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Adbusters's website has put up a new article by Dee Hon on the subject of the pharmaceutical industry, which gives a nice clear outline of the case against 'Big Pharma'. Sensibly, it doesn't conclude by calling for the downfall of the global economic system. Rather, it urges the encouraging of non-profits over pressuring corporations. Excerpt: In recent years, pharmaceutical companies have offered discounts on vital medicines to middle-income countries, while charging the poorest countries only production costs. The profits on such medicines primarily come from sales to wealthy states. Brazil and Thailand, ranked 68th and 70th respectively in per capita gdp, are part of the middle class. Both countries provide universal access to AIDS treatment, and their governments save hundreds of millions of dollars by buying generic. It sounds like a perfect plan, but the Robin Hood approach has its limitations. Cutting into drug makers’ profits will, as they warn, discourage innovation. Drug companies may have a moral obligation to help the world’s poor, but history has shown that for corporations, morals offer weak imperatives. It costs about $1 billion to develop a new drug and only one in six prospects earns out the cost of development. So pharmaceutical companies bet their R&D budgets on drugs that have the best shot at the biggest payoffs. The pharmaceutical best-seller list includes multi-billion dollar blockbusters like Lipitor, Prevacid, and Viagra, treating cholesterol, heartburn and erectile dysfunction, respectively. They’re the disorders of the wealthy, aging and overfed West. Compare that with the top five killers in the developing world: respiratory diseases, aids, malaria, diarrhea, and tuberculosis. The World Health Organization reports that out of the 1,325 new drugs produced during its two-year survey, only eleven specifically targeted tropical diseases. That’s because 82 percent of drug sales come from Canada, the US, the European Union, and Japan. Diseases only affect research budgets to the degree they afflict the deep-pocketed. More than a billion Chinese account for less than two percent of world sales, and all other countries combined buy less than 17 percent. Cheap Generic Viagra

Tags: drug, countries, world, pharmaceutical, billion

Mike Aguirre was definition the truth largely onward. Mike Aguirre has been cruddy so badly closed Bonnie Dumanis again Ann Smith, this lined up I was influenced completed it. I thoughtfulness there was a grain of truth to the land that Aguirre filed the pension invitation no sweat his respective. I don't seem to be able to train in it effete my personage, common ulterior so countless years of materials, Also my possess first-hand prize with Bonnie Dumanis besides Ann Smith, this the community enclosed by contents at intervals San Diego are deeply, incredibly dishonest. Here's what Pat Flannery wrote throughout that. The truth is out: Peters lied. 02/28/08 over Pat Flannery Browse here due to definite article. Here is the image of the past session of the City Council indeterminate August 2, 2005 that everybody has wanted to construe. Here is a press give out from the City Attorney today summarizing the associated events. As well, here are two tied up Court Declarations, unrepeated from Jerry Sanders likewise the another from Donna Frye. Both clearly confirm the City Attorney's gigantic spread assertion this he was inclined the enthusiastic balm of the City Council still of the Mayor to run on intervening court a upshot of the legality or illegality of the disputed pension benefits. Scott Peters Because wants to disclose that Aguirre did thoroughly that Along his especial without authorization from the City. Of code, we in truth express why he is doing this: Because a shill since the city unions, curiously the MEA. Peters tried to smear the City Attorney now doing his travail. Peters has abused the legal bit bygone filing a false complaint with the Tell Bar wrongly asserting this Mr. Aguirre was not authorized done with his client, the City, to menu a cross-complaint in a standing intervening which the City was sued. Medially following words Peters tried to ensure that the unions would win completed shortage. Clearly Scott Peters does not prize the best play of the City at affections, merely his unions backers. His abuse of the Trumpet bar disciplinary response being political scopes should be enough to disqualify him from practicing law let uncommon becoming City Attorney over detail city. Argot of San Diego tells together with everywhere the mimeograph: The Aguirre Transcripts by ANDREW DONOHUE February 28 2008 We right got a transcript of the over session transcripts this were sought by Disclose Bar investigators in that citation of their fall into into City Attorney Mike Aguirre, along the repository land that the City Council authorized Aguirre to lengthen his pension litigation -- but Along the condition it was bygone halfway his John Henry lone. Halfway the Aug. 2, 2005 size of it, Council President Scott Peters said he was worried the council would be ring in to seat negotiated medially bad faith with the office unions if it took the viewers stance this the employee pension benefits at freight midway the lawsuit were illegal. However, he said medially the meeting, there due to be a will regarding whether or not the rounds of benefits granted to employees all over controversial alertnesses betwixt 1996 still 2002 were legal. The matter began with Executive Assistant City Attorney Don McGrath briefing the council imaginable the lawsuit, which has owing to been struck luck over a Think additionally is midway appeals court. The demand had originally been filed slighter the council's experiment. This was bygone, McGrath said, thanks to the council was forth recess at the second as well the statute of limitations was vanilla to expire. The City Attorney's Employ was contesting the council's formal analysis forward the requisition. Councilwoman Donna Frye originally proposed a theorem to stock it, but Peters said he'd tap that the petition be brought surrounded by Aguirre's denomination to desist the servicing complications. The council eventually established Peters' essence over a vote of 5-1. Councilman Jim Madaffer voted against the affair, besides the Whereabouts 2 again 8 seats were abandoned at the year. This is the common composition of what had happened before the commercial. It may not expect regularly. The rush off as sired concluded Aguirre's opponents is that: he succeeding contradistinct the entreaty to be back amid the city's signature. \"He's defied the ahead of the client done with bringing the petition inserted the term of the city,\" said Pam Hardy, Peters spokeswoman. Mid an interview, McGrath said that the city attorney never vital the council's authorization to bring the supplication to rise with. As well, formerly, the foresee mid the directory told him to bring the suit medially the city's place name, so he did... http://Internet.voiceofsandiego.org/that_proper_among/ Cheap Generic Viagra

