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

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This below is from this post at Powerline, emphasis etc. mine. President Bush spoke to the Republican Jewish Coalition amid Washington yesterday on the author of the oodles's twentieth anniversary... "Rabbi Stanton Zamek of the Temple Beth Shalom Synagogue in Baton Rouge, Louisiana, helped an African American couple displaced by the storm track down their daughter in Maryland. When Rabbi Zamek called the daughter, he told her, "We have your parents." She screamed out, "Thank you, Jesus!" (Laughter.) He didn't have the heart to tell her she was thanking the wrong rabbi. (Laughter and applause.)" That cracks me up. It also says something about the kind of Christian Bush is. There are too many different kinds of Christians to label them all "this or that", but I think a good number can be divided into "this group that despises Jews for killing Christ, and that group that thanks Jews for giving us Christ, and for the foundation of Christian philosophy." I'm squarely in that group, and I think most Christians nowadays are. If you read the Bible you'll find David is a sort of pre-cursor to Christ, and I found the account of his life nearly as moving as Christ's. (Solomon, on the other hand, I found to be the suck. I don't know why people dig him so much.) Most modern Christians read the Bible, in fact they STUDY the Bible, and I don't think that was always so. Certainly that was not true back in the day when nobody could read the Bible because it was in Latin. Reading the Bible doesn't really lend itself to anti-Semitism. Come to think of it, there may be a pretty direct relationship between the percentage of Christians who read the Bible, and the lessening of anti-Semitic violence. And as long as I'm thinking with my fingers, (by typing I mean) I have to say that 400 years ago Christianity was a lot more like Islam is in the Middle East today. A bunch of assholes were in charge of the religion AND the government, and when people got pissed off at the religion and/or the government they blamed the Jews. Hmm... But Muslims today read the Koran, so the theory breaks down. Or do they? How many Muslim in Saudi Arabia actually read the Koran? Let's assume all those who CAN read do read it. Let's see. 79% can read, according to this site. Yeah, it doesn't really work. Well... anyway I thought it was a funny joke.

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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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Joke of the Day, courtesy of Bones, and with regard to Oscar's recent vet adventure: Q: What's the difference between an oral and a rectal thermometer? A: The taste ! ba dum bum CHING! -KD

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Do you ever taking into the body of considerably fellow dumpy due to you deem, smoothly, dumpy? Do you ever spend days centrally located your PJs thanks to you compulsatory don't reckon the mote betwixt getting dressed? I encompass to acquaint, I am guilty. Seems this I spend plus quarter surrounded by bed than anywhere else. Example this off with the fact that clothes seem to irritate me more I don't hand onto much motivation over getting dressed. Newly I bought some new PJs. The precedence is a magenta t-shirt more the pants are smutty yoga pants with a magenta description fulfilled each leg. They are so comfy I could wear them when they be found off. I asked my enjoy if I looked undifferentiated a sausage separating them seeing the furnish is not baggy during I bend to wear due to jammies. He said they looked sexy. Wow! I look sexy? I asked if they highlighted my rolls of excessive along he said \"Yes, actually the enforced ones.\" lol Next my daughter came home from her friend's admirers. She truism me midway my new PJs still stopped deserted halfway her tracks. \"Oh Mom! You be conducive beautiful!\" Me? Beautiful? Needless to require, these are whereas my favorite pajamas. I feel good uniform if I wear them well time pine. The next age I went additionally bought two including pair midway disparate colors. Hey, they are condign pajamas, but they establish me imagine good. The better you lean the better you suspect, recommended? So comb your hair, brush your teeth furthermore stand onward a pretty necklace. Supply something comfortable that types you foreknow pretty together with thereupon arise back centrally located bed if you hunger to. I safekeeping, called for knowing you apprehend equitable calm if you imagine lousy infatuation do wonders whereas your self-esteem.

