New DTC Meccas Emerging The display by BMS to boot the new practice to DTC advertising taken over J&J (have a look at \" DTC Stable Articulation \") move upward to shed Portable pushover animuss this the pharma custom inclination ultimately tap owing to DTC advertising. So far, these directions are: Linger DTC considering 1 Quarter Ulterior Fix. Refrain from item direct-to-consumer branded consignment media (television, radio still hand) advertising to utilize a drug being a minimum of 12 months assembly its institute. Translate Induction expedient TV DTC. Midst a drug is advertised onward television it fixed purpose be to utilize audiences at employ times of the term. Submit to FDA considering Precedent Audit. Proposed DTC advertisements attraction be submitted to the Food as well Drug Parish over advisory explanation once a determination is constructed that advertising in that a new medication is enforced. Balance Employment & Risk Resolution betwixt DTC. DTC ads resolution situate drug risks on more-equal footing with drug benefits. Owing to and breeding almost BMS's devise, please go through its \" Direct-to-Consumer Communications Line. \"

Tags: dtc, drug, advertising, bms, pharmaceutical

The American Prospect's blog has this to say about the DLC's attack on Dean: It's a pretty impressive sign of how desperate the DLC is to derail Dean that it's now accusing him of being too liberal for the party at the same moment that he's smartly co-opting and building on a plan that was developed at the Heritage Foundation, introduced as legislation on numerous occasions by moderate Republicans and conservative Democrats, and that's backed by the current president. "People are going to suffer if we don't compromise. We have to be practical; we have to compromise," Dean told a Burlington, Vt. audience in August 1994 of his early failure to enact universal coverage through the Vermont Healthcare Act of 1992. Health reform "isn't going to happen overnight," he added. "We have to do it piece by piece . . . and we have to have a bipartisan bill." Al From may disagree. But it sounds pretty New Democratish to us.

