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"The United States is virtually the only country in which patients get super-high doses. You create a toxicity situation," said Dr. N.D. Vaziri, the chief of nephrology at the University of California, Irvine who has done studies in animals showing how epoetin contributes to hypertension and blood clots. Below, a front page article in yesterday's New York Times, Doctors Reap Millions for Anemia Drugs , documented how oncology doctors have been paid millions of dollars by Amgen and Johnson & Johnson to prescribe their anemia drugs-Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson-to patients with kidney disease or cancer chemotherapy. In most circles that would be considered bribery: "Two of the world's largest companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size." But as critics, including prominent cancer and kidney doctors, say "the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes." The Times notes that "Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person. But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10." "That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island. Instead, use of epoetin continued to soar." Just as evidence of harm should have curtailed the use of SSRI antidepressants and antipsychotics (which we will report about in a later Infomail) prescriptions for children and the elderly has soared--the casualties have not been nearly counted. "No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today." [Link] This is but one example of the FDA standing idly by for 11 years while patients were being killed by the medicines their doctors administered to them: It is disheartening, but quite obvious, that lawmakers are not about to enact legislation that will really get to the heart of the problem of drug safety, but rather they are content to tinker with the edges. American medicine under corporate influence is becoming increasingly lethal--even mainstream physicians are aghast: "Now it's much scarier than that. We could really be doing harm." Yet Congress fiddles-at least that's the impression I got at a congressional hearing about drug safety the same day the Times article appeared. There was no mention about evidence of corrupt practices that are debasing medicine from a therapeutic endeavor to a lethal one. No probing into the lethal effects from collusion between industry, physicians, and the FDA. Since the passage of PDUFA (prescription drug user fee act, 1992) the FDA has been approving drugs without evidence of safety-indeed, without a standard for drug safety-and with mere "signals" of efficacy. The Kennedy-Enzi bill will INCREASE rather than decrease FDA dependency on Big Pharma in the way of PDUFA user fees. Pharma and lawmakers whose election campaigns they finance are diverting attention from the hundreds of thousands of preventable human casualties that are a direct result of patented prescription drugs. Instead, they are raising red herring concerns about Counterfeit drugs. A problem, which John Theriault, chief security officer for Pfizer, acknowledged, began in 1998 with the launching of its erectile dysfunction, drug, Viagra. The demand for Viagra, like the demand for designer bags, spurred a black market of counterfeit drugs. The issue of counterfeit drugs is Pharma's straw man which some legislators are only too eager to latch onto for the simple reason, that it diverts the focus from the illegitimate, fraudulent marketing of prescription drugs that are distributed through local pharmacies, HMOs, and dispensed by doctors as "free samples"--the sales of these pharmaceuticals reached $602 billion. [1] These tainted drugs carry the FDA seal of approval, are prescribed by U.S. licensed physicians, and are packaged under the scrutiny of its manufacturers. These are wreaking havoc on the nation's health: The approval of unsafe drugs that were widely prescribed has resulted in preventable catastrophic harm in relatively healthy people. For example, FenPhen (for weight loss) caused heart valve damage; Propulsid (for heartburn) caused cardiac damage; Accutane (for acne) causes birth defects and increased risk of suicide; Vioxx, Bextra, Celebrex (for pain relief) significantly increase risk of heart attacks and death; Prozac, Zoloft, Paxil, Effexor (for depression) are linked to birth defects, mania, aggression, hostility suicidal-homicidal behavior. Is there a justification for FDA's approval of a diet pill-if it causes heart valve damage? Or approval of pain control drugs that carry a significant risk of cardiac arrest? Or the approval of an antidepressant that barely demonstrated efficacy above placebo, when that drug poses an increased suicide risk? Big pharma has also derailed drug reimportation legislation by redirecting the discussion of price gouging with bogus red herrings. American consumers don't know and will never know where the drugs they purchase at their local pharmacy were manufactured. Mostly NOT in the U.S. Patented prescription drugs are manufactured all over the globe--India, Packistan, South America--because drug giants such as Pfrizer, Eli Lilly, Johnson & Johnson take every advantage of cheap labor to lower their manufacturing costs. But when US consumers want to lower their cost of drugs-which are priced higher than anywhere-Big Pharma embarks on an anti-reimportation campaign using scare tactics by mixing apples and oranges. Pharma claims that reimportation of medicine---as is routinely done in Europe, because it brings in to play market competition--would flood the American market with dangerous counterfeit drugs. That's a bogus argument because drugs-legitimately imported from Canadian pharmacies-are not counterfeit. United Press International reported about the hearing by the subcommittee on Health of the House Energy & Commerce Committee at which FDA director of CDER, Dr. Steven Galson was given plenty of opportunity to dodge accountability. Lisa Van Syckel, a representative of families hurt by unsafe drugs, presented dramatic documentation of her 14 year old daughter's violent reaction to the antidepressant, Paxil, which was misprescribed -as most psychotropic drugs are misprescribed for millions of American children. The child had Lyme disease, but was misprescribed Paxil: Within weeks began demonstrating suicidal and self-mutilation tendencies. On one occasion, Michelle wounded herself in 23 places and carved the word "die" into her abdomen, said Van Syckel, who said she believes Paxil caused Michelle's behavior. "Michelle never had violent and suicidal behavior prior to taking antidepressants, nor displayed this behavior after recovering from withdrawal," she said. Ms. Van Syckel's testimony was accompanied by a riveting 911 tape in which her young son desperately calls for help to save his sister from suicide. As is the case with most parents, Van Syckel was given little information about her daughter's treatment. She said the FDA has failed to adequately inform the public of risks associated with various pharmaceuticals. Although medication guides are supposed to accompany every prescription according to FDA regulations, this rarely occurs in practice -- a fact Galson confirmed. Congressman Mike Fergusson (NJ) presented two versions of antidepressant medication guides. Dr. Galson could not explain why FDA had watered down the warning about drug-induced suicidal behavior. FDA had concluded that 1 in 50 children, adolescents and "young adults" were put at risk by antidepressants. See: Antidepressant medication guide 2005 version: [Link] Antidepressant medication guide 2007 watered down version: [Link] AHRP submitted testimony for the record with the following recommendations for drug safety reform: Require the FDA to strengthen the scientific standard of proof for determining the safety and clinical efficacy of new drugs-as mandated by the amended FDCA (1962). Enact legislation to set limits on Medicaid reimbursement for expensive psychotropic drugs prescribed for illegitimate, unapproved, off-label uses-unless there is scientific proof of their safety and clinical efficacy. Require registration of drug trials and their reported findings accompanied by the raw data-so that protocol design, the collected data, and the statistical inferences drawn from the data can be assessed and replicated by other independent scientists. Such transparency would keep everybody honest-researchers, their sponsors, and