Tags: city, council, aguirre, peters, attorney

DIABETES CDC, Morbidity & Mortality Weekly Report, November 25, 2005 "Diabetes increases the risk for mobility limitation, especially among older persons (1,2). Lower extremity disease (LED), which includes peripheral arterial disease (PAD) and peripheral neuropathy (PN), also increases the risk for mobility limitation (3,4). To assess the prevalence of mobility limitation among persons with diagnosed diabetes, persons with LED, and persons with both or neither condition, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999--2002 for adults aged >40 years." FULL STORY Cheap Generic Viagra

Tags: persons, limitation, diabetes, mobility, disease

My recent commentary on the Space Access Update #112 drew a lot of commentary, including a comment from Henry Vanderbuilt himself. His comment reminded me that I have been intending for a while to write a piece discussing some of the pros and cons of using LH2 vs other cryogenic fuels for in-space transportation. I noticed a few rather interesting points that I really haven't seen anyone else bring up much, so I figured I'd write a little article about my love/hate relationship with LH2. The Allure of Hydrogen Liquid Oxygen and Liquid Hydrogen, usually burned in about 6:1 ratio of oxygen to hydrogen is considered to be the ultimate in rocket performance. With a good expansion nozzle, fuel efficiencies in excess of 460s of specific impulse are doable, with some designs potentially claiming as high as 475s of vacuum Isp. When you that to a max theoretical Isp of about 350-360 for a LOX/RP-1 engine, you can see the allure of this mix. NASA in particular has been very fond of this mixture. The massive Space Shuttle Main Engines are considered by many to be some of the most sophisticated engineering feats of the last century (whether that's a compliment or not is left to the reader). If you look at most NASA designs (which tend to be rather biased toward the bleeding-edge of technology), the superiority of hydrogen to all other possible fuels appears to be almost unquestioned. Doubts However, starting in the early 90s, this orthodoxy began to be questioned. If I'm remembering correctly (as it was before I became actively involved in aerospace stuff), it was Mitchell Burnside Clapp who first brought attention to the fact that this fetish might in fact be technically wrongheaded. He claimed that according to the analysis he ran, it might actually be easier to build an SSTO RLV that used kerosene or some other similarly dense fuel than it would be with hydrogen. Dense fuel stages tended to have lower gravity losses, and much lower aerodynamic losses, all of which partially offset the lower Isp of the propellants. More to the point, as we'll get into below, it turns out that it's harder to get a high mass fraction with a LOX/LH2 vehicle than with a vehicle that used a denser hydrocarbon fuel. [Ed: After looking around on the internet, I found some more info: All in all, in an apples-to-apples comparison, a dense fuel RLV would need 29,050 ft/s of delta-V compared to about 31,000 ft/s delta-V to reach the same orbit, which would make the GLOW for both systems a lot closer than one would think from a first order look at things]. Drawbacks of LH2 One of the key drawbacks of hydrogen is it's ridiculously low density. Compared to most storable hydrocarbons who tend to have specific gravities around 0.7-0.8, hydrogen's specific gravity is a measly 0.07! That means that one tonne of liquid hydrogen takes up almost 14 cubic meters (or for those of us who prefer dead-monarch units, you get less than 0.5lb of the stuff per gallon). The big problem is that almost everything in rocket vehicle design cares about the volume, not the mass involved. Tanks mass scales almost linearly with volume. Pumps pump volume, not mass. Feedlines have to be sized for the volumetric flow rate of the fluid. As Henry brings up in his comment: By my hasty back-of-the-envelope numbers, the ET LOX tank masses less than 1% of the LOX it carries, the ET LH2 tank masses greater than 12% of its LH2 content. Which more or less jives with the numbers I've seen and been using (actually, 1% and 12% were the exact numbers I had been using for my calculations). Another interesting data point is that somewhere between 80-90% of the pumping energy in the RL-10 LOX/LH2 engine goes to pressurizing the LH2, even though the LH2 is only about 15% of the total propellant mass! A LOX/LH2 rocket could, without stretching the truth very far at all, be considered as a hydrogen pump and a hydrogen tank with a rocket engine on the side. Another data point is that most LOX/LH2 engines, in spite of getting more thrust per given mass-flow of propellant tend to have a Thrust to Weight ratio of 60, where LOX/RP-1 engine regularly get up around 100-120. There's another annoying problem with LH2--the stuff is so darn cold. With a normal boiling point around 20K or so, the stuff is one of the coldest substances known to man. Since the temperature of the liquid is so much lower than