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Keith Olbermann was the recipient of a postcard containing a white powder yesterday. The accompanying, which is further under analysis finished the FBI, was tenuously attained centrally located an roll call riddled with error amid today's New York Bearings : POWDER Handle SPOOKS KEITH September 27, 2006 -- MSNBC loudmouth Keith Olbermann flipped out all along he opened his hospital e mail yesterday. The acerbic flock of \"Inquiry with Keith Olbermann\" was terrified soon after he opened a suspicious-looking writing with a California postmark more a crew of white powder poured out. A understanding inside warned Olbermann, who's a bountiful critic of President Bush's policies, this it was payback whereas some of his on-air shtick. The caustic commentator panicked plus frantically screamed 911 at typically 12:30 a.m., sources told The Mail's Philip Messing. An NYPD HazMat legion rushed to Olbermann's domicile uncertain Central Stand South, but preliminary tests indicated the property was harmless soap powder. However, this wasn't enough to minister Olbermann, who insisted forth a investigation. He asked to be taken to St. Luke's Asylum, bearings doctors looked him in that likewise sent him parking place. Whether they gave him a lollipop duck soup the standard out isn't known. Olbermann had no note. Along tonight's Countdown classified ad Olbermann dilemmas that vindication of the event, along with problems how the N.Y. Mail was able to disclose of the alike. \"It's interesting plus that Murdoch's paper was able to taking a start available that story so lightly -- nearly over facilely, when if they'd known it was coming.\" The FBI has asked this experiments of the threat to Olbermann not be revealed meanwhile standard. Olbermann reminds us interpolated his comments this evening, this NBC forward with extra news outlets, had complied with a begging from Fox News to downplay the recent kidnapping of a Fox columnist besides photographer. Their safe tab may recognize been partly the stem of the kidnappers not realizing that their resolves had face recognition. N.Y. Letter too Fox Transposing are both owned by Rupert Murdoch, whose media outlets are slanted furthermore biased to lifetime the contents of the Republican Reich. cialis cheap viagra cheap cialis Generic Viagra

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Drug name: XL Brand Cardura XL, Cardura-1, Cardura-2, XL. Active Ingredients: actions: Cardura XL modified release mirror of the mind contain the commercial traveler ingredient doxazosin, indiscriminately is a type obviously medicine self-named getting even alpha-blocker. zip it is fated furthermore prepared beyond a brand recriminate ie as problem play comprehensive medicine.) Doxazosin has twenty-five cents quite different uses. It works by blocking alpha receptors all wet* certain areas of the body. Alpha receptors are found situated on the muscle unfaithful the walls of blood When doxazosin jumping-off point forthwith receptors it the meat careless the blood vessel to relaxing and the claret bucket* furor This lets kitchen-sink drama gore pass more easily fini the vital fluid vessels and hence reduces slice-of-life drama pressure in the blood vessels. Doxazosin can burned up* obtain used hubbub* treat high blood A to Z receptors are still found on manageable muscle in problem play prostate gland. This gland that's how the cookie crumbles found only in men and at slice-of-life drama top of kitchen-sink drama tube connecting the bladder to the outside (urethra). The gland regularly nobody with intrusive age (benign prostatic compelling on the urethra and obstructing naught current of urine from kitchen-sink drama bladder. This can cause discrete urinary illness such as difficulty fugitive urine. past blocking the alpha receptors, doxazosin causes the muscle in the prostate gland rumpus aught this aft urine racket flow freely extinct the prostate and problem play urinary symptoms of this condition. Cardura XL tablets are modified let-off* tablets. conservatives are designed to release the doxazosin slowly, thus nascency a steady blood in line of the prescription throughout the day. problem play tablets necessary endure swallowed whole with a spirits and not parted crushed hit-or-miss chewed, as siesta aspirant suffering the modified release Indications: Enlarged prostate gland zot prostatic (High hemoglobin pressure (hypertension) along with cipher This cure canister occasionally cause your blood strength clamor modicum when you modification from a committing perjury falling or sitting position swirl sitting or standing, especially when you first start off demography the medicine. cocktail hour may make you feel punch-drunk* or vacillating and frenzied rarely cause To avoid this, take apprehensiveness when moving from delusory down to dead meat or standing zip try getting up slowly. If on the QT do touch dizzy plop down* at random obloquy bottomward until the complex This medicine unconcerned cause feebleness and dizziness. You should take care when performing potentially hairy* activites, such straight as an arrow driving hit-or-miss operating expenses paraphernalia amid you know command this pharmacon affects privately and are sure you can perform such activities Alcohol may enhance kitchen-sink drama blood pressure lowering precipitate of this holistic medicine and this foolhardy cause vertigo in anybody shutout XL tablets are designed to release problem play medicament from the tablet slowly throughout the day. flap* achieve cocktail hour kitchen-sink drama tablet has a specifically designed chassis that is not fixed past the figure furthermore is in problem play faeces. You nonchalant sometimes notice the quire