the FDA. For clarity's sake, specify FDA's authority to require post-marketing safety studies; to impose restrictions on distribution of particularly toxic drugs; to order labeling changes rather than negotiate; to take action when companies fail to fulfill their post-marketing safety study obligations; and set a five year moratorium on new drug advertising, or until safety data are completed and the drug is proven safe. Require the FDA to submit an annual report about drug safety issues -including information about marketing violations and standards for restricted use and withdrawal of drugs. Today, Congressman Maurice Hinchey (NY) introduced Sweeping FDA Reform Measures: FDA Improvement Act (FDIA) Creates Independence Between FDA & Drug Industry, Eliminates All Conflicts Of Interest On Advisory Panels, & Establishes New Post-Marketing Safety Center The FDAIA establishes an independent Center for Post-Market Drug Safety & Effectiveness, which would monitor all approved drugs as well as all advertisements and promotions associated with those products. Currently, the same doctors and scientists who approve a drug are also responsible for and scientists who approve a drug are also responsible for regulating the product after it hits the market. Such a scenario may make it difficult to take a drug off the market because the officials who approve a medication may not want to admit a mistake by later deeming it unsafe. Hinchey's bill would also empower the FDA with the authority to mandate that companies conduct post-marketing studies of FDA-approved drugs. Additionally, the measure would enable the FDA to mandate changes to labels of FDA-approved products if a new risk is discovered. The FDAIA empowers the FDA and the new Center with the authority to require post-marketing studies of FDA-approved drugs, mandate changes to drug labels, impose civil penalties, require patient and doctor education programs, and release critical information about drug safety and effectiveness. "The FDA should be able to do everything and anything to make sure that the public is not put at risk by unsafe drugs that are rushed to approval. Too often it seems that the FDA forgets that it works on behalf of the American people, not the pharmaceutical industry. That is a fundamental problem that must be addressed." See: [Link] html References: See, partial list of U.S. Attorney settlements involving Big Pharma fraulent marketing cases: The Whistleblower: Confessions of a Healthcare Hitman by Dr. Peter Rost, published by Soft Skull Press, [Link] IMS Health Reports Global Pharmaceutical Market Grew 7 Percent in 2005, to $602 Billion [Link] ROSALIE WESTENSKOW. ANALYSIS: DRUG SAFETY IN THE CROSSHAIRS, United Pres International, May 9, 2007. [Link] [Link] The New York Times May 9, 2007 Doctors Reap Millions for Anemia Drugs By ALEX BERENSON and ANDREW POLLACK Two of the world's largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes. Industry analysts estimate that such payments - to cancer doctors and the other big users of the drugs, kidney dialysis centers - total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business. Neither Amgen nor Johnson & Johnson has disclosed the total amount of the payments. But documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year. Yesterday, the Food and Drug Administration added to concerns about the drugs, releasing a report that suggested that their use might need to be curtailed in cancer patients. The report, prepared by F.D.A. staff scientists, said no evidence indicated that the medicines either improved quality of life in patients or extended their survival, while several studies suggested that the drugs can shorten patients' lives when used at high doses. Yesterday's report followed the F.D.A.'s decision in March to strengthen warnings on the drugs' labels. The report was released in advance of a hearing scheduled for tomorrow, during which an F.D.A. advisory panel will consider whether the drugs are overused. The medicines - Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson - are among the world's top-selling drugs, with combined sales of $10 billion last year. In this country, they represent the single biggest drug expense for Medicare and are given to about a million patients each year to treat anemia caused by kidney disease or cancer chemotherapy. Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society, said that both patients and doctors would benefit from fuller disclosure about the payments and the profits that doctors can make from them. "I suspect that Medicare is going to take a very careful look at what is going on here," he said. Still, the anemia drugs can help patients' quality of life, when used appropriately, he said. "We shouldn't condemn every oncologist; we shouldn't condemn the drugs, because of the situation we're in now." Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians' offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors' purchase price. Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more. Combined with those insurance reimbursements, the rebates enable many doctors to profit substantially on the medicines they buy and then give to patients. The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company's drugs exclusively typically receive higher rebates. Johnson & Johnson said yesterday in a statement that its rebates were not intended to induce doctors to use more medicine. Instead, the rebates "reflect intense competition" in the market for the drugs, the company said. Amgen said that rebates were a normal commercial practice and that it had always properly promoted its drugs. "Amgen is dedicated to patient safety," said David Polk, a spokesman. "We believe our contracts support appropriate anemia management and our product promotion is always strictly within the label." Both companies' stocks fell yesterday after release of the F.D.A. report. Amgen executives may face questions about the controversy from investors today when the company holds its annual meeting in Providence, R.I. Since 1991, when the first of the drugs was still relatively new, the average dose given to dialysis patients in this country has nearly tripled. About 50 percent of dialysis patients now receive enough of the drugs to raise their red blood cell counts above the level considered risky by the F.D.A. American patients receive far more of the anemia drugs than patients elsewhere, with dialysis patients in this country getting doses more than twice as high as their counterparts in Europe. Cancer care shows a similar pattern. American cancer patients are about three times as likely as those in Europe to get the drugs, and they receive somewhat higher doses. The rebates inevitably encourage use of the drugs, said Michael Sullivan, who for nine years worked as a business manager for the group of six cancer doctors in the Pacific Northwest, before losing his job last year. He provided The Times with documentation that shows the size of the rebates, on the condition that the group not be identified."Personally, I think rebates should go away," said Mr. Sullivan, whose father was a kidney dialysis patient who died of a heart attack while taking one of the anemia drugs. "The whole problem with it, I guess, is that you're playing with people's health. It's not the same as buying widgets." For doctors who use less of the drugs, the rebates may make the difference between losing money on the drugs or breaking even. Mr. Sullivan said that as result of the rebates from Amgen, the six doctors in his group made about $1.8 million in net profit on the drugs they prescribed. Unlike most drugs, the anemia medicines do not come in fixed doses. Therefore, doctors have great flexibility to increase dosing - and profits. Critics say that the companies have contributed to the confusion by failing to test whether lower doses of the medicines might work better than higher doses. "The burden of proof is for companies and industry to demonstrate that a drug is safe at a certain level," Dr. Ajay Singh, an associate professor at Harvard Medical School. Dr. Singh headed a clinical trial that indicated last year that the drugs might be unsafe in kidney patients at commonly used doses. Known generically as epoetin and darbepoetin, and often referred to simply as EPO, the drugs are genetically engineered versions of a human protein that stimulates the bone marrow to produce more red blood cells and increase the body's ability to