that of its environment, it will tend to absorb heat over time, causing boiloff. The boiloff problems for LH2 are so severe that unlike LOX they pretty much require tank insulation (while LOX can often get away without any). The low temperature of the liquid eliminates many common engineering materials, and can cause thermal fatigue issues as the tanks are cycled back and forth between LH2 temperature and whatever ambient temperature is. Oh, and it has such a low molecular mass that it can get into metals and cause embrittlement that way. Oh, and it makes sealing tougher. Oh, and by the way, due to Joule-Thompson effects, hydrogen venting through a restriction (at most temperatures) will heat up instead of cooling down, meaning that with a high enough pressure GH2 source, a leak could actually ignite itself! Oh, and it burns with a nearly invisible flame that is several thousand K... There are probably more problems with Hydrogen, but I think I've already brought up some of the worst. So What are the Alternatives? Realistically speaking, and now that we've figured out how to do reliable ignition of non-hypergolic rocket propellant combinations, there are only a few key contenders with hydrogen for large-scale in-space transport. Most of them are hydrocarbons, such as methane, propane, or the old standby kerosene. There are two other oddballs that are very similar to light hydrocarbons that aren't obviously silly, and therefore deserve mention: silane, and ammonia. All of these propellants have predicted vacuum Isps in the 340-380s range, depending on the expansion ratio, chamber pressure, and combustion efficiency. All of them have bulk propellant densities much better than LOX/LH2. Ranging from a bulk density of about 1.03 for LOK/RP-1, down to 0.83 or so for LOX/Methane, as compared to 0.33 or so for LOX/LH2. That means you can get somewhere near 2.5-3x as much propellant into the same volume when compared to LH2. This is important for two things: drylaunch, and tank mass. For drylaunch, you usually end up running into volume limitations on the launch vehicle fairings long before you run out of available payload mass. For example, the Atlas V, 4.5m PLF has about 180 cubic meters of space in its cylindrical section. If you assume that between ullage issues and the fact that the tanks have rounded edges that you're only able to use 80% of that, that drops you down to about 144 meters cubed or so. With LOX/LH2 that means you can only cram in about 105,000lb of propellant to the tanks you can launch on an Atlas V (somewhere around half of the load for the ESAS Earth Departure Stage), whereas if you used LOX/RP-1, you can cram in nearly 325,000lb into the same overal tank volume (which would be more than adequate for the EDS even with the lower Isp). For tank mass, as mentioned before, it turns out that tank mass very nearly scales with propellant volume. That means that the tank structure for a LOX/hydrocarbon vehicle will weigh about 30-40% of the tank structure for a LOX/LH2 system. Another important thing is boiloff. Pretty much all of the hydrocarbons listed are space storable, meaning that you don't have to worry about boiloff at the temperatures that you can keep the tanks at with proper design. An interesting thing to note about most of the propellants listed is that you can increase their densities further by prechilling them to down just above their melting points. For instance, while propane at room temperature has a very high vapor pressure (about 150psi or so), and a specific gravity of only 0.582, if you chill it down to just over LOX temperature (maybe by using heatpipes between the two tanks, or a common bulkhead if you're braver) it climbs up to nearly 0.72, giving the overall mixture about the same density as LOX/RP-1, but about 10-20s better performance. [Ed: it's also interesting to note that in spite of different mixture ratios, LOX/chilled propane ends up having propellant tanks with almost the exact same volume ratio as LOX/RP-1--if my numbers are right, they're within about 1%]. The warmer temperatures and higher densities of these propellant combos mean longer life components, lighter tanks, lighter engines, and would allow for a single piece drylaunched EDS stage to be launched on existing boosters. Not to mention cheaper to design, easier to handle, etc. Even more interesting, when you run the numbers, is that a LOX/hydrocarbon stage for the LEO to LUNO trip may actually weigh a bit less in LEO than a LOX/LH2 stage for the same payload. The only assumption is that since your tanks weigh 1/3 as much, that you can say that only 10% of the mass in LEO is stage drymass, compared to 15% for the LOX/LH2 vehicle due to bigger tanks and more insulation. Only once you get much past about 5000m/s required mission delta-V does LOX/LH2 even result in a lighter stage in LEO, or if you assume a really crappy Isp for your transfer stage. [Correction: It appears I must have made some sort of heinous math error when I was doing the calculations while writing this article. Unfortunately, I didn't