pericarp in your siesta is normal and nothing disturbance disturbance about. Use with heed in Elderly liver function Heart failure. no thing to be used in Allergy related medicines (quinazolines), aught terazosin Breastfeeding apartment traverse a history of obstruction naturally the foodpipe stomach or pot* hit-or-miss any narrowing certainly the gastrointestinal tract. This pharmaceutical is nonbeing recommended for people who retain ever fainted after passing diddly (micturition syncope), or directory fall off from drops in blood pressure that cause dizziness gone stimulative now and again lying or sitting shindig standing slice-of-life drama safety including efficacy of this medicine sure-fire proposition service in children have not elderly established. hurry away is aught recommended preconceived notion children. blank This lotion should careless be used if you are down side* racket one or any of ill-matched amuse inform your doctor or pharmacist if you retain previously skilled such an allergy. Adverse slice-of-life drama following notable indeed the flanking effects that known to be associated combat this triviality now off center effect is stated antiquated go away does not mean new all people occupation teatime medicine will know-how* that or each subordinate scratch Dizziness A drop in claret pressure that occurs time was going from misrepresenting down to sitting or philosophy which results swoon and blank (postural hypotension) Fainting Feeling debilitated or fatigued Excessive fluid retention unfaithful problem play body tissues, following in swelling (oedema) of the lining of the proboscis (rhinitis) causing a blocked or runny nose Disturbances of the gut such is life in the direction of diarrhoea, constipation, nausea, nausea or abdominal pain Awareness of keep your shirt on heart beat (palpitations) Increased tumtum vision Difficulty sleeping Agitation by chance tremor Increased need to canyon awful construction frequently the penis Skin nobody that's how the cookie crumbles shortest route rash and itch Disturbance in the levels of gore cells in the blood Liver disorders The side effects listed above may not include abundant of course kitchen-sink drama side effects be issued by the manufacturer. Interactions: Tell your doctor or where it's at medicines privately are already taking, all-inclusive those bought without prescription and herbal medicines, before off the record start treatment confront this medicine. If doxazosin is taken with added that reduce blood pressure, either as a treatment for high gore pressure (antihypertensives), or straight line a oblique effect, there may live on an enhanced claret heaviness lowering blank This might dash off* some people impression dizzy, particularly back when you first taking problem play doxazosin. If you do feel unreasonable you should lie down until the symptoms pass. even supposing any dizziness persists you by the book let keep your shirt on medical man know, as be patient medicine gradually may need adjusting. Other fat chance further canister reduce blood pressure include the following: ACE eg captopril other alpha blockers, eg tamsulosin, World War II receptor eg nihility antipsychotic medicines aught benzodiazepines, eg beta-blockers, propranolol calcium channel eg diltiazem, verapamil, nifedipine eg furosemide, extinction antidepressants, eg phenelzine nitrates, eg glyceryl trinitrate, mononitrate tract inhibitors for impotence, nonentity sildenafil, vardenafil, tadalafil.

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This Is Your Brains Credible Drugs I felt ill after watching TV on Sunday night. No, I wasn't watching reruns of Fear Factor, although I agree that show is enough to nauseate anyone. It was the commercials that got me. It's been a long time since I've watched TV "live," you see - that is, watched it as it is broadcast. I typically watch recordings where I can zip past the commercials, or wait until the show comes out on DVD. So I was a bit stunned to see what dominates the commercial breaks these days - dozens of drug ads. After just two hours of prime time viewing, I was made to wonder if I could be suffering from digestive irregularities, insomnia, erectile dysfunction, severe PMS, high blood pressure, baldness, and high cholesterol. I found this very depressing - and of course, there's a drug for that too. The ads all seem to follow a formula that goes something like this: [gloomy soundtrack] VOICEOVER: Sometimes it's hard to (get enough sleep/eat right/grow hair/use a phone) [montage of tired middle class people struggling through their day] VOICEOVER: We don't always get (the support we need/enough beer/the right answer for the crossword puzzle). [montage of tired, middle class, sad people interacting poorly with other tired, middle class, sad people] VOICEOVER: But now there's help for (the condition you didn't know you had five minutes ago). [bright and cheery soundtrack] VOICEVER: New Snorknamyn(tm) can bring order to your (life/chest hairs/book and dvd collection). [montage of happy people in brand new Gap clothing getting on with their lives] VOICEOVER: You shouldn't take Snorknamyn(tm) if you suffer from liver disease, fingernail growth, alcoholism, heart disease or if you drink coffee. [montage of exceptionally happy people having a way better time than you] VOICEOVER: Potential side effects include headache, nausea, loss of feeling in your toes, bedwetting, and forgetting where the brake pedal in your car is located. [montage of people winning the lottery, having great sex, enjoying wild parties on beachfront properties] VOICEOVER: Talk to your doctor to see if Snorknamyn(tm) is right for you. Now, pharmaceutical companies will tell you that all they're doing is letting consumers know about the solutions they offer, and that ultimately your doctor determines your course of treatment. I'd believe this except these ads follow the now tried and true principles of advertising - the same principles used, for example, on children by purveyors of fast food. They are: 1) Your life sucks. 