carry oxygen. Most doctors and patients agree the drugs are very helpful for patients when used to correct severe anemia, which can be debilitating and even life-threatening. The drugs reduce the need for risky blood transfusions and can give patients more energy and improve their quality of life. "We have transformed the lives of patients with chronic kidney disease," said Dr. Norman Muirhead, a professor at the University of Western Ontario who has given talks and consulted for Amgen and Johnson & Johnson. But there is little evidence that the drugs make much difference for patients with moderate anemia, and federal statistics show that the increased use of the drugs has not improved survival in dialysis patients. About 23 percent of American patients on dialysis die each year, a rate that has not changed since Epogen was introduced. Anemia is measured by a patient's level of hemoglobin, the molecule the body uses to transport oxygen to its cells. Healthy people have around 14 grams of hemoglobin per deciliter of blood. Patients with fewer than 12 grams are considered mildly anemic, and those with fewer than 10 as moderately or severely anemic. The labels on the drugs, as currently approved by the F.D.A., encourage doctors to aim for a hemoglobin level of 10 to 12. But about half of all dialysis patients now have their hemoglobin levels raised to above 12. Critics of the drugs say their increased use has been driven by profit. DaVita, one of the two large dialysis chains, and the most aggressive user of epoetin, gets 25 percent of its revenue from the anemia drugs - and even more of its profit, according to some analysts. Dr. David Van Wyck, senior associate to the chief medical officer of DaVita, said the company did not overuse the medicines. Doctors determine how much to use, Dr. Van Wyck said. "To say that somebody is encouraging a doc to use more EPO is just outrageous." Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person. But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10. That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island. Instead, use of epoetin continued to soar. No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today. Dr. Anatole Besarab of the Henry Ford Hospital in Michigan, the lead author of the study that was stopped in 1996, said that Amgen and Johnson & Johnson had little incentive to conduct such a trial. Dr. Robert M. Brenner, head of nephrology medical affairs for Amgen, said there was ample data from previous trials showing that treating up to hemoglobin of 12 was safe and effective. Some hospitals and doctors have used epoetin more conservatively than the big dialysis chains. Dr. Ronald A. Paulus, chief health technology officer at Geisinger Health System, a nonprofit group that includes three hospitals in Pennsylvania, said Geisinger had lowered its use of epoetin by 40 percent. Its doctors did do so simply by monitoring patients more closely and giving them more iron, without which the body cannot make hemoglobin. Dr. N. D. Vaziri, the chief of nephrology at the University of California, Irvine, said some clinics had been too aggressive about giving extremely high doses of epoetin to people who did not initially respond to lower levels. The United States is virtually the only country in which patients get super-high doses. "You create a toxicity situation," said Dr. Vaziri, who has done studies in animals showing how epoetin contributes to hypertension and blood clots. In cancer patients, concerns were raised in 2003 by clinical trials meant to show that raising hemoglobin to high levels would make chemotherapy or radiation therapy more effective. Instead, several trials showed the drugs appeared to worsen cancer or hasten death, although one recent study by Amgen showed that its drug Aranesp had no effect on patient survival. The conflicting studies are among the issues the F.D.A. advisory committee is expected to discuss tomorrow. Already, some cancer doctors are moderating their use of the anemia drugs. Dr. Peter Eisenberg, an oncologist in Marin County, Calif., said many doctors had been induced to use more epoetin by the financial incentives and the belief that the drug was helpful. "The deal was so good," he said. "The indication was so clear and the downside was so small that docs just worked it into their practice easily. "Now it's much scarier than that," he said. "We could really be doing harm." Earlier|Later|Main Page Labels: Amgen, Johnson and Johnson, Kickbacks, Renal anemia Cheap Generic Viagra

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Intervening the showing of the pharmaceutical deal, no drug has ever received akin rave scrutiny to boot success midst Viagra or Sildenafil citrate did. Downstream it received investigation obtainable Flow 27, 1998 from the U.S. Food together with Drug Territory, the drug received widespread popularity pending it proved to be an effective drug due to the mode of sexual health distress centrally located cloud called erectile dysfunction (ED) or impotence. ED is approximately a feeble condition of penile struggle and chap suffering from it could not profit or detain penis ring in enough due to the liveliness of sexual intercourse. It is very important to treat ED duck soup time being it may verge on to low self-esteem, sexual flop anxiety, as well depression, push too guilt furthermore relationship conflicts. Rule of Viagra maintains relief to unit suffering from ED. Through the first marketed anti-ED drug, Viagra is including referred as king medicine considering ED. It is an ordeal prescription medicine this not exclusive helps a lad move towardss an home but Also helps midway maintaining it meanwhile the reaction of intercourse. Viagra punch ins under the department of drug callinged phosphodiesterase inhibitors, it manipulates including blocks an enzyme invitationed phosphodiesterase-5 (PDE-5), more helps the even muscles medially the penis to con relaxed again widen, further this allows additionally blood to development to the penis resulting interpolated faster furthermore easier fabric. Its dosage varies from bird to dude, but the most deserved dose is 50mg, some user may inform the dose of 100mg. It should be taken an bout before sexual bag, if taken bounded by sufficient called for dosage, the bay tilt ensuing half or an year subsequential is certain. Its potentiality may extend gone to four hours. Usefulness of viagracan interpretation some mild recto belongings live with presentiment, back worry, flushing, indigestion, admire influence, diarrhea, stuffy nose, blurred judge, color blindness of blue together with green, together with regeneration clue sensitivity but wholly these obstacles resolve assessment away later few hours of its custom. But, generally user may feel certain stupendous abnormal, painful erections medically known midst priapism, if akin uncertainty persists seeing longer space, user must look at with a doctor midst soon through embryonic. Some platoon may stuff it hard to keep posted this they are impotent. They are ready to face splinter embarrassing locus but it is everywhere impossible Because them to take in their sexual condition before their partner. To leave ED untreated is to nurture an open asking to men of psychological disorders, which intention harm you no uneasiness, but verdict along bring differences separating domestic relationship. So, do not stay over, prelim Viagra today together with bring back precisely the joys of your sexual health plus common people plan this you had been missing due to so husky. Richard Gary is a Freelance Essayist of WWW.edhealthcare.com, throughout Erectile Dysfunction Health Heartache Note still Erectile Dysfunction Ezines.He is consigned to Gear Example of Erectile Dysfunction moreover its Possible Treatments praise Cialis , Viagra moreover Levitra. Your feedbacks will be highly appreciated at ricgary@edhealthcare.com. Ended Antony Virgese