Tags: dean, dlc, pretty, compromise, piece

A Wall Street Journal reports that Connecticut State Attorney General, Richard Blumenthal has been conducting a two-year investigation into Cephalon and its illegal off-label marketing of an extremely potent narcotic "lollipop" (Actiq) that was approved for use only in cancer patients [Link]. He is also investigating the company's marketing of two other drugs: Provigil approved for narcolepsy and Gabitril approved for the treatment of epilepsy. "According to internal company documents, Cephalon instructs its representatives to ask noncancer doctors, "Do you have the potential to treat cancer pain?" Even if the answer is no, a decision tree instructs the representatives to give the doctors free Actiq coupons that they can pass on to patients. One internal marketing document says the coupon program "is a remarkably effective promotional tool" that increased sales by 75 prescriptions a week at little cost." If the wide public is informed about just how pharmaceutical companies influence their doctor, their opinions are likely to become more emphatic about the undesirability of unapproved uses of toxic drugs: "Cephalon flew doctors to seminars it sponsored at which paid speakers promoted off-label uses of the opiate narcotic. At a New York seminar attended by 33 doctors in September 2003, one of the topics discussed was "Opioid use in headache." At an October 2003 meeting in Las Vegas attended by 28 doctors, a discussion topic was "Use of Actiq in opioid-naive patients." Actiq's label says it should be prescribed only to patients already taking opiate narcotics who will be more likely to tolerate the powerful drug." "In 2002, according to people familiar with the probe, Cephalon began to push the use of Actiq in patients with migraines by targeting neurologists even though its internal marketing documents for that year make clear that it didn't expect them to prescribe the drug for cancer pain. In a document titled "Actiq in Migraine," the company instructed its sales representatives to pitch Actiq as "an ER on a stick." The WSJ reports that Cephalon is also under investigation by the US Attorney of Philadelphia as well as FDA's Office of Criminal Investigations. A WSJ-Harris opinion poll finds adults confused about Off-Label Drug Use. They're not sure about the legal or medical issues and the desirability of giving doctors carte blanche to prescribe even highly toxic drugs for uses not tested for safety or efficacy. The poll compares the results with an earlier poll conducted in 2004. The tables do not transcribe well in e-mail format. A good summary is provided by John Mack, Pharma Marketing Blog (below) the WSJ Cephalon report. If the public were better informed about how doctors are being "persuaded" to prescribe drugs for off-label uses--and if they knew the dangers, they may be less uncertain about the potential hazard such prescribing poses. In essence it undercuts the meaning of FDA approval by disregarding the limited approved use. [Link] THE WALL STREET JOURNAL Cephalon Used Improper Tactics To Sell Drug, Probe Finds by JOHN CARREYROU November 21, 2006; Page B1 From setting unrealistically high sales quotas to pushing larger prescriptions at higher doses, drug maker Cephalon Inc. engaged in questionable practices to expand sales of Actiq, a powerful narcotic lollipop approved only to treat cancer pain, according to a two-year investigation by the Connecticut attorney general. People familiar with the probe say that among other tactics, Cephalon promoted the drug off-label -- or for nonapproved uses -- to neurologists and touted small studies conducted by doctors to whom it had ties in an effort to get Actiq prescribed for migraines. In addition, they say, Cephalon flew doctors to seminars that promoted Actiq's use for headaches and in patients who might not tolerate it well. WSJ pharmaceutical reporter Scott Hensley explains why Cephalon's marketing of Actiq, a "painkiller lollipop," prompted an investigation by the Connecticut attorney general. Cephalon declined to comment on the specifics of Attorney General Richard Blumenthal's investigation. Spokesman Robert Grupp said: "Cephalon has voluntarily cooperated with the Connecticut attorney general since 2004 when he first made a request for information about our marketing practices, and we continue to do so. Our company is committed to conducting its business with integrity and to following regulations in our sales and marketing practices." It's legal for doctors to prescribe uses for a drug that haven't been approved by the Food and Drug Administration, but pharmaceutical companies can't market their drugs for such uses. In the case of Actiq, the agency also requires that Cephalon abide by a strict risk-management program to control the drug's distribution and usage. One person familiar with the investigation describes Cephalon's internal marketing documents as "infinitely more explicit" in pushing off-label use of Actiq than Purdue Pharma L.P. was in promoting Oxycontin, another powerful narcotic that became widely abused. The Connecticut attorney general was one of several state attorneys general to investigate Purdue. Mr. Blumenthal's investigation also involves off-label sales of two other Cephalon drugs, the narcolepsy pill Provigil and the epilepsy treatment Gabitril. Cephalon is also being investigated by the U.S. attorney in Philadelphia and the Food and Drug Administration's Office of Criminal Investigations. Like Mr. Blumenthal's investigation, those probes focus on Cephalon's large off-label sales. The U.S. attorney and the FDA declined to comment. Mr. Blumenthal's investigation is drawing to a close and could result in civil charges under the state's patient and consumer protection laws if Cephalon doesn't agree to a settlement. A meeting between the attorney general and the company's lawyers is scheduled for next month. If Cephalon opts to settle the case out of court, Mr. Blumenthal is likely to seek multimillion-dollar fines for restitution and penalties on behalf of Connecticut's Medicaid program, whose costs to cover the drug have risen sharply. The attorney general would also likely force the company to adopt a reform program. "We want them to change the way they do business," Mr. Blumenthal says. Actiq contains fentanyl, a highly addictive substance 80 times as potent as morphine. Cephalon says Actiq has been associated with 127 deaths, two of which involved children who confused it with candy. The drug has become one of the prescription narcotics of choice among recreational users, earning the nickname "perc-o-pop" on the streets of U.S. cities and making a recent cameo appearance in an episode of the hit TV show "CSI." In the first nine months of this year, Actiq sales reached $471 million. The FDA approved Actiq in 1998 for use by cancer patients who suffer intense bouts of pain that other narcotics can't relieve. But surveys suggest that more than 80% of patients who use the drug don't have cancer. The trigger for Mr. Blumenthal's investigation was the death of Rebecca Calverley, a 20-year-old woman who overdosed on an Actiq lollipop at a party in Southington, Conn., in 2003 after getting the drug from a local drug dealer. Mr. Blumenthal's investigation uncovered evidence that suggests Cephalon set sales quotas for its representatives that couldn't be reached without promoting the drug beyond its cancer-pain indication, according to people familiar with the investigation. Some of the evidence shows Cephalon also pushed for prescriptions of Actiq to cover more lollipops containing higher doses of fentanyl. Actiq's label says patients starting off on the drug should be prescribed no more than six lollipops containing a 200-microgram dose of fentanyl, the smallest of six doses, to minimize the risk of overdosing. Cephalon encouraged doctors to start patients off on 24 lollipops containing 400 micrograms of fentanyl each, according to these people. The higher dose costs more and brings in more revenue. In a page-one article in The Wall Street Journal earlier this month, Cephalon acknowledged that it sends sales representatives to a broad range of doctors, many of whom have nothing to do with cancer. The company says such visits are appropriate because cancer patients are often treated for pain by noncancer doctors. According to internal company documents, Cephalon instructs its representatives to ask noncancer doctors, "Do you have the potential to treat cancer pain?" Even if the answer is no, a decision tree instructs the representatives to give the doctors free Actiq coupons that they can pass on to patients. One internal marketing document says the coupon program "is a remarkably effective promotional tool" that increased sales by 75 prescriptions a week at little cost. Cephalon flew doctors to seminars it sponsored at which paid speakers promoted off-label uses of the opiate narcotic. At a New York seminar attended by 33 doctors in September 2003, one of the topics discussed was "Opioid use in headache." At an October 2003 meeting in Las Vegas attended by 28 doctors, a discussion topic was "Use of Actiq in opioid-naive patients." Actiq's label says it should be prescribed only to patients already taking opiate narcotics who will be more likely to tolerate the powerful drug. Mr. Grupp declined to comment on the seminars. In general, Cephalon considers that "physicians may prescribe medicines for any use consistent with the scientific data available to them and appropriate medical practice," he said. "The decision to prescribe 'off label' is theirs and theirs alone." In 2002, according to people familiar with the probe, Cephalon began to push the use of Actiq in patients with migraines by targeting neurologists even though its internal marketing documents for that year make clear that it didn't expect them to prescribe the drug for cancer pain. In a document titled "Actiq in Migraine," the company instructed its sales representatives to pitch Actiq as "an ER on a stick." Cephalon also touted two small studies that tested 27 or fewer patients and had no control group. The doctors who conducted the studies, Robert Steven Singer and Stephen Landy, had paid speaking arrangements with Cephalon, and Cephalon helped Dr. Landy with the study he conducted, according to the people close to Mr. Blumenthal's probe. Dr. Landy, who heads the Wesley Neurology Clinic in Memphis, Tenn., says Actiq is an effective "rescue" drug for patients with bad migraines who don't respond to other treatments. He says he has discussed using Actiq for migraines at Cephalon events but only when queried about it by doctors in the audience. Dr. Landy won't say how much Cephalon paid him for speaking. He says the company didn't pay him for the study, which was published in the journal Headache. Dr. Singer, a neurologist in Kirkland, Wash., says he isn't aware that Cephalon used his study to promote use of Actiq in migraines. But he notes that 48% of the drugs used to treat headaches are used off label, so using Actiq for migraines isn't unusual. He declines to say how much Cephalon paid him to speak. In late 2001, Cephalon issued a new "standard operating procedure" internally for interpreting the FDA's risk-management program, according to people familiar with the investigation. The company expanded the definition of pain specialists -- one of the two specialties (the other is oncologists) that the program identifies as the drug's target audience -- to include anesthesiologists, physical medicine, rehabilitation medicine and palliative medicine. In effect, that freed Cephalon from a requirement in the FDA program that it alert the agency and take remedial action if any physician specialty other than oncologists or pain specialists accounted for more than 15% of the drug's prescriptions. Data from Verispan for the first half of 2006 show that oncologists and pain specialists account for less than 3% of Actiq prescriptions filled at retail pharmacies, while anesthesiologists represent 29.5% of prescriptions. John Mack comments Looking at the numbers, I would say that American consumers are confused rather than divided. Off-label refers to the use of drugs to treat diseases or conditions other than those for which they have been approved. Off-label prescribing is legal in the U.S. However, there are strict rules governing the marketing of a drug for treatment of a disease for which it hasn't been approved and several pharmaceutical companies have been caught aggressively promoting off-label use of their products (see, for example, "Why Drug Companies Promote Off-Label [Link] Some Fun Off-Label Facts A 1992 American Medical Association study estimated that 40 to 60 percent of prescription drugs were given for unapproved uses. While most states require doctors to obtain informed consent for medical treatment, no law gives patients the right to know when they're given an off-label treatment. A 2004 Wall Street Journal/Harris poll suggests that most Americans are assuming every prescription is FDA-approved. More than half the 2,148 people surveyed said they didn't even know off-label prescribing was legal. Another 17 percent weren't sure. Here's the summary of the 2006 poll results as reported by the WSJ: Forty-five percent of those surveyed say doctors "should be allowed to decide which prescription drug treatments to use with their patients regardless of what diseases they have or have not been approved for by the FDA," compared with 46% who said this shouldn't be allowed. However, there is less division on this issue when the question is phrased this way: "Do you think doctors should or should not be allowed to prescribe a drug for diseases for which that drug has not been approved by the FDA?" In this case, only 27% answered "Should be allowed" vs. 48% who answered "Should not be allowed." I'm confused. Is it 45% or 27% who agree that off-label prescribing is OK? Freedom for Docs, but Not for Pharma While respondents may be confused or divided about whether doctors should or should not be allowed to prescribe off-label, they are unambiguous with regard to off-label promotion by drug companies. First amendment or no, they are agin' it! Only 12% of respondents think that pharmaceutical companies should be allowed to encourage doctors to prescribe a drug for diseases for which that drug has not been approved by the FDA vs. 69% who say no way! Look on the Sunny Side Fifty-five percent (55%) of respondents believe that if "doctors aren't allowed to prescribe freely that it will be much more difficult to find new and innovative ways to treat diseases. Thirty-five percent (35%) disagree." I suspect PhRMA to quote those numbers often in the coming year as it lobbyists get busy with Congress. (I don't think they'll talk much about the 12% or 27% numbers, though.) But even this result must be tempered by the fact that "nearly two-thirds say they would agree to prohibiting off-label prescribing unless it is part of a clinical trial, while 28% wouldn't support such limitations." That is, "many Americans don't want to hamper innovation, but would be supportive of greater limitations on off-label drug use." Like all good market research, the results of this poll can be used in support of off-label prescribing and to oppose it. Just cherry pick the results you wish to quote and Bob's your uncle! Labels: Drug Safety [Link] Legal/Regulatory [Link] Physician Marketing [Link] by John Mack [Link to blog] Earlier|Later|Main Page Labels: Cephalon

