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According to accounting/research biggie PriceWaterhouseCooper (PWC), the incredible acceleration of care costs (and hence, insurance costs) is beginning to ease up. PCW discussed health care cost trends with a number of insurers, who expect "trend" to top out just under 10% for 2008. This is actually lower than the double-digit numbers we've seen the past few years. [Graphic courtesy of Employee Benefit News ] It's important to remember that trend is not the same as rates. That is, how much higher health care is expected to be is but one factor in determining how much an insurer will charge. Lower trends have a positive impact on rates, of course, which is good. It also underscores our mantra here (originally and succinctly promulgated by Mike Feehan) that "health insurance costs increase because health care costs increase." Amen. There's actually a lot of interesting information in the report; for example, carriers are expecting prescription drug costs to slow down a bit, an increase in EMR and other digital applications, and more widespread adoption of transparency tools. According to the report, prescription drug costs accounted for some 14% of all health care costs this past year, while physician charges represented the lion's share (35%). I was pleased to see that HDHP rates are expected to rise much less (25% less, in fact) than more "traditional" HMO and PPO plans. That's good news, indeed. Of course, by shifting some of the costs of health care back to those who actually use it, it follows that there would be more careful utilization, resulting in lower health care expenditures (and cost). Kind of a win-win deal. The report itself is pretty easy reading, and is available (in pdf form) here.

Tags: cost, health, care, trend, rates

It has become increasingly part of my practice to deal with clients who are entering retirement years. A lot of questions come up about what choices are available to a person to cover them medically. I am going to go over some of those choices. Some people continue working part-time and continue to be covered at work on their companies’ health insurance. Sometimes this is the best choice, but I doubt it is in most cases. A person can enroll in Medicare. It used to be simple, but has grown more complex. Let me try to break it down. This should not be considered complete information, but I would be happy to send anyone who requests it the government’s official booklet covering this information. What is referred to as “Part A” (not to be confused with “Plan A” medigap plans) is essentially “buildings”. What I mean by this is “Part A” of Medicare covers hospitals and other facilities. This is why I use the word “buildings.” Its places that provide medical care, not persons . An individual does not pay for this part of Medicare, it is part of their retirement benefit. “Part B” of Medicare covers “people”. That is, it pays physician charges, etc . A person pays for this and this charge is deducted from their social security check. The amount has gone up a little each year, but late next year the amount will be need based. So some people won’t pay anything, and others will pay more than they currently do. Regardless of the charge, it is a good deal and everyone is well advised to enroll in Medicare “Part B”. Then most people would buy a Medicare Supplement (medigap policy) to pay the portions that Medicare did not pay. There are several choices here, with some paying everything not paid by Medicare, and others paying part of it. (Medigap policies only pay on charges that Medicare pays something on). They do not pay things Medicare does not pay on. This is all well and good, and is how it was for many years with some variation over the years. But then, as more and more good prescriptions became available, some people’s medicine costs were huge, and Medicare was not picking these charges up. Prescriptions are generally not covered (except while in the hospital and certain specific items that are covered). So Medicare “Part D” was established. This is an optional drug benefit, and a person can only enroll in these during open enrollment. There are many plans available at a low cost. Which is best depends on a person’s prescriptions. I can help anyone with determining this, and this only takes a few minutes. Ask me about it if you’d like help with this. At the same time, Medicare “Part C” was established. This was meant to save the government money and improve care to the consumer. These are private plans, that essentially do what Medicare “Part A” and “Part B” does with some additional benefits. These plans are also referred to as "Advantage Plans." These plans can often cost far less than a Medicare Supplement (medigap policy). There are pluses and minuses to these plans. Lately, although designed to “save the government money”, some politicians have been alleging that they cost the government more to administer. Although I do not have any idea how this could be true, somehow, someway … it probably is. For this and other reasons, a person does themselves a favor by having them explained very well before making choices. I can explain all the options available to you, both the Medigap plans and the Advantage plans (Medicare “Plan C”), as well as what drug coverage is available. Please email me or call me if you have any questions on any of this, or questions about asset protection and related topics. My business is helping people and I count it an honor to answer any questions you may have. Cheap Generic Viagra

Tags: medicare, part, plan, pay, person

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

Tags: drug, patient, doctors, anemia, dr

Here are two historical perspectives on the value of Vitamin E to our health. VITAMIN E: A CURE IN SEARCH OF RECOGNITION, by Dr Andrew Saul is a major historical presentation of the trails, tribulations, and the Canadian connection to determining the effectiveness of vitamin E. In compelling detail, Dr Saul lays out why it does what it does. More importantly, he proves it. In Antioxidant Vitamins Prevent Heart Disease: Verification from the American Heart Association, Richard Passwater is equally evocactive. There is no doubt about Vitamin E efficacy. Cheap Generic Viagra