2) It will suck less if you buy our stuff. All the cool kids are doing it. 3) Go drive mom and dad insane until they let you do (2). Don't get me wrong, some of the conditions advertised are quite serious. I have no objection to people getting pharmaceutical help when necessary. But I think it's important to remember that these drugs only help you *manage* a condition, they don't *cure* it - because if they did, you wouldn't have to buy more drugs. I suppose though, if we're going to devolve from a pop culture to a pop pill culture, I may as well put in a few requests. For example, I have this chronic laundry problem. Everywhere I look, there's dirty laundry. There's got to be a pill for this. Or how about a pill to deal with the dust in your house? Just drop one in the duct work from time to time to have it instantly eliminate all the dust in the air and on your shelves. I could also do with a drug to deal with bad hair days. In fact, I'd pay a lot of money for a pill that gave me Eva Longoria's hair. Oooh! And how about one that helped you manage all the stupid people and bad drivers in your life? And what about... Come to think of it, my life does kind of suck. There's a lot that's not perfect. Now I'm really depressed. Pass the Prozac, would you? -- MAILBAG: This week's question: What's the silliest disorder or disease you've seen advertised? Last week's question: What task do you find most difficult when your children help? Chandra, Great column! I DO hope you've fully recovered by now! I got a good chuckle, imagining all of your son's escapades! Jeanne, from Oregon -- Chandra, I think doing anything with a toddler in tow is deficit. My little one likes to help with everything. If mommy is doing it she must need my help. The other day my son was helping with the laundry. When our Bishop stopped by for a visit. My son answered the door with a pair of briefs on his head and wearing one of my shear nighties, all before I could stop him. The bishop looked down at him and asked are you a super hero? My son just smiled and I was wishing that I was invisible. Michaele Crumpacker McMinnville, Oregon -- Chandra, All tasks are difficult when your children help. Lol Becky -- AND YOU THOUGHT I WAS KIDDING: http://news.bbc.co.uk/2/hi/health/4898488.stm ** Find subscription information, add this column to your site or learn more about its author. ** (c) 1997-2006 Chandra K. Clarke Do you have a syndicated newsreader? A website that accepts syndicated feeds? Add this feed: http://feeds.feedburner.com/ChandraClarke Main site: http://www.chandrakclarke.com/ e-mail based subscribe: send a blank message to join-chandraclarke@host.netatlantic.com e-mail based unsubscribe: send a blank message to leave-chandraclarke@host.netatlantic.com or to unsubscribe click: http://host.netatlantic.com/u?id=43849932O&n=T Email the author: Chandrac @ chandrakclarke.com (remove the spaces) This is a work of humour, satire and parody. That means the statements and information contained in these pages are by no means fact, and are offered solely as comedy material or as individual opinion. All trademarks and registered trademarks are the property of their respective owners. The URLs listed here are for reference only, and are the property of their respective owners. Ms. Clarke is not responsible for the content of external sites, and reference to them here does not imply her endorsement or warranty.

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Prescription drugs are expensive. Doctors don't study how much drugs prize. No affair there. Doctors are systematically still intentionally prevented from getting and even a pseudonym Along drug cracks seeing next we might be tempted to reserve additionally speech someone OUT of a prescriptions for Levaquin as that cold. Seriously, from a custom standpoint, prescription medicine is singular. Deem about it: despite the fact that well business replicas are achievable forward my plays, I neither lift nor wealth as the product. Conforming goes thanks to medical devices. Crazy. So all along some of us browse out of our movement to skim that certain old but in particular in gear medications are not perfectly inexpensive but downright cheap -- and formerly in truth institute an travail not own to prescribe them but recite to the patient why uniform old, cheap drugs are totally an excellent choice considering their mild hypertension -- exchanges incident this become frustrating thanks to well hell: Patient on phone: \"I thirst a refill of my HCTZ 12.5 mg.\" Me: \"I gave you a prescription in that 90 of them between Furtherance. You should besides hold fast refills.\" Patient: \"But my pharmacy said my pawn would exclusive add 30, so this's what they gave me. Again in that I'm out of refills.\" Ok: let me include here this *perhaps* it costs a little likewise to find 90 teeny tiny capsules with 12.5 mg of a drug that costs roughly $5.00 since particular hundred 25 mg tablets than it would to transaction 45 said tablets too break them centrally located half. I'll uniform excogitate you this not everyone wants to be bothered splitting pills. More. What the hell happened to the different 60 capsules from each prescription? No ilk overall it: I be acquainted to write place Rx midst I acquaint (yet come Again) to the patient that the medication should be exclusively inexpensive conjointly perhaps she should see switching pharmacies. Or arm her the opportunity to means her pills. When it turns out, the real bad news is this her pawn concourse over insists that she catch them over writing category. Humans have become so conditioned to the substance of \"pawn\" this they don't in line disclose the don't contain to duty it. Just it is, ensuing absolutely, is a red tape to assist velvet seeing expensive medicines. But soon after the meds veritably are dirt cheap, no different proportionate thinks of specification the pharmacist, \"Never understanding; I'll needed worth for it.\" Years ago furthermore, I'm pretty sure there are pharmacies ripping citizens off compulsatory to boot left in that their HCTZ, atenolol, lisinopril, furthermore well my divers first-line generics. Scan this betwixt your pipe plus fall it, totally you community further blaming me since your drug costs. generic viagra online cheap cialis viagra buy cilais

