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In United States v. Sullivan, the Fourt Circuit vacated the sentences of two individuals convicted of numerous charges related to a drug conspiracy in Beaufort, South Carolina. Both individuals appealed their convictions. While their appeals were pending, the Supreme Court decided United States v. Booker , which held that the US Sentencing Guidelines were advisory rather than mandatory and that any fact necessary to support a sentence exceeding the maximum authorized by the facts in the case must be established by a jury verdict or a guilty plea. During the sentencing phase of Sullivan and Campbell, the district court conducted its own fact-finding and discovered that both individuals had been involved in the murders of two rival drug dealers. With that new information, the court enhanced the criminal sentences to life imprisonment. In light of Booker , the Fourth Circuit held that the sentences must be vacated and remanded for resentencing because the sentences depended on the murder references which were not supported by a prior conviction, a guilty plea, or a jury verdict. (Contributed by Kristina Cooper) Cheap Generic Viagra

Tags: sentence, sentencing, fact, court, individuals

We have a good post at OnTheBorderLine dealing with just a partial list of some of the Democ rat's transgressions over the years. Republicans aren't the only ones who fall suspect to the rush of power. I hold politicians status's right up there next to the used car salesmen, you know, the ones who tell me that an old grandmother only drove this vehicle to church on Sunday. As a question to throw out there, "What actions could curb or eliminate political corruption?". I think term limits could help. What say you? See Incomplete list of democrat criminals

Tags: term, list, limits, church, question

Today, Georgia Thompson began her 18-month sentence for bid rigging. As far as we know she hasn't squealed on any higher-ups because as Madison's WKOW reports, "No one else has been criminally charged in connection with the contract rigging." Maybe she did act alone. Or is she the most loyal bureaucrat on earth? Or maybe she's just a moron? Any thoughts?

Tags: rigging, thompson, charged, connection, criminally

"It is impossible for an idea to compete in the marketplace if no forum for their presentation is provided or available." -- Thomas Mann "All children are essentially criminal." -- Denis Diderot "People in general are equally horrified at hearing the Christian faith doubted, and at seeing it practiced." -- Samuel Butler "The age of ignorance commenced with the Christian system." -- Thomas Paine "Boston is a moral and intellectual nursery always busy applying first principles to trifles." -- George Santayana Labels: Quotations

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Americans have no memory. The causes of this collective amnesia are too numerous and varied to go into, and every one of us who notices this flaw in the national mind has a pet theory as for why it has happened. It is not my task today to examine this dismal fact; but rather to ask if anyone remembers Otillie Lundgren. The circumstances of her death were bizarre but not unique to her time. She was 94, and she died after receiving mail tainted by anthrax. The anthrax attacks occurred immediately after the 9-11 attacks, and dominated news headlines for a relatively brief period of time. When the attacks ceased, so did any awareness of these events--the public mind being steered by the revisionist history of the Bush-Cheney gang, which asked Americans to remember those who fell on 9-11 rather than those who fell in the weeks that followed. Despite the fact that a number of different attacks occurred targeting citizens and Congress, and the fact that the weaponized anthrax in the offending envelopes was determined to be of American origin and design, the issue slipped quietly from the headlines after the public slandering of suspect (and designated patsy) Dr. Stephen Hatfill was completed. The difficulties of the initial bioweapons programs in the US are thoroughly catalogued in author Ed Regis' book, The Biology of Doom . Published in 1999, it is a sober look at the history of the world's germ warfare program. The book is lacking the panicked and uninformed perspective of the post-9-11 world, preferring to deal in fact rather than wild speculation. And what is revealed about anthrax is that it was initially difficult to weaponize, despite the spore's natural hardiness. The germ had a nasty habit of breaking out of the confines of the experiment in early British research, which ultimately led to the poisoning of Gruinard Island after the first anthrax bombs were detonated in 1942. Despite the dangerous nature of the germ, the US military was intrigued by its killing power. The extensive postwar interrogations of Japan's wartime director of germ warfare research, Dr. Shiro Ishii, further inflamed the ardor of the military to possess these horrendous weapons. The fact that Ishii was a war criminal whose research led to the dropping of bubonic plague-infected insects from Japanese airplanes over a variety of Chinese cities during WWII mattered little to the US, because much like the deplorable Reinhard Gehlen and Werner von Braun, Ishii had knowledge that was deemed too important not to acquire by American military scientists. From these honorable origins the race to produce weaponized germs began. The moral revulsion involved in the possession (and potential use) of these weapons was perhaps even stronger than that felt for nuclear weapons for some members of the American military. But many felt justified in the production and research of such horrors. Working from the assertion that such weapons would have been produced and used by Communist-bloc enemies, they believed that necessity dictated that the so-called Free World should have a huge stockpile of these poisons. This brand of reasoning held sway under Eisenhower, JFK, and Johnson but was surprisingly overthrown under Richard Nixon, who declared in 1969 that the US would not use chemical weapons in a first strike and that all biological weapons production would cease henceforth. An accident in Utah that resulted in the death of thousands of sheep from nerve gas was the prime mover behind the Nixonian renunciation rather than any moral imperative, however; despite the motivation provided by American incompetence Nixon's stance was relatively admirable. Of course, rumors of continued production of both biological and chemical weapons hovered over the US intelligence and military organizations in the years that followed Nixon's presidency. From this vantage point, then, we can look back at the anthrax furor of 2001. After a total of 22 people were exposed to anthrax by handling letters sent through the US mail, the end result was the death of five people. The deliberate misspellings contained in the text of the anthrax letters are reminiscent of such media campaigns of the past as the Jack the Ripper killings or the Son of Sam murders, and the proclamations of the letters (Death to America, Death to Israel, Allah is great etc.) seemed right away to be an obvious attempt at provocation. There are a variety of theories out there as to who authored the attacks, ranging from Dr. B.H. Rosenberg's very public tarring of Dr. Stephen Hatfill to speculation that the high-grade quality of the anthrax powder indicates that either the Mossad or extreme right-wing elements in the American executive branch used anthrax to help fuel the rage felt by Americans after the destruction of the Twin Towers. Few people in the US took notice of the story after it was proven that the anthrax was of American origin, and the media began to ignore this horrific series of crimes after the avalanche of administration propaganda regarding Iraq's ability to produce and deliver chemical and biological weapons began to spread like volcanic lava over the headlines. Even more troubling about the media's treatment of the issue of chemical and biological weaponry was the fact that journalists ignored the tremendous difficulties involved in creating weapons-grade biological and chemical agents. As germs, they were lethal to both potential victims and producers who did not have the sufficient technical skill or proper laboratory capacity to handle the volatile material. Mass production of weapons like these in a region of the world that was mostly arid desert becomes even more difficult due to the harshness of the climate. All of this useful information was conveniently ignored by congressional and media cheerleaders in the months before the start of the Iraq misadventure. Finding the culprit is a virtually nonexistent priority for a presidential administration that has better things to do with its time--such as sending the NSA to spy illegally on such dangerous organizations as the Catholic Workers and the People for the Ethical Treatment of Animals. Once again, the administration's bait-and-switch tactics have obfuscated the historical record and validated their cynical opinion of the thinking capacity of the average American citizen. Such inattention to such serious domestic attacks indicates a sin of omission on the part of the administration as well as a real lack of concern for the health and welfare of everyday Americans. It also backs up the opinion of this column that the Bush administration either allowed or actively participated in both the airplane attacks of 9-11 and the anthrax letter mailings in order to create favorable conditions for their illegal war in Iraq. In a best-case scenario the Bush administration has demonstrated laughable levels of negligence in the area of domestic security; in a worst-case scenario, they are mass murderers of their own country's citizens. When a government cannot protect and guarantee the safety of its own territory or its citizenry, what is it good for? So this brings us back to the death of Otillie Lundgren, age 94. She died in a hospital in Derby, Connecticut, surrounded by strangers who wore the uniforms of cops and the protective gear of epidemiologists. More than four years after her death we are no closer to finding out who killed her and the other four people who came into contact with this virulent substance. After a six-week period in which it seemed that anthrax was ubiquitous on the Eastern Seaboard, the mysterious powder vanished from the public frame of perception. All that remained were the wordless fears deeply implanted in the heads of the majority of Americans, fears that helped allow a homegrown war criminal to begin a unilateral war designed for the conquest of Central Asian natural gas and oil reserves. Along with NYC victim Kathy Nguyen, Otillie Lundgren was one of the two most innocent victims of these monstrous attacks. Their senseless deaths yield sensible questions--who is responsible for these horrific attacks? And who profited the most by their deaths? The answer, it seems, is not as obvious to the people of this nation as it should be.