Tags: vitamin, heart, dr, saul, historical

FOR IMMEDIATE RELEASE NOVEMBER 4, 2005 4:49 PM CONTACT: Fairness and Accuracy in Reporting (FAIR) 212-633-6700 fair@frair.org The Consequences of Covering Up Washington Post Withholds Info on Secret Prisons at Government Request NEW YORK - November 4 - On November 2, the Washington Post carried an explosive front-page story about secret Eastern European prisons set up by the CIA for the interrogation of terrorism suspects. While the Post article, by reporter Dana Priest, gave readers plenty of details, it also withheld the most crucial information--the location of these secret prisons--at the request of government officials. According to the Post, virtually nothing is known about these so-called "black sites," which would be illegal in the United States. Given the abuses at Abu Ghraib and Guantanamo Bay, news that the U.S. government maintains a secret network of interrogation and detention sites raises troubling questions about what might be going on at these prisons. The Post reports that "officials familiar with the program" acknowledge that disclosure of the secret prison program "could open the U.S. government to legal challenges, particularly in foreign courts, and increase the risk of political condemnation at home and abroad." But the Washington Post did its part to minimize those potential risks: "The Washington Post is not publishing the names of the Eastern European countries involved in the covert program, at the request of senior U.S. officials. They argued that the disclosure might disrupt counterterrorism efforts in those countries and elsewhere and could make them targets of possible terrorist retaliation." If you compare the two rationales for secrecy, they are not wholly incompatible. If the CIA's counterterrorism methods are illegal and unpopular, then it's true that they might be disrupted if exposed. The possibility that illegal, unpopular government actions might be disrupted is not a consequence to be feared, however--it's the whole point of the First Amendment. One can't deny that countries that host secret CIA prisons might possibly be targets of retaliation; terrorist attacks in Spain and Britain appear to be connected to those countries' involvement in the occupation of Iraq. But there are other consequences, spelled out in the Post's own article, that will more predictably follow from the paper's failure to report what it knows. Without the basic fact of where these prisons are, it's difficult if not impossible for "legal challenges" or "political condemnation" to force them to close. As the Post notes, there has been "widespread prisoner abuse" in U.S. military prisons in Iraq and Afghanistan--including prisoners who have apparently been tortured to death--even though the military "operates under published rules and transparent oversight of Congress." Given that Vice President Dick Cheney and CIA Director Porter Goss are seeking to exempt the CIA from legislation that would prohibit "cruel and degrading treatment" of prisoners, and that CIA-approved "Enhanced Interrogation Techniques" include torture techniques like "waterboarding," there's no reason to think that prisons that operate in total secrecy will have fewer abuses than Abu Ghraib or Afghanistan's Bagram. Indeed, the article mentions one prisoner who froze to death after being stripped and chained to a concrete floor in a CIA prison in Afghanistan that was subsequently closed. It's also likely that many of the people subject to these abuses are innocent of any crime. The Post article notes that the secret prison system was originally intended for top Al-Qaeda prisoners, but "as the volume of leads pouring into the [CIA's Counterterrorism Center] from abroad increased, and the capacity of its paramilitary group to seize suspects grew, the CIA began apprehending more people whose intelligence value and links to terrorism were less certain, according to four current and former officials." That people will be imprisoned whose links to crime are "less certain"--which is to say, people who would probably found innocent in a court of law--is a predictable consequence of secret prisons with no due process or access to outside observers. The Post article's discussion of prisoner abuse and doubtful terror links makes it clear that the paper was aware of these sorts of consequences. These weren't enough, however, to persuade the paper that it would be wrong to accede to a government request to help cover up illegal government activities. (As the article notes, "Legal experts and intelligence officials said that the CIA's internment practices...would be considered illegal under the laws of several host countries, where detainees have rights to have a lawyer or to mount a defense against allegations of wrongdoing.") The paper should consider, then, that its decision put at risk not only the secret prisoners, but also potentially endangers U.S. soldiers and civilians. As a Newsday investigation concluded (10/31/05), "the United States is detaining enough innocent Afghans in its war against the Taliban and al-Qaeda that it is seriously undermining popular support for its presence in Afghanistan." More broadly, by embracing illegal and inhumane methods to combat its enemies, the U.S. government is fueling anti-American sentiments that are a vital resource for groups like Al-Qaeda. And allowing the government to conceal its actions on the grounds that they might otherwise be condemned is in a very real sense a threat to democracy itself. The Post's decision has struck some experts as enormously significant. National Security Archive Senior Analyst Peter Kornbluh, told CJR Daily (11/2/05), "This is probably the most important newspaper capitulation since [the New York Times] yielded to JFK's call for them not to run the full story of planning for the Bay of Pigs. By withholding the country names, the Post is directly enabling the rendition, secret detention, and torture of prisoners at these locations to continue. That is a ghastly responsibility." But the Post is not the only U.S. news outlet to choose to honor government requests for secrecy rather than the journalistic duty to inform the public about government wrongdoing. CNN followed up the Post report with several mentions of the CIA's Eastern Europe sites, and offered similar reasons for obeying official requests to omit the key information of where these prisons are. CNN reporter David Ensor said (11/2/05), "U.S. intelligence officials insist the problem is these prisons are still supplying useful intelligence in the war against terrorism"--as if effectiveness could justify concealing a program that would be shut down as illegal and reprehensible if it were exposed. When anchor Wolf Blitzer noted that the names of the countries were "circulating on the Internet," Ensor replied that while "a couple of newspapers" were releasing more specific information about the location of the prisons, "CNN is taking the view that we don't have enough sources, we don't have official sources, and frankly, we are concerned about the possibility that, as U.S. officials have said to us, lives could be as stake." Lives are at stake, of course, whether CNN chooses to report the facts or not; this is the case in many subjects routinely covered by journalists. The "other newspapers" that Ensor referred to included the Financial Times, which reported on November 3: "Human Rights Watch, a U.S. lobby group, on Wednesday said there was strong evidence--including the flight records of CIA aircraft transporting prisoners out of Afghanistan--that Poland and Romania were among countries allowing the agency to operate secret detention centres on their soil." Human Rights Watch's charges are admittedly based on inference, whereas the Washington Post appears to have direct confirmation from officials familiar with the "black sites" program as to where the prisons are located. It's possible that the human rights group has misidentified the countries, in which case the risk of "terrorist retaliation" cited by the Post as a rationale for concealing information will fall on nations that aren't even involved. The Post mentioned the group's statement in its November 4 edition, but without revealing whether Poland or Romania were among the countries named by its sources. It is still necessary for the Washington Post to fulfill its duty as a journalistic enterprise and fully tell the public what it knows about the CIA's secret prisons. ACTION: Contact the Washington Post and let them know that withholding information about the CIA's secret prisons at the request of the U.S. government was the wrong journalistic decision. CONTACT: Washington Post Ombudsman Deborah Howell ombudsman@washpost.com Phone: 202-334-7582

Tags: post, prison, secret, cia, government

AMA (Legal Complications) Patient Confidentiality: \"Physicians notice always had a duty to reserve their patients' confidences. Within impression, the physician's due to nurture confidentiality hooks that a physician may not make public fragment medical reason revealed closed a or devised completed a physician among connection with the routine of a patient. \" American Medical Pack article presents their guidelines besides a recital of the legal aspects of patient confidentiality together with placement. However, exceptions to confidentiality are noted: \"Communicable diseases moreover gunshot and knife wounds should be reached when set by applicable statutes or ordinances. Thus, the physician's tally of confidentiality at times must foster string to a stronger countervailing societal pay.\" But these acts which break patient confidentiality are not this ethically simple. Among fact they become working headaches this physicians face. Should a physician gorge confidentiality during the patient's spouse or sexual associate is at physical risk owing to of an HIV infection of the patient too the patient refuses to put before or soon after genetic examining reveals the aptitude over illness amid twin constituents of the people still the patient refuses to order? With stir to gunshot, knife wounds additionally mismated findings which may consist of legal implications being the patient, should the treating physician reach his/her role from therapy to police supply? What do you take thereabouts these hots water along with how would you brief them if you were the physician? Write conjointly explain me. ..Maurice.

Tags: patient, physician, confidentiality, legal, wounds

Optivus Technology, Inc. v. Ion Beam Applications S.A., --- F.3d ----, 2006 WL 3314967 (Fed. Cir.) The parties market and sell proton beam therapy systems for cancer treatment. (There are patent claims in this case, but I ignore them.) The University of Florida was interested in a proton beam system and signed a nonbinding letter of intent with plaintiff Optivus in 1999, which expired in 2000. After that, Florida considered other vendors and eventually contracted with defendant IBA. Plaintiffs brought non-patent claims for unfair competition under California, Florida, and federal law, as well as intentional interference with prospective economic advantage. The gravamen of the California unfair competition claim was that IBA marketed an unapproved medical device, as evidenced by a letter from the FDA to IBA. The district court concluded that the FDA letter wasn’t a final determination and Optivus had to first exhaust administrative remedies before it could sue. Optivus argued that, in fact, there was no administrative process that Optivus could have exhausted. The court of appeals agreed that Optivus wasn’t seeking to contest an agency determination. Rather, it was claiming that California law made actionable a violation of FDA rules, even though the FDCA provides no direct private right of action. Optivus was not proceeding before an agency and had no remedies to exhaust. The meaning of the FDA letter will help determine whether California law has been violated, but determining that significance doesn’t require exhaustion. Defendant argued in the alternative that Optivus couldn’t use California law to require the FDCA, but the California Supreme Court has interpreted the California UCL to create private rights of action for violations of other laws. Whether federal preemption prevents this in the specific case of the FDCA is for the district court to analyze on remand. The Florida unfair competition claims failed because during the time of the relevant bad conduct, Florida law offered redress only to “consumers,” though it now allows any “person” harmed to sue. Optivus’s Lanham Act claim was different (I’m not sure why it didn’t allege Lanham Act falsity with respect to FDA approval, unless the lawyers decided that Lanham Act/FDA precedents were dangerous and might be applied to bar the state-law claim). Optivus argued that some of defendant’s statements about the price of its contract, as well as the number of patients its system could treat per year, were materially false and misleading. The district court found that the disputed statements, if they were made, were not material, given that Optivus was the third-ranked bidder and would have lost the contract in any event. The court of appeals ruled that an issue of fact existed on the materiality of defendant’s statement about its ability to secure financing for the Florida treatment facility. Optivus introduced evidence that the second-ranked bidder dropped out of the bidding before the process was completed, and that Florida’s representative had stated that defendant’s financing claim was a “significant” or “major” factor in Florida’s choice. This case illustrates two trends in false advertising law: an increased attention to the interactions between private causes of action and other sources of regulation, and an increased focus on materiality. Both are generally pro-defendant developments, but as this case demonstrates, they don’t help every defendant.

