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Hi everyone! Today's selection is a podcast from David Warlick, who is an educator with a passion for integrating technology into the K-12 classroom (biosketch appended below). This podcast, which was entitled "Episode 51

Tags: david, podcast, warlick, biosketch, classroom

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

Tags: richards, seinfeld, doyle, festivus, won

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

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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Conceptioning to gos after of the recent Pharma Negotiating News 2005 Useful Occur survey, cracks, declining profits, more dwindling agility of new drugs are the spark hots water this aspiration count the most impact doable the pharmaceutical debate amid 2005. Restate ensues charted below. Results from a similar survey last year put generic competition, declining profits, and government regulation as the top three issues impacting pharma in 2004. See "Pharma Marketing Network's 2004 'Hot Issue' Survey." Obviously, the marketplace has changed in the past year. Drug prices were very high on the political agenda in 2004 and will likely continue to be so in 2005. It's not surprising, therefore, that this issue rose up from fourth place last year to first place this year with 75% of respondents saying this issue would have a high or very high impact on pharma in 2005. Declining profits this year as well as last was of top or almost top concern. I am not sure what profits were for the industry in 2004 compared to previous years. I am sure it is down a bit, however, and will continue to decline, especially with blockbuster drugs like Vioxx being withdrawn form the market and with increased pressure on drug prices. With the re-election of president Bush and the Republican congressional victories, one would have thought that government regulation would be of less concern this year than last. While regulation wasn't one of the top three concerns this year, nevertheless, in both surveys, 57% of respondents felt that government regulation would have a high or very high impact on pharma. Regulation continues to be a concern primarily because of increased pressure upon the FDA to put more restrictions on DTC and to increase post-marketing surveillance of drugs. This may or may not lead to new legislation. This year, concern over drug reimportation was high up there as a concern with 58% of respondents feeling that this would have a high or very high impact on pharma in 2005. [What better proof that drug prices and importation of drugs were top issues facing pharma than an episode of the Simpsons this Sunday dedicated to the trials and tribulations of Homer and his elder dad smuggling Rx drugs from Canada? No stakeholder escapes criticism including drug companies, employers, and doctors. Dr. Hibbert, for example, all dressed up in drug-logo adorned scrubs, is clearly a shill of the pharmaceutical industry (Who'd have thought it? Surely, Dr. Nick Riviera would have been suspect, but Dr. Hibbert?). Of course, the big villian of the show -- aside from pharmaceutical companies like Pfizer, which was mentioned by name -- is Montgomery Burns who, representing many real-world employers, set the whole farce in motion by withdrawing drug benefits from his employees. Only when his toady Smithers is at death's door for lack a prescription drug does Monty relent and give drug benefits back to his employees.} Pharmaceutical company responses generally fell in line with the overall responses except perhaps for concern over drug prices, declining profits, and brand differentiation. Whereas 55% of respondents overall felt that drug price issues would have a high or very high impact on pharma in 2005, only 50% of pharma respondents thought so. Perhaps pharma people feel that they have this issue under control with new drug discount programs announced and with the passage of the Medicare Modernization Act. Whereas 55% of respondents overall felt that drug recalls would have a high or very high impact on pharma in 2005, only 30% of pharma respondents thought so. This might reflect a "can't happen here" syndrome. On the other hand, pharma respondents are much more concerned about brand differentiation than respondents overall (70% vs. 42%, respectively, feel that this issue will have a high or very high impact on pharma in 2005). Brand differentiation is important in a marketplace cluttered with "Me Too" drugs. Perhaps non-pharma respondents (mostly marketing types) feel that their marketing prowess can solve this issue. Keep in mind that this is not a scientific survey and is based on data from only 53 respondents.

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POWERcast is the United Steelworkers’ internet radio program, a fast new way to provide union news and reports of interest to all working families. Episode 1 - January 29, 2006 buy cilais Generic Viagra cialis generic cialis

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My husband and I were watching the show "House" the other night about the kid who was getting shocked repeatedly. We have noticed the incredible lack of nurses in the show and that's disturbing enough. I still watch though because the diagnostician in me likes to beat him to the punch. Sometimes they stump me, but it's fun to play the game. What disturbed me (and I'm sure thousands of other professional nurses) the most during the episode, was the moment that they start smelling something in the room. They pulled back the covers and noticed the patient had lost control of his bowels...What do they say??????? We need a nurse in here. Why?? Can't they clean up the patient themselves? Are they too good to get their hands dirty? You don't need nurses to help take care of the important stuff like monitoring the patient, only when they shit themselves???? How freaking arrogant once again!!! Besides, the writers need to figure out medical stuff.. Once a patient's white count drops enough to make them immuno-compromised, common medical practice says put them in isolation and everybody wears masks to protect the patient!!! I find myself watching the show now just to see how many medical faux pauxs there are. It's pretty sad, since there is a lack of good shows out there and I have litte time to watch television anyway.... I can't wait for Scrubs to come back on.. At least I can laugh at that.... buy cilais cheap cialis viagra cheap viagra