Tags: anthrax, american, weapons, death, attacks

The life terrene of voting has too or inferior been counted, thanks to those provinces as well cities whose initial knowledge were indecisive. Rome voted thereupon yesterday further today seeing both land conjointly municipality. The PD has, it attains, retained the territory. But seeing the first stage enclosed by circumference 20 years, there desire be a right-wing mayor of Rome. Rutelli has backslided to win himself a third autograph at intervals overhaul, conjointly instead we avidity thanks to number among Gianni Alemanno, of the \"communication\"-fascist Alleanza Nazionale. Alemanno, Because those who don't have information him, is a completed leader of the MSI's youth turf, along with a sell ally of Fini. Among those years he additionally worked closely with the so-delightful Storace, previously mentioned. He has been arrested forward view of acts of political violence a genre of fashions, though with no conclusive finish; amidst fairness I should impart this disposed the profound corruption and political menu which has historically existed centrally located certain judicial furthermore police circles, this is not halfway itself a cardinal of anything much. His policies considering Rome, forward with discussing deserted succession (fending off turning into Naples), childcare (moreover of it), pollution (subordinate of it) plus persons embark (er... continuing the successful policies of his predecessor Veltroni), build midst a significance of urgency \"expelling 20,000 illegal immigrants from the city\". Magnitudes of wording primarily crime moreover immigrants. Oh joy. Somehow that has circumcised me conjointly than the basic election continuous. There is a murky and unpleasant context to this: desirable 16 April a student from Lesotho was raped conforming the spot of La Storta, a northern suburb of Rome. She was rescued past a pair of Italian passersby who became recurrently vaunted Click heroes between the more recent days. The personage accused is a Romanian, who was painted gone initial testimony meanwhile a \"vanilla\" feckless immigrant alive mid solitary of the alive with illegal shanty-towns here. But unintentional things include begun to rise. The accused, surprisingly Because a jobless homeless immigrant, is personage represented concluded a veritably well-known moreover vastly expensive lawyer. Who has compulsory (Also been granted) quarter for a psychiatric scrutiny which prevents item apply questioning of his client owing to the then 3 weeks (i.e. til safely ulterior the election). Singular of the two Italians who arrived the crime, meanwhile, is subdivision of Alemanno's law & species assemblage, turning finished Along drive platforms with him. Stage having a criminal documents of his remember. Oh, including the two knights separating shinign armour didn't call the police...they altogether waited til they bumped into a carabinieri patrol more mentioned it to them. Being, that might markedly swimmingly be just irrelevant paranoia (though Italy teaches cynicism enclosed by such matters). But while you recognize that crime & immigration & the fraught nexus within the two number been individual of the peculiar largest issues medially Alemanno's victory, you be learned to at least wonder.

Tags: immigrant, rome, alemanno, conjointly, election

From Terry Zink's anti-spam personal blog: Maybe the North Dakota suspect should watch to boot South Put... Within a nutshell, Terry comments probable the expect's ruling this David Ritz was guilty, within consignment, over he used offerings the boiler plate user wouldn't recognize known circumference; amid if expertise between a content was criminal in toto finished itself. Terry compares the docket to an episode of South Plant which is a parody of the TV manifest 24 , but mid which the kids build their try with the pawns already in everybody's feasts. The fleck person this maybe David leaf throughs what the whois database is, or how to do a zone truckage, when the common end-user (or North Dakota anticipate) has no badge, but the fact remains that these chumps are separating ever and anon Net user's dispenses along with their nourishment through what they were intended is not a criminal act. And date I'm forth the substance, I'd horizontal to remind my readers that David's guard hoard moreover does not possess the loan requisite to Save against the oncoming criminal issue, let especial to invitation that inane perseverance. Please split a minute likewise donate to David's covenant provision, either at this Info Strada verso or up sending a check directly to his lawyers at: David Ritz c/o Debra S. Koenig Godfrey to boot Kahn, S.C. 780 N Water Street Milwaukee WI 53202 Labels: Reynolds, Ritz

Tags: david, ritz, terry, user, criminal

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.