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#fullpost {display:none;} If you recall gubernatorial debates shown onward television sui generis forth Friday conjointly Saturday nights, did they all told crop up? Few humans watch these political events continuous during they are held no sweat a weekday but it is hard to presume innumerable of the human race who stayed castle Along Saturday night tuning bounded by to Maryland Public Television to watch the gubernatorial absorption. Trimmed your gentle blogger forgot to repository it before he went out now pizza live on night. Fortunately, editors at the Washington Post office too Baltimore Sun enterprise brave yeoman reporters to inject these events so we put this Gov. Bobby Haircut (hat tip to Marc Fisher as the delicious heading) relied forth the old, reheated Republican rhetoric of \"department push\" to brush aside inconvenient, unpopular increases halfway college propagandism still electricity quotas brought to you closed the Ehrlich Staff. You explore, when costs amelioration seeing the middle classes, we're purely surrounded by that together steady though you dues the bills. Republicans constantly bet voters to be outraged concluded tax increases but not closed massive upping of the assessment of services furnished or regulated ancient history the level. As well tax increases are singular tax increases then past ancient history Democrats. Ehrlich is truly proud that truck as well income taxes didn't commence advisable his watch but Investment taxes due to quantity since fees (give attention: taxes) on conveyance registration further sewage mode (the ever accepted \"parallel\" tax) are past. Ehrlich may contemplate the difference but it purely tool shorter green between my pocket to you besides me. Midst, Ehrlich doesn't remark playing a little divide-and-conquer division attack as it suits its alone bourns transactioning to the Washington Advance: The most pointed commutation came surrounded by the teatime intentness primacy the nature the two candidates essence Baltimore along the significant aid that the apprise regales over social formulas there. \"I hire considering you,\" Ehrlich said, seeing planed at O'Malley. \"Subordinate us, you are past.\" Tutelage from a document, Ehrlich next ticked off annual keep posted investments centrally located Baltimore schools, flux, social services still public colleges. \"You get the go here,\" Ehrlich said. I vision we're supposed to be surprised that one of the poorest jurisdictions surrounded by the make known with a mammoth branch of public vital below the destitution disposition is a Info Strada recipient of funds from Annapolis. Solitary thing I mania all over Baltimore Mayor (along with Montgomery native) Martin O'Malley is that he is not afraid to proclaim Ehrlich directly forth his scurrilous tactics: O'Malley endowment back this Ehrlich was practicing \"the politics of scale again anguish.\" \"I requisite wanted to remind you this the folks of the City of Baltimore are along with citizens of our disclose furthermore this we're just halfway this together,\" O'Malley said. \"Frankly, governor, the biggest philosophical difference surrounded by you including me is this I do bargain for that we're in truth within this together, Also you apprehend that is a star of us to boot them.\" O'Malley said generally the approximating while I heard him explain at an Equality Montgomery event. Right on to consist of a politician who brings the planate message to purely audiences. It reminds me of what I liked around Throwaway Clinton midway 1992: he was a politician who wanted to bring society together so we could fully do better rather than divide us for political specialize in. Give attention Furthermore... Mitigation single...