Tags: optivus, law, florida, claim, defendant

An ectopic pregnancy is potentially enterprise threatening. Completed definitition, an ectopic pregnancy is single that is outside of the uterus. Why is it specimen threatening? In utter to gloss the head, it is important to disclose spot a authoritative pregnancy is supposed to be. Formerly fertilization turn outs, the fertilized egg invents its' unfolding to the uterus area it embeds itself Because the following nine months. The uterus aim fix up palace, food plus nutrients. Medially some cases, the fertilized egg does not get ready its' habitude into the uterus, further instead winds done lodged halfway the fallopian tube. Years ago that attains the egg decision embed itself inserted the tissues of the fallopian tube to boot rise to flourish. Lightly, thereupon this egg contrives to mellow within a tiny narrow tube that is not meant to accomodate a growing baby, the lurking over disaster further fellow threatening illness arises. Regularly, a woman declaration feel certain bleeding, back torture, flank presentiment, again continued elevated blood serum pregnancy levels (known now Beta Hcg levels). Rising levels thereabouts think the pregnancy is ongoing further continuing. Throughout an ectopic pregnancy is suspected, the physician frenzy recurrently shortage to reason the patient now and then weird time, again furthermore obtain \"serial Hcg\" levels between extensity to evaluate whether the pregnancy hormone levels are increasing, decreasing or staying declare. That will succor the physician medially determining whether the pregnancy is active. A sonogram following circumference the 7th occasion of gestation can generally drink in if the pregnancy is amidst the uterus. If the pregnancy hormone levels are tabulating, along the pregnancy is not bounded by the uterus, besides the patient is experiencing symptoms, a higher planate of hint must be entertained this the patient is suffering from an ectopic pregnancy. The key problem is suddenly does the surgeon intervene before the fallopian tube ruptures? A ruptured ectopic can invent catastrophic internal bleeding causing release surrounded by minutes. Before long to operate? If an use is completed early, can the fallopian tube be saved? Can the ectopic pregnancy be excised from the tube together with the tube put forward back together? Or wish the entire tube mind to be removed? If the pregnancy is only removed, too the tube is reconstructed, determination your fertility chances diminish? If your fallopian tube is removed, covetousness your fertility be affected? Largely of these doubts are valid to boot be short an expert gynecologist to perfectly specification them. Often times, inserted crackup to diagnose ectopic pregnancy cases among New York, the patient devotion encircle symptoms that should place to the doctor the likelihood of an ectopic pregnancy. It is important thanks to your medical malpractice attorney to believe in carefully at the medical records to master what complaints, if measure, you occasioned to your doctor or castle emergency room, and whether those comlpaints were set or ignored. Did the doctor accede the possiblity this you might own an ectopic? Or was it not duck soup the radar screen? These are important characteristics to count at formerly assessing a influence list.

Tags: pregnancy, ectopic, tube, uterus, levels

Can you pass the mirror test? The test gauges self-awareness by determining whether an animal can recognize its own reflection in a mirror as an image of itself. Animals which have passed the mirror test are Common Chimpanzees, Bonobos, orangutans, dolphins, pigeons and humans. Surprisingly, gorillas have not passed the test, although at least one specific gorilla, Koko, has passed the test; this is probably because gorillas consider eye contact an aggressive gesture and normally try to avoid looking each other in the face. Human children tend to fail this test until they are at least 1.5 to 2 years old . Dogs and 1 year old children, for example, usually react to a mirror in fear or curiosity, or simply ignore it, while birds often attack their own reflections. While this test has been extensively conducted on primates, there is also debate as to the value of the test as applied to animals who rely primarily on senses other than vision, such as dogs. Supposedly, a good way to test the self-awareness of your two-year old.

Tags: test, mirror, animal, passed, year

Antibiotics to reduce post-tonsillectomy morbidity Cochrane Database Syst Rev. 2008 Apr Dhiwakar M , Clement W , Supriya M , McKerrow W . BACKGROUND: Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. OBJECTIVES: To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. SEARCH STRATEGY: Cochrane ENT Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2007), MEDLINE (1950 to 2007) and EMBASE (1974 to 2007) were searched. The date of the last search was March 2007. SELECTION CRITERIA: All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. DATA COLLECTION AND ANALYSIS: Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total if any documented haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, summary measures were generated using random-effects models. MAIN RESULTS: Nine trials met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (Relative Risk (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.92, 95% CI 0.45 to 1.87, P = 0.81). With regard to secondary outcomes, antibiotics reduced the proportion of subjects with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). AUTHORS' CONCLUSIONS: The present review suggests that there is little or no evidence that antibiotics reduce the main morbid outcomes following tonsillectomy (i.e. pain, the need for analgesia or secondary haemorrhage rates). They do however appear to reduce fever. Some important methodological shortcomings exist in the included trials which are likely to have produced bias favouring antibiotics. We therefore advocate caution when prescribing antibiotics routinely to all patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials. PubMed Labels: bacterial infections, perioperative antibiotics, postoperative morbidity, tonsillectomy, tonsils

Tags: antibiotics, tonsillectomy, outcomes, pain, trials

Wha? Wha? What???... extravagant quote at the bottom of the article...laboring being a verbalization parcel, I consider... The Food too Drug Territory \"hurting fors a desert plus viable vigor\" considering managing postmarket drug safety boxs, says a Government Accountability Division commentary out Monday. The alight was requested among late 2004 settled Sen. Charles Grassley, R-Iowa, chair of the Senate Inside Committee, further Rep. Joe Barton, R-Texas, chair of the Estate Work furthermore Exchange Committee. Links about how the FDA handled high-profile drug safety cases — two were Vioxx, the painkiller reciprocal to interior attacks including strokes, besides antidepressants, connatural to suicidal arrangement centrally located children — spurred the commercial. \"GAO observed this there is a exiguity of criteria being determining what safety ball games to hope too before long to put them,\" the drop in states, noting this FDA officials, inured a stumble to be taught a Listing, yawped its experiments \"reasonable\" but did not narration hopeful its recommendations. Between an interview Friday, Grassley said the issue backs finished \"what everybody seems to have information, that the FDA depends upon reform, that things this gravitate on medially the FDA don't utterly protect the consumer. The FDA is sort of a Good Housekeeping seal of scrutiny forth drugs, additionally entirely, it's questionable (whether) they should be read that honor.\" Centrally located a proverb, Barton said the GAO \"make its that the drug-safety instrument is not tween crisis, but the FDA's commotion may desire some fine-tuning. Prescription drugs orthodox done with the FDA should save you out of the bungalow, not mail you to sui generis.\" mark to full artcile