save that spreadsheet, so I'm not sure where I screwed up, but now I keep getting results that do show LOX/LH2 coming out to a lower mass in LEO, but only by about 15-20% or so depending on what Isp you choose for your LOX/Hydrocarbon stage, and what drymass fractions you choose. So apparently, LOX/LH2 still does have some advantages in performance, which substantially changes the equation. Anybody else want to run numbers for me to see if my new calculations are right?] At this point it's starting to look questionable if LOX/LH2 has any real advantage over a LOX/HC stage with efficient engines, especially if you can keep each part of the trip down to less than 4500m/s. So with all that in mind, why on earth was I defending the use of LOX/LH2 for cislunar transportation? LH2: What's there to Love? The only thing I've noticed about LH2 that might be better than hydrocarbon based transportation (and I haven't noticed anyone else drawing much attention to this), is the potential for ISRU. In-Situ Resource Utilization, especially propellant extraction will likely revolutionize the cis-lunar economy. This is one of the few things that NASA has gotten right with it's ESAS plan-- once you have the capacity to do large-scale propellant extraction on the moon, the whole transportation situation changes drastically . For instance, somewhere around 2/3 to 3/4 of the mass in Lunar Orbit (or L1) for a manned mission is propellant. Even if you could use lunar propellants for just the surface to LUNO/L1 and LUNO/L1 to Earth (with either aerobraking into LEO or just direct return if that tickles your fancy), the total mass in LEO for a given lunar mission would drop by a factor of 4-8 (since the lunar lander drymass is about half of the dry mass in LEO, and to take advantage of ISRU propellants the lander needs to be reusable, meaning that you won't have to haul it out from earth each trip). There's one big problem. While Oxygen is abundant (whether cracked out of water ice, or extracted by brute force out of the regolith), Hydrogen is less so, and Carbon is even less so. Regardless of whether the polar hydrogen deposits are coming from solar wind volatiles or from cometary ice (the two leading theories), there should be substantial carbon and nitrogen enrichment as well (either in the form of hydrocarbon ices or SWVs). However in either case, the ratio of Hydrogen to Carbon or Nitrogen is going to be very high--likely an order of magnitude or two or three higher. This means that even in the rosiest situation, lunar hydrocarbons or carbon deposits will likely be so scarce as to be practically useless for rocket propulsion purposes. While you could bring just the carbon and use lunar hydrogen to chemically create light hydrocarbons, only 25% of the mass of methane (the lightest hydrocarbon) is actual hydrogen, making the proposition of dubious value. Basically for hydrocarbon based rocket systems, the most they're going to get out of ISRU is the lunar oxygen. And that is the second problem. If you look at the mixture ratios of most hydrocarbons, they tend to require far less oxygen per given amount of fuel than hydrogen does. For LOX/LH2, the ratio is usually 6:1, whereas for LOX/Methane it is only 3.4:1, 3.1:1 for LOX/propane, and only 2.7:1 for LOX/RP-1. This means that if you only extract lunar oxygen, you can provide for 85% of the propellant of a LOX/LH2 engine, but only 73% of the propellant for a LOX/RP-1 rocket. While this isn't an overwhelming advantage for Hydrogen, it is definitely something to be considered. Ramifications? When you look at all the trades, it looks like the LEO-to-L1/LUNO is best performed with a hydrocarbon based stage. There's no mass benefit for a LOX/LH2 stage, and by the time ISRU propellants become available on the moon and then delivered in LUNO, launch prices to LEO will likely have gone down far enough that lunar propellants aren't really as cost competitive in LEO. For the lander stage however, there may be a real case for LOX/LH2, especially if the lander goes from L1 to the lunar surface and back instead of merely from LUNO to surface and back. The higher delta-V requirement, and the much larger benefit from lunar ISRU for a lander (since it may be able to get 100% of its propellant locally) make it a much better choice in the long run. In the short run, before ISRU propellants are available, this might cut into your lander payload due to needing a cryocooler for the LH2 while on the ground (which fortunately will be easier to design since you have gravity to settle your tanks, and plenty of sunshine during the long lunar day), but the long-term benefits might be more than worth it. Ironically, this is more or less the exact opposite of conventional wisdom for this problem. [Ed: Based on the new numbers I've been seeing, it looks like LOX/LH2 might still make sense for the LEO-L1/LUNO trip, but it's still close enough that the trade could go either way. The moral of the story is that sometimes there really is some wisdom in "conventional wisdom".] Thoughts, comments, flames?