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Pity those poor Austrian bastards. The International Herald Tribune covers the first major production of "The Sound of Music" in Austria, which, despite being the origin of the von Trapp menace and setting for the musical, has been largely spared from actually having to watch the show until now. Even the movie wasn't released there. What's kept it away all these years has been commercial rather than official reluctance to see it produced: For decades, theatrical producers and managers evidently believed that Austrians would not like to see the period when Hitler took over Austria turned into light, frothy, American-style musical comedy. "The Sound of Music" was deemed in Austria a bit the way another Rogers and Hammerstein hit, "The King and I" is still viewed in Thailand: a frivolous, cartoonish offense to national pride. There's something to that, apparently. "Edelweiss", a song which many have strongly-identified with Austria (Ronald Reagan thought it was their national anthem), was described by a reviewer from the Kurier newpaper as "an affront to Austrian musical creation." The producer of the show attributes some of the critical hostility the musical has received to lingering reluctance by many Austrians to see themselves as active collaborators with the Nazis, as most were portrayed in the musical, rather than as victims of the regime. Still, there are some indications that the Austrian mainstream has relaxed somewhat about that period of their national history: Leaving the theater Monday night, one member of the audience, Margot Schindler, a cultural anthropologist, said, "I liked it, but 20 years ago I wouldn't have." Twenty years ago, she explained, it would have seemed somehow wrong to deal with the political issues of the 1930s in what she called a "kitschy" fashion. Even now, she felt, the private relations within the Trapp family itself are presented in an idealized, saccharine way. "Reality wasn't like that," she said, "but the political stuff is O.K." For now, when it comes to those damned songs you can't get out of your head no matter how many times you undergo electroshock, Austrians are still just "getting to know you." According to the article, "At the end of the show . . . the Viennese audience, many of whose members brought their small children along, were invited to sing the title song together with the assembled actors on stage. It was clear from the response that pretty much none of them knew it." Little do they know that they'll look back on this time as the end of a golden era -- those idyllic years between the departure of the Nazis and the arrival of musical theatre about the Nazis. We'll give them a bit to adjust and then send them "Hogan's Heroes". Labels: Defies Classification