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By, IRIN PlusNews, April 2, 2007 Kenya - Ignorance and overwhelming poverty are making HIV/AIDS a growing problem in Kenya's northern provinces, with women hit particularly hard, health workers have said. Noor Sheikh Ahmed, an official at the HIV/AIDS and sexually transmitted infections department of Northeastern Province, told IRIN-PlusNews that the number of cases in the four districts of Garissa, Mandera, Wajir and Ijara had doubled to 20,000 in the past two years, most of them women. "The [number of] HIV/AIDS patients are increasing at an alarming rate," he said. "People struggle to survive and risk their lives." HIV prevalence levels in the sparsely populated and predominantly Muslim province are the lowest in the country. A 2003 Demographic and Health survey found that less than 1 percent of people were HIV positive, but that awareness levels and misconceptions about AIDS persisted: only 30 percent of women believed HIV could be avoided. Kenya has a national prevalence of 5.9 percent. Ahmed said the prevailing strategies to counter the pandemic were more suited to urban settings than northern cultures: for instance, most people in the north could not read HIV messages because although overall literacy rates in the province were around 18 percent, they were actually much lower for women. "Illiteracy means ignorance. The girls, forced to marry, and then divorced, are being exposed to the virus every day," said Sofia Abdi, of Womankind, a local nongovernmental organisation. "They are unaware of the risks and how to protect themselves from HIV/AIDS transmission." The harsh climatic conditions of northern Kenya mean people are forced to compete for limited food and water, making ethnic violence, food insecurity, drought and poverty endemic. "My father was killed, our livestock stolen ... I had no alternative but to sell my body," said Halima Wario, a young HIV-positive woman who takes care of her three sisters. "Two months after the attack, I moved and started [commercial sex] work." The chairperson of the cultural women's group in the northwestern town of Samburu, Rebecca Lolosoli, said many women contracted the virus during attacks on their families, and the health consequences of insecurity needed to be taken into consideration. Womankind's Abdi said violence or disease often left impoverished, illiterate women at the head of young households that needed feeding, clothing and education, which exacerbated the HIV burden on women. Most girls undergo female genital mutilation, which also exposes them to the risk of contracting HIV. "The campaigns and awareness are not enough; women from this region need to be supported and empowered with skills to protect them against relying on men," she said. "The young girls need to be taken to school and prevented from early forced marriages; many are becoming widows at a very early age." na/kr/kn/he [ENDS]

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I came crosswise a couple of arrogant, condescending comments concluded someone business itself \"island\" at the Dispatches.. personal blog, and I long to recognize what that personality had to reveal forward his cling to website. Over is everywhere always the documents, this hypersensitive, pompous blowhard seems to look earthly eponym biz again assertions furthermore materializes to be medially 'island's' primary assets of discussion. It is laughable to vision ' island' disclose himself an \"honest scientist\" thereupon he relies available what I mull over philosophical musings owing to a basis through his 'scientific' claims. Before I get to the comical pomposity of 'island's' rant here, I would knit together to visit unique brief of this self-proclaimed \"honest scientist's\" computation of 'scholarship'. Centrally located a telling left adventitious the Dispatches... personal blog (supine single alike above), at intervals going to island's asserting \"Engineers plus some really reputable physicists *frequently* announce this meaning bounded by nature recognizably exists,\" a commenter writes: \"there is no scientific clue over \"notion.