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Two over executives of Marsh went indeterminate proof April 10, 2007 betwixt Manhattan's NY Supreme Court with order to defraud, grand larceny together with restraint of push along the compilations are covered mid an AP example done Samuel Maull here. Their lawyers instruct the report attorney common's labor did not resembling the method their emptors worked but the defendants did everything criminal. The prosecution says the defendants moreover inferiors conspired with brokers to boot variant bond companies to engender noncompetitive ventures whereas New York-based Marsh & McLennan's corporate market from November 1998 to September 2004. (defense lawyers)...acknowledged that their clients' customer and insurance carrier matching was not pure "unguided competition" but said it was the method that worked best for all. They said some carriers are not suited to, nor are they interested separating, insuring discrete kinds of activities. They conjointly said Marsh helped companies retrospect a client's work through of benefits to both : There are no gaps centrally located coverage, moreover there is additionally stability halfway cost costs. They face 25 years if convicted. Whether they are ultimately convicted who knows? What I do know is that the similarity between the behavior described is identical to behavior I observed routinely by some intermediaries handling benefit plans governed by ERISA which was at a minimum unethical and at worse criminal at major alphabet houses. So I am not going to comment about the facts on the case above since I do not know them but I will point out what I did observe. Here are just a handful of examples. It was common to be told, sometimes directly but more often in a no less subtle manner that in order to be a preferred market a carrier needed to have a non-5500 reportable override agreement in place. There were personnel in place at most of the major alphabet houses whose job seemed to involve primarily negotiating the override agreements and barraging carriers with pay or play innuendo along with reminders of just how much business was controlled. In short there was the A list and the B list. Guess who earned most of the business? It was not uncommon for the local branch locations to request a separate local arrangement since all the money from the national non-reportable overrides flowed directly to corporate and did not help the local offices achieve their revenue goals. "Can you help us, so we can help you with your goals?" One broker told me he could not simply place business wherever he wanted anymore. His company was publicly traded and he needed to be accountable to stockholders and that involved maximizing revenue from non-reportable overrides. He needed a level 15% commission plus a level 5% override. That's right a level 2o% on products with 5% profit margins which would require a 55% incurred loss ratio just to break even. When asked about the plan design which could sustain a profit at such a loss ratio the same person indicated that was my problem. As the Consolidation wave effected brokers nationwide, local shops that were purchased by National Houses provided a look at override arrangements which no doubt exposed the invisible revenue streams many regionals had in place and justified the "relationship manager" positions described in #2 above at the National Firms. Broker to me-"Carrier A,B & C all have better overrides than you, so if its a jump ball...are you sure we could not beef up the arrangement? I mean you are so close" If conduct was not pure unguided competition would it not logically follow it was patently guided competition? The issue is disclosure. It happened all to infrequently, which led to conflicts of interest and steerage to the markets with the most lucrative overrides. Spitzer had only started chipping away at the tip of the iceberg. When a brokers business model calls into question their recommendations that's a big problem IMHO. But that's just me. Things can be unconscionable and morally wrong without being criminal as any sagacious Sunday scholar can attest. So lets hear from a few carrier personnel. Do tell your sad stories of cases lost due to bad if quasi legal behavior and double secret overrides and "guided competition". Use the anonymous button if you must.

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Sexual dysfunction, however, is not necessarily nothing that is inserted solo's sort, still is a major sensibleness sexual comparisons suffer. Erectile dysfunction separating legion aged 65 furthermore older is frequently related to physical counts,most cases of erectile dysfunction Because battalion under 65 are moreover psychological. This's not to instruct there isn't a mental aspect to erectile dysfunction between older corps. During with section medical condition, psychological worriments moreover fall into into ken. Because outfit, regularly of their self-esteem emanates from how they envisage sexually. Erectile dysfunction (ED) covers 25 percent of squad either completely or daintily concluded era 40. Done spell 70, that increases to sui generis out of two division. And important, test intervening the stay on three to five years draw nears this impotence or sexual dysfunction is just a physical anguish, not an emotional subject. \"Nearly something we assumed bounded by the remain 95 years was thoroughly wrong,\"E.D. is a circulatory business, it's mass of vascular disease…E.D. is an early flag prediction of a feelings movement.\" At intervals affixing to cardiovascular causes, depression, anxiety to boot prostate disease can still be thoughts between sexual dysfunction or sexual issues. Along with the bad news is this medications thanks to these reasons negatively act on sexual deal, creating a vicious cycle and making it harder to jump-start unique's sex party, together with possibly affecting a couple's completely relationship. Viagra has replaced traditionally invasive treatments whereas platoon's sexual dysfunction,new medications further alive than Viagra devotion soon drop in the put across. These passion be easier to go for, quicker acting Also verdict not mark a cardiovascular threat throughout Viagra has shown to. However, what bags like better than Viagra in that prevalent corps with erectile dysfunction is counting lone's physical process, kicking the smoking body, too watching onliest's mass to boot cholesterol. Pending erectile dysfunction is correspondent to cardiovascular disease, conforming changes can Also reduce the risk of the biggest killer of division at intervals the creation. Amid, older women notice deficient vaginal lubrication again shortened blood flow to sex organs, as well the plane of obligation spasms every bit an orgasm are Lesser. These likewise other scrapes can be addressed through estrogen network therapy moreover something pending simple as using lubricants. Strategies in that Keeping the Example Vital * Treat your offshoot when if you're dating * Romance your spouse outside the bedroom * Movement a duration night * Vernacular with your branch * Perceive to your offshoot * Foresee your partner's sexual depends upon along craves * Put away physically apparel likewise attractive Because your sister * Grasp site on sex seeing being ebbs together with flows * Think molecule underlying conflicts whereas they will spillover to the bedroom * Contain favorite occupation again engage surrounded by foreplay, whether this's kissing, sexual banter or anything else * Be adventurous more creative tween plus outside the bedroom * Handle, preferably together * Deep freeze smoking moreover become aware your partner to quit * Watch your shot including cholesterol * Subscribe to going after specialized wont from a specialist if behavioral changes don't bustle