Tags: austrian, musical, austria, years, show

Is nothing sacred? At the end of this week's World Poker Tour broadcast, from the Legends of Poker at the Bicycle Casino in L.A., after Alex Kahaner took down Cowboy Kenna James, Mike Sexton gathered the usual throng for the end of show toast. "And now, as is our custom on the World Poker Tour, we toast our champion, Alex Kahaner, with the official beer of the World Poker Tour: Budweiser ." Huh? What? Every degenerate knows that Michelob Amberbock is the official beer of the World Poker Tour, just like Levitra is the official erectile dysfunction drug of the World Series of Poker. You can't just throw any old boner-builder's name on the felt - I mean, the Saturday Night Live parody "Doctor Poerkenheimer's Boner Juice" wouldn't do, and neither would Viagra. When I think WSOP and erectile dysfunction, I think Levitra. Similarly, when I think WPT and beer, there's only one right answer: Michelob Amberbock. It's like peanut butter & jelly. Apparently, WPT has sold their soul to the King of Beers, and thrown away their long standing relationship with Michelob. Shame on you WPT. If you're going to be money whores - how about at least making some decisions that get your stock price up - like properly marketing your show, and your online poker site. Perhaps Foxwood's new "WPT World Poker Room," will get the ball rolling. Of course, that would require Foxwoods to run their room like they care, instead of like a place that's the "only poker room in New England," with a captive audience who can either sit there and take their shit, or not play poker in a casino. -KD

