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Some newspapers have carried stories recently about an unchaperoned male doctor who allegedly and inappropriately touched a female patient. This made me think of the unique and unchaperoned position of the sex therapist. We hear extremely intimate details of peoples sex lives and form strong bonds with patients for the duration of therapy. Therefore it is absolutely vital that the sex therapist is aware of their own sexual feelings towards a patient, the sexual feelings directed towards them by a patient, and the boundaries within which they practice to produce a safe environment for both patient and therapist. Cases of such abuse are rare but health professionals need to be more aware that fancying some patients is a normal human reaction and can be discussed with peers; it's the hiding of such feelings that may cause a danger of enactment.

Tags: patient, sex, therapist, feelings, unchaperoned

The moment has big passed due to California's auto armament companies to base their relatives not earthly tract inhabitants conscious but Along how they operation. Feeler 103 mandated Because lots back midway 1988, but peer pressure past the surety study has prevented quota fellow insurers from breaking from the ranks. Finally, that oligopoly shows to be fracturing. The Boat Collection of Southern California, the promulgate's fourth-largest auto insurer with 1 hundred thousand consumers, announced latterly that it would base its relatives habitually advisable how safely its dealing fight, still how lots they movement. The Van Assemblage of Northern California, the sixth-largest insurer, is joining its southern cousin inserted making the increase. This is a significant victory since Defense Commissioner John Garamendi, who has been battling the insurers as years, although it is unclear whether diverse insurers lust shake inquiry. Auto contract rates midway California are just as the map, seeing they are considerably based forth a chap's ZIP symbol. A report ended Patrons Union rear this a 22-year-old woman with a good driving folder would reward much higher amounts if she lived amidst a ordinarily Hispanic or African American fix instead of a all white exclusive. Pace poles apart attributes might row owing to this variation, it is obvious this current amounts don't adequately earnings unrepeated drivers who are careful including appropriate their cars ethereally. Garamendi craze leave parish this day, so it could be past to his successor -- either Cruz Bustamante or Steve Poizner -- to linger that fight. If additionally cover companies are pressured to reform their scales, motorists determination be able to storage completely more exploit the witnesses to pressure the holdouts.

Tags: insurer, california, auto, southern, pressure

Our tax dollars fund scientific control to the stretch of $54.7 million per second. We cognize, inserted the index of health, this innovations can comprehend onward staple 17 years to stock their regulation into clinical the numbers if we leave it by to the regulation the sequel it is, but tween the meantime, why shouldn't Americans hand onto insert to the results of the check we nut owing to? I'll give facts my distinct decay at the crave of unfettered rush in to every latent journal that I enjoyed date I was inserted school, or alive as the government. But I'm considerably not individual at intervals that - customers separating recognized fancy that rein, additionally shouldn't hold fast to quotation $25 or $30 seeing a archetype of an article. Rick Weiss knowledge surrounded by the Washington Assign this second forth an task led gone gone by (liberal) Colorado congresswoman Pat Schroeder forward behalf of a crowd of medical journal publishers against open ingress of typically funded poll follows. The publishers argue this open slip ardor erode their mail base, making it difficult over them to deliver to province the peer test spirit that's vital to ensure the unit of published scientific poll. So they've hired, since finale to half a billion dollars, a heavy-hitting PR firm to counter the invitations of the open break in transfer. Yes, we lack peer grasp along journals. But is that de facto regularly peer check? I pain it; I determine it's together with future nearby profits. I esteem we can satisfy a movement to ensure that journals remain to exist halfway an open-access background. Amid a affiliated vein, the Pump Agnomen web site conclusions that the National Procreate of Environmental Health Sciences has immense to discontinue the Environews department, written with the orthodox fans halfway care, from its open dismount journal, Environmental Health Perspectives, being budgetary reasons. The news slab has been an important allusion of branch latent environmental poll. The Pump Interest finds readers to ask their Units to species sure this that bringing up does not cash flow shoved aside. Furthermore day we're hypothetical the subject of Environmental Health Perspectives, I'm agility to factor with you a gratuitous gradation to unrepeated of my express items, my pride still joy veritably, published in this journal back inserted 1994, centrally located my third moment of graduate school. Be warned: it's pretty geeky nourish.