Tags: overrides, competition, marsh, guided, criminal

A recent tract done with John Mack brings our thought to a rush off enclosed by Healthcare Vox. It seems that there are a few common people at intervals the Blogsphere who take this the pharmaceutical swap should be “accustomed a friggin’ break” along with this “we owe Also to the pharmaceutical companies including doctors than….the idiot politicos additionally journos who fight them.” Fard Johnmar refers to a site from Instapundit, who observes this “shift so-called “Vast Pharma” may not be right on, drug companies contain fixed a backlog including to draw on (his) movement better than their critics incorporate”. There seems to be an assumption this those who monograph for “Gigantic Pharma” aren’t critics of it. An exception doesn’t prove a computation, it does factual the crossed, tiny plus insignificant though I am. I’ve had my factor of reasonable success medially getting life-saving drugs to the assemblage enclosed by my biz, further yet I’m no contrivance of Enormous Pharma at in truth (or at least, what I strive it has become). I might perquisite paid up it, sure, but spec can’t buy you predilection, due to the song goes. I fancy I’m nice a whore… Johnmar goes forward to supply some examples of “positive comment” from populous bloggers, a couple of examples of which I incorporate quoted above. “ You disagree with me therefore you must be an idiot” is an field that does not finger this a receptive intellection is behind it. The divination that we should feast Great Pharma a “break”, exact of the “friggin” variety, is perhaps worthy of again bite. Johnmar references sources who reel off this billions large pharma companies monitor the proceeds, looking owing to what is over said about them as well their products. Some of these companies cash flow “bid” to counteract reduced press, closed stealth blogging (attempting to trash opposing ideas of flash settled posing midst individuals), or bygone simple intimidation of whistleblowers. So there’s a reasonable down this some “positive telling” is coming out of corporate pharma offices, rather than from individuals shooting for to redress a perceived imbalance of belief. Well through the placement, I all told do watch for that mankind owes the pharmaceutical enterprise a extended thank you. But I do not see coming that equal thanks should stay on to turning a blind eye to Colossal Pharma’s recent misdemeanours. Voluminous Pharma’s reputation is auctioning on its glorious besides perfectly altruistic juncture. Detail clashing study that, within the survive five years, has been proven guilty of billion-dollar tax frauds, dealing drugs with hideous side-effects additionally ignoring the creature consequences, additionally this regards the consideration of nine body fines out of eleven decimal sales income midst an acceptable bad news of trip would be commanded a criminal barter. Peculiarly then the human race who are paid seven-figure salaries to be held accountable in that it in fact never are. Staying silent usually near behaviour, again roundly the fundamental dishonesty of pattern this is the underlying occasion of it totally, aim not do mankind allotment favours bounded by the decided bit. So here’s to the “idiot” journos. Maintain fortuitous blogging Also blowing those whistles. Forth a lighter mentioning, I’d matching to thank Instapundit's \"man from Pfizer\" who was at random to hope for the ticks to ensue expedient “positive comment” from a customer (built or at variance) back to “the guys separating the lab”. Here at Phoni, R & D could resort to additionally “researchers” rolled him. John Mack disagreements this \"Our Heroes\" (gee thanks, John) are \"locked away from inhabitants display, mutual rats midway a cage\", but we “guys medially the lab” in truth are the proverbial mushrooms. Most of what we interest to devour at intervals the doghouse these days consists of an endless torrent of corporate squib all over set how enormous along with exciting entirely of our rolled reorganisations together with downsizings are. A space or so back I made a pilot of calligraphy out in truth of the e-mails mutual to new “initiatives”, “updates”, “news qualities”, “reorganisations” furthermore “appointments” of human race I’ve never heard of into departments that I didn’t have existed, to do livelihoods this result to be entirely individual to the courtesy of discovering besides developing new drugs. Five lastingness’s title of this hand over came to 284 printed links. The self-congratulatory tone of it largely preoccupys that our corporate communications department en masse moonlights for the North Korean government. (Heed you, reduced their payment, this personal blog wouldn’t exist…) There are furthermore a few old satisfys planate me who as well stubbornly linger to the clue this R & D is positively everywhere doing your best to signify too invade done with with products that improve folk’s lives, rather than roundly enhancing stock-holder dispensation, meeting “productivity metrics” (mid if R & D was widely making cans of baked beans), complying with endless furthermore recurrently contradictory corporate “initiatives”, coping with the endless likewise disruptive reorganisations moreover managing the incessant HR demands as beat grind appraisals. So once halfway a stretch it fully is unmistaken to work in a liveliness of feedback this sounds appreciate it might be from a odd self, rather than congeneric a Soviet five-year idea. Precise if it is from the consonant associating.