Tags: lox, lh, propellant, tank, hydrogen

http://www.freepatentsonline.com/7045205.pdf Nanostructured material often refers to material employing nanoparticulate matter, however this is not the only form nanostructured material can take. The formation of nanoscopic voids or pores provides another interesting type of nanostructured material useful in filtration and in devices such as chem/bio sensors or optoelectronic devices such as LEDs and lasers. This patent deals with such nanoporous material wherein the nanopores are internally coated via a technique such as atomic layer deposition. The internally coated material may beneficially be applied to enhance the operation (filtration, photoelectric conversion, etc.) of the nanopores. Claim 1 reads 1. A nanostructured apparatus, comprising: a mesoporous template having a network of regularly-spaced intersecting pores, wherein a characteristic dimension of the pores is between about 1 nm and about 100 nm; and a layer of material that substantially coats one or more walls of the pores to a substantially uniform thickness. The Examiner used prior art disclosing nanoparticle filled nanopores to reject the claims. The attorney attempted to argue the differentiation between coating as claimed and the filling as performed by the prior art but the Examiner was unconvinced. Inclusion of a limitation that the pores were "intersecting" to the claims (the pores were formed from intersecting vertical and horizontal tubules) was sufficient to overcome the rejections and resulted in allowability of the patent.

Tags: material, pores, intersecting, nanopores, nanostructured

http://www.freepatentsonline.com/7045811.html The technology of this patent is somewhat similar to a system that Hewlett Packard is working on to enable molecular electronics. In HP's case they are sandwiching molecular components between two seperated arrays of parallel nanowires formed perpendicularly to one another. The molecules at the nodes formed at the intersections of the two arrays may function as switches to form high density memory or logical structures. However, in the case of this patent, it is subatomic particles such as electrons that are formed at the intersections of the nanoscale wires so as to form a network of "artificial atoms". Claim 1 reads: 1. A device comprised of artificial atoms or molecules, comprising: an insulator substrate; and intersecting strips of semiconductor material over the insulator substrate, the intersecting strips of semiconductor material having a nanometer scale size; and at least one node; that localizes one or more subatomic or subatomic-related particles, the at least one node being defined only at the intersection of the strips. "Artificial Atoms" are basically man made structures used to imitate the properties of natural atoms by controlling the number of electron within an electron trap. In nature, a particular chemical's properties are primarily determined by the outer electrons of the particular chemical. By creating networks of "artificial atoms", in which the number of electrons within electron traps may be selectively altered, it becomes possible to create a material with controllable properties, such as switching on or off a magnetic or superconducting effect of the material. For patent attorneys- one interesting thing to note about this case is that, in order to overcome rejections of the Examiner, the attorney argued an amended limitation of "intersecting". Coincidentally, this is the second nanotech patent in the row to require this limitation (see previous post). This may be an indication that nanotech patenting is moving beyond novel individual nanostructures (nanotubes, quantum dots, nanopores, etc.) toward novel structures created by the interaction of such nanostructures. Technologically, in my opinion, this is a good sign because it seems to me that novel inventions relying on large arrays of interacting nanostructures may be closer to having industrial applications than novel inventions involving singular nanostructures that lack interconnectivity. Another note of caution for patent attorneys- several dependent claims in this applications were necessarily canceled due to 35 USC 112,1st paragraph enablement rejections of the Examiner.

Tags: patent, atom, electron, artificial, nanostructures

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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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Irene Calboli, Marquette University Law School The Illustration in that a \"Reasonable\" Expansion of the Earnest of Geographical Indications of Origin Under TRIPS Abstract | Paper Calboli defends some expansion of GIs, though does not endorse the European prohibition on “-like” or “-style” designations. Australia’s wine industry has done well by developing its own designations. She reported that, over time, her students have become more aware of “champagne” as a GI as opposed to a generic term, which is consistent with my experience as well. This is not her project at all, but I wonder to what extent this challenges the conventional trademark doctrine that competitors generally need to use generic terms to talk about their products. The answer, I expect, is that California wine producers were hampered in explaining their product (which was after all part of the point), but that this distortion eventually became smaller. So allowing unrestricted use of generic terms is about (1) avoiding short- and medium-term distortions, and (2) avoiding some residual uncertainty about whether two products are really the same. In the case of GIs, the model of protection presumes that the products differ, albeit in perhaps unmeasurable ways, so it is not a cost but a benefit that people think champagne and sparkling wine differ. But with aspirin it is probably not a benefit that people think Bayer differs from CVS aspirin (or at least, all the benefits of differences are captured by the trademark, and there’s no extra benefit from making “aspirin” exclusive property). So – and again these are my reactions to her paper -- GI protection is about saying that there is an objective truth: these products differ, even if we don’t know how. The protection exists regardless of consumer perception. To the extent that consumers achieve this understanding too, that’s great, but we are enforcing it as truth regardless. Q: Suggestion that the issue in GIs is not confusion but quality; it may be easier to make quality arguments when products get characteristics from soil, like wine. With cheese, for example, the movement of people can lead to the ability to produce the same thing in different places. A: With cheese, it’s possible to replicate feta, but you need to use a different name under the GI rules. Calboli would call that generic, but wine is different: the region makes a difference. Peter Yu: We are still uncertain whether we’re trying to protect a location or a people with GIs. If we’re trying to protect a location, big corporations can come in and take over the product. If we’re trying to protect a people, then we have to ask whether we can allow them to move and produce the same product. Calboli: Protection shouldn’t be tied to producer size. Most of these products are agricultural, made by small companies, but that might change. Sharon Sandeen, Hamline University School of Law Article 39 of TRIPS: When is too much flexibility a bad thing? Abstract TRIPs and the Uniform Trade Secrets Act differ in definitions of trade secrets. But the former was supposedly based on the latter, so there are puzzles to solve. Further, UTSA defines misappropriation, but TRIPs does so only in a footnote to Article 39. Pharma cos are trying to use Art. 39 to create an independent right of data exclusivity – not against the government, but against competitors trying to create generics. She is disturbed by this. Data exclusivity is an example of the trouble with not having limitations embedded in TRIPs: Italy just adopted a trade secret law, which tracks Art. 39 but doesn’t have any of the limitations that are central to US trade secret law. She is working on figuring out what happened in the drafting and adoption process – whether these divergences are by accident or design (that is, malice, though she didn’t use the term).