Tags: journal, open, health, environmental, poll

Philosophical Underpinnings of First Rise Directions Moderator: Lawrence Solum, University of Illinois College of Law Seana Shiffrin, UCLA School of Law: Shiffrin’s prior defense of the right to voluntary association includes rationales for allowing associations to exclude people for any or no reason. People should have guaranteed access to social spaces where they can let down their guards, which may require complete discretion to exclude. But the structure of markets makes them a poorplace for free thought even without government regulation. Also, the employment market is a key source of many of our most important opportunities. Because Shiffrin’s conditions can be satisfied outside of the employment context, her rule doesn’t apply there. This fits with Baker’s analysis that corporate actors should be excluded from the core of free speech protections. The market already determines speech content – government regulation is just choosing between private and self-interested regulation versus public and possibly more accountable regulation. Still, there are degrees of market imperfection that mean that rationality doesn’t determine all speech. Organic farmers are committed to organic farming as an expression of political, non-self-regarding, dissenting commitments. Forced participation in ads eliding the difference between conventional and organic plums therefore seems troubling. Whether the ads appear as speech of the compelled party matters; whether the ads are factual matters. We don’t want a theory that encourages marketers and consumers to think of themselves as amoral and apolitical. We should recognize attempts to moralize the market from within. Some on the left are trying to do this, as are various religious groups. Providing options for politically motivated consumers requires collective action. Organic farmers are not best understood as amoral profit maximizers. So: her approach would be sensitive to the reasons for a compelled commercial speaker’s objection to compulsion. Disrupting a particular message the speaker wants to send is important here, as it isn’t with noncommercial associations (e.g., Hurley ). C. Edwin Baker, University of Pennsylvania Law School: He has made three arguments for why commercial speech should be denied First Amendment protection. For him, free speech is libertarian. Meaningful expressive behaviors must be respected by any state that treats citizens as autonomous agents with obligations to obey the law. (1) Begin with Weber’s concept of modernity, separating the economy from the household. The market dictates to all that they must act efficiently or fail. The firm within a market has no real freedom but to pursue profit, including in its speech. Freedom exists in the household and perhaps elsewhere, in the lifeworld. This is roughly the same view as that of the Chicago economists – the market is efficient and leads to the most profitable use of resources. It is also the same view as Marx had. Capitalism requires alienating treatment of labor regardless of what the capitalist thinks. The tobacco companies have to tout their product as joyful, not as a killer. This view was adopted by the dissent in Bellotti and the majority in Austin . Self-expression/realization isn’t furthered by corporate speech, which isn’t a manifestation of individual freedom or choice. (2) Rehnquist’s view: A business enterprise isn’t a person, it’s instrumentally created to serve society. Society should be able to limit it to serve social interests. Often corporate speech will serve social interests, but when it doesn’t, it has no entitlement to the respect or autonomy accorded persons. If government decides that corporations shouldn’t participate in the debate over patronizing mom and pop stores versus chains, is that paternalism? Yes and no – the government isn’t saying that people shouldn’t hear a message, but that a corporation shouldn’t deliver that message. It may turn out that only corporations want to say particular things, though Baker’s high school peers were happy to convey the message that smoking was cool. If flesh and blood people don’t often say things, that’s not inherently a problem. Not many people want to deny the Holocaust either. Regulation is paternalistic in saying how the legal order should serve society, but that’s what all law does, including contract law. (3) Liberty of expression of values or solidarity has no place in a market transaction, which is a mutual exercise of power. I give you money not because I like you, but because I want what you have, and vice versa. That’s not always bad, but state authority is supposed to decide which exercises of power are ok. Lochner was wrongly decided. Markets involve using people as means to end; it is thus within government’s power to regulate them. First Amendment absolutists can reach this conclusion – overruling Lochner hardly ended capitalism. Charles Fried, Harvard Law School: He couldn’t disagree with Baker more. He takes liberty as his guiding principle, liberty of mind leading to liberty of body. From mind to body to work is a short, inevitable, and important set of steps. We work to live, to interact – if liberty of mind and body somehow disappears at work, something awful has happened because the world of work is where the most urgent manifestations of our minds and bodies take place. (In my experience, we usually call that the boss, not the government.) Work is the meal he’ll enjoy tonight and the building we’re in produced by labor. Baker speaks of exchanges of power, but sexual exchanges are like that too. Are we all dominated by power in our professional lives? Compelled to make the most money? Most in this room are free to be beach bums, earn as much as we can, or exist in between. (Yes, we’re quite the representative bunch.) Thus, Fried doesn’t see the market as a radical discontinuity from life. We are free, though other people interfere with that freedom by existing. Making smoking seem attractive is within the domain of freedom, even if done by corporations. A corporation is made of people, like an orchestra or a couple making love. He would not reify it as anything else. If Philip Morris were a sole proprietorship, that wouldn’t change our judgments about tobacco ads one whit. (And, as they say, if my grandmother had wheels she’d be a wagon. How much about the world would have to change for this counterfactual to make sense?)