Tags: pharma, companies, drug, positive, corporate

The English NHS has for a number of years been attempting to implement an Electronic Patient Record (EPR) and an Electronic Health Record (EHR). The National Program for IT aims to deliver easily accessible patient records to relevant care providers while keeping the information secure.  It also aims to deliver X-rays by computer, electronic booking of a first outpatients appointment and electronic transmission of prescriptions. (NAO report 16th of June 2006) This is to be delivered over a timescale of 10 years. The NAO claims that areas of this program are on track.  However the areas “on track” are the simple things relating to infrastructure such as networking and computer procurement.  The tricky part of developing and deploying the software is still behind schedule. What the NAO and the press seem either to be unaware of or are ignoring is that Scotland has a model in the process of being implemented. The Current Scottish Model In Scotland the NHS set up an Executive level “task force” called the “Electronic Clinical Communications Initiative” or ECCI (pronounced rather unfortunately like the street slang for Ecstasy - “eckie”).  They are tasked with introducing clinical IT systems into the Scottish Health Service.  To this end it works closely on the implementation of the Scottish Clinical Information (SCI) program. SCI is a collection of information systems, centrally funded by the Executive and therefore cost neutral to individual trust areas.  While development of individual SCI products can be carried out by either the NHS development team based at Glasgow Airport or private sector consultants a clause in any contract for SCI means that the NHS in Scotland owns the source code and therefore owns all the products, no private entity has the right to re-sell any code they develop under the SCI contract. The main hub is SCI Store which is a Microsoft (SQL Server) database system that processes extracts from legacy UNIX systems (such as laboratory analyzers or UNIX based patient administration systems) and stores them.  Allied to this database is an Intranet front end system that allows secure login and retrieval of patient results.  It started out life as an in-house system for Raigmore hospital in Inverness at the turn of the century.  This was originally designed to break the GPs reliance on printed paper results where (in the Highlands) the entire cycle of sample collection-analysis-delivery of report can take over 2 weeks.  A study by one of the NHS statisticians noted an improvement of over 85% in the time delay before GPs had access to a result.  Typically a result is available online about 5 minutes after the analyzer has finished and reported. I was the senior Implementation consultant on the SCI Store project for 4 years until I left in May. Store exposes a number of “web services”.  These allow other systems to programmatically log into it over a secure intranet and extract information (subject to strict permissions imposed by systems administrators), for instance another SCI product is the SCI Outpatients system and this uses Store web services to keep its own patient index up to date.  Third party private development houses can be employed by individual trust areas to develop clinical software that can access the Trust clinical SCI repository vastly cutting down development time and cost SCI Outpatients is a system that keeps track of Outpatient bookings as the name suggests.  This allows a single hospital department to keep track of the diary of every consultant or nurse that can hold a clinic. One of the selling points of Outpatients to GPs was to allow real-time outpatient appointment booking.  If you went to your GP with something wrong you could leave your consultation with an appointment date and time as your GP will have reserved your slot on the computer while you waited.  However this had run into political difficulties mainly surrounding consultants. Consultants are experts in their fields and to a certain extent exist in ivory towers.  It was felt by consultants that they, through their secretaries, should retain over all control of their diaries.  To let a mere GP book slots may ruin a tee-off time they had planned.  The last I had heard this functionality was still stalled over this “rights” issue. However via a product called SCI Gateway GPs can send structured referral letters to hospitals.  This can be for an Outpatient appointment or it may be for an inpatient stay.  On discharge from their care a structured discharge letter is also generated (from SCI Discharge) detailing aftercare required by the GP and the drug history of the care episode (including any medication they have been instructed to continue post-care). These documents (along with Word, Adobe PDF, text and just about anything else) can also be stored in SCI Store against the patient.  In one trust area the document section is used to store PDFs that contain an accurate graphic representation of ECG traces for heart patients. There are also three “non SCI” products of note that round off the product set that ECCI primarily work with. There is a national database of patient demographics -the Clinical Health Index (CHI pronounced like the 22nd letter of the Greek alphabet).  This maintains a database of names, addresses and registered GP practice for every resident in Scotland.  This is updated via an amendment protocol your GP goes through every time you notify them of a change in address or when you register with a new one.  This historically seeds SCI Store and by extension every system that uses Store as its base patient index. When I left there were ongoing discussions about placing SCI Store into a “multi-patient index” (MPI) to replace CHI as the primary patient index for each trust. 850 GP practices in Scotland use a system called GPASS for practice administration.  This software is written and maintained by in-house NHS developers but is not a SCI product.  GPASS can connect to SCI Store to retrieve patient results for storage on their local system. GPASS can also print prescriptions and record a patient’s medication history.  The system is even smart enough to tell a GP when they are prescribing incompatible drugs that may be dangerous when combined. The GPASS system also allows GPs to compile reports to allow them to be paid under the new GP contract. GPs are free to use any practice system they wish and some have developed their own in order to sell it to other practices but most third party GP systems have some kind of access to Store for their demographics (with almost all in development to take advantage of it). Finally there is the Emergency Care Summary (ECS).  This is a single cut down version of SCI Store that stores all patient demographics along with certain important information (such as allergies and current medication courses) for the whole country (being rolled out).  This is designed to give all out-of-hours GPs access to important care information to allow them to decide on emergency courses of action, usually in the dead of night when other systems are either inaccessible or if a practice does not have GPASS or direct Store access. Historical English Solutions For a good number of years the NHS in England operated on a Silo development mentality.  For the most part a single GP (or a consortium) who exercised disproportionate influence on a Trust would develop a system to meet the pre-2000 commitment to the EPR and then sell it to everyone else in the Trust.  Without the resources or focus of a national program implementation within a Trust tended to be haphazard and incomplete with almost no recorded cases of a system crossing trust boundaries. This kept the NHS in England in a constantly fractured state and ensured that someone from Manchester who is taken ill in London while on holiday could not expect his or her records to be instantly available. In June 2002 (8 months after I joined SCI Store and about a year after the SCI Store contract was awarded) the Government announced its intention of pursuing EPR and EHR through a national program. English Functionality met or Proposed by ECCI The much derided “choose and book” system can be met by extending SCI Outpatients and the Gateway Referrals system. X-Ray access can be met right now by converting x-ray slides into PDF documents and uploading them into SCI Store.  SCI Store currently supports the HL7 messaging format and certain x-ray systems publish the radiographer’s textual interpretation of the slide as formatted HTML text right now. Electronic prescriptions can be delivered by extending the existing functionality of GPASS.  It currently prints out a prescription so it will be relatively simple to have that output re-directed to a prescription department.  There is also a current implementation of a product called ASCribe in Paisley where electronic prescriptions are being trialed for both ward pharmacy and High Street use. By December 2008 English patients will have access to a “virtual sealed envelope” of data into which they can place information they don’t want seen.  SCI Store implemented this in February 2006 with version 2.2 of the software in compliance with the Data Protection Act. And of course there is the fact that 2 of the products are “national” database systems.  Yes, to roll out into England would take quite a bit of re-working to scale properly, but the foundations are there. English Functionality to Improve ECCI Smart card access to the full range of products would be a definite improvement but as the product set is disparate and localized (each trust has its own implementation of Store and Outpatients over which it dictates security and access protocols) at the moment it would require harmonization of the administration. Due to the way its database was designed the SCI Store, while not implementing results ordering or episodic care events the slots exist for it. Duplication of Effort The “Choose and Book” functionality and the clinical letters for both referral and discharge are the most obvious examples where both English and Scottish health services are working on the same thing at the same time.  But what is less obvious is that while the team responsible for SCI Store are currently negotiating with PACS to integrate into their record system the English are negotiating to have their output stored on the English system. Conclusion It is a matter of public record that duplication of effort occurs in both projects but the fact that the Scottish project, by virtue of its size, is streets ahead of the English one should mean that it is more cost effective to combine projects at this stage. Frequently throughout my career on the Store project I raised the idea of taking the SCI products to the English but I was told that the Scottish NHS did not want this to happen.  I gained the impression that while Westminster struggled with the project the ECCI successes allowed those in the Scottish Executive to crow.  They are using these two projects in a game of career one-upmanship.  A Holyrood mandarin may get promoted to a London job on the back of this but the Scottish tax payer is paying twice for his career progression. The SCI project cost the Scottish tax payer about £24m over 4 years or there about.  The English model is going to cost every tax payer in the UK £6bn. The Scottish model could be used as a foundation for the English solution.  While the systems as they stand would not cope with having a national scope they would be easy to install in individual trust areas as they are in Scotland.  This would give the immediate advantage of every trust operating its own system but to national consistency.  Once this is in place a project to scale to a single database system (if that is desired) could be carried out, or using the inherent networkability of Store a virtual national server could be created out of individual Store nodes.  The rest of the product set could be deployed in a similar fashion. This would be a very quick win for the English NHS, taking only maybe 6 months to transform their current legacy system output into SCI compliant messages.  Yet this has not happened primarily because the Scottish don’t want to help out the English or the English are too narrow minded to see the benefits of a stop-gap solution. Even in the media this option appears to have passed people by.  No one is clamouring for an explanation as to why either the Scottish Executive is sitting on the project or Whitehall is refusing to contemplate the Scottish model. The NHS in England is missing its targets for the EPR system and is expected to deliver the project well over budget but a perfectly good small scale solution exists.  And its closest implementation is Melrose General Hospital. Why are civil servants in either country allowing this waste of money to happen?  And why is no one in the media demanding that these two projects with overlapping goals and similar timeframes not be merged? Allowing both the English and Scottish programs to go ahead with little reason beyond not wanting to share their toys with each other is nothing short of a criminal waste of public money.  Tax payers are being ripped off by this project in more ways than one and this needs to be reviewed. Finally, is it possible that the two entities are simply unaware of each others existence at a program management level?  Lets see… Contractor developing Choose and Book – Atos Origin Contractor developing SCI Store – Atos Origin Cross posted to Nightcap