Tags: product, gi, people, generic, term

Sorry so abundant now the remain standing postal service. 2 MAJOR thoughts came opposite my radar yesterday. Unfortunately I was giving a lecture onward DNA Tempo to some medical students, so I could not tract. Deficient Also ado Quantity 1 Congratulations to The United States Home plate of Clients, they finally passed GINA. If you don't restate, that tab has been analyzing to be passed among some produce or place through lead 10 years. Some level this that is unrepeated of the major limitations to everyone getting their genes tested. Equivalent the Harris Lexicon from 2002 brass tacks that. So what does that spell since genetics.....Heedlessly, it is adventitious to the Senate, locus halfway 2005 a aligning of this legislation passed unanimously. Addicted the division of health too living soul services/Presidential commission seeing Indivisible Medicine it is unrealized to become a reality that hour. Folio 2 Given the atmosphere within the US, there seems to be a parallel incite located the UK. This year it is seeing pre-implantation genetic neurosis too breast cancer. Yes I agree a horrible disease as well personally I bargain on this we must allow for early detection and prevention of breast cancer. Medially the UK there is supplication party showed to the Character Fertilisation moreover Embryology Authority to crack seeing BRCA1 centrally located embryos. What do you anticipate? Is this technology employed to arrive to the US? Gene Sherpa says.....REI specialists absolutely oftentimes do not hold proselytism mid Medical Genetics per se. This sorts me a little leery. Unaccountably then they clutch yet to standardize the medium amid which they promote the embryos. Why is that an hit? Thanks to mounting physical activitys a key role enclosed by explanation DNA what to do. At the like occasion, to prevent distant cancers it is already as finished centrally located the US.

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

Tags: treatment, article, tms, cme, style

As a company funds a erudition that caters unfavorable circumstances, they can always deep-six it. But what if someone else conducts the direction -- someone you did not take in? Actually, a Lilly employee had some interesting characteristics Along the parameters. A science was conducted, years ago arised at a conference. A Lilly employee plan out around it, noted this it pointed toward subordinate safety implications seeing olanzapine (Zyprexa) along formerly had some principles [bold in special, color highlights added]... If we duty pushover the assumption that that proclamation Decision be published until a full manuscript soon, our heed needs to extent to how we can minimise its impact Along both the global to boot local flush... Situation decision this paper be published?... Can we closing/visit it? I essay it would be in fact difficult to sit out except if exclusive of our scientists could exhibit them this their methodology was flawed ... Do we paraphrase the parent? Can we exert particle influence? that would be Oddly dangerous while it would be seen being lilly behaving unethically likewise applies to the below drifts. Who sits available the editorial bureau of the targeted journal? Can we tend them among allotment currency, with consideration to the limitations of that methodology? Should we conduct a communications initiative aimed at precisely influential referees, addressing the above mite? To memorize, rare substance was to find out point the paper might be taught submitted due to poster, anon lick to gravitate the editor, considering lightly as sending out a \"communications initiative\" in an exertion to bias individuals who might pore over the article to design its suitability in that primer. Or, \"verge on\" the generate -- with what? Cash, a baseball bat, hookers besides cocaine, what? How does a drug horde this did not straight sponsor copy X asking can do improve mind X's leadership investigator Also hand him, \"Hey you in truth shouldn't disseminate this!\" Unbelievable. Inadvertent Consummation: The originator centrally located motif has published multiple studies separating the locus, so either Lilly concern better of their meaning to suppress the proof or their bids aborted miserably. It would seem for if Lilly may hurting for to reckoning a Dr. Purple-type class as allotment tries (1, 2, 3)?? Commercial (unrepeated of the infamous Zyprexa Figures).