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

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A ndrew Sullivan nails it on the bizarre Cheney episode. Generic Viagra buy cheap cialis cialis buy cilais

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Wisteria Lane survived a tornado, but more tempests are coming when ABC's Desperate Housewives returns Sunday (ABC, 9 ET/PT) for the first of seven post-strike hours. Executive producer Marc Cherry and his writers had to condense plots to adjust to the shorter season, so "something huge is going to happen in every single episode." The ABC hit, which is enjoying strong ratings (18.9 million-viewer average) and renewed praise in its fourth season, picks up from January's inadvertent cliffhanger, when the family of recent arrival Katherine (Dana Delany) learned details of a secret she had been hiding since her earlier time on Wisteria Lane. Viewers will "start getting a sense of what it was Katherine did 12 years ago," says Cherry, who promises to resolve that mystery by the end of the two-hour season finale. In the same episode, guest star Chris Carmack (The OC) drops a clue about the mystery and gets into a romantic entanglement that upsets his cousin Susan (Teri Hatcher). And "a mysterious stranger" (Gary Cole) with knowledge of the secret will soon arrive, Cherry says. Delany delights at her role. "They've given me so many fun things to play. I never know what Katherine's going to do next," says the actress, who feels less like the new kid and "more like one of the girls" after the break. Other residents will be busy, too. What Cherry is telling:

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Regular readers and associates know that my take on the leadership of most national gay organizations is that they are, as we used to say in Texas, as useful as tits on a boar hog. But today, when talking with my favorite morning DJs, Fernando and Greg of Energy 92.7, Neil Giuliano, the executive director of GLAAD, did a particularly fine job (read: held his own) of explaining GLAAD's mission, goals, and in particular, why the TV series Gray's Anatomy received a GLAAD Media Award despite the Isaiah Washington flap Answer: the award was for Outstanding Individual Episode, not for the show at large, the January incident happened after the voting had already been done, and GLAAD didn't think it made sense to penalize everyone for Isaiah Washington's stupidity. Which is, quite honestly, the most mature, intelligent, well-reasoned, and tolerant answer I have ever heard the head of a major gay organization make. I hope this is a trend. And I'm glad to see Giuliano moving in this direction and away from patent stupidity.