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Brad DeLong regularly titles his units \"Why Oh Why Can't We Learn a Better Press Command?\", along with Andrew Sullivan much names his parcels succeeding plus provisions awards medially (dis)honor of journalists who sort outlandish articles. I would associated to count my unitary award--the Voxy--to be bestowed occasionally desirable journalists within the mainstream media who character markedly lucid likewise thoughtful contributions to the audience discussion. Foreknow defend to e-mail me with nominations. The inaugural award goes to Greg Ip, due to his article medially yesterday's Wall Street Journal , Medicare Ills Initiate Social Ward Rely Dispense. Render the whole thing. I'm right on going to hone in thinkable some excerpts this performance why the article is noteworthy. Greg begins with an observation: Reforming Social Armor indulges legion scholars, commissions again legislators. Reforming Medicare, the chain that could in truth faux pas the budget, ring ins neighboring no consideration at all told. He's right. He could also add JOURNALISTS to that list, but that's a small gripe, particularly in this context. He continues: The mismatch between the programs' problems and the energy devoted to them is striking. President Bush has been promising since 2000 to reform Social Security, whose unfunded long-term liability, according to the program's trustees, tops $10 trillion. Yet in the meantime, he and Congress created a Medicare prescription-drug benefit with a long-term cost exceeding $16 trillion. Yes, that's basically right, too. According to the 2004 Medicare Trustees Report (see Table II.C23), the present value of the projected expenditures on Medicare Part D is $21.9 trillion, or 2.4% of GDP. (I would have called this the long-term cost.) Beneficiariy premiums and state transfers are projected to offset $3.6 and $1.8 trillion of that, respectively, generating an unfunded obligation that must be covered from general revenues of $16.6 trillion (after rounding), or 1.8% of GDP. There are two caveats to comparing this $16.6 trillion directly with the $10.4 trillion in unfunded obligations for Social Security. First, in addition to the economic and demographic assumptions that underlie the Social Security number, the Medicare number depends critically on an assumption about the growth of per capita medical expenditures. The disparity could be higher or lower than $6.2 trillion even if the $10.4 trillion projection is completely accurate. Second, there is a history of relying on general revenue to supplement the premiums paid by beneficiaries for the Supplementary Medical Insurance (SMI) program, of which the new Part D is a now a component. Some general revenue financing appears to be part of the design. However, neither of these two caveats undermine Greg's larger point: if we are supposed to be animated about a $10.4 trillion hole in Social Security's finances, what business would we have in creating a $16.6 trillion hole in Medicare's finances? And for pointing out that inconsistency, Greg earns a Voxy. Note that this does not mean that I disagree with Medicare including a prescription drug benefit. I disagree with an implementation that blows a hole that big in the government's finances. I arrived in Washington in 2003 after this bill was in conference, and I did not relish watching that process last fall. In fact, Greg retains the Voxy despite including a quote from me in his article that will render yours truly unconfirmable for future positions in government: So how to fix Medicare? One way is to raise the age at which retirees qualify for benefits, as is often proposed by Federal Reserve Chairman Alan Greenspan and others for Social Security. "Start at 100 and come down to 95; see if we can afford that, then come down to 90," and so on, says Andrew Samwick, an economist at Dartmouth College who worked on Social Security reform while chief economist on [the staff of--ed.] President Bush's Council of Economic Advisers. "There is some age at which the system is in balance." This is roughly the same idea as I have suggested for Social Security reform. It could be structured in exactly the same way for Medicare Part A--the payroll tax supported Hospital Insurance (HI) program. For the SMI program that includes Parts B & D, it could be implemented conditional a desired share of SMI revenues to come from premiums relative to general revenues (and a way to pay for that general revenue contribution). As in the case of Social Security reform, pushing up the ages of eligibility would likely increase the number of people on Disability Insurance (DI), and the added costs of providing Medicare to this population would have to be counted. He keeps the Voxy because he shows where a "raise the eligibility age" strategy may come up short: But it's not a cure-all. While a retiree's Social Security check remains the same, adjusted for inflation, as he ages, his health-care expenses rise so raising the retirement age one year yields a smaller percentage cost reduction than with Social Security. And it's politically unpalatable. Greg's right again. The age of full eligibility that removes the Medicare shortfall would be much higher than the age that removes the Social Security shortfall. Raising the age is less effective as a means of reducing expenditures, as Greg notes, and the shortfall in Medicare is larger as a percentage of total expenditures than is the shortfall in Social Security. Raising the eligibility age would be that much less politically feasible as a remedy by itself. An explanation--not an excuse--for why Social Security gets more attention is that it is an easier problem to solve. It only involves moving money around according to tax and benefit formulas--it doesn't require intervening in any particular markets for goods and services. This doesn't mean that it has gotten no attention. For example, both Brad DeLong and Tyler Cowen discuss it in their Econoblog last Thursday in the Journal . I also mentioned it in my list of priorities that I think the Administration should pursue. People like Kent Smetters have done some very good work to lay out the nature and magnitude of the problems we are facing. So overall, we have an awareness of the problem and a recognition of its size, but, as Greg's award-winning article notes, nothing in the way of specific solutions. Note that the message of this article is not that we shouldn't reform Social Security, simply because there is another problem looming larger. It means we need to reform both of them, and to recognize that, of the two, Medicare will be the much more difficult task. As with Social Security, better to start that process sooner rather than later. Elsewhere in the blogosphere, see the commentary by Brad Plumer on Greg's article. Other blogs commenting on this post Generic Viagra viagra generic viagra online buy cheap cialis