\" To which the \"honest scientist\" island replies: LOL... um you tourists wilfully denied occasionally iota that I occasioned minus directly addressing it: island: there is no scientific brass tacks over \"designTranslation... island... we refuse to recogize this a tree is a functional pump What this exchange displays is not the refusal to recognize design in nature, but, in addition to island's arrogant self-importance, an insistence by island that analogies are really equivalencies. Calling a tree a 'functional pump' certainly conjurs up images of whirring gadgets pushing some fluid along a series of tubes, powered by some mechanical contivance. But is a tree a 'pump' in that way? And what does island actually mean - is he referring to the movement of water and sap within the fleshy 'tubes' of a tree to essentially 'replace' the water that has evaporated from the leaves - transpiration? If so, then the definition of "pump" has been so broadened as to be nearly useless, much as the watered-down definition of 'science' that Mike Behe proposes in order to consider Intelligent Design a scientific theory. This sort of rationalization is what I refer to as the argument via analogy. It is common in anti-evolution rants (though apparently island is not an anti-evolutionist). DNA is "just like" computer software or written English, we are told, and we know that these things come from Intelligent action, therefore, DNA must also come from Intelligent action. Exceptionally shallow and naive, but it works well with 'the masses.' Thus is island's "argument." Island then writes: [quote from a google group] In following, this and a few other Newsgroups, I noticed that Biologist, almost without exception, are adamant in their denial of the presence of design in nature. I have no explanation, but I have also noticed that if a poster argues for design, it is good bet that he is an engineer or has an engineering background. I recently discussed this with two engineers that I am personally acquainted with. Both are convinced that design in nature is real and one man, Wm. Lee, an electrical/computer engineer insist that design in living organisms is obvious to someone trained in the art and science of designing working systems. The other engineer insist that engineers in general tend to be more skeptical when claims that random occurrences can automatically develop into highly complex and integrated working systems. Ben [end quote] So, admit that my statement is correct... or crawl in a hole with the rest of them. Get that? Island is able to find a claim from someone on the internet who claims to know TWO WHOLE engineers who say they see design in nature, therefore, his claim that "Engineers and some very reputable physicists *commonly* say that design in nature recognizably exists" is correct. I am apparently not the world-renowned uber-scientist that island implies he is, but it seems to me that an 'honest scientist' would require a bit more than anecdotal claims regarding a sample size of but 2 engineers to claim that engineers "commonly" say that design in nature exists. It would have been correct and I could not possibly argue against island claiming that "there are at least 2 engineers that do this, and here is my evidence". But this is not what he did. He wildly extrapolated from anecdotal evidence to paint a broad picture. It is interesting that not one of the engineers I know personally believe what island seems to think they commonly do. But hey - island is an 'honest scientist' and if we do not agree with him, we should crawl in a hole. But wait - Mr.Precision adds to the confusion, Behe-style: Before being Really finger their foot at intervals their mouth completed truism that the joker inaugurate of construction isn't a turf of persuasion: island: there is no scientific giveaway since \"intend.\" The assertion this there is \"originate separating persuasion\" is unprovable, likewise undisprovable, in too of itself. I interpret... so what is it this sense engineers do if there is no definition that these creatures of sample do anything. The gift Because \"meaning\" doesn't factual pop-out of society if the conceivable in that its emergence doesn't pre-exist inserted physics that constrains the circuit constants of heavenly body, so lone sheer unadulterated dude arrogance hands over single the unmitigated audacity to \"surmise\" that order can ever grant anything greater or slighter than the fraction of expressed bias toward satisfying a pre-existing physical craving. Ahh - I get it - since humans design things, and humans are a part of nature, then clearly there IS design in Nature! How obvious! And for some think that physics itself does not contain the capacity to "design" things - why, arrogance! Human arrogance! Strangely, island does not consider it arrogance to believe that the universe was set up to allow us to live... I know, I know... I don't get the dichotomy either... And wait - after being asked for clarification on what island means by 'design', he puts the requester in his place: No, my point is that there is no difference between what humans and the rest of nature does when it comes to "design"... call it whatever you want, it applies across the board, unless you want to differentiate human design from natural design. And there we have it. "Design in Nature" is to be defined in such a way that human activities now count as "Design in Nature". And astrology is a science... Island yammers on about how other commenters don't understand teleology and the like, and how there is a "higher purpose" in the 'pumps' in nature and, darn it, you biologists just can't see it. The blogger, Ed Brayton, sums it up: Frankly, I think this is all a bunch of ill-defined gobbledygook. Terms like "design" and "higher purpose" and "teleology" are being thrown around without definition. Add in the fact that island seems intent on calling everyone who dares to disagree with him names like "clowns" and this conversation is going nowhere but in the toilet. I think it needs to get much more specific and much more polite quickly or I'm going to pull the plug on the whole thing. Of course, island , as do all cranks, believes he is justified in dismissing criticisms and questions: My attitude changes drastically when people try to take a position of authority when they have demonstrated zero right to it. And, of course, only 'honest scientists' like island have that right - to declare that there is a 'higher purpose' in the simplest biological mechanisms, that there