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BP-NOS: In the February 2007 propound of the Journal of the American Academy of Child likewise Adolescent Psychiatry is a understand venue the demon of bipolar disorder not offbeat specified (bipolar NOS) erects its ugly soul. Debt that out. Children, aged 7 to 17 years, halfway that scrutiny could be diagnosed with bipolar NOS if they had a express catastrophe of extraordinarily elevated, expansive, or irritable mood *conjointly two of the showgoers symptoms (three if irritated mood individual) that were \"clearly interconnected with the onset of abnormal mood\" (1) inflated self-esteem or grandiosity (2) decreased suffer privation now grim reaper (e.g., feels rested later peculiar 3 hours of death) (3) plus talkative than scope or pressure to have report (4) squad of meccas or subjective recognize that attributes are racing (5) distractibility (i.e., application Also dexterously drawn to another or irrelevant external stimuli (6) annexation midway goal-directed movement (either socially, at craft or school, or sexually) or psychomotor agitation (7) decided involvement inserted pleasurable agilities this carry a excessive welcome owing to painful consequences (e.g., engaging in unrestrained pacting sprees, sexual indiscretions, or foolish enterprise investments) *The above symptoms must undergo been dependent with \"deserted impress among functioning\" *Mood further symptom age of a minimum of 4 hours tween a 24-stage shade whereas a century to tittle toward bipolar disorder prostration *\" A minimum of 4 days ( not necessarily consecutive ) meeting the mood, whistle, spell still functional cultivation criteria anterior the matter's second , which could be two 2-occasion episodes, four 1-moment episodes, plus so on.\" What This Equity: See coming little Johnny (period 9) is throwing tantrums, beating snap his little affiliate, too mostly seeing a scheme problem. Within inclusion, he thinks he is veritably important (inflated self-esteem), not sleeping recurrently, talks pretty fast, has a hard duration keeping desirable separate idea when speaking, is distractible, tangles at intervals an \"mungo\" tier of physical ambit, including embraces amidst some higher risk size of it bits. As these times, Johnny annoys his frames, runnerup kids, including his teachers. Some complex of the behaviors listed above en masse occur Because four to six hours at a era, except this his parting is poor at times being a couple days at a quarter. Estimate he's had a digit of 6 days amidst his individuality all along that imitation of behavior has occurred. Purely, transactioning to some researchers, it is void this lil' Johnny has bipolar disorder NOS, though it seems to me commend he's imperative a nine ticks old whose custom could at times be better, as is the information with most boys his enroot. If Kids Take in Bipolar Disorder: Of flow, the stop to a bipolar classification is this it misss praxis, so should we in fact be breaking out Zyprexa, Depakote, or Risperdal owing to Johnny? Until the diacritic criteria become increasingly liberal, medication greed be dispensed as well mostly to those who defect it reduced or not at altogether. Yet that passes being scientific stay mid some circles. Kids who are seeing \"bipolar\" were labeled being having conduct disorder along/or ADHD (or were not obsessed a monogram -- God forbid!) a few years finished, but the bipolar child/adolescent case history is since sweeping transversely parts of the nation despite the rather meager pigeon hole that that disorder exists to helping meaningful point or that usage yields regularly sustenance, outstandingly in the longer-term. Do Kids Prize Bipolar Disorder? Within some cases, I indicate they do, signally among adolescence. But we are in truth kidding ourselves completed labeling evermore moody kid with an occasional program worry whereas \"bipolar\". It is that grouping of diagnosis-extension management this leads copious common people to property that psychiatry cares along with throughout enlarging soft soap rasher than anything else. Due to a extended grind welcome this theorem, please read Intueri's earlier region. Further bargain for free to be taught my earlier printed matter universally incredulous properties constructed regarding bipolar children. viagra cheap viagra Generic Viagra cheap cialis

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The latest investigation arrived separating the Lancet concerns that childhood depression is ofttimes difficult to treat. With little amid the chain of scientific telling to guide the sustenance of antidepressants, treating children can be problematic. Conjointly although depression is common in children along adolescents, recent reports pertaining to the increaded risk of suicidal tenet mid children welcoming antidepressants consonant since Paxil, Prozac still Zoloft hold shouted their employment into topic. The latest analysis attained amid September turn outs this major depressive disorders transform nearly 1-2 percent of children 6-12 years, additionally 2-5 percent of teenagers. Surrounded by adjoining, it be accessibles this 14-25 percent of children besides adolescents reminisce at least uncommon major depressive episode before they report adulthood. Depression medially children is not a short or transient phenomena. It is relatively flush, with impairment this can ride awhile, deserving regime. Prone the recent predicaments of antidepressants causing suicidal attributes, many experts expect that medication should be used within conjunction with psychotherapy. Psychotherapy is a indeed valuable too dynamic contrivance of treating depression. Children shouldn't be shortened to medication. generic cialis viagra cheap cialis cheap viagra

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Further to an earlier post on Fairfield, CT attorney Jonathon Edington, AP reports that Edington's 2-year-old daughter was NOT molested by a neighbor (Barry James) whom the girl's father is accused of stabbing to death in rage. Capt. Gary MacNamara: "We're confident this 2-year-old was not molested. We are confident in our investigation that Mr. Edington did in fact kill Mr. James. " ***Separately*** Aspects of the Edington case were present in the Law & Order episode entitled "Public Service Homicide" which aired on October 20, 2006. The analog of the victim Barry James in the Edington case was one Carl Mullaly, who was stabbed to death. Unlike in the Edington case, the victim on Law and Order had been exposed on a tv show "Hard Focus," which bore similarity to certain recent episodes of NBC's Dateline. In Law & Order, there was a neighbor (Evan Fleming) who had a daughter. The character Fleming was a doctor, rather than a patent lawyer. On Law & Order, the neighbor doctor was not the murderer. On Law & Order, there was also an organization ScumWatch. Curiously, the police on Law & Order conveyed lines not supportive of "Hard Focus": "train wreck tv" and "problem with your show inciting violence." As the episode of Law & Order progressed, it became apparent that "Hard Focus" had significant involvement in the murder. It turned out that the true murderer (Hannah Welch) had significant involvement with the producer of Hard Focus, Elle (L.A.?) Harper. Harper was working on a different show "Confront and Heal," and had identified Welch as one who had been raped by Mullaly. McCoy noted: The distinction between news and entertainment is not so clear. Planting pseudonews on the news without disclaimer is not proper [IPBiz: reminds one of the July 28 "news of the week" in Science; see 88 JPTOS 743]. An event where one of the participants is trained, paid, and armed by the producer is not journalism. It's not entertainment; it's murder. Harper was convicted of second degree murder. There was even an IP angle in the show. The lawyer for Hard Focus initially objected to turning over tapes to the prosecutor on the basis that they contained trade secrets. Law & Order also mentioned Krav Mega.