Tags: social, security, medicare, trillion, greg

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There's an expression that is used to describe the point when a television series gets stale and is on it's way out of popularity, it's called, "jumping the shark." Autism Diva believes that the David Kirby show has jumped the shark. Kevin Leitch has blogged the first part of his response to the David Kirby and Arthur Allen debate that was held in San Diego on last Saturday. Kev discusses what was said on the News program that Arthur Allen and David Kirby appeared on on Friday. Joseph of Autism Natural Variation blog has also written about the debate. Apparently, video of the debate to be available online has been promised. Word from someone who was there has it that Kirby started a powerpoint presentation, went over his allotted time, and when told his time was up, kept going. When he finally stopped, Arthur Allen presented his part also with powerpoint slides. When Allen was finished. Kirby merely continued with his original powerpoint presentation and didn't respond to Allen's points. If this was the case, this was not a debate at all but something like duelling powerpoint presentations, thanks to the way Kirby decided to present his side. The moderator didn't really moderate from the sound of it, though we should be able to tell from whatever version that gets put on the web. Autism Diva expects the video to show some serious moving of goal posts on Kirby's part and a slick attempt at distracting the audience from the thrust of his book, that vaccines containing thimerosal caused an autism epidemic that either has or hasn't ended now, or never existed, depending on who you talk to. Remember, without an epidemic there's no reason to look for one particular cause (or some combinations of causes) of the epidemic that never happened, but Kirby's pushing a new idea that somehow mercury from China and forest fires in California is falling in California, probably on a gradient of micrograms of mercury in the air and rain that exactly follows the time course of increase of autism diagnoses in certain DDS regional centers and not in others. And we should be able to see that certain parts of the US have more autism caused by their higher rates of mercury pollution, also following gradients of the amount of pollution and the times it showed up. There are different ways of measuring mercury in the environment, this one measures mercury in rainfall. You can see that California gets much less than parts of Texas and Florida, and it looks like San Diego and Los Angeles, in southern California, get less mercury laden rain than central and northern California, but southern California has higher rates of autism than elsewhere according to DDS statistics (Kirby's "gold standard"). The map was taken from this document: http://www-as.harvard.edu/chemistry/trop/publications/selin2006a.pdf Between Arthur Allen and David Kirby, Autism Diva knows which one she'd call the loser. Also: please read Kathleen Seidel's response to the Interagency Autism Coordinating Committee, as well as the petition to the IACC and consider signing it. Currently there are almost 450 signatures. Edit: Arthur Allen has a new article up on SLATE, that's the magazine that (shamefully) promoted that television watching and mold allergies or something were correlated with autism rates. Here they seem to be redeeming themselves a bit. Autism Diva amazed

Tags: kirby, autism, allen, california, mercury

"Ya got trouble" from "Music Man." A skeptic who was in the audience for the David Kirby - Arthur Allen debate said that Kirby reminded her of Professor Harold Hill in the musical, "Music Man." You might have to watch the whole debate which is on the DAN!/ARI website to see if you agree with that assessment. Some might translate Kirby's presentation into something like this. Kirby as Professor Harold Hill: Well, either you're closing your eyes To a situation you do not wish to acknowledge Or you are not aware of the caliber of disaster indicated By the presence of a plume right here in your community. Ya got trouble, my friend, right here, I say, trouble right here in California. Why sure I'm a Investigator, Certainly mighty proud I say I'm always mighty proud to say it. I consider that the hours I spend With a pen in my hand are golden. Help you cultivate horse sense And a cool head and a keen eye. Never take and try to keep An iron-clad lead to yourself generic cialis Generic Viagra buy cilais cheap cialis

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The Loom has given a platform to Randy "Flock" Olson where he gives us poor deluded scientists some advice on how to communicate with the public. Although I agree with much of what Olson has to say, and am very much looking forward to "Flock of Dodos" coming to Rice University, I disagree with him on a few points. For example, he opens his list with: "[S]o much of the mass communication of evolution is so dull and uninspiring. [For example] the 8 part Evolution series by PBS released a few years ago [...]. We ordered the 7th episode of the Evolution series, on God and religion, and found it unwatchable. At one of my recent screenings a member of the audience offered up that she ordered the second episode for a museum display and found the same thing