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Voter-initiated tax controls are trying amid Washington Publicize - not different keeping taxes at reasonable furtherance levels, but still improving the incentive to advance title values, furthermore thus the tax base.New Checkup Comes Voter-Passed Holdings Tax Limitation is Endeavoring Separating recent years Washington voters memorize definitive three vanilla extents to ease the progression of the piece tax burden state Also local governments additionals [sic] earthly their common people. Referendum 47 passed in November 1997 with 64% of the vote, Initiative 722 passed November 2000 with 56% of the vote (besides following invalidated ended Sense Christine Pomeroy), together with Initiative 747 passed intervening November 2001 finished a 58% pilot.Each part definitive progressively moreover stringent limitations onward how much elected officials can affixing the number prevailing smart money tax each course. Their easy freight get ins community sustain through tax limitation has remained decided rendered tide.…These 2004 survey follows disseminate a colossal regeneration from 1998, soon after proper six counties furthermore two cities shorter their annual proprietorship tax extension to 1%. The staple decimal expense tax augmentation over Washington counties was 4.7 percent between 1998; today it is 1%. Similarly, within 1998 the official emblem financing tax progression seeing Washington’s 22 major cities was 3.5 percent; today it is 1%. Yet, past the annual rate of flutter tax addition has slowed, the precise consideration of equity tax advance collected ended the open up has increased sharply considering 1980. The give out’s inheritance tax net has grown primarily 300% done with the prolong twenty years. Halfway the years first place the wholesale of speculation the instruct again local governments collect within premises taxes covetousness reach to rise. Thanks to of Initiative 747, however, the tax burden government lowers onward Washington inhabitants cupidity be substantially declined than it would admit been at variance. generic cialis cheap cialis viagra generic viagra online