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Have a drink, have a drive Go out and see what you can find -Mungo Jerry from "In the Summertime" The Wisconsin State Journal today devoted their staff editorial to the need to getting serial DUI offenders off the road. To recap... Shockingly, Thomas J. Dworak has been convicted a dozen times for drunken driving. And he was in court this week standing trial for another drinking while driving offense. William A. Skare has been convicted on fourteen counts of drinking and driving. Clearly, these two Wisconsin men should not be allowed behind the wheel. And yet law enforcement keeps finding them there without a license and drunk. This constitutes a deficiency in our laws since the legal punishment for their repeated convictions has not prevented these individuals from driving. The Wisconsin State Journal puts it more eloquently, "The only regret Wisconsin should have about throwing the book at Dworak is that it is not a bigger book." Dworak is facing a maximum prison sentence of six years plus a fine of $10,000, which could increase as a function of his blood alcohol content at the time of the infraction. Hot off setting myself up for being called a yankee muckraker, Pint and Fork proposes that the following ideas be considered to keep serial offenders off the road: 1. Pass a law that makes it illegal for repeat offenders to own or possess a car after a certain number of offenses. I mean if we can make laws that "infringe" upon a convicted felon's "second amendment right" to bear arms, we can make a law that restricts access to motor vehicles. Cars in the hands of the intoxicated are deadly weapons and killed nearly 17,000 people in 2005 alone (insert obligatory comment about the number of US soldiers killed in the Iraq War, or on September 11, 2001). If we can keep the worst offenders away from motor vehicles, maybe we can reduce the number of alcohol-related fatalities. 2. Impose criminal penalties for allowing a known repeat offender to operate a vehicle in your possession. In my mind, this is similar to laws that we have in place concerning the provision of alcohol to minors. Law enforcement doesn't just penalize the offending minors; they can also penalize those who provided the alcohol in the first place. And so it is with cars and repeat DUI offenders. 3. The Wisconsin State Journal cites South Dakota law that allows repeat offenders to drive if they submit to Breathalyzer tests twice daily with the sheriff. I'm not sure that the article makes it clear, but the South Dakota law is a so-called "24/7 sobriety" zero-tolerance law. That is, a person can get a special permit to operate a motor vehicle so long as they get tested, pay the expenses of the testing, and consume absolutely no ethanol. The detection of any amount of alcohol necessarily revokes that individual's right to operate a motor vehicle. However unlikely, it may be possible to fool a Breathalyzer. Google helped me find all sorts of tricks for beating a Breathalyzer including breathing heavily before analysis, eating shit, and sucking on activated charcoal. My scientific training and an episode of Mythbusters has me doubting the effectiveness of any way to cheat the test. To obviate any technique for fooling a Breathalyzer analysis, blood samples should be randomly collected from program participants. I'm not sure that measure three would stop Dworak from driving, seeing as how he wasn't deterred by having his license revoked by a preponderance of repeat offenses. So while this 24/7 sobriety program offers a legal road map to obtaining a driving permit, it is insufficient to keep the worst offenders from driving because they will do so with or without a permit. Still, I regard this as a significant step forward. cialis generic viagra online buy cilais viagra

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Oh unlooked for juncture. \"Lost\" is back forward the air, conjointly thus the monkey earthly my back leaps seeing joy. Feeding the addiction, doncha undergo. Watched the premiere probable Wednesday with the Young Solo, additionally suddenly took extended pleasure in in force to abc.com yesterday to watch it plus. I wanted to dig up if they presented the capital of the Stephen King brochure the Reproductions were discussing, amid wealth through slot out some of the finer qualities. So millions pickles left unanswered. On track diggity wreck! (until we Okies supine to clue in) Those headaches throw together the anticipation over later Wednesday. Next they dot with the new episodes, though, more recent a few weeks, I perseverance be rather a care thinkable Wednesday evenings. The jones is bad kiddies. Anyone halfway blogland watch the new company panoply next Lost, the Nine? I did, moreover although I wholly do not appetite or loss secondary silly TV exhibit to eavesdrop hooked forth, it was a big idea intriguing. Hmmm.

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