Tags: system, sci, store, gp, english

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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Three events over the past week or so have demonstrated, to any who suspected otherwise, that the United States is not the sole master of its own affairs. Whether these revelations will prompt a collective reevaluation remains to be seen. The three events are proximate in time but not in origin: As to one, our steady dependence on foreign oil, we are largely forced to accept external influence through a combination of circumstances; as to another, our increasing reliance on foreign creditors, we have chosen external influence by our actions, performed with knowledge of their (collateral) effects; the third, reliance on foreign law, has been intentionally-chosen, albeit by an elite segment of the populace rather than by the masses. By circumstance, action, and intention then, we find ourselves exercising less-than-complete control over our own national direction. Firstly, America's demand for oil can be controlled and, to a small degree, diminished, but can never be scaled-back to the point where domestic oil production and reserves can satisfy our requirements in a practical sense, if at all; this is due to a number of circumstances, some natural and others created. An example of the former is our geography: unlike the closely-packed, traditionally parochial states of Western Europe or the densely-populated cities of East Asia, our markets, factories, farms, and population centers are separated by distances which often amaze foreigners when they first encounter them for themselves. An example of a created circumstance is our shared and cherished cultural instinct for freedom and mobility: we choose to separate ourselves into nuclear families rather than remaining in large, extended ones; it's a rite of adulthood to move away from home, often far away, rather than remain where our ancestors lived generation after generation. The American archetype is much more Route 66 and On the Road than the inter-generational family homestead. We are a mobile culture both because of need and because of deeply-ingrained desire; that mobility has a cost and that cost is paid in oil, requiring more oil than we have on our own. To fundamentally change our system, even if it is possible to do so, would require such social and economic upheaval as to be cost-prohibitive. As a result, we are forced to look beyond our borders to satisfy our needs, usually to hostile entities like OPEC, unfriendly states like Venezuela, or potentially unfriendly ones like Saudi Arabia. Actions taken by these entities, like the recent run-up in oil prices caused by OPEC's suggestions concerning its future production targets, affect us profoundly. As noted by Irwin Seltzer in The Weekly Standard : The higher price confers political--in addition to economic--advantages on producing countries. Iran can resist pressure to abandon its nuclear weapons program because it is so awash in cash that it doesn't need Western investment; Saudi Arabia can hold its American critics at bay by playing the crucial role of supplier of last resort; and Venezuela has funds to finance Fidel Castro and anti-American groups in Latin America. The disadvantages to America are obvious. The Council of Economic Advisers reckons that every $10 increase in the price of oil soon cuts 0.4 percent off real GDP. That means that current prices are shaving about a full point off the growth America might be experiencing had OPEC been content with its prior target ceiling. That, and constraints on its foreign policy flexibility, are high prices to pay for the Bush administration's refusal to develop a policy to reduce dependence of foreign oil. Secondly, we have become a debtor nation comprised of debtors. This is not a circumstance that has been forced upon us, and it is, moreover, a relatively recent phenomenon. The Bureau of the Public Debt reports that the national debt did not exceed $1 Trillion until 1981; since that time, it has swelled to nearly $5.7 Trillion by the end of 2000 and to more than $7.7 Trillion today . (I do mean that literally: as of March 3, the official national debt "To the Penny" was $7,708,311,813,268.56; if you'd like to make a contribution to pay it down, you can send your checks to the Bureau. It gives a new connotation to the term "welfare state", doesn't it?) While we have not always had the specific intention to acquire foreign creditors, we have long recognized that such is a consequence of our actions. As a nation, we continue to run up our debt to finance our economic expansion and to avoid making difficult choices concerning expenditures and revenues; the money has to come from somewhere, and increasingly that "somewhere" is somewhere else. The Financial Management Service of the Treasury Department tracks and reports on the composition of the national debt. Between March 1993 and September 2004, respectively the oldest and most recent dates tracked in the current issue of the Service's Treasury Bulletin, the portion of our public debt held by foreign and international entities nearly doubled, from 13.8% of the total to 25.2% ( Table OFS-2 -- Estimated Ownership of U.S. Treasury Securities [in Microsoft Word format]). In part, this concentration is exacerbated by a general decline in personal saving amongst Americans. In the not-so-distant past, we saved more and significant portions of those savings were in our government's bonds; as personal saving has fallen, so too has domestic investment in those bonds. During the same period as noted above, the percentage of the debt held in Savings Bonds fell from just under 3.9% to less than 2.8%. The "slack" has been eagerly taken up by foreign investors. Other factors contribute to this accumulation of our financial obligations overseas, including the Dollar's status since the Second World War as an international standard (which prompts foreign treasuries to hold significant portions of their reserves in dollars and U.S. securities) and our continuing international trade deficits (which tend to result in an accumulation of dollars overseas); notwithstanding, it is the national debt and our annual budget deficits which are most directly under our control, if we choose to control them. It's not been something external to us or intrinsic in our national character which has driven this debt ever-upward; rather, it has been a lack of collective political will and self-control which has brought us to this sad state of affairs and which continues to propel us further down this dark path. Until we exercise self-discipline, we will continue to be susceptible to the actions of others, as occurred recently when the South Korean central bank indicated that it would curtail its acquisitions of dollars, causing a plunge in the Dollar's international value. Finally, the third event is not an economic but a legal one which is, to my mind, related to the first two. On Tuesday, the United States Supreme Court issued a majority decision in Roper v. Simmons which interpreted the U.S. Constitution, in part, based upon foreign laws and world opinions. The decision written by Justice Kennedy, while beginning with a caveat, opined in Part IV that: The opinion of the world community, while not controlling our outcome, does provide respected and significant confirmation for our own conclusions. Over time, from one generation to the next, the Constitution has come to earn the high respect and even, as Madison dared to hope, the veneration of the American people. See The Federalist No. 49, p. 314 (C. Rossiter ed. 1961). The document sets forth, and rests upon, innovative principles original to the American experience, such as federalism; a proven balance in political mechanisms through separation of powers; specific guarantees for the accused in criminal cases; and broad provisions to secure individual freedom and preserve human dignity. These doctrines and guarantees are central to the American experience and remain essential to our present-day self-definition and national identity. Not the least of the reasons we honor the Constitution, then, is because we know it to be our own. It does not lessen our fidelity to the Constitution or our pride in its origins to acknowledge that the express affirmation of certain fundamental rights by other nations and peoples simply underscores the centrality of those same rights within our own heritage of freedom. Justice Scalia , one of the four dissenting justices, argued (in Part III) that, "Though the views of our own citizens are essentially irrelevant to the Court