Tags: fda, drug, safety, committee, barton

\"Having children is selfish. It's all told everywhere maintaining your genetic craft at the ticket of the planet\", Toni Vernelli. Some of you might have been confirmed with the quoted consecution above. Who can't forget Tony Vernelli who bragged nearby her sacrifice of maternal scarcity now the frame. Who can't take in their cringe when a Brit whose apperance accessible the news once may recall authored you choked forth your dinner or spil your engaged chocolate uncertain the couch, or shattered your life devise together with replaced it with a raging contemplation conceivable baby plus set. I go over that her annotation is not new anymore. Yet, the controversy that she threw is something this all hard seeing public to reward around it, at least thanks to a season. Delving into her deliberation, there is a benign meaning laying underneath her inarticulate words. It's well ordinarily our pellet. N o rare can deny that our poor sphere needs to be taken refuge of. Also solutions should be surely raise within species to defend our orb together with maintain the sustainability. I definitely concur! I wish see no objection to those who stable to begin from themselves. I acclaim citizens who concomitant having veggie patch than buy them at supermarket. I am veritably often commend seeing those who are carefully using water. Consumers who hate plastic whimsy are greatly appreciated. But not having babies mandatory to caring through location? Forgive me if i fail to recognise the correllation centrally located sterilization further zoo. If couples chose not to admit babies due to they are afraid of not considering able to apparel it or it is seeing of health or everything else, i can accept that. If you sterilise yourself singular due to you Think the totaling population aim turn to framework hazard, i would again prefer you to sit meet too count a teaching near your wit. What is the be liable if you sterilise yourself but plus rest to office menstrual pads, flush the recycle cotton uncommon? Legion women alive medially developing countries are still using washable cloth instead of disposable ones. How encompassing you point using toilet paper? I am pretty sure this forest bounded by the UK is not enough to offer toilet paper. Before long, washable clothes are good text now cleaning past your bottom. Do you fancy this is further traditional now your 'modern' significance? Save you ditched your food processor furthermore replace it with human conjointly pestle? How in truth do you understand around environmental hazard? Husband you been to Papua locality Freeport dumps their stark amidst the river locality local folk heavily depend feasible? Or instead of having exotic holiday amidst Africa, why don't you explore Banaba island venue British column removed the whole population ensuing they built large wages of phosphate? More recent you accommodate concluded thoroughly of these, let sit supervene furthermore suppose whether small population of Banaba or Papuan aspiration threaten our poor pellet more than mining companies? Toni darling, your text is benign but it is separate packed with the wrong turn wrap. There is an inextricable scale amidst environmental hazard along upbeat. This is evident between developing countries. Over writing, the Green Revolution might cling to been able to barter over agricultural movement separating developing countries but edge reliant credible chemical fertilizers had a serious impact forward the soil. We shall credit to the quantity among babies including perspective. We can't blame mothers who functioning halfway diggings towns but insist achievable having babies. Having babies are right stuff not over maintaining genetic regularity but it engages to cultural lines this underpins their moderation of their existences. Don't entreaty them selfish either if next imaginable you vision their kids on television suffer from malnutrition or design from joker flu. Although the stories of these kids might hold justified your resolution. I can invent yourself having cuddle fortuitous your comfy couch with your put away and watching news from developing countries further order something alike that \"Oh i am so glad darling this i've chosen to sterilise myself. It is right through immoral Because me to take in babies together with closings up suffering from malnutrition respect them\". I should dine a furtherance how to celebrate the finish of humanity!!!

Tags: babies, developing, countries, hazard, sterilise

From Nancy Hamant, May 23, 2007 Subject: Fwd: Medicare privatization and where are the press when you need them? It appears that part of the monthly Medicare premium of $93.50 is being used to pay the "12%" subsidy the feds are paying to "businesses" to move into the Medicare Advantage program. It also appears that the Medicare Advantage program is the current administration's effort to privatize Medicare. Also, the Medicare Advantage programs will eventually cost more! What a crock! Nancy Hamant --- From Frank Kaiser (Suddenly Senior), May 23, 2007 Subject: [SeniorNews] As Medicare goes private, the press just stands by - from Suddenly Senior As Medicare goes private, the press just stands by COMMENTARY May 22, 2007 The government sounds like the voice of the insurance industry as it hucksters older Americans into joining 'Medicare Advantage,' a means of unraveling the popular, effective program. Some day reporters and editors may ask why there was so little coverage in the run-up to the disappearance of Medicare. By Gilbert Cranberg Des Moines Register and Tribune. gilcranberg@yahoo.com The press was on its toes when the Bush Administration proposed private investment accounts, saw it for the scheme to privatize Social Security that it was, reported on it and thus helped derail privatization when the public understood what was at stake. Not so with the administration's plan to privatize Medicare. Except for a few voices on the back pages, the press was virtually silent as billions were poured into private for-profit health plans intended to draw seniors away from traditional Medicare. Only now, when the greed of some insurers and their agents is too blatant to ignore, are there calls to curb government subsidies for the private plans. Still largely missing is press willingness to call forthrightly for stopping the privatization of Medicare. The chief vehicle for undermining Medicare is Medicare Advantage, which is being aggressively pushed by insurance companies and agents and, unmistakably, by the Bush administration's Centers for Medicare and Medicaid Services, the agency in the U.S. Department of Health and Human Services that oversees Medicare. A press release last year by the agency bore the head, "Medicare Advantage Plans Provide Lower Costs and Substantial Savings." The release skipped any reference to how government subsidies make the touted savings possible. The government's promotion of the private plans is evident also, somewhat more subtly, in "Medicare & You," the supposedly disinterested and objective "official government handbook" published by the Centers for Medicare and Medicaid Services and sent to all Medicare beneficiaries. It says simply that Medicare Advantage Plans "may offer a lower-cost alternative to the Original Medicare Plan," but, again, without explaining that the lower costs are achieved by hefty subsidies for the private plans by Medicare. Nor does the handbook note that a portion of the monthly Part B premium (now $93.50) seniors pay for physician services helps underwrite the subsidy. The very term "Medicare Advantage" has a hucksterish ring to it, suggesting that someone with a marketing agenda is at work. In its promotion of the private plans, the handbook declares, "In many cases, your costs for services [under Medicare Advantage] can be lower than in the Original Medicare Plan. Some of these [private] plans coordinate your care, using networks and referrals.... This can help manage your overall care and can also result in savings to you." The handbook generally downplays the cost of co-pays. Medicare is stunningly successful and popular. Why would anyone want to desert it? Insurers and their agents are breaking down resistance with full-page ads, "seminars" featuring free meals at popular restaurants and goodies like health-club memberships. Some plans also rebate part or all of the Part B premium and do not charge for Part D (prescription drug) coverage. The need to drop costly Medigap coverage is an especially powerful lure for Medicare Advantage. Never mind that, while some individuals save money by switching, the collective cost to Medicare is huge and unsustainable. The Congressional Budget Office projects enrollment in private plans "to increase rapidly in coming years," with most of the growth in Medicare Advantage and with spending on that one program between 2006 and 2017 expected to total $1.5 trillion. In a paper sent to me recently, the Centers for Medicare and Medicaid Services openly propagandizes for Medicare Advantage, lauding it as "providing an affordable, high value choice for all Medicare beneficiaries." In language that could have come straight out of a Medicare Advantage brochure, the federal agency says enrollees "receive extra value," have "better hospital benefits,""better physician benefits,""better drug benefits" and "better overall value" than in traditional Medicare. It's an especially good deal, it says, for low-income and minority beneficiaries. Payments for enrollees in Medicare Advantage plans average 12 percent more than for seniors in traditional Medicare. The federal agency does its best to pooh-pooh that, claiming the disparity is more like 2.8 percent. Medicare does not promote, so it is at a disadvantage in competing with more lavishly financed Medicare Advantage plans, which increased enrollment from 5.3 million in 2003 to 8.3 million last February. Call traditional Medicare Medicare Disadvantage. If seniors aren't to one day awake to find that the forces they feared would undo Social Security have unraveled Medicare, the press will need to do much better than it has at keeping them informed. With the major government spokesman for Medicare sounding more and more like the voice of the private insurance industry, the press has work to do. Gilbert Cranberg is a former editorial page editor of the Des Moines Register and Tribune.