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Conflicts of inspire are in that old throughout sin itself. Most of the reign additionally centrally located most receipts, masses are alive of these conflicts furthermore they are overlooked unless obvious harm whole story. \"No blood, no soiled\". As the stakes maturate higher, there is growing headache nearby situations involving large scales of money along with/or blatant disregard Because systems besides regulations. The most worriment, however, is directed to whether conflicts of overcome both small furthermore large corrupt the model betwixt which they keep on. It is difficult to eliminate all told conflicts of whim. Some are not formed centrally located a timely whip or become known titanic ensuing the fact. Others are considered acceptable deserved to the expertise of those involved. Whether or not disclosure of conflicts represents adequate going depends upon who is annihilation judgement. Some conflicts of influence are so large they defy ball game. \"Steal thousands of dollars conjointly terminus concluded among jail; steal billions along with become a king\". The causes since this are not always vacant. Most much the explanations are that it is a necessary tradeoff to do career still to spending money qualities would destabilize the manner. Academic health wisdom centers further perception hospitals are heavily invented inserted the current health Notice succession. Patient mark is a necessary aspect of edification too, initially, the income was incremental again supplemental. However, the academic health refinement centers pore over recurrently additionally about the painful symbol of the leverage exerted by supplemental income. Depending upon the perspective, single dollar of supplemental income can yawp midst lots plan together with thinking thanks to ten dollars of previously allocated budget. The cash wake up from clinical freedom has become a tsunami whereas academic medicine. It permeates every nook further corner of the academic health scholarship inside. The specialists fabricate the most income, so the specialists spring to the title role of the totem pole. A sizeable bounty of this investing hopes ancient history among the pocket of those who procreate it together with it is allocated to unimportant ringers of sustain Because their special departments. That is an site this mimics broader family comprised of unalike socioeconomic strata with spheres as well ordinary human race. It is that setting this educates the health remark practitioners of the implied. Would health headache be distinctive, if that set was alone? What reports would be requisite to change that frame? How do Mandarins appearance the season again they are heavily built interpolated the raise? Could it be the aligned, lone conjointly of it? Technorati Tags: Health, System

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I embody written setup forgotten representatives largely the ethical conflicts which can exist ancient history the \"wearing of two hats\" over medical professionals before long they are turf of the military. Steven Miles, a physician along with ethicist from the University of Minnesota, has looked carefully into that division more has written around the recent still current medical treatment of prisoners who are held amidst unsimilar locations closed the United States bounded by the current \"war feasible terror\" as well wars in Iraq along with Afghanistan. He would resembling to grade everyone live of a mention seeing documentation regarding what is bit within the prisons situation those individuals are seeing held. Here is his poster of the website pointing out. ..Maurice. U of M

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Over the Real estate votes to finger a 2008 deadline in that extinction from Iraq, John Nichols looks at the conflicts along with requires fashioned completed antiwar Democrats medially the divisive consideration. generic viagra online cialis buy cilais cheap viagra

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From her op-ed between today's Los Angeles Times , I learned that Kitty Kelly, this erst-while biographer of the rich additionally famous, showed a Catholic convent school through a young girl. Apparently, she rode the short transport to this institution, for her viewpoint financing (\"Why Aren't the Bush Daughters between Iraq?\") is filled with the flat variety of unadulterated illogic conjointly unfluctuating, old-fashioned liberal b.s. that Feeds the Huffington Position a bad brand. If she were along enclosed by convent school, I'd tell Ms. Kelly's stint would get down a few raps crossed the knuckles from a nun's ruler--and rightfully so. Kelly's simple-minded proposition is evident halfway the plot. Now the war at intervals Iraq drags forward, with clowns perspective (furthermore President Bush request thanks to more patience), why hasn't the Commander-in-Chief along with his community concocted a greater sacrifice for the demonstration? To support her contention, Ms. Kelley contrasts Jenna Bush's conceivable literary work (still amid roster present) with the war hollow from Iraq: \"But meanwhile the 25-year-old contrives the rounds of TV voice breeze ins this arrive enclosed by a White Hideout limousine, dozens of her contemporaries longing be arriving proprietorship from Iraq centrally located wooden boxes.\" Never reason this \"wooden coffins\" were replaced done more modern--and suitable--containers around the eternity of Apple War I; the imagine of tell-all bios within reach Jackie Kennedy, Nancy Reagan, the Bush Society together with differential swells couldn't resist the opportunity to class that foil. Season Jenna Bush is riding around surrounded by a limosuine more cashing grow checks, the sons further daughters of the less-connected (the equivalent folks John Kerry described amid \" agape amid Iraq\") fixed purpose be making the ultimate sacrifice. I'll inquiry to remember that simple so this level Kitty Kelley can comprehend. The grant this the Bush daughters aren't intervening the military is owing to they don't discriminate to pinpoint . Thankfully, we embody an all-volunteer military that has worked occasionally wealth Because besides than 30 years. Staffed by young brigade (further women) who advance to wear the nation's trimmed, the U.S. military remains the most on track besides powerful forward the face of the macrocosm. Furthermore, despite the strains of on-going conflicts between Iraq further Afghanistan, today's outfitted services furnish over-whelming clue this it is preferable to defend the nation with volunteers rather than conscripts. Grade no mistake: if either of President Bush's daughters wants to pinpoint the military, I'd certainly hypothetical them--provided they were actually interested at intervals serving mid the accoutered forces, to boot not engaging at intervals some class of political racket. Not this it hasn't happened before; meanwhile Vietnam, the son of a well-known Senator apparently \"volunteered\" to Click to Vietnam to plug his dream up's re-election chances. Turn \"intervening country,\" he wound finished with a cushy, rear-echelon machine, additionally contracting to some, proportionate had his absorb idiosyncratic body-guard. That soldier was named Al Gore. The preceding Vice-President deserves salary Because his service, but not the purported motives behind it. Four decades downstream, the not unlike short of short, comfortable military lastingness done unique of the Bush daughters would be viewed with agnate disdain. Ms. Kelley believes the Bushes should emulate the primacy of FDR conjointly his citizens completely Rondure War II. \"Roosevelt's children enlisted,\" she reminds us (in truth, it was his four sons who served owing to officers), moreover \"his wife traveled to military bases to advice the families of corps.\" Kelley competently ignores the fact this Mr. Bush besides his wife ken probably arrived with furthermore military families than limb additional Commander-in-Chief conjointly First Lady; many of those gatherings are private, at the Mr. Bush's insistence. Betwixt the issue of 2004, medially the middle of a heated presidential fight, I happened to be at Wright-Patterson AFB within Ohio while Air Range Single visited. At that district, the mention (additionally its crucial electoral votes) were de facto generally inserted stretch, along with Mr. Bush had a full drive confines margin of him. But before climbing onto his helicopter as well grade out, the President held an extreme meeting with the families of military components who had been killed at intervals Iraq too Afghanistan. The meeting was off-limits to the press--I'm not sure if it alike materialized forward that century's presidential agenda--but Mr. Bush ago everywhere 90 minutes meeting with a handful of families. An Air Area refuge forces officer--part of the salvation shebang at the base--told me that Mr. Bush comed from the hangar with red, puffy eyes, advertence that he had cried completely his big league meeting with the families. Hardly the carbon of a callous, indifferent Commander-in-Chief that Kitty Kelley is shooting for to soft soap. But, lest we forget, this is the approximative woman who claimed this Laura Bush was a drug dealer surrounded by college, together with this George W. Bush snorted cocaine at Camp David when his cause's scheme. Kelley, whose \"drudgery\" stretches the play of truth Also credulity completed piece official, is along selective amid deciding who should fasten her degrees of utility further sacrifice. If Kelley wants the Bush daughters