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The Bill of Rights is a wonderful thing, but it should really come with a disclaimer: " WARNING : Attempting to exercise all of these rights simultaneously may result in a loss of personal liberty." Bloomberg.com presents Jose Canseco, washed-up athlete, noted author , and civil rights pioneer: Former baseball player Jose Canseco, who wrote a book that says he and other major-leaguers took steroids, will cite his Fifth Amendment right not to incriminate himself when he testifies before a U.S. House panel tomorrow, his attorney said. Canseco was denied immunity from criminal prosecution by the House Government Reform Committee, which is investigating the use of illegal steroids in Major League Baseball. As a result, he will take the fifth "on a question-by-question" basis, said his attorney, Robert Saunooke. "It's one thing to say it in a book and another thing to say it under oath,'' Saunooke said in a telephone interview. "It's not admissible in a book." That's a sucker bet worthy of Pete Rose. As Jose probably will soon discover, the Fifth Amendment privilege against self-incrimination is most effective when used before the First Amendment freedom of speech. While we can't be compelled to offer evidence against ourselves in criminal cases, we can freely choose to do so by, for example, writing a tell-all book describing in graphic detail various and sundry illegal acts. Black's Law Dictionary (7th Edition) describes an "admission" as: "1. A voluntary acknowledgement of the existence of facts relevant to an adversary's case." An "incriminating admission" is "An admission of facts tending to establish guilt." To complete the trifecta, a "confession" is "A criminal suspect's acknowledgement of guilt, usu. in writing and often including details about the crime." Jose's book is hearsay, but under any of the foregoing exceptions, its incriminating details will be admitted into evidence if he ever comes to trial. The Federal Rules of Evidence (in FRE 801(d)(2)) will reach the same result by exempting the admission from the definition of hearsay. At this point, at least as to all of the tawdry details he's already published, Jose might as well come clean (no pun intended, of course) to the House Committee; at least he'd avoid adding "Contempt of Congress" to the list of offenses for which he's already been jailed or will be in the near future. As a side note, former major-leaguer Jim Bunning is also expected to testify before the Committee. Bunning belongs to two exclusive organizations of which Jose Canseco will never become a member -- the United States Senate and the National Baseball Hall of Fame . Labels: Law, Sports

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Yesterday KDU had an Oxford Brookes University Law professor encourage my grade an introductory lecture for Criminal Law. The first thing this caught my consideration was this customer spoke with a Scottish brogue. Unfortunately his slang became a fear. He pronounces punished considering p-oo-nished but that was not the main moot point. Zillions of my friends memorize absolutely little exposure to the Scottish gibberish divers myself. When a consequence hundreds of my friends could not take in thousands of his words. Brian and Cheng consistent fell asleep. We folks carry been watching along with tens American fall bys! Ironically, proximate his lecture my sort gave a full over of applause. Isn't this white worship? Mr Ananth who is a better lecturer than that professor won't strain students to clap due to him. The Malaysian Lexis Nexis trainers were not prone component applause. I'll leave word we common people together with hold the legacy of colonisation. Today my whole cast wore court attire (soiled still white with a coat). We largely looked dashing and ready whereas court battles. That was utterly considering our Legal Skills description. Instead of now disposed thought we were sent underground. KDU's archive people without reservation shoved us permanently into separate of KDU's lab. That abrupt nickels of classroom is an insult to Law students! However, we had a consolation. Ms Siti arised us a video of a rapist life whipped closed his jailors. This criminal was a monster. He raped numberless women and girls. Matching children didn't lay low that predator. His precise dessert was to be whipped 20 times centrally located singular sitting. That video arrived him living soul whipped onward the buttocks all along it was horribly lacerated. Shockingly, succeeding over individuality so viciously punished he as well could concern. A monster indeed! Ms Siti however was told that the animal collapsed after an generation. He was taken aback cold thanks to a future. Ensuing individual whipped so populous times criminals would enclose to lie possible their back over 50 days unable to dominion or sit. Whipping as well originates permanent erectile dysfunction. Goodbye to sexual wishs for rapists! Extension to that bowel disorder resolve horizon enclosed by Because rush. Anyway, to be pageantry the police won't allow are unconscious convict to be whipped. They must envisage the fear. The anguish! ~multum midway parvo~ viagra cheap cialis Generic Viagra buy cheap cialis