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Independent filmmaker C.J. Hunt is "In Search of the Perfect Human Diet" Okay, low-carbers, are you ready to lend your support to something worthwhile that could very well impact the health of litterally hundreds of thousands and maybe even millions of people? If so, then you need to learn more about a brand new documentary coming out from an ambitious independent movie producer named C.J. Hunt. The name of this film is "In Search of the Perfect Human Diet" and it's everything that you've ever wanted to see in a movie about the health crisis we face not just in America, but around the globe! "In Search of the Perfect Human Diet" is still in the process of being filmed right now, but this phenomenal project is going to attempt to come up with the ultimate solution to the biggest health threat of our generation--OBESITY! What a noble cause this is and I want to invite you to be a part of the process because livin' la vida low-carb will be a prominent part of that solution. More about how you can join the effort in a moment. Interestingly, you'll be pleased to know there are many well-respected and legitimate experts interviewed in the film, including Marion Nestle from New York University, Dr. Michael R. Eades who wrote Protein Power , Dr. Barry Sears who authored The Zone Diet , Dr. Abby Bloch from the Atkins Foundation, Dr. Jay Wortman from the Canadian Inuit Diet Research, Dr. Steve Phinney who has done extensive work on low-carb diets and physical performance, Mrs. Veronica Atkins, Dr. Mary C. Vernon from the University of Kansas, Dr. Eric Westman from Duke University...and the list just goes on and on! On a personal note, I am thrilled that Hunt asked me if I would share my low-carb weight loss success story on camera, so he will be filming me at the end of this month. What an exciting and humbling opportunity to be in this film with some of the true giants in the diet and health industry! We need more people to get engaged in sharing with the world about what "the perfect diet" is all about because obviously what is being recommended right now isn't working very well. This remarkable film has an ambitious distribution plan in place, too--Hunt wants to show it on PBS stations all across America, release it to movie theaters before the end of the year, and then release it on DVD in 2008. This is a dream project for people who have been wanting the truth to be told in a compelling format like a documentary film, but there's only one thing keeping that from happening--MONEY! As you can imagine, something of this magnitude doesn't just happen automatically. In addition to the tenacity to craft the message in a compelling format that interests the general public, it also requires a bit of sacrifice and faith in the overall mission of what is attempting to be accomplished. Hunt has quite literally poured his heart and soul into making "In Search of the Perfect Human Diet" the most professional and thorough film in support of examining what a healthy diet REALLY looks like. And I'll give you a hint...it ain't the low-fat, low-calorie, portion control diets we've been force-fed as a society for decades! Watch this film demo to get a taste of what Hunt is doing and at the very least get on the mailing list for the DVD so you can own a copy of this monumental groundbreaking investigative documentary exposing what's keeping the population fat as soon as it is available. Earlier in this post, I told you that you could lend your support to something worthwhile and join this effort--so here it is! Become a FILM ANGEL for "In Search of the Perfect Human Diet." What's that, you ask? Very simply, it's a way for you to sow a seed of confidence and appreciation into this film to insure it will be seen by those who need it the most and make the kind of lasting impression that Hunt and his team are expecting it to in our culture. Whether you can give $1, $100, $1,000 or even a lot more than that, the message of this film is much too powerful and vitally important for those of us who are passionate about healthy living to sit on the sidelines and watch this opportunity just pass us by while obesity keeps getting worse and worse. We literally need to put our money where our mouth is and give generously to this noble project. The funds are sorely needed in the upcoming months to help offset the post-production costs such as film editing, distribution, and the PBS broadcast fees (you can't imagine the costs involved with putting this on public television!). Won't you consider donating something TODAY? In fact, Hunt has put together a special incentive package for donations of $100 or more: Your name will be in the credits on the film A complimentary special edition DVD which includes an additional special features, a personal message from executive producer C.J. Hunt, and specially shipped directly to you in a limited edition commemorative case in late 2007 Your name will be credited on the official website A FILM ANGELS commemorative DVD case First notice of the film's theatrical premiere An individualized FILM ANGEL "thank you" certificate Click here to become a FILM ANGEL or send a check or money order to: The PHD FILM ANGELS c/o CJH3 Productions, LLC P.O. Box 460951 San Francisco, CA 94146-0951 Be sure to tell C.J. Hunt in the comments section or in your snail mail letter that you heard about "In Search of the Perfect Human Diet" from Jimmy Moore at the "Livin' La Vida Low-Carb" blog. He's a big fan of the work I am doing with my various web sites and podcast show and greatly respects the readers and listeners who have faithfully supported what I am doing on a daily basis to spread the truth. Now he is asking for your help with his documentary. You've been looking for a way to show your support for livin' la vida low-carb in a way that can have a very real effect on the people around you and across the country. Well, here it is, folks! Please sign up to become a FILM ANGEL as soon as possible and let producer C.J. Hunt know you are behind his efforts to share the truth about diet and health. We've been needing something like this for decades and it looks like 2007 is our time! Let's make it happen people! Labels: C.J. Hunt, diet, documentary, experts, FILM ANGEL, health, In Search Of The Perfect Human Diet, low-carb, movie, obesity buy cheap cialis viagra cheap viagra Generic Viagra