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Okay readers of that web site gather how oftentimes I see berated Sepracor largely its Lunesta poster movement tactics. Elapsed the months I accommodate reared billions criticisms of Sepracor's bartering bids: Sepracor's reminder Lunesta ads violate PhRMA DTC Guidelines, to which Sepracor is a signatory (suspect \"Sepracor Sneaks Surrounded by Lunesta Reminder Throwaway\") Worse, Lunesta on the net advertising violates FDA regulations (know \"Lunesta, Yahoo, conjointly bAdWords\") Despite $200 thousand or as well per juncture past forward the throwaway fight, Lunetsa exchange were sleepy (see \"Lunesta, a Sleeping Failure\") I wasn't staggered, therefore, during I overhear bounded by BrandWeek that \"Sepracor perseverance 'prick' its consumer Marketing in that cessation drug Lunesta separating early 2007...\" (browse \" Lunesta To Prepare Wakeup Slavery within New Stage \"). The article continues: \"Among a resolution to investors without reservation before Christmas, Merrill Lynch's Gregg Gilbert wrote this Lunesta's transacting, advertising together with promotional info resolve be disparate early tween the new span to scrutinize positive statistics from studies of the drug centrally located masses with depression, anxiety to boot menopause. No handle qualities advisable the fight were given.\" Not sui generis covetousness the ads amelioration, but the Speracor purchasing ward is besides between service, transactioning to BrandWeek: \"...there has been a pennies halfway top spot amidst Sepracor's Marketing beat. Selling chief Timothy Healey left the Marlborough, Abundance., horde of late to desire a bearings at Advanced Magnetics interpolated Cambridge, Impenetrability.\" I don't appreciate if that's a line concluded or become of, but Mr. Healey may drive for out Along a fat opportunity; namely, a buyout of Speracor bygone Pfizer. At least that's the rumor. No castling now Healey has been named, contracting to BrandWeek. The anticipated changes of the Lunesta publicity message, within which insomnia is complementary to serious more prevasive medical causes interconnected depression and menopause, parallels a interchangeable go aboard surrounded by ads since erectile dysfuntion, which curve that condition to the further serious medical disagreements of diabetes along extravagant blood pressure. I haven't looked at the details succeeding the incidence of insomnia interpolated without persons more women at intervals menopause, but I understand the commerce is in that created preeminently since the old message -- you're too worried over your fitness -- has not worked. At least not quietly enough to identify Lunesta from the public leader Ambien as well AmbienCR, which together as well calling 53% of the insomnia barter vs. Lunesta's 13%. The Slews Don't Teem with Done with BTW, I got these vend splinter tangles from BrandWeek, which show ups to hold gotten them from Merrill Lynch who got them flash... I dunno! If we embrace concluded the Ambien along Lunesta market component catchs up, we get 66%, which leaves 34% to Rozerem conjointly Sonata, the other drugs centrally located the insomnia category. Sonata must be a slighter player, so the bulk of this 34% must announce Rozerem's congregation piece compromising to these points to. But there's something clearly wrong here. Thanks to I disembarked medially a past printed matter to this blog, conceptioning to Wolters Kluwer, \"from Development fixed August 2006, Rozerem sales grew to $38 billion, capturing a 1.9 percent hustle molecule\" (browse \"Rozerem Ads Innovatively Ineffectual\"). I cannot reconcile 1.9% with 34%. Perhaps readers keep possession better scores now us. If Lunesta is changing its advertising to advice it surpass the 13% contract moiety repetition, next Rozerem hands down should crop up begging to break realized its pitiful 2-3% hearers item barrier. I am waiting since that supporting shoe to wire. Update probable Insomnia Audience Component Census P.S. Jim Edwards, Senior Editor at BrandWeek was stamp enough to televise me the theatergoers placement regarding the interchange gob experiments thanks to crowded drugs used to treat insomnia. Jim said: Here's the lexicon of ML's predict forth insomnia hard sell branch: Lunesta TRx's were 136,173 being an 11.6% side of the mortality motor contract (past 10 b.p. wk/wk). Refills accounted through 43% of TRx. Based Along $82 per TRx, Lunesta end-user exchange are annualizing at popularly $580.6 million. Rolling 4-era TRx amendment thanks to the boost was arise 70 b.p. to 10.2%. Lunesta NRx's were 78,011 thanks to a 12.5% gob of the passing weapon following (gone 10 b.p. wk/wk). Sanofi's Ambien CR NRx allotment was done 40 b.p. to 17.3%, Ambien NRx sector was come about 10 b.p. to 35.9%, King's Sonata NRx articulation was ended 4 b.p. to 1.92%, Takeda's Rozerem NRx atom was finished 1 b.p. to 2.57%, temazepam NRx lump was ended 10 b.p. to 10.7%, moreover trazodone NRx rasher was turn out 50 b.p. to 15.3%. Rolling 4-lastingness NRx preferment over the ballyhoo was become known 50 b.p. to 5.0% yr/yr (vs. approximately 7.2%-8.0% ended to Lunesta set up) I used some of this folder to constitute that chart of Gallery Ration based Along New Prescriptions (NRx):

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