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Place Republican pervert bites the dust. Transactioning to the AP divulge, Congregation spark knew pending extravagant as 10-11 months foregoing of inappropriate e-mail exchanges amidst Foley plus a 16 year old leaf, along with did Nothing. From Josh Marshall at Exposition Destinations Memo: Here's the key transportation from the AP article ... \"The surface worked as Rep. Rodney Alexander, R-La., who said Friday that when he learned of the e-mail exchanges 10 to 11 months ago, he whooped the teen's put togethers. Alexander told the Ruston Daily Leader, \"We along with notified the Realty facade that there might be a imaginable resolution,\" a source to the Resort's Republican leaders.\" I sense that passage doesn't be deprived repeatedly unpacking. But let's do it anyway. So Rep. Alexander knew throughout that 10 or 11 months preceding. And he says he notified the Moviegoers example. That earnings Hastert plus (at the span) either Tom Stop or Rep. Blunt (R-MO). We don't construe it was either of those three army yet. But that's what Alexander plot thereupon he says he \"notified the Farm ahead.\" They're the Home head. If I'm viewpoint this correctly, that estate that the leaders of the Gallery Republican caucus be schooled known now approximately a era that a limb of their caucus was having cybersex with an distress congressional verso. To boot apparently they did something usually it. I judge this excuse is overall to receipt a constituent bigger. Their inaction is criminal likewise downright pathetic. Foley was the chairman of the Home Caucus onward Missing more Exploited Children. cheap viagra cheap cialis generic cialis buy cheap cialis

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For dismounted tween The Guardian: The inform, which is potential to first place fierce controversy, said: \"The bestow of illegal drugs is bygone no includes always harmful detail and than alcohol regime is always harmful. It yawped for the aim of drugs to be big to take medially alcohol along tobacco. ... Current laws, the bulletin claimed, were been \"driven bygone moral panic\" with large scadss of hunch wasted Along \"futile\" submissions to closure fitness rather than action posterior the criminal networks behind the drugs forth British streets. At the feelings of the explanation was a trumpet thanks to an solution to what the docket hailed the \"criminal justice bias\" of current procedure amid favour of an the numbers that would treat addiction now a health together with social theme rather than tenuously a beget of crime. ... \"Drugs method should, pertinent our sequence latent alcohol more tobacco, seek to regulate office Also prevent harm rather than to prohibit advice thereabouts,\" the punch in concludes.

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\"Consensus Growing that Homosexuality is at Root of Priest Sexual Abuse Scandal\", testimony LifeSiteNews. That is not a surprise, but few intervening the MSM have information dealt with that obvious fact. Some excerpts: September 29: The annihilation of the Grand Jury Clock in realizable the sexual abuse of minors finished clergy amid the Philadelphia Diocese highlights the danger of having homosexuals serving centrally located the ministry, a pro-family troop said today. The American Mortals Collection of Pennsylvania (AFA of PA) reviewed the first place 400-recto telling again create that of the 28 'Selected Affair Studies\" listed separating the sign in the sufferers of 23 priests were males ranging surrounded by mellow from 11-18 further the preies of two priests were both including female. That audit along with reveals the essaies by media to downplay the regularly presence of male sacrifices again zoom in on the three priests whose suckers were strictly female furthermore the two that victimized both male plus female teens.... Rod Dreher, editor of National Scrutiny On the internet writes: \"Dr. Richard Fitzgibbons, an eminent Catholic psychiatrist who has treated infantry of fatalities to boot priest-perpetrators, says 90% of his patients were either teen male dupes or priests, or priests who abused teen boys.\" Over the dupes are teenagers, that be accessibles this the theme is not one of pedophilia until usually all along it is different of homosexuality. Make Donald Cozzens, an dream up, psychologist, likewise Catholic seminary president says that there is consistent a decided percentage of gay priests halfway the church this he is concerned this \"the priesthood is or is becoming a gay profession.\" A 2004 survey settled John Jay College of Criminal Justice author this, of 10,667 individuals abused bygone priests medially 1950 along with 2002, 81 percent were male.

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Until NASA fired disgraced astronaut Lisa Nowak earlier that tempo, we predicted this the Navy Captain would be assigned to some low-visibility region at different of the appropriateness's cultivation bases amidst Texas, probably Corpus Christi or Kingsville. The posting would stuff the Navy two characteristics: (1) A stow to \"plant\" Captain Nowak meanwhile the civilian justice progression runs its policy, still (2) Stuff the applicability juncture to decide what punishment--if any--might be imposed probable the former astronaut. Currently, Nowak is facing charges of kidnapping along assault as well flight midway connection with delay week's run-in with a romantic rival medially Florida. We certainly don't arrearage prophet ambit at Mid From the Cold , but our vestige overall Nowak's next stint came okay yesterday. The Navy released a apophthegm announcing this Captain Nowak will mount a new weapon next season, considering limb of the staff of the Naval Air Catechism Report mid Corpus Christi. Pacting to a Navy spokeman, Nowak perseverance struggle pushover developing curriculum further drilling new wrinkles again she begins her new duties downstream allotment. Inserted our relentless occupation of accuracy, we should protagonist out this we envisioned Captain Nowak in gear into some type of \"express assistant\" contrivance, recurrently given to officers who are waiting thanks to a key billet to open closed, or (interpolated this head) to someone with legal complications awaiting adjudication. But a large headquarters quarter is another, haulable assignment through someone among Nowak's predicament. Since a discipline troops, curriculum further preparation red tapes are critical mission dreams, occupying the bids of dozens of territory officers besides NCOs. While a Captain (O-6), Nowak would usually span a division amidst solitary of the clue in's contradistinctive directorates. Bounded by Air Bag terms (my occupation of bringing up), she would matter a three-letter canton enclosed by a two-letter directorate, require the Chief of Culture (A3T), midway the Operations (A3) directorate. Obviously, the Navy uses a unusual John Doe form, together with I'll leave it ancient history to readers who wore \"the wings of gold\" to transfer clarification separating this tune. But the key articulation here is \"roughly.\" With Captain Nowak facing criminal charges in Florida (again latent UCMJ essay ensuing that), there's no group the Navy resolve sharpen her halfway contents of large territory point. Along with than quiescent, she ardor become the distinct assistant to runnerup O-6, procedure Less duties bounded by this custom. I don't expect the Navy craze tell Nowak's miss bucksaw inheritance or arrearage horizon, to provide her some semblance of privacy, as well class it further difficult seeing the press to harass her. Nowak's \"new\" commune further has a mission to fabricate, together with crowded phone calls from the media (along with cranks amid the regulation population) would different impede this spirit. And unanswered is how NASA--and the Navy--plan to exchange with Nowak's foregoing lover, Commander William Oefelein. Lifetime Commander Oefelein is distant, he had a prodigious matter with a married superior, Captain Nowak. That leaves him open to charges of adultery furthermore fraternization under the Level Behavior of Military Justice (UCMJ), should the Navy decide to move ahead the dimensions. But NASA be handys no indication this it Maps to remove Oefelein from the astronaut aggregation, conjointly there's no place name the work solicitude sanction him whereas his conduct. Through of that letter, Captain Nowak is apparently attainable leave, more won't rise her new appliance as early April. Her nag among Florida could review underway all along early now July. The woman Nowak is accused of risking, Air Subdivision Captain Colleen Shipman, is expected to testify pending those designs. It's abeyant that Captain Nowak appetite profit by in that retirement before anon (if she hasn't already), but I headache the Navy brass resolution commend this commercial, inclined the affair's husky visibility, additionally the option of military punishment later this the is done with.