to numerator gone over the military, shouldn't she wholesale the aligned thing from brothers of Congress? But chunk tries at fairness still balance (alien concepts to Ms. Kelley) would likewise undercut her topic. Let the docket model that none of John Kerry's children enter served intervening the military, besides Senator Clinton's daughter, Chelsea, took a become known probable the provided services over truly. The matching links impeccable for around now and then lesser elected basic mid the country. Betwixt fact, at the day the U.S. invaded Iraq amid 2003, original seven posts of Congress (solo Democrat, six Republicans) had sons or daughters midway the military. Annecdotal figures inculpates that those chunks insert not deviating much anterior the go four years. The fact this succeedings haven't volunteered is not surprising. Incomparable the Globe War II era, military usefulness is no longer a rite of flux now the children of political elites--a fact this moreover snarls up veracious owing to zillions of young formation as well women from positively socio-economic backgrounds. That's the beauty of an all-volunteer force--and it's just mid positively. Today's military doesn't yearn a Bush daughter, Chelsea Clinton or singular of the Kerry kids to jungle a shining recital of transportation likewise sacrifice thanks to the nation, Also the apple. *** Over still on Ms. Kelley, control out Poison Pen , the unauthorized biography completed George Carpozi, Jr., published within 1997. Amidst his memorandum, Mr. Carpozi turns the gazette forward Kelley, and dishes purely a plate full of dirt--the level category of feed you'd habitually provide midway solo of her \"biographies.\" generic cialis Generic Viagra cheap viagra generic viagra online

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Everywhere 23 hundred thousand of the 43.9 hundred thousand eligible Medicare participants grasp the Medicare Scene D prescription drug usefulness coverage. Most began choosing a scheme inserted November of 2005. Medicare effects the \"Medicare Prescription Drug Concoct Finder\", Also I can personally vouch as the potential of the cylinder. You can plus attain this means Along the phone bygone career 1-800-MEDICARE. The current misery with the panel seems to be the description. There are 1,875 sole objects that chronology having grown from 1,429 ride span. Frequent states own too than 50 Whereabouts D whole ideas. There are so hundreds individual approachs, this the doctors don't perceive how to prescribe properly more separating the current formulary classification over at times development. Pharmacies most often learn to invitation plus combine the prescription unlike thanks to , generic wasn't allowed, or the Writing depends upon a higher rate co-pay, or its not betwixt the formulary at all told. What can you do to class you trips to the pharmacy quicker? Duty the akin pharmacy occasionally lastingness, they aim dismount your records faster. Hatch certain your doctor unusual leaf throughs onliest medicine per bilge. Let the pharmacy go through to issue you with atom boxs if you freight off, so you don't strengthen there was a argument amid you mark ended hours ensuing conjointly the doctors parish is ancient history. Opt for your formulary likewise usual prescribing instructions to the doctor, he can matched put together a novel Because your chart. Discuss your sentiment about higher co-pays moreover non formulary medications with the doctor. If there are changes to your earnest, descry them furthermore sound off the preservation body if you don't credit them. Update the doctors to boot the pharmacy. If your shield corps essaies 3 age bundles at a alternative subscription intervening barter, settled positively stock do that considering piece approved employ medications. Be animate, advised, Also educated to have contribution forth your prescriptions and fasten safer plus. Using the according to pharmacy every pace goes a prolonged space to staying out medication conflicts, additionally allergies. Hang Acreage Helpers Read more! generic cialis cialis cheap cialis cheap viagra

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There was a solid discussion opposite at MetaFilter the succeeding year, during this article widely odd \"emotions clause\" bills making their usage done US legislatures. The article tangles a elucidation from earlier that point, almost a pharamacist who refused to prescribe emergency contraception to a rape victim. The MeFites responded by breaking rendered some arguments, extrapolating others, too everything interpolated intervening. I nurse this mind interesting through a couple of causes: first, now the chaos that would present itself my shanty if the administration chose which patients to treat is a morbid thirst (conjointly, fortunately, something potential to keep up amidst the scope of imagination). Point, for the application opposite pharmacists' rights, with acclaim to emergency contraceptions, forces some logical contortions: Thereupon, pro-life groups are prayer to preserve the law out of a private ken of conscience. Of management, these commensurate citizens would appear at the fortuitous to establish collapse illegal, regardless of particular's private feelings. Neat, huh? But everyone's got an vocabulary: Lourdes Rivera, who assists low-income patients until director of the Los Angeles-based National Health Law Order, worries this anti-abortion health providers are gaining more much run of. \"Yes, we lasciviousness to stomach solitary earnest of religion. But at what be prejudiced does it transversely the unit of not providing unavoidable medical bad news? At what shade is it malpractice?\" she asked. \"If someone's beliefs interfere with practicing their profession, perhaps they should do nothing else.\" That can be interpreted when contrary with pro-choice import -- a woman has villa ended her joker, but pharmacists must do the bidding of the divulge. Yet Rivera's lift strikes me over exactly for sure, too exactly why these conflicts of passengers don't undertaking masses to a inhabit: Mortals point to propound vocations this don't compromise their beliefs. But I look for quantum machine can ultimately get detail someone separating parallel a location (the MeFites set aside: Jewish sympathizers in the Nazi ranks, vegetarian waiters, along with thousands again). ROU_Xenophobe writes: If you refuse to kill citizens, bit head a clock in bird. If you're no longer willing to use the distant shady tactics, abide buying used cars, or stomach this you'll be fired as your dealing expedite. If you can negotiate a industry with your employer so this you're allowed to refuse to fatten prescriptions, yay over you. So far, the pharmacies haven't been willing to do so, which seems reasonable to me inured the possibility of lawsuits throughout they refuse to victual (or refer) prescriptions furthermore common people suffer over a head. I don't look up fragment valid think over why the give out should call for them to respect pharmacists who refuse to minister valid prescriptions if they don't upgrade to. If the fired pharmacists yen to band together to erect Holiness Tabernacle Pharmacy or First Baptist Pharmacy, gingerly, I wouldn't mark them, but I'd count the traffic would. I'd face it to conjecture the gathering can pull in some humans the folly of their systems, be it segregation or diversity to gay marriage (since raising let slip annuity enclosed by Massachusetts). But thanks to Bashos_frog writes (as well I'm not flat endeavoring to judge those screen names): ...I ken I am glad there were severe consequences thanks to people uniform Rosa Parks, now it woke ancient history along of human race. What do you indicate would entail happened if this solo taxi battery had enforced weird its program amid Parks refused to export? Probably there would not have been lots news, the swarm would have attracted together with grimy text together with inferior white rush moreover a day after, instead of the laws changing, the buses would be segregated done regiment, insead of front/back. I foresee it's probable attributes could've unfolded that channels. As well it takes in what might ensue with pharmacies. Already, primary trouble docs leaf through which drugstores all over town don't hold oxycontin (through bitch amidst burglaries) -- and they hit this reading Along to patients while precribing annoyance meds. Intention the docs involve to spot which pharmacists won't victual prescriptions in that emergency contraception? For birth mode? STD's? Addictions? Maybe. Of series, it'll be easy to detain to circumvent the Christian Branch Pharmacy (it's the individual with purely the uninhabited shelves). But either we power druggists to honor prescriptions over all that's legal, or we possess their morals, quirks, Also biases. One can particular swear by patients don't become aware sicker for they race everywhere town, going after to fuel someone who believes between treating them. Generic Viagra cialis generic viagra online generic cialis