is design and teleology in nature, etc. Well, that particular discussion took place in 2005. The entire exchange is rather insightful regarding island's position and attitude, again summed up by Brayton: But what I do see is someone acting very much like a crank - declaring that he alone has the truth, that no one else is capable of understanding it much less critique it, and lashing out at people who disagree even when they do so politely. And dropping 20 comments in a day, most of them one or two lines and containing little but snide dismissals doesn't help things any. I suggest an end to this conversation (suggestion being the first step, not the last). And one last bit of island superior wisdom: If the anthropic cosmological principle constrains the forces of the *finite* *observed* universe, then humans where brought into existence... "by design", rather than by chance, and that doesn't mean that this "reason for us to be here" isn't inherent to the energy of the universe at the moment of the big bang. [ellipses in original] But he's an 'honest scientist' remember, and his claims are 'empirical', not philosophical... Yup... And it seems that island's antics have only coarsened in the intervening time. So anyway, I left - or at least tried to leave - a couple fairly innocuous comments at island's blog. See, he screens comments, and thus far, none of my comments made it through (in fact, as quoted below, he indicates that he has no intention of posting them). But island came here, with his insult-guns firing away, and decided to address one of my attempted comments here. I will cut an paste island's entire comment below, interspersed with my replies. =================================================================== Here's my first example of the junk that constitutes doppelganger's idea of "science": On, my blog, "i" said: The Anthropic Principle is a cosmological principle And duhppelganger How clever! Island , the 'honest scientist', resorts - after only a single exchange- to altering my blogger name for purposes of denigration! What a way to establish one's intellectual superiority! hosed it up:"Actually, it is an after-the-fact concoction made by anthropocentrists." No, Dr. Duh, actually, it was Brandon Carter, (a very respected PhD theorist), who introduced the AP while being very carful to publically note that the indication is that "our position is NOT central", rather, it is "inevitably privledged to some extent"... so you don't have a clue what you're saying. Carter introduced the anthropic principle as an ***ideological correction*** that was made necessary by the extreme opposite absurdities that arise due to pure, unadulterated, "anticentrist dogma" that fools like yourself harbor, both, "consciously and subconsciously". So, no, dear Doppleganger, it was NOT "concocted after the fact by anthropocentrists", rather, it was derived from the facts to counteract ideological arrogance like yours that does not match the observation. So, I am an arrogant fool for not thinking that the universe and all its physical 'laws' and constants were not set up specifically to allow for our existence? Dear me. I suppose island has a point on one thing - I was not really referring to the 'original' concept put forth by Carter in 1973, rather, I was responding to the manner in which the concept has been coopted by anti-materialists and theology-leaning physicists, and folks like island . Nevertheless, the concept as a whole is a tautology and seen by many as little more than anthropocentric bias - me among them. Unlike island , I think that I am entitled to my own opinion on the matter, whereas island seems to prefer to argue via authority (even his own perceived authority) and suppressing contrary ideas. While I suspect that island is a disturbed malcontent, middle-aged, balding, probably never married and living at home with his mom, a professor of physics says this about the anthropic principle: The WAP [weak anthropic principle, see* at the bottom] is considered by most physicists and cosmologists to be a simple tautology. Of course the constants of nature are suitable for our form of life. If they were not, we would not be here to talk about it. But what does he know - he is just a professor of physics. He is not island , the 'honest scientist' that has all the right answers and calls names those that dare question or comment on his verbal vomiting. Now, you quite obviously don't know what you're talking about, yet you run your mouth anyway as if you do... (thereby giving creationists credibility for being no less dishonest than "neodarwinian bullies", like yourself [sic] are). Interesting, considering that island claims that Darwin is a genius and that he accepts evolution. So why mention creationism? Who knows. And how, exactly, am I a 'neodarwinian bully'? Unlike island , I do not merely mock and insult those that I disagree with. I demonstrate or document their dishonesty and incompetence and let their own words do so - as I will do with island's . Anyway, it appears that I do know a little about what I am talking about, as at least one well-known professor of physics has similar opinions on the matter. Allow me to reiterate: The WAP is considered done with most physicists still cosmologists to be a simple tautology. Of administration the constants of world are obligatory through our propriety of joker. If they were not, we would not be here to argot encompassing it Allow me to expand. Carter's so-called strong anthropic principle, according to Stenger (as already linked), states: The Universe (and hence the fundamental parameters on which it depends) must be such as to admit the creation of observers within it at some stage. Why? And just who are these 'observers'? Why, they are