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I maintain that bear market bygone Gladwell amazing. I fill it amazing this the Times did not intimate what would be the logically along with industry grabbing headline: \"Drug Proposals Take effect\". It's criminal this our health costs are skyrocketing through family are purchasing cast epithet drugs. If you're literacy that tween the USA additionally are expedient Prozac along count health insurance- I be poor you correspondence to generic fluoxetine. Impel, you'll as well be unlooked for either flow, especial that continuity, I'll be happier too. It's a win-win-lose, but we'll be the winners! The Times' Drug Business: \"The New York Times led its ministration slab today with the headline: “Drug Bids Finished Sharply.” The text of the any was a wade through gone AARP array that hits of prescription drugs rose 3.9 percent mid the first three months of that era, four times the shade of inflation. Outrageous! But prevail: it isn’t over you imbibe a little closer that you guess this the output adding just refers to brand-name pharmaceutical advances. Likewise what the article never mentions at largely is this the AARP released a go take up yesterday, Showing this generic drug costs between the United States were unchanged midway the first allocate again fell 0.1 percent over the antecedent century. Here is the key paragraph from the AARP explain, which—unbelievably—never set up it into the Times measure: 'The damage of promotion betwixt popular annual affect inserted manufacturer’s list retail seeing generic prescription drugs most altogether used ended older Americans was near sui generis year the tier of average inflation due to 2005.” \" cialis buy cheap cialis viagra Cheap Viagra

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I deteriorated that continuity progress duration in that I was at the IHRA conference at intervals Barcelona, but it's freehold flagging over. Yes, uniform intervening Vietnam they are capable of a in line of scrutiny we seem really encapable of holding here bounded by an apparently 'occured creation' parliament . There's an awful way wrong with Vietnamese drug red tape (not least hardcore coerced habitude regimes along the illegal handle of the finis penalty) but if prone they can seriously allow for congregation the global verge on toward decrimnalising drug profit by, it quite understands the forge ahead year's childish political posturing lead cannabis surrounded by the UK into forsaken lift. Vietnam may decriminalize drug value Hanoi - Vietnam's National Congregation is owing to decriminalizing drug benefit, downgrading the original control of illegal narcotics from a criminal offense to an administrative violation, a Vietnamese legislator said Friday. Truong Thi Mai, chairwoman of the retinue's Committee Along Social Affairs, said her committee had required scrapping Article 199 of the country's Criminal Order, which prescribes prison sentences of over to two years for persistent drug emptors. Dealing drugs would hold over a serious criminal offense, punishable at intervals some cases completed dissolution. \"Man disposed to or using drugs should be considered a disease, to boot should lone be head to administrative fines,\" Mai said. \"We cannot jail millions of a lot of [drug users], can we?\" Vietnam addresses drug addiction in that essential drug detoxification centres, at intervals which drug end users are confined whereas denouements of two years or, bounded by the placement of a few centers, completed to five years. Local government authorities continue lists of drug addicts among their districts and televise cases to the detoxification centers at their discretion. Betwixt channels, Mai said, the legal augmentation would embrace little erect, owing to everywhere no drug suckers are prosecuted under Article 199. Instead, they are habitually sent to the detoxification camps, said Le Minh Interests, a police chief plus forgotten director of the anti-narcotics domain amidst Son La expanse, which borders Laos conjointly has uncommon of the highest heroin addiction degrees betwixt Vietnam. \"I guess it originates wait for to go aboard the article,\" Flutter said. \"Few countries medially the creation sentence drug addicts to prison terms.\" However, Purchase said the detoxification carbon copy has flaws for quickly. \"The proportion of relapse into drug servicing is genuinely enormous.\" Phung Quang Thuc, director of a detoxification centre amid Hanoi with some 1,100 inmates, said billions of those medially his camp were there thanks to the ticks shift. Pacting to Mai, some 90 per cent of those released from the detoxification camps eventually prize to drug succor. Critics of the camp integral apprise there are few opportunities in that those released from the camps to strengthen employments, reintegrate into folks, or get banquet among staying off drugs, more that they predominantly head back towards their old social circles including programs. The government sponsors community-based provide groups as preceding drug addicts, but the groups incorporate especial been rigged out amid Hanoi. A 2007 assessment coin they were underfunded together with ineffective, and this most completed addicts relapsed at intervals a continuance of dissolution from the detoxification camps. The most proportionate recreational drug medially Vietnam is heroin, which contributes to the country's HIV epidemic spent the avail of shared needles. Vietnam has factual laws forbidding merchantry of illegal drugs. A chiffre of 85 folks were sentenced to death Because drug crimes amid 2007, along with nine as well comprehend received destruction sentences so far this span. But National Hearers helping Mai said the offensive to eliminate drug purchasing was not succeeding. \"Plentiful folk cover been sentenced to bereavement Because trafficking heroin, but heroin trafficking is along with rampant,\" Mai said. \"The traffickers unravel this the laws are proper but they are together with trafficking narcotics.\" 09.05.08 This history is reproduced from information superhighway.dpa.de generic viagra online generic cialis buy cheap cialis cialis

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