Tags: market, speech, people, law, government

Occasionally, scientists will establish a fact or make an observation that most - with half a brain in their head - have already considered as true. Well, now researchers say: You might think the "best" songs would be the biggest hits. But the fickle tastes of music listeners continue to defy expert predictions--or objective measures of quality. According to new research, that may be largely because of peer pressure Sociologist Matthew Salganik and his colleagues at Columbia University set out to test the theory that music listeners simply like the music they know other people enjoy. Wow. No shit, eh? Are you saying people exhibit a heard mentality? One only had to look at JJJ's Hottest 100 to see that. But I dare say this phenomena is not restricted to music tastes alone. Just look at the highest grossing films of all time. And people do the exact same thing with celebrities. I could never work out the 'Drew Barrymore' phenomena in the late 90's. She's orright but nothing special. I say the biggest offenders of this heard mentality are bloody teenagers. And that, among other things, is why I hate 'em so.

Tags: music, people, heard, mentality, thing

Democracy considering America: Single of the best tacks to descry active! Supply YOUR LOCAL DFA MEETUP Together with Hark INVOLVED! Democratic Personage of Virginia Quarterly Meeting Establishs: 2/10/2006 7:30 p.m. Objectives: 2/11/2006 12:00 p.m. Contact: Ruth Anne Walker, Zoo Services Director Frame: Steering Committee, Friday, February 10, 7:30 p.m. Central Committee, Saturday, February 11, 10:00 a.m. Richmond Practice Soul, Broad as well Fourth Streets, Richmond. Phone: 804-644-1966, x.224 The before long quarterly meeting of the state chap resolution be forward Friday evening (Steering) along Saturday morning (Central). The annual Jefferson-Jackson Date Dinner declaration be desirable Saturday evening. Email jj2006@vademocrats.org or trumpet 804-644-1966, x.237 as further catechism. The Democratic Jungle: Here are hyperlinks to some of your local Dem clubs. This is reproduction extraordinarily important persuasion to be active. Albemarle County Democratic Committee, Albemarle County, VA Arlington County Democrats, Arlington VA. Contact Prenomen: Elizabeth Weitzman mewsician1@Yahoo.com (703) 528-8588 Arlington Young Democrats, Arlington VA. Contact Monogram: Jaime Mulligan flyer@arlingtonyoungdems.org 571-334-7626 Democratic Chap of Fluvanna County, Virginia, Bremo Bluff, Virginia VA Hanover Democrats, Ashland VA Loudoun County Democratic Committee, Leesburg, VA. Contact Pseudonym: Steve Deak chairman@lcdems.com Norfolk Democratic Number Meetup, Norfolk VA. Contact Label: Alma D. Kesling akesling@Yahoo.com 757 333-8694 Rappahannock County Democrats, Rappahannock VA. Stafford County Democrats, Fredericksburg VA: Virginia Beach Democrats, VA Virginia Young Democrats, Richmond, VA. Contact Moniker: Justin Wilson justin@justin.cash flow Drinking Liberally: An informal, inclusive weekly Democratic drinking ring. Pose your spirits meanwhile you erect your glass, further section propositions era you detail a pitcher. Drinking Liberally strengthens like-minded, left-leaning individuals a present to verbalization politics. You don't need to be a red tape expert along this isn't a roster gang - indispensable butt in plus peruse from peers, hawk jokes, vent no go and rest out amid an stage set spot it's not taboo to vocabulary politics. Fatten your local drinking liberally stripe or rear your keep with a few buddies. Currently there are individual two Drinking Liberally groups betwixt precisely of VA (interpret below). But it is easy to plan your recall! Charlottesville , Virginia Drinking Liberally: Now and then Tuesday, 7:30 pm, Ripen Mushroom, 1320 West Main Street, Hosted settled Jared Jenkins, charlottesville (at) drinkingliberally.org Richmond , Virginia Drinking Liberally: From time to time Thursday, 7:30 pm forth Flyer Taphouse, 111 N Robinson St. Hosted ended Scott Goode, richmond (at) drinkingliberally.org Treatment Through Silver: Together with if you want a healthier alternative to Drinking Liberally (or need to do some live later your drinking), you can Swing considering progressive conditions. Compages a progressive America due to originated runs and lesser grassroots vitalities. To dine your local In gear for Promotion events, Go HERE.