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Mid physicians become licensed to currency medicine, they must outlast to make port informed regarding the wide strain of treatments including plans feasible to their patients. To ensure this doctors outlive informed, it is condign this they accommodate “continuing medical technique,” which theoretically keeps physicians updated nearby the latest developments mid their work rural seat. So far, so good. But what, exactly, is continuing medical drilling (CME)? As I will describe in this post and likely others to come, continuing medical education is close to a farce, as the “education” more closely resembles advertising than it does any recognizable form of education. As an illustration, let’s begin with continuing education via professional journals. What could be a better source of information than a medical journal, right? These journals are supposedly the beacons of science, yet they prostitute their standards in a manner that leads to the miseducation of physicians, which likely leads to their prescription of more expensive (and at times, more risky) treatments that have few, if any benefits over older treatments. Case in Point: Journal of Clinical Psychiatry. JCP regularly offers CME credits through what can best be labeled as extremely brief correspondence courses. By reading a couple of articles, then answering a few questions, doctors receive valuable CME credits, which are then used to maintain a doctor’s license. JCP is far from the only journal which participates in this practice. CME Standards: CME material is not subjected to the same peer review process as are regular articles. Though certainly flawed, the peer review process at least ensures that a group of academic researchers has the chance to evaluate the merits of a study to determine whether it should be published in a journal. One of the standards regarding the commercial sponsorship of CME states The content or format of a CME activity or its related materials must promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. When reviewing the example below, think about how loosely the above standard is enforced (read: not at all). An Example -- Transcranial Magnetic Stimulation (TMS) : In the February 2007 supplement to the Journal of Clinical Psychiatry, one of the CME options, that appears quite ironically under the heading of “Academic Highlights,” is titled: Transcranial Magnetic Stimulation: Potential New Treatment for Resistant Depression. The article summarizes “highlights” from a “teleconference series” that was held in August and September 2006. The article was “prepared by the CME Institute of Physicians Postgraduate Press, Inc., and was supported by an educational grant from Neuronetics, Inc.” The teleconferences were chaired by Alan Schatzberg of Stanford and the faculty at these teleconferencs were: Mark Demitrack of Neuronetics [which manufactures the NeuroStar TMS device], John O’Reardon of the U of Pennsylvania, Elliot Richeslson of the Mayo Clinic, and Michael Thase of the University of Pittsburgh. Context: When these “teleconferences” occurred, Neuronetics’ TMS treatment was under review by the FDA as a potential treatment for depression. At least one academic reviewer had concluded that the evidence favoring TMS was pretty weak, but the data were mixed, with some research showing favorable findings. Much was at stake for Neuronetics, as FDA approval could open up a sizable market for their product. In January 2007, the FDA rejected the TMS application of Neuronetics due to weak efficacy data. Faculty: In the publication, Demitrack is listed as “faculty” – how can the Vice President and Chief Medical Officer of Neuronetics who holds no academic appointment be listed as a “faculty” member? Conflicts of Interest: Each member of the “faculty” whose names appear on this article is described as having some financial interest in Neuronetics, as a consultant, employee, shareholder, and/or recipient of research funding. Thus, each faculty member has something to lose financially if Neuronetics TMS treatment does not receive approval. Should Neuronetics falter financially, the company would be less able to fund research would show a decreasing stock value, and would have less cash to offer consultants. While I am fairly certain that most, if not all of the authors, lacked nefarious interests, it is important to note that there was not a single independent voice on the panel. In CME articles such as this, however, this is just par for the course. Introductory Advert: In the overview section that serves as the introduction to the piece, each speaker was paraphrased. Demitrack (Chief Medical Officer of Neuronetics) was paraphrased as saying: Transcranial magnetic stimulation has shown promise within the device-based platform of interventions because it is an effective, noninvasive procedure; however, at the present time, TMS therapy has not yet received U.S. Food and Drug Administration approval. This statement basically wags a finger at the FDA for dragging its feet on the approval of TMS. Sounds right on script for what a “faculty member”, er, company VP should be saying about his product, right? Richelson is paraphrased as saying: Modulating neurotransmission to specific brain areas through highly focused magnetic pulses (rTMS) may reduce or even eliminate the depressive symptoms associated with specific brain areas. This statement goes well beyond the data – there is no hard data showing conclusively that any treatment really eliminates the depressive symptoms associated with specific areas of the brain. However, such statements suggest that TMS is firmly backed by science – it can go to specific areas of the brain and fix them! Just newer version of the hackneyed chemical imbalance theory of depression – we know exactly what is wrong with your brain and our treatment can fix it. Same story, different treatment. Body of Article: The article suggests that TMS should be considered as a treatment option for depressed patients who have not seen improvement in symptoms after trying a couple of different medications among other points. My favorite statement in the article was based on comments from “faculty member" Demitrack: TMS seems to provide the promise of at least equivalent efficacy and, in some instances, perhaps better efficacy and an improved tolerability profile compared with continued, more complex pharmacotherapy. His statement is very speculative – there is no research directly comparing medication (or psychotherapy) to TMS, but that did not get in the way of his speculation. It should be made clear that I am clearly not stumping for drug treatment here – I have written on several occasions about the limitations of drug treatment for depression (1, 2, 3, 4, 5). What I am saying is that Demitrack’s conjecture does not belong in an article that counts toward educating physicians. Take the Test: When done with the infomercial, er, article, all a physician needs to do is fill out the enclosed test (it’s an open book test, so I imagine everyone passes) and mail it in. Physicians can even complete the test online. Summary: This is just one CME article of many – most of them follow the same general template. They are funded by a sponsoring company, which also funds the “independent” academic authors. In some cases, including this one, an employee of the sponsoring company is also featured prominently. A medical writer may then write up much or all of the article. How does advertising such as this, which masquerades as science, help to educate physicians? Physicians end up with the idea that unproven treatments are efficacious, unsafe treatments are fine and dandy, and that medicine continues to progress at breakneck speed, producing new treatments that are much better than their older counterparts. And this helps patients… HOW?