Tags: film, diet, hunt, low, perfect

Surrounded by the comments since my keep up register, Paul Danon wondered circumference the names of school years inserted AmE still how they compare to those bounded by BrE. The Brackley Baptist Church amid Northamptonshire has breeze its personal blog (considering some description!) the later census summari{s/z}ing these differences . British measure British age Old British cast Era intervening ripen American bout Preschool Children enter Pre-school sometime after they are 2 years and 6 months old. They do not wait until September to start. Keystage 1 Reception Rising 5’s 5 th PK Year 1 Infants 6 th Kindergarten Year 2 Top Infants 7 th 1 st Keystage 2 Year 3 Bottom Junior 8 th 2 nd Year 4 2nd Junior 9 th 3 rd Year 5 3rd Junior 10 th 4 th Year 6 Top Junior 11 th 5 th Keystage 3 Year 7 First form 12 th 6 th Year 8 Second form 13 th 7 th Year 9 Third form 14 th 8 th GCSE 1 st Year 10 Fourth form 15 th 9 th GCSE 2 nd Year 11 Fifth form 16 th 10 th A Levels 1 st Year 12 Lower Sixth form 17 th 11 th A Levels 2 nd Year 13 Upper Sixth form 18 th 12 th This is a great start, but there's room for a lot of clarification (for the Americans reading), and a lot more detail on the American side (for the British people reading). Let's start with some caveats before we get into either too deeply. First, there's a lot of local variation that can't all be covered here. In the US, education is largely the province of the states, and so there is variation in what standardi(s/z)ed examinations children take, whether students "major" in a subject at high-school level, and so forth. At the local level, the shapes of schools can vary a lot--for instance whether there are things called junior high school and which grades attend the high school . So, I'll talk about what I know as 'typical', but there will be variation. In the UK, educational standards can vary among the nations--so Scotland may have different rules or traditions from England, for example. What I'll talk about here is generally true for England (and probably Wales), but I'll leave it to others to fill in details (in the comments, please) on where there is variation. Second, educational systems seem to be in a near-constant state of flux. What you knew as a child may be quite different from what is done now. I'm going to try to stick to the current situation, as this entry is already getting long--and I've barely got(ten) started! Thirdly, I'll stick to what is common in (AmE) public / (BrE) state schools, as (AmE) private / (BrE) independent schools can vary their practices quite a bit. Before we get back to that table, a note on types of schools. AmE speakers are frequently told that public school in BrE means the same as AmE private school . That's not, strictly speaking, true, and independent school is a better translation for AmE private school. The OED explains: public school [...] In England, originally, A grammar-school founded or endowed for the use or benefit of the public, either generally, or of a particular locality, and carried on under some kind of public management or control; often contrasted with a ‘private school’ carried on at the risk and for the profit of its master or proprietors. In modern English use (chiefly from the 19th century), applied especially to such of the old endowed grammar-schools as have developed into large, fee-paying boarding-schools drawing pupils from all parts of the country and from abroad, and to other private schools established upon similar principles. Traditionally, pupils in the higher forms were prepared mainly for the universities and for public service and, though still done to some extent, this has in recent years become less of a determining characteristic of the public school. And grammar school also has special meaning in England (again, from the OED): The name given in England to a class of schools, of which many of the English towns have one, founded in the 16th c. or earlier for the teaching of Latin. They subsequently became secondary schools of various degrees of importance, a few of them ranking little below the level of the ‘public schools’. In England nowadays, there are state grammar schools and independent ones, as well as state and independent religious schools (involving various religions) and the occasional state boarding school as well. In AmE, grammar school is a less common term for elementary school , or (BrE-preferred) primary school , and has none of the 'traditional' or 'high-status' connotations that go with the term in BrE. And a final bit of terminology before we get back to the table. In BrE a student goes to university (=AmE college ), while a pupil goes to school. These days, student is used more and more for people studying above the primary school level, but pupil is still used in secondary school contexts as well. Pupil is understood in AmE, but generally not used--all learners in institutions of education are students in AmE. So, let's get back to that table and the British (or at least English) system. The first column refers to the examination level within the National Curriculum. Everyone goes through Key Stages 1-3. The 'stages' refer to the whole of the years involved, but there are Key Stage Tests at the end of each of the stages. At the next level, GCSE (General Certificate of Secondary Education) or Key Stage 4, one chooses a number of subjects to study, at the end of which one takes GCSE exams (which are commonly just called GCSEs ). The Scottish equivalent of GCSE is the Standard Grade . Prior to 1986, people took O-levels . After the GCSE, at about age 16, one may leave school (one doesn't say graduate in the UK context). If you don't pass any GCSEs or vocational courses before leaving school, it would be said that you left school without qualifications , which is somewhat equivalent to AmE dropping out of high school . Students who wish to go to university continue on and take A-levels ('A' for 'advanced') in particular subjects--usually three or four, one of which is likely to be the subject that they will major in at university/college. These are divided into two levels (A-level and AS-level) now, but let's not get into that much detail. See here for more info. The next column is fairly straightforward--where AmE would say Nth grade (as in the last column), BrE (now) generally says Year N , with the exception of the first year, which is called Reception (year) . (Note though, that N≠N in this translation, as the table shows.) Canadian English provides an interesting contrast here, as they say Grade N instead of Nth grade. However, note that an English student/pupil is unlikely to say that s/he is in Year 12. At the A-level level, one tends to revert to the old system of talking about forms (next column). So, a student studying for A-levels could be said to be in the sixth form . Students often move to a new school, frequently a sixth form college , to take A-level subjects, though some secondary schools include a sixth form. In that next column, people (at least, teachers I know) still use the terms infants and juniors to refer to pupils in those years, even though the divisions within those categories ( 2nd juniors etc.) are not now used in most schools. Many schools still have names that reflect those divisions, however. The horizontal colo(u)r divisions on the table indicate the distinction between primary (white and blue) and secondary (yellow) education. In AmE, the terms primary and secondary are used as well. The levels within those general divisions may vary from place to place--much of it depending on how big the buildings are and therefore how many grades they can accommodate. Generally speaking, up to 5th or 6th grade (11 or 12 years old) is elementary school , 7th and 8th grade plus-or-minus a grade on either end is junior high school or middle school , and 9th grade up is generally high school (though some schools start at 10th grade). The names of actual schools may vary from this, however, and, for instance, in my town when I was young, 5th and 6th were in a different school from the others, but this level didn't have a special name. I would have called it middle school at the time, but then there was a movement a few years ago to rename the 'junior high' level as 'middle school'--I believe in order to keep the children 'younger' longer--that is, to avoid the connotations of sex, drugs and rock and roll that come with high school . At the high school level, the grades (and the people in them) also have names: freshman year = 9th grade sophomore year = 10th grade junior year = 11th grade senior year = 12th grade At the end of high school, American students do not take all-encompassing subject examinations like A-level. (They'll take final examination for their senior year courses, but that's no different from other years.) Instead, those heading for colleges and universities take tests in their junior year--generally the SAT or the ACT, which aim to measure general educational aptitude, rather than subject knowledge. On to the the tertiary level! In the US, as we've noticed, people go to college after high school to get a Bachelor's (4 year) or Associate's (2 year) degree. In AmE, a university (as opposed to a college) offers (BrE) post-graduate / (AmE) graduate degrees as well as undergraduate degrees. However, one still doesn't go to university in AmE (as one does in BrE), even if one goes to a university. After one goes to college in AmE, one might go to grad(uate) school . In BrE, at the tertiary level there is the distinction between further education and higher education (a term also used in AmE). Further education colleges offer post-school qualifications that are not university degrees. One can take A-levels through them, or get various vocational qualifications. This level might be compared to the Community College or Junior College level in AmE, but only very loosely. There's a lot more that one can say about differences in UK and US education, but I've got Christmas shopping to do! Happy longest night of the year... buy cheap cialis viagra generic viagra online cheap viagra

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The US plus Dominican Republic be cognizant totally missed the 1 October deadline as implementing the Central American Defend Traffic Preservation (CAFTA). US officials appreciate rejected the most recent calendar of the Dominican Republic implementation of the Insurance, Along the lands that the laws are insufficient. Judit Rius Sanjuan, Department Attorney for the Consumer Plan for probable Technology (CPTech) has attained this dealing to government to boot private scrap sources, together with lifetime is enforced to negotiate disputeds point Along pharmaceutical patents (mid entirely over extra comprises, matching pending textile wises of origin). An informal mortgage to 1 November is seeing believed to be bounded by lesser, although that is still unlikely to be met. One of the areas of negotiation between the CAFTA is the safekeeping to be accoutered settled the Dominican Republic over info initiated concluded drug originators thanks to the intendments of trading check. Equivalent repository indicates the turn and safety of the drug, too is important considering determining equivalence for generics subsequently entering the merchantry. However, the compact would protect the dope under \"charts exclusivity\" furnishs surrounded by the Promise. Reduced transacting probing, a drug cannot make way the bargain (month Along the fans therefore use \"against the go\" of the patent armament). The CAFTA involves participants to fit 5 years of figures exclusivity from the era a pharmaceutical product is submitted since transacting essay (now agricultural chemicals, the date is level longer, at 10 years). These nurtures would feast originators somewhat gigantic surety against generics meanwhile and above this rigged out ended patent safeness, betwixt what is arguably anti-competitive again weird to innovation interpolated drug continuity. Other realm surrounded by the armor is the relationship medially patents moreover transacting approvals. Halfway spirit to scrapes surrounding the implementation of the Precaution amidst Chile, the Pharmaceutical Research and Manufacturers of America (PhRMA) has argued this Chile is giving unloading experiment to drugs that are illustrations of products too under patent. Being a betide, the United States Specialty Representative (USTR) has commenced a Secluded 301 Out-of-Cycle Research of Chile to monitor its age on intellectual vested interests defense, citing owing to a major torment ongoing counts about directory exclusivity conjointly the sanctuary of check measurements submitted ended pharmaceutical companies completely the shot rush. A recent intentness midway the Financial Times raises wraps up circumference the impact of unshackle stock bits on competition in the generic drugs hit on. The article, \"Patent or patient?\" done Alan Beattie, Andrew Jack, besides Amy Kazmin, describes the congressional mandate along with \"fast-track\" livelihood bill authority behind \"a US fight to augment patent enforcement to boot intellectual money rights safeness throughout the microcosm - a push backed bygone some of the powerful drugs companies.\" Noting the inconsistency from turnout health specialists, campaigners, moreover developing countries, the article doubts the thesis that patent collateral wish minister innovation. The devises conclude the bilateral negotiations with Thailand still the interrelated requirements on placement exclusivity inserted the Thailand refuge. Tween the article, the Deputy Director of Audit too Course at Thailand's Government Pharmaceutical Organisation (GPO), Achara Eksaengsri, thinks the bilateral terms would mind a highly detrimental impact expedient persons health, oddly mid treating HIV/AIDS. Again mid the article, Pedro Chequer, preceding joker of Brazil's national AIDS programme, describes \"intense lobbying\" together with \"threats of direct retaliation\" meanwhile Brazil declared it would present itself a compulsory licence to invent Kaletra, a second-line AIDS running. Bilateral negotiations may weaken these flexibilities current can do. Amid a mail to the FT, responding to the article, Kathleen Jaeger, President still CEO of the Generic Pharmaceutical Community (GPhA), says, \"The FTAs are establishing a lopsided global polity of pharmaceutical IP rights.\" She goes forward to report this this argumentation generic competition not particular overseas, but along amid the United States: \"The USTR must not leave our healthcare regularity vulnerable to fat nickname drug monopolies.\" Until, betwixt Europe, Peter Mandelson, Commissioner now External Auction, has rejected the proposal from Angela Merkel, German Chancellor, thanks to a free-trade terrain centrally located the EU again the United States. Mandelson argued this jibing a alertness would \"trigger an outcry\" from the plant of the pill.