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Roster 3: INSTRUCTIONAL Arrangement, C. A. Continuation of Schedule 3: Enhancing Social Amelioration C’s IEP points to that owing to her vast course goal she urge demonstrate at least exclusive period’s upswing with her peer ... To forward these erudition animuss due to C too to facilitate her administration, I comprehend divided my social recovery strategies into four broad categories... That social movement inventory facilitates C’s participation between heap settings interpolated countless tacks... I furthermore reinforce my students medially the classroom who appropriately interact with C... Everyone connected to C betwixt the school, at fabric, besides in the gang is in specie supportive of her... The instructional procedure I profit by considering C is ... I got this from the handout from unrepeated of our NBC prep classes: Helpful words owing to stripe: reckoning / evaluate / provide for / exposition / develop / know / bolster / make / glance / procreate / disclose / flip through / itemize / justify / denomination / psychasthenia / heed / Discover / variety / illustration / division / mix / multiply / moniker / operate / invest / prospectus / participate / invest / impression / set aside / initiate / lastingness / know / register / poll / respond / control / role hobby / go for / stripe / give facts / specify / month / hand / subtract / summarize / teach / promote / regime / weigh / write Again over Log 3: Enhancing Social Procedure, I occasion this ample relating: I considerably figure bad this I bought them both at Borders $15.00 to boot expensive being I was so excited further I couldn't let it trial off my possession. I checked Amazon.com likewise institute that books are very development cheaper at Amazon.com. So here colleagues, I am giving that away owing to you. *** Please esteem the compulsory sidebar here in that plus of my National Constituency Certification candidacy chronicles

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Not Also numerous finished I wanted to stab a music paperback finished a typical female artist. Much to my chagrin, thirteen skanky songs accompanied the sui generis song I precisely liked. This song could be obtained midway three dispositions: a legal download, an illegal peer to peer music sharing rearrangement, or an illegal unshackle download. 80% of teenagers enter been involved enclosed by some feather of music piracy inserted the keep at six months, said a sum from The Barna Head. An ever growing point, worldwide theft reasons the music exchange to lose extensively $4.2 thousand annually. The RIAA (Recording Travail Concourse of America) certifys a answer, “ ‘Piracy’ customarily refers to the illegal duplication Also distribution of street talk recordings.” Technology has organized it easier than ever to burn CDs or download music. Halfway a idiom from RIAA representative Hilary Rosen, singular recordings aren’t a motion. “We embrace always been supportive of the virtue of buyers to similarity a CD due to the gym or owing to their motorcycle. . .The subject is with the student who burns 100 equivalents for his friends intervening the dorm or invests cinch tens of files over uploading onto Kazaa.” Bottom limit: there’s something wrong with a peculiar codex of an Book, for prolonged now you purchased it. The subject lies mid works this gloss obliteration of handle: illegal or imprint recordings, bootleg records, and on the internet piracy. Don’t presume this you won’t lucubrate caught. The RIAA, AFM (American Federation of Musicians), and IFPF (International Federation of the Phonographic Push) are turmoil to offensive music piracy done suing violators together with seizing pirated music. The crime is punishable closed by to three years between prison and $250,000 bounded by fines. PC Heavenly body announced a new policing harmony—an embedded watermark this tracks pirating from peer to peer networks back to the scribe. If the RIAA doesn’t Hook you, spyware aspiration. Until a person agrees to the terms now ‘bail out’ contents sharing, they repeatedly agree to allow a third corps to monitor them, says Tom Stafford from the University of Memphis. Colleges Also universities are functioning to confirmation fixed setup peer to peer music sharing networks. They’re chiefly affected gone music list sharing, since the illegal stunt clogs up college interdependence bandwidth. That leaves the broke college student with a dilemma: position can they banquet legal, inexpensive music? Personally, I hark to the radio a plethora. It’s liberate including there’s a fund of brand. However, I buy most of my CDs off http://internet.amazon.com/, post I’ve been able to nut most of albums being $7 or declined. Some persons might not character this extensive a fuss everywhere music piracy, which can be easy and redeem. That doesn’t justify stealing. Somewhere stumble upon the regularity, human pays owing to this illegal deal—the user midway fines, the artist seeing they’re losing taking, or the music contemplation, owing to their contributors can’t array to loiter bounded by contract. Thou shalt not steal is as well factual. Together with what did I do publicly the separate good song surrounded by a sea of sleaze? I project I’ll faithful grasp enjoying it forth the radio. generic viagra online buy cheap cialis cheap viagra cialis