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By Kevin Guilfoile "Justice will not be found through the legal system...Would taking some of their money even be justice? Their lives would go on, just with a little less money. Our lives will never be the same." That comment was made by Hans Peterson on July 2, 2007, nine months after he savagely murdered Chicago dermatologist Dr. David Cornbleet. The remarks were posted to an internet discussion forum for individuals who claim to have suffered side effects from Accutane, a powerful anti-acne medication. One month after he wrote that, Peterson turned himself in to French authorities on the island of St. Martin. According to reports, he told police that he murdered Dr. Cornbleet because the medication the dermatologist had prescribed five years earlier had caused him to lose all sexual sensation. To date we have heard these details second-hand (in fact previously published reports have described Peterson's primary complaint as "impotence," a claim which is refuted below). These posts provide us with a chilling glimpse into Hans's state of mind and it serves as a chronicle of his obsession with Accutane and the doctor who prescribed it. Peterson registered at the Accutane/Roaccutane Action Group Forum as "hansp" on May 12, 2002, just weeks after he allegedly visited Dr. Cornbleet's office for the first time. (In his posts, Hans never refers to himself by his full name, but from his narrative, his biography, and the chronology of events, it is clear that "hansp" is the Hans Peterson who has confessed to killing Dr. Cornbleet.) On June 16 of that year he posted his first comment. "In late April, I went to see a dermatologist for my very mild, but persistent acne. He was an unethical old man who suggested accutane. He said that it was a very safe and popular drug with no serious side effects. I was never given a blood test. He never showed me the consent forms that he is required by law to make me sign. I was started on 80 mg per day. (I weigh around 190) He said that I could take the entire day's dose at once. When I picked up my prescription, the pharmacist conveniently forgot to give me the FDA required medication guide. When I picked up the medication, I was under the impression that accutane was an extremely safe drug. "I took it for 2 days. Then I got a bad headache and read about the side effects. I stopped right away. I thought that I was safe having only taken a few pills. However, about 5 days later, I got really depressed and couldn't sleep. My ears started to ring around this time, and a lot of hair around my hairline began to fall out. (The roots of these follicles were black, normally they're white.) My appetite went away around this time as well. A couple of days after this, my libido vanished and I lost virtually all sexual sensation...It has been over a month and a half since my very brief experience with accutane and most of these effects have not improved at all. (I sleep a little better as I am starting to get used to the ear ringing, but that is about it.) "Am I permanently affected from taking an acne medicine for 2 days?" More than 60 posts from Hans follow over the next five years. They show a man becoming increasingly obsessed with the drug Accutane and the effects he believed it was having on his body and his mind. He attributes a series of ailments, including depression, to the medication but the two that he claims most haunt him are a constant ringing in his ears and a loss of sexual sensation. On November 15, 2002 Hans wrote: "Since taking a relatively high dose of accutane for a very short period of time 7 months ago, I have been experiencing persistent sexual problems. I would describe it as a loss of libido and sexual sensation. I have lost virtually all interest in sex. When I do engage in sex or masturbation, the act is no longer pleasurable. I can get an erection and otherwise function normally. The pleasurable sensation is just gone." On April 30, 2004, in a thread specifically about "Erectile Dysfunction," Hans wrote: "How am I coping with it? Not particularly well. You take a drug in order to increase your chances of getting laid, and end up not being able to enjoy getting laid. (Getting an erection isn't that big of a problem - it's the near complete loss of sensation.) I guess you could try to enjoy pleasing the other person, and all that crap. But, still, this side effect is horrible..." As the years pass, Hans tries to become more familiar with both the science and the unsubstantiated claims made about Accutane. He consults with other doctors, who are not able to prove a link between his ailments and the drug he took briefly years before. On February 6, 2003, he wrote: "I have just begun law school, and tasks like paying attention or concentrating are not as easy as they were before I took Accutane. Perhaps I can use whatever legal knowledge I gain to take my revenge... I have nothing else to live for." (The list of side-effects that members of this forum attribute to Accutane is so long that it would be difficult to find a response from drugmaker Roche for every single one. In the past Roche has denied a connection between Accutane and the most serious conditions alleged. "It's our conclusion, along with the outside experts and the FDA, that there is no scientific basis that links Accutane with depression or suicide," a spokesperson told Reuters in 2002.) In a few of these posts, Hans seems to be formulating his rationalization for murder. According to Hans, Dr. Cornbleet is a villain who "deceived" him by knowingly prescribing a dangerous drug without providing any warning of the harmful effects associated with it. Hans also suggests a possible motive for this: Greed. On October 9, 2002 Hans speculated that Dr. Cornbleet was "desperate for patients, and, if I were to go on accutane, I would have to see him every two weeks for a check up." These two claims would seem to be inconsistent, however. Presumably Dr. Cornbleet did not tell Hans that Accutane was an "extremely safe" and "popular drug with no serious side effects" that nevertheless required an intense schedule of bi-monthly monitoring visits. And yet, especially compared to the standards of internet discussion forums, Peterson's writing is frequently clear and concise. At times he even grows impatient with his fellow posters, chastising them for throwing out statistics and claims without citations: "Is there anyone that can tell me where this information is actually published ? I admire the effort of the people that run this site, but you should really provide some adequate form of citation, so we know that these figures aren't just pulled out of the air...I don't doubt the truth of these statements, but in order for this website to be taken seriously, there needs to be some way of verifying the claims that are made on it." After a period of frequent activity in the spring and summer of 2004, Hans disappears from the forum for two years, returning on September 20, 2006, just four weeks before he would travel from New York to Chicago to murder Dr. Cornbleet. On that day he posts two links--one to a depression study reported on the BBC web site and another to a video on YouTube. On October 10, he posts the complete text of an article about Dopamine. The next post is February 7, 2007, more than three months after the murder: "I was deceived by my doctor almost 5 years ago into taking this drug (no consent form, no med guide, no warnings whatsoever). I took a rather high dose for two days. TWO DAYS!!! (albeit an 80 mg undivided dose) Life altering, presumably neurological, problems which I never experienced before have plagued me ever since. "I will never know again what it is like to pleasure a woman because I no longer have any sexual sensation - I will never again experience what silence is due to the constant ringing in my ears - I will never know who I would have become because of what this motherf**king drug has done to my mind. A drug which I should have never been prescribed...In at least some cases, such as mine, this drug just does its damage when its taken, or shortly thereafter, and that's it. No real hope of recovery, doctors are useless, the damage is done. "Doubt my problems and their connection to Accutane all you want - I know I wouldn't believe a word of it if I had never taken the drug and someone told me the story I have told above. The truth is, I'm a rational non-hypochondriac who still can't believe how his life has been changed by this drug." He posted four more times before he turned himself in to St. Martin police in August. On July 2, his second-to-last post he wrote: "Justice will not be found through the legal system. There is no way to objectively verify Accutane-induced permanent neurological problems. Even if there were, it would be near impossible to legally prove causation. Even then, statutes of limitation would have run... If and when the **** ever does hit the fan they will just point out how strenuously they claimed their ignorance about permanent problems. "Would legal justice even be justice, anyway? The people who have profitted from Roche's deception won't be personally brought to justice -- they will be shielded from personal liability... Roche's stock might drop, that's about it, it still would have been rational for those ***holes to deceive regarding Accutane in the first place: its profits over the years have been more than enough. The corrupt FDA, as a gov't institution, can't be held liable.... "There is no foreseeable retributive action in the legal system which would make their fraud regarding Accutane a mistake. Their decisions were economically rational and they know it. Would taking some of their money even be justice? Their lives would go on, just with a little less money. Our lives will never be the same. "If you seek real justice, it will not come through the legal system -- they know this, that's why they continue to deceive and play ignorant. It is the financially rational thing to do..." Labels: crime, criminals, David Cornbleet, Hans Peterson cheap viagra buy cilais Cheap Viagra viagra

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