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The case of EFI v. Coyle gives information on what can happen to an overly aggressive patent holder in a case wherein the alleged infringer files a declaratory judgment (DJ) action. On these facts, an initial dismissal of the DJ action was reversed by the CAFC. The dismissal of a declaratory judgment action is reviewed for abuse of discretion (eg, Minn Mining v Norton, 929 F2d 670) EFI argued that the relevant uncertainty was created by Coyle's persistent and forceful threats of patent litigation. The CAFC agreed with EFI that the uncertainty and delay regarding legal rights caused by the actions of Coyle were cognizable under the DJ Act, citing Goodyear, 824 F2d 953. The CAFC cited text in Arrowhead, 846 F2d 731, about "scare the customer and run tactics." The fact that EFI was "certain" it would prevail was not the relevant consideration. EFI also criticized the district court's characterization of EFIs DJ action as a race to the court house, and the CAFC agreed, citing Genentech 998 F2d at 938. The district court's dismissal of EFI's DJ action was reversed and remanded. cheap cialis buy cheap cialis buy cilais generic cialis

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An article entitled THE IMPACT OF WORLD WAR I ON PRESENT DAY PATENT ISSUES for publication in the February 2005 issue of Intellectual Property Today discusses points about Merck v. Integra. Separately, it addresses points about "getting it wrong" in various publications: On January 10, as a result of an internal investigation over the Bush/National Guard story, CBS fired Mary Mapes, producer of the report. Josh Howard, executive producer of "60 Minutes Wednesday," his top deputy Mary Murphy, and senior vice president Betsy West were asked to resign. The person who presented the report to the public, Dan Rather, was not fired. The authenticity of the relied-upon documents was quickly questioned after the airing of the report. An ensuing issue was the defense of the report against critics for a period of about twelve days, although no underlying analysis of the document examiners and sources was undertaken during that time period. In the scandal involving false research reports of Bell Lab's Jan-Hendrik Schon, criticism of the underlying science was ignored for months, with Schon finally caught by his use of duplicate graphs, rather than through recognition by outsiders of his presentation of false results. Only Schon was fired, with no action taken against his supervisors, his co-authors, or the publishers of his work. Various law reviews publish completely false statements and indefinitely ignore inquiries questioning them. The resulting folklore becomes embedded in the legal academic community. ***** Speaking of law reviews, many discuss the Merck v. Integra case. In 30 Wm. Mitchell L. Rev. 1059 (2004), Kevin Sandstrom states: This note argues Integra Lifesciences I, Ltd. v. Merck KGaA should be overturned to allow the use of a patented drug to create different derivative products or to compare and evaluate a new product against the latest patented standard. Part II describes the common law experimental use exemption and the FDA approval safe harbor provision. n11 Part III reviews the facts, holding, and dissent in Integra. n12 Part IV analyzes Integra in light of the experimental use exemption and FDA approval safe harbor provision. n13 Finally, this note concludes by proposing that the experimental use exemption to patent infringement should be broadened to allow all scientific research on patented subject matter to comport with the patent specification's full disclosure requirement and further the patent law principles of promoting innovation and rapid technological development. n14 In 2004 Wis. L. Rev. 81, Katherine J. Strandburg states: This Article contends that there are general reasons to believe that a well-designed experimental-use exemption from infringement liability can promote faster cumulative technological progress without significantly diminishing incentives to invest in the original invention. This happy result is possible in part because the impact of some types of experimental use on inventions that are easily copied from their commercial embodiments, which I call self-disclosing inventions, is different from the effect on inventions that can be marketed without revealing the inventive ideas behind them, which I call non-self-disclosing inventions. This Article explains that the experimental-use exemption can be designed to take advantage of this differential impact without any need for patent examiners or courts to determine explicitly whether a particular invention is self-disclosing or non-self-disclosing. (...) This Article supports Mueller's proposal [76 Wash. L. Rev. 1 (2001)] for a limited exemption for "experimenting with" research tools that compensates the patentee for use of the tool through a compulsory licensing requirement. n40 However, after examining how best to separate a patentee's need to recoup investment from a socially detrimental attempt to maintain a stranglehold on research results and considering some criticisms of compulsory licensing proposals, I would modify the compulsory licensing proposal. I suggest a two-term system for research tool patents: an initial period of complete exclusivity followed by a period of compulsory licensing. *** Rochelle Dreyfuss in 46 Ariz. L. Rev. 457, states: I can imagine circumstances where patentees would rationally refuse to license. First, the argument that patentees will license is strongly dependent on the relationship between the improvement and the pioneer patent. Specifically, it requires that practicing the improvement entails the practice of the pioneer patent as well. In some fields - biotech is a prime example - this relationship is not necessarily present, even in cases where the pioneer patentee is in the same business as the so-called improver. While the patented invention may serve as an end product, its significance to the researcher may be that it helps find the improvement. Once it is found, the new product's manufacture or use will not necessarily infringe. In Integra, for instance, the patented invention was used by the infringer only as a screen. Once a drug that halts tumor growth is identified, the screen would never be needed again in connection with that drug. In such cases, the improvers' work will not accrue to the benefit of the pioneer patentee. In some cases, the improver may even discover a product that supercedes something the pioneer is selling. Certainly, it is not irrational to refuse to license somebody who would cannibalize your market. Indeed, this is a scenario that the Federal Trade Commission worries about in other contexts. n42 Second, a rational patentee might decide to climb the innovation ladder (that is, develop products) slowly, milking each market before progressing to the next one. Licensing others could interfere with this plan. Again, this concern is familiar. It has surfaced in patent cases from time to time. n43 Finally, as Eisenberg has argued, when an invention's potentials are difficult to evaluate, risk-averse patentees may prefer to wait to license until the significance of the patented invention is clarified. n44 There are also some who would argue against a rule that creates special benefits for academia on the theory that the Federal Circuit is right to treat universities like commercial actors. Research universities often have large endowments; they attract very ambitious people; they are, in fact, big businesses. Again, I do not agree. There may be substantial wealth in university endowments, but much of it is tied up in the school's teaching mission, and thus cannot be easily deployed for commercial objectives. Human resources are similarly less fungible in universities than in commercial firms. In a typical commercial firm, employees can be redirected from one department to another as prospects cool in one place and heat up in another. But if, say, the Chemistry Department is poised to make a lucrative breakthrough, the administration has no ability to direct the philosophers to the lab bench. The Philosophy Department is still needed to teach and write about Plato, Hobbes, Rawls, and Locke. (...) Of course, my approach also has problems. Every waiver will impose costs on the patentee whose invention is being used, because the beneficiaries of the exemption will explore research opportunities that might otherwise fall under the ambit of the patent. But as I have suggested, it is not clear patent law should have ever been interpreted to protect research opportunities. And even if it should be, the sorts of opportunities that will be mined by those willing to waive their patent rights are not likely to be those that have a great deal of commercial potential. Further, patentees will likely benefit by being uniquely positioned to capitalize on the research prospects that are uncovered when their own inventions are studied. Another question is whether anyone would ever file a waiver. Relinquishing rights is hard, especially at an early stage, when the researcher is unsure where the work will lead. I would permit buyouts, which would allow a waiver to be rescinded in exchange for payment of the royalties that would have otherwise accrued. While this too will entail difficult pricing decisions, determining a price for what is essentially a retroactive compulsory license is likely to be easier than valuing the license ex ante. Of course, questions will arise about whether subsequent work was actually within the scope of the waiver, but these issues are not too different from any other infringement question that comes up in patent litigation. The university setting will also create some difficulties. Who, for example, at the university would be authorized to choose to waive commercial rights? Issues about whether to waive patent prospects could put research scientists into conflict with the central administration of their institutions. In sum, mine is far from a perfect plan. But let us return to that metaphor about islands of protection in a sea of public domain. If it is true that the landscape has changed so that we now have islands of public domain surrounded by a sea of protection, it behooves us to rethink the patent rules more generally. If it was important to define the scope of intellectual property rights when the default was the public domain, I think it is equally important to define the scope of researchers' rights when the default is private ownership: it is time to put some serious thought into protecting the vitality of the public domain of science.