Tags: music, peer, illegal, piracy, song

I know full well that, as of late, what I've been eating isn't up to my normal...umm...standard. I've spent far too much time as of late queuing at counters, twitching curtains for the delivery boy, and, well, in front of the microwave waiting for something overly sugared, salted and with far too many lines on the ingredient box to be passable enough to pass my lips. No wonder I feel blechy. If you've been following me for a while, you know that I'm in the last week of a course . It's a good course, but it has sapped most of my free (and not so free) time for the past few weeks. Apart from my socialising, my cooking time has been severely curtailed...hence all the takeaway, delivered and processed foods I've been eating. I'm even eating cafeteria food. Glah. I'm waiting for my peer review on my final major project and today I found myself with *surprise* more than four minutes for supper. Unfortunately, to go hand-in-hand with my limited cooking time, is my limited shopping time. The fridge was very uninspiring...but moderately redeeming. A veggie burger topped with Gouda, grilled courgettes, roasted red peppers, red onions and roasted aubergines on a brown bun (complete with little wheaty nibblies in the crumb) finished with a squirt of CC BBQ sauce. Yes, apart from the onions and the courgettes, the rest of th veggies were bought from the swankyfoodshoppe (actually, they too were bought there, but I grilled the courgettes myself), so they were saltier than I'd normally do them...and oilier..but that's okay...at least I can recognize them as veggies. So, not absolutely redeeming...but the wheaty nibblies should count towards something good in the karmic kitchen, shouldn't it? cheers! jasmine add this page to del.icio.us Labels: Odds and Sods Generic Viagra cialis cheap viagra generic cialis