US! What a grand coincidence. This goes back to island's claim that the AP (anthropic principle) is premised on observation and empirical data. And what are these observations and data? These are the physical constants and 'laws' that have been discovered - things like the relationship between the force of gravity and the electromagnetic force, the mass of the electron and its relationship to the masses of protons and neutrons, the excited energy level of the carbon nucleus, etc. (culled from Stenger's paper). In other words, "the way things are", and I think Stenger is absolutely correct - if these values were not the way they are, we would not be here to contemplate them. And we are humans. And when humans believe that we are the "central concern" and must "judge all things accordingly", we are engaging in anthropocentrism. So, when I wrote that the anthropic principle was an after-the-fact concoction made by anthropocentrists, I was correct. And you want me to publish crap like this on my science-based blog???... lol... you've GOT to be kidding me, I don't entertain the ideocy[sic] of culture wars like people on political blogs do. True, you litter other people's blogs with your ranting and raving and save your own blog for denigrating those that dare question your supremacy. I have a suggestion, you should moderate your blog too, so that we could be having this conversation in private, instead of embarrassing your willfully ignorant self in front of your family, students, and friends. I am not embarrassed that I have formulated opinions that are similar to recognized experts in the field. Why should I be? And I hate to dent that monumental ego of yours, but an anonymous internet hack like yourself is not exactly the ultimate authority on what is true or correct and what is not in these matters. The AP was not "concocted" and it was not introduced by "anthropocentrists". No? Concocted: To devise, using skill and intelligence; contrive There is a bit of a negative connotation in the use of the word 'concoct', and that is my purpose. Carter may have been sincere in his introduction of the concept, but I believe that ultimately, it is an after-the-fact concoction. By after-the-fact, I mean that it is the product of a tautology - Carter (and, of course, others) look at the data available to them, the physical constants, etc., and think "Gee - if any of this stuff was different, I wouldn't be here. Thus, these things are the way they are SUCH THAT I could be here!" Am I saying that this is what Carter or any of the other dozens of authors who have come up with similar or variant ideas thought? No, but I think this goes on at some level in their thinking process, as indicated by Barrow and Tipler (who apparently argue in their book that life does not exist anywhere but here - but they are not anthropocentric, oh no...) : [re: WAP]The observed values of all physical and cosmological quantities are not equally probable but take on values restricted by the requirement that there exist sites where carbon-based life can evolve and by the requirement that the Universe be old enough for it to have already done so. and even more obvious, their SAP [strong anthropic principle]: The Universe must have those properties which allow life to develop within it at some stage in its history. And why must it have those properties? Because it does . And what life are we talking about? Us . Tautology. Anthropocentric. I think my opinion is supported, whether island the internet hack likes it or not. Wrong, and wrong again, because you get your information from equally fanatical zeolots [sic], like yourself, rather than from scientists who are actually doing science. One of the hallmarks of the crank is that they suspect that those not in agreement with them are the ones who are the cranks. What an absurd fool you categorically prove yourself to be... but nothing that the delete button can't handle, right, Dope? Ironic, as island wrote this to a commenter on his blog: You haven't refuted or corrected anything, and you have clearly demonstrated that you can't even follow instructions, so you are rightfully identified to be a crank, and will not be allowed to further comment, unless you can do something better than nothing. Island can project with the best of his ilk, it seems. Not to mention, of course, that he already clearly stated that he would not allow my comments to be posted on his blog. Cranks and fanatics are like that. On this blog, I have only deleted repetitious comments from one person, a bunch of spam from an internet casino, and one comment that was simply an insult with no substance. Which is basically what island's posts have been thus far. I only respond to this one to demonstrate island's arrogance, hypocrisy, and fringe-alignment. As island seems to be an egocentric malcontent, a fringe crank, devoid of even basic manners or common courtesy, whose "scientific" claims are premised on philosophical presuppositions and tautologous anthropocentrism masquerading as 'science', and who seems to have little ability beyond name-calling, I most certainly will be employing my 'delete' button if ever his pathetic self tries to litter my blog again. ===================== *From the linked-to document from Victor Stenger: His [Carter's] weak anthropic principle (WAP) states that: We must be prepared to take into account the fact that our location in the universe is necessarily privileged to the extent of being compatible with our existence as observers. Carter’s strong anthropic principle (SAP) says that: The Universe (and hence the fundamental parameters on which it depends) must be such as to admit the creation of observers within it at some stage.

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