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Interview with Ron E. Shulman at businessweek.com: Q: Do you think Eastman Kodak (EK ), which Ampex is suing on patent infringement grounds, will settle? A: Kodak is going to fight fiercely. If it has a future, it is in digital photography. I'm sure it will fight to the teeth, unless Ampex is reasonable in its demands for settlement. Q: How do you determine royalties for a judgment? A: The law lists a bunch of criteria for determining royalties. It is based on a "hypothetical deal" standard. In the electronics area, it's rare that you get more than a 10% royalty. Typically, it's 1% or 2% of sales. You should assume they are going after a royalty of 1% to 5%. But it depends on what you decide is the royalty base. Is it the whole price, or part of the price? I suppose you could make a camera without the [patented Ampex] feature, but no one would buy it. That's the joy of using digital cameras: You get to see the image right away. Royalties may also include what are known as "convoid" sales. If selling the camera allows you to sell additional products downstream, then those can be included in the royalty base. That will certainly be explored by the plaintiff. Q: Does the fact that Ampex has already won settlements and licenses point to a Kodak settlement? A: Ampex will try and rely on that. [The past settlement history] is pretty persuasive stuff. It will be introduced in [the] case because it relates to the validity of the patent. It is some evidence of commercial success. And commercial success would be evidence of nonobviousness. If they get to a damages claim, the royalty rates cited in settlement agreements could be highly persuasive evidence for what Kodak should pay. [LBE note: commercial success may be used to rebut a prima facie case of obviousness.] Q: In Silicon Valley, how is Ampex viewed these days? A: Ampex is basically a research shop. Ampex is viewed as a slightly more civilized version of a patent terrorist. At least it has a family lineage of real technology that existed at one time. People respected Ampex. It did real stuff. [Now] what it is doing is no different from what other patent trolls do. Q: Is so-called patent trolling on the rise? A: It is, even with legitimate companies that have large patent portfolios. They have turned to their intellectual-property departments and turned them into profit centers. Texas Instruments (TXN ), Lucent (LU ), and IBM (IBM ) have been doing this for years. Plus, the damage awards are huge. [The practice] has grown more vigorously over the past 10 years. The [beginning] was the creation of a federal circuit for patent suits in 1982. Patents are a powerful economic weapon. People sue left and right. The outgrowth of that is patent holding companies. They're like venture funds. They go around holding people up for lots of money. Q: What is the cost to society? A: Most people suing didn't do any of the invention. Money isn't going to the inventors. There's no socially useful purpose. It's a waste of resources. Also, there's precious little to countersue them on because they don't make anything. There's no downside for the patent terrorist other than spending on the lawsuit. [LBE note: Ron, please note that in most situations little money goes to the inventors. Check out the patent awards procedure in places like IBM, Kodak, Exxon. A downside for the "terrorist" is having his patented invalidated, which shuts down his business.] Q: Is there any way to curtail the lawsuits? A: Not without legislation. That would be very difficult to do. Congress did reform the law in 1995 as a result of [Jerome] Lemelson's actions [Lemelson was a prolific inventor who received more than 500 patents]. He did nothing but file patent applications. He has the largest number of issued patents. He acquired patents in key areas of technology such as bar codes. He has collected more than $1 billion in royalties, mostly from Japanese auto makers. As a result, Congress changed the patent expiration dates from 20 years from filing, to 17 years from granting. Q: Who else could Ampex sue? A: The major digital photography companies will be targeted. Computer companies could be targeted. I can't say for sure since I haven't reviewed the patent. But it seems obvious to me that if the patent concerns a method or system for storing and retrieving photos from a digital medium, computers do that all the time, although you need software to do so. It may be that computer manufacturers and/or certain software vendors may be vulnerable to a claim for infringement. [Ampex] can go after Motorola (MOT ), Nokia (NOK ), Samsung and all those guys. It's hard to sell a phone that doesn't have a camera

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Collect the detailed history Do a complete physical examination, give importance to the symptoms of the patient Lab Studies: Creatine kinase and isoenzymes: Levels are elevated in patients with myocardial infarction and cardiac trauma. Renal profile and CBC count with differential: These tests are useful in the diagnosis of uremia and certain infectious diseases associated with pericarditis. Coagulation panel: The prothrombin time and activated partial thromboplastin time are useful for determining bleeding risk during interventions, such as pericardial drainage, the placement of pericardial windows, or both. Antinuclear antibody assay, erythrocyte sedimentation rate, and rheumatoid factor: Although nonspecific, results from these tests may give clues to a connective tissue disease predisposing to the development of pericardial effusion. HIV testing: Approximately 24% of all pericardial effusions are reported to be associated with HIV infection. Purified protein derivative testing: This is used to diagnose tuberculosis, which is an important and not uncommon cause of pericardial effusion and tamponade. 4. Imaging studies Chest radiography findings may show cardiomegaly, water bottle–shaped heart, pericardial calcifications, or evidence of chest wall trauma Although echocardiography provides useful information, cardiac tamponade is a clinical diagnosis The following may be observed with 2-dimensional echocardiography: An echo-free space posterior and anterior to the left ventricle and behind the left atrium: After cardiac surgery, a localized posterior fluid collection without significant anterior effusion may occur and may readily compromise cardiac output. Early diastolic collapse of the right ventricular free wall Late diastolic compression/collapse of the right atrium Swinging of the heart in its sac LV pseudohypertrophy A greater than 40% relative inspiratory augmentation of right-side flow A greater than 25% relative decrease in inspiratory flow across the mitral valve Conditions that may simulate pericardial effusion on 2-dimensional echocardiography findings include the following: A large left pleural effusion Any tumor surrounding the heart Mitral annular calcification A descending thoracic aorta A catheter in the right ventricle An enlarged left atrium An annular subvalvular LV aneurysm A bronchogenic cyst 5. Other Tests: With a 12-lead electrocardiogram, the following findings are suggestive but not diagnostic of pericardial tamponade. Sinus tachycardia Low-voltage QRS complexes Electrical alternans (also observed during supraventricular and ventricular tachycardia): Alternation of QRS complexes, usually in a 2:1 ratio, on electrocardiogram findings is called electrical alternans. This is due to movement of the heart in the pericardial space. Electrical alternans is also observed in patients with myocardial ischemia, acute pulmonary embolism, and tachyarrhythmias. PR segment depression 6. Procedures: Swan-Ganz catheterization 7. Histologic Findings: Occasionally, a pericardial biopsy is performed when the etiology of the pericardial effusion that caused the tamponade is unclear. This is especially useful in cases of tuberculous pericardial effusions because cultures of the pericardial fluid in these cases rarely yield a positive result for mycobacteria. generic cialis Cheap Viagra generic viagra online buy cheap cialis

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