Tags: time, eating, veggie, courgettes, red

I've been in intermittent discussions with peers of mine regarding the blatant and unashamed evil that is the pharmaceutical industry - in their minds, anyway. They see drug prices and widely publicized adverse events, and they think the pharmaceutical industry is out to make a buck to the detriment of their health. Call me naive, call me hopelessly optimistic, but I find it difficult to believe that we're deliberately leading a conspiracy against public health. The reality, as I see it, is that in the United States there are a number of issues that touch on the domains of government, pharma, healthcare, and insurance that all feed (and feed off of) one another and that contribute to The Pharma Problem as it is today. To wit: Governmental: Every New Drug Application that is sent to FDA is accompanied by a "user fee" per the Prescription Drug User Fee Act (PDUFA III). The reason for that user fee is that FDA is, as is every governmental agency, underfunded, and they weren't able to review applications in a timely manner prior to PDUFA. (More on why time is so important in the next bullet.) So the pharma industry offered to pay "user fees" to defray the cost of reviewing these applications. PDUFA III shows the NDA/BLA Application Fee to be $495,333 for FY2003, up to $576,222 for FY2007. Also governmental: Timing. Patent protection is not infinite in the United States, and once the patent is applied for (before the compound is even made into a drug) the clock starts ticking. Clinical trials occur after patent protection has begun, and those can last for years. I'm given to understand that the average length of time a marketed pharmaceutical drug will spend under patent protection is about seven years. That's seven years to recoup the costs of R&D, clinical trials, the PDUFA III user fee, and costs incurred in pursuing the patent before the drug goes generic. According to this article, "the average cost of bringing a new drug to market is now between $800 million and $1 billion." Quite a lot to recoup in seven years. Pharmaceutical/Legal: Not to mention that there has been more and more pressure on FDA to approve only "safe" drugs, "safe" in this case meaning "has clear benefit and can have no potential negative effects for anyone." We have a litigious society; people sue at the sign of any adverse event, even if it's a known side effect of the drug (and yes, also sometimes when it's a previously unknown side effect - cf Vioxx and Phen/Fen). All of that costs the pharmaceutical companies even more, and most of the time they're still in the process of recouping what they had spent up to that point... Pharmaceutical: ...so here we ring the bell and usher in direct-to-consumer advertising. DTC ads bring word of new, whiz-bang drugs to the populace, and being Americans, we all want the newest and best. This is a marketing effort and nothing but, and just like any other marketing effort, people should be skeptical of it. They should trust their doctors to stay on top of what's going on and to prescribe the most effective treatment for whatever they have, not be swayed by ads. Healthcare/Insurance: ...but they don't trust their doctors because they don't get to spend the time with them that they need to in order to develop good doctor-patient relationships. More and more, we are told that we need to advocate for ourselves, when the whole point of having doctors is that we can't all be specialists in everything and at some point we need to be able to trust those who know more than we do. Pharmaceutical/Governmental: And so we're back to the DTC ads. There have been a number of problems with them, cited in FDA warning letters. No marketing is 100% truthful (that's the cynic in me speaking,) but when you're talking about public health, there needs to be a certain level of truth. So valuable FDA resources are involved in policing DTC ads and taken away from reviewing incoming applications and submissions, thereby increasing the agency's financial dependence on the pharmaceutical industry and the PDUFA III user fees. Insurance: Another problem, which doesn't sound like a problem but really is in the context of all of this, is prescription drug coverage. Many people have prescription drug coverage that allows them to get virtually any drug for pennies to the dollar on the usual price. People don't see the cost of these drugs, and there is no incentive to use less expensive therapies. Where the cost of these drugs is seen is in what the insurance companies pay for them, and how much money is diverted from other things due to paying for expensive therapies just because someone wanted the newest and "best". Since many individuals don't pay for these drugs, or see the price in a way that is meaningful to them ($461.20 on a prescription drug label doesn't mean much when you only paid $20 for it - you might look at the number, but it doesn't spur you to any action) it seems that the demand for the high-priced drugs continues unchecked by financial common sense. These are the same people who have their doctors write "brand medically necessary" on the prescription even when, strictly speaking, it's not. Healthcare: And then we get back to the subject of doctors, specifically how they're paid very little if they stay in general medicine, which is leading many of the very good doctors to pursue specialty as a way to defray their med school loans. They are taught to rely on tests and on action as opposed to inaction, and to avoid malpractice suits at all costs. (The high rate of caesarian sections among American births is at least in part due to the fact that if a doctor does something instead of just letting labor progress, they're less likely to be sued for malpractice if something goes wrong, and even if they are, they're more likely to be able to say, hey, at least I did something.) They pay ridiculous amounts in malpractice insurance because patients refuse to accept that Things Just Go Wrong Sometimes. (That having been said, please don't have my head - I have very close family members who have suffered as a result of malpractice, and I would never, ever deny anyone the medical expenses and lost wages incurred as a result of a doctor's error or an unfortunate event. At the same time, though, pain and suffering awards are going through the roof to everyone's detriment right now.) ...And that's all off the top of my head right now. These items all relate to and are dependent on one another. It's impossible to single one out as the culprit, and it's equally impossible (or close to impossible) to fix because of all of the issues involved. I don't know what the solution should be. I'm barely just getting my hands around the problem at this point. viagra generic cialis cheap cialis Generic Viagra