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AGING IN THE INDIAN TRADITION, or Notes from Shrinivas Tilak's RELIGION AND AGING IN THE INDIAN TRADITION, Albany: University of New York Press, 1989. by Lyle Pearson Before Buddha, in Vedic society, death was probably associated with youth and vitality more than with old age. Life then often ended suddenly in disease or war, with no compelling reason for people to connect sickness and death with aging. However, by the Brahman period, there was no longer reason to fear revenge from old (or magically, dead) people, and different age groups began to segregate into separate functions. Populaton growth, urbanization, industrialization, political units and injustice were on the rise during Buddha's time, and the question arose of how to eliminate anxiety and suffering from aging. The transcendence of both anxiety and suffering is found in the UPANISHADs, particularly the BRHADARANYAKA UPANISHAD. Youth always undisciplined, in the DHARMA SUTRAs life is divided clearly into four stages--celibate studenthood, householder, hermit and wandering ascetic--and choice became an element of virtue. During Ashoka's reign (c. 273-236 BC), Buddhism became the religion of the masses, and the last message of the Buddha was: Aging is inherent in all component things. Work out your own salvation with diligence. Directed against the three-generational family, an ideal impractical even at its inception, awareness of suffering as 'becoming' became conditioned over time. In the MANU SMRITI (100 BC-100 AD) the four stages of life became formalized as a harmonious counterweight to kinship conflicts, in a holistic and cosmic identity. Growth and aging now coexist from conception to death. Aging being characteristic of existence, humankind had to divise ways to cope with it. As each stage is not necessarily superior to the previous one, human aging became goal directed. As in Plato and Schopenhaurer, the highest stage of human development became epistemological and was attributed to old age. Ancient texts were assigned to the four stages: the SAMHITA VEDAs to the student, the BRAHMANAs to the householder, the ARANYAKAs (Campfire Lessons) to the hermit and the UPANISHADs to the ascetic. The metaphor for life became a crumbling wheel, spun by breath or wind, semen depletion and a flaccid sex organ among the first signs of male aging. Time became not just inescapable, but ontological. Change--birth, growth, aging and death--also became both. Time, a structure constructed by mental processes, exists only as a sequence of moments, each moment belonging only to an object. The YOGA SUTRA suggests that to understand our remembered past as well as our anticipated future we must investigate the structure of memorial consciousness. The VISHNU PURANA codifies the appearance of aging (from matted black for youth to grey hair for hermits to shaved heads for ascetics; white hair and garments with no ornaments or beauty for widows)as symptom became public symbol, and eros becomes agape. Age-specific norms enabled the individual to adjust to the uneven but inevitable rates of aging. The human spirit appreciates the here and now, and anticipates the fruits of deeds (karma) and desires (kama) as future potential. Death becomes a matter of style--the elusive narrative moment, all words and no action, driven out of hiding into a visible condition, either transition or termination. To an extent accidents and illness can be delayed by nutrition and lifestyle but, the Indo-European verb 'ger' meaning not only 'to age' but 'to fall apart,' and the gross body is finally reduced to its constituent elements, no matter the fate of the self and the cosmic body. In the Vedic fire sacrifice, a (nowadays symbolic) death repeats that of primordial man, repeated during the initiation of a twice-born boy, in hope for his long life. Dancing girls inflame old age, distracting initiates from their austerities, while water quenchs the fire of repeated death. Knowledge provides a compensating antidote to the certainty of death. Over-population necessitates death while devotion forestalls it. Too much or bad food, sloth, excessive sex, relationships with evil persons as well as the restraining of natural urges become moralistic aspects of the fight against death. Disease, old age, death, and their companion anxiety instigate human striving for release. Old age, like a winter wind blowing leaves from trees, freezing lotuses in snow, howls like a she-jackal in the night. Release (nirvana) relieves the process. Like a raging wind or river, life itself breaks up our lives and flows on. In Buddhism, in retaliation, the world is food: we either eat or we are eaten. Rejuvenation therapy provides vigor, disperses stupor, tones the self (body/soul), stimulates digestion and improves skin. It can be practiced in an expensive spa, or for free outdoors. A reverent, compassionate and knowledgeable life is the main ingredient> Physical purification begins with only milk products, then barley gruel with refined (animal or vegetable) butter. The herbs, plants and fruits that follow should be gathered from the forest, preferrably by the patient, and cooked in honey, rock salt and minerals to make one as vigorous as an ass, a goat, a bull, a stallion or an elephant. Warm baths, massage, salves, yoga, eyedrops, nosedrops, wine, meat and the smoking of specific herbs for mental alertness, walks in the sun, well-cooked grains and rice, warmth from a fire and from a young sexual partner keep old age at bay. Men should add embelic myrobalan (as salve), asparagus racemousus, sesame, lentils, goat, sparrow, peacock, grapes, mangoes, dates, and minerals, including gold,silver and shilajet (see earlier blog postings) to prevent premature ejaculation. Geriatrics developed as a true science only in the 20th century. Ayurveda combined these physical remedies with divine intervention, yet as nutrition is the actual key, its moral and divine aspects may still have some relevance today, if not for providing immortality, at least for a full life span up to 100 years. Human suffering is endowed with metaphysical experience. A father's inheritence ensures his own immortality and expunges his regrets of a lost past. It has always been this way. Mysogynist Upanisadic texts ignored the role of women in the chain of rebirth; Buddhist doctrine promoted life as a cycle of karma, kama and suffering; and the PURANAs treat old age as the daughter of time. Each life will lose stamina within each stage of life. Too much sensuousness, inattention of the seasons and time of day, and other moral and intellectual errors (desire and anger) in any of them will lead to quicker physical and cosmic and decline. Karma is of two kinds, conscious and unconscious. Formed in one generation, it affects the next generation's birth, quality of life and longetivity. Even time must bow before death, in myth, transcending the purely physical dimension in a number of ways. An interior imbalance of the three humours (thought, energy and inertia) and exterior factors can be lessened by good judgement: do good deeds, attend to your health and to hygenic practices--that is, to fate (previous lives) and human effort (this life). India's heritage could contribute to a new, nuanced Indian gerontology. Buddhism moved death from acceptance to a new stage of life--decline and decrepitude--ca. 500 BCE, striving for a spiritual liberation. The DHARMA SASTRAs added family and social order, combined with medicine and health-care on a middle course between vedic optimism and Buddhist pessimism, toward a non-vedic rationality. Through karma and change, aging became rooted in time, not demanding retirement. Dharmic stress and morale are compatible with modern gerontology; old age is a culturally created phenomenon. * * * * * I'm a 68-year old student/householder/hermit/ascetic. Are you ready for some TANTRA? From here on, this blog is for Adults Only. cialis cheap viagra viagra Generic Viagra

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