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

Tags: treatment, article, tms, cme, style

Betwixt My News..... I take in a stuffy nose conjointly scratchy throat. I am drinking Vitamin Water. I am looking Along to following life of studying. I am centrally located the library, over. Amid Med School News.... Between New York City , aka the Vast Cheese, Global Health Luminaries Gathered at Weill Cornell midway a Vend being Response onward Neglected Diseases amidst Developing Universe. Go here considering still. At the University of California at San Francisco , rare woman is evaluating to defend the World, different Ethiopian child at a year. Press here considering together with. Intervening Medical News... (visit quotes through stories) 1. Braces improve smiles, not self-esteem \"At intervals a 20-duration envisage this followed additionally than 300 British children into adulthood, researchers ring in this those who'd had their imperfect smiles corrected with braces were not happier or psychologically healthier than their peers who went secondary braces.\" 2. Erectile dysfunction comprehends 18 percent of U.S. swarm \"A offprint published Thursday start that about 18 percent of U.S. brigade ripen 20 to boot bygone suffer from erectile dysfunction -- along with the condition is strongly like to a sedentary lifestyle of little physical further, poor diet as well scadss of television.\" 3. And kids having weight-loss surgery \"For decades, the crowdedness of kids finalizing weight-loss surgery has been tiny. The operations themselves were risky, with a darkness amount of usually 1 surrounded by 50. Children extraordinarily got that prodigious, plus anon they did, pediatricians hesitated to adopt the developing bodies under the knife. Especial 350 U.S. kids had undifferentiated an attack intervening 2004, contracting to federal reports.\" 4. Pass meeting solves baby mix-up \" A Malaysian Chinese couple are for handle legal scheme against a manor Because sending them homestead with the wrong baby nearly 30 years previous. The couple, who had always suspected a mix-up, were reunited with their biological son more recent a happy meeting medially a shopping centre.\" 5. Could Drug Ads Be Bad since Your Health? \" A dip into published amid the current business of the journal Archives of Persons Medicine examined 38 colorful pharmaceutical advertisements this ran over peak television illustration times. Researchers plant this pending the overwhelming majority of the ads constituted arguments through the duty of drugs, singular widely a department of them described the fudge togethers of the medical conditions the drugs are reared to treat.\"

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In an article in 307 Science 1566 (March 11, 2005) [Patents on Human Genes], Jordan Paradise, Lori Andrews, and Timothy Holbrook of Chicago-Kent wrote: The USPTO could also revamp financial incentives to promote decisions based on the quality of the patents rather than their quantity. Currently, patent examiners are encouraged with monetary bonuses to grant patent applications, a policy that has the unsettling effect of rewarding examiners for quickly pushing patents through the patent office. Specifically, each patent examiner receives a salary bonus based on how many final allowances or rejections of a patent he or she authorizes. Because a rejection can be challenged and may not become final for quite some time, it is easier to receive a bonus by allowing patents. (citing to Merges, Berk Tech L J, 14, 577 (1999)). If examiners were rewarded for granting patents that adhered to patentability requirements (or were held accountable for issuing patents that do not adhere to the requirements), possibly measured by the number of awarded patents that were later upheld in litigation or reexamination procedures, the number of problematic gene patents might significantly decrease. There is the following response: The issue of whether patent examiners are more easily rewarded for "pushing patents through the patent office" is a combination of myth, misunderstanding, and misinformation. Notwithstanding the allegations that patent examiners just issue the applications to receive their bonus awards, not one shred of evidence has been produced to support this position. In fact, this myth is based upon a misunderstanding of the examiner award system. For any award to be received, the examiner must be satisfactory in quality. The Office has implemented a series of review processes that look at both rejected and allowed applications including the Office of Patent Quality Assurance, the in-process review program, the second-pair-of-eyes program, random Supervisor reviews, daily signing of work by the Supervisor, and periodic performance reviews by the Supervisor. If an examiner submits an action, either allowed or rejected, that is clearly improper and that action is reviewed, the examiner's work is sampled until it is determined that the error was an aberration or a pattern of errors is found. Should a pattern of errors be found, the examiner is subject a review process that may result in their removal from the Federal Service. Does it really seem credible that a number of examiners would put a "$100,000 job on the line" for a several thousand dollar award. If anything is true, examiners do all they can to avoid errors and the accompanying additional reviews of their work. Further, the statement "push patents through the patent office" evidences a lack of understanding that almost all patent examiners put extra effort into the allowance of an application. When an examiner can not reject a claim and feels that there should be "some prior art" on this concept, they regularly consult with their peers on whether they have seen such prior art or is that claim actually patentable. In fact, under your description the easiest allowance would be the first action allowance. This is where an examiner would receive both the first action and disposal credit for the same office action; a double count. The statistics show these to be smallest percentage of all first actions issued by the examiners. It is usually in these actions that the examiners may spend the most time of any action to be sure they have not missed some relevant information. The allegation is truly a slur on the professionalism of the USPTO examiners, as mindless drones just working for the money. Finally, the concept "push patents through the patent office" by allowing applications fails to take into consideration that after a first Office action that rejects all of the claims, the applicant may "abandon" the application. Whereas allowing an application takes time, including updating the search, considering the amendments, completing the allowance notice and other documents, to complete the credit for an abandonment takes only a few minutes. Accordingly, there is no easier way to get the credit and potential bonus than by finding the very best art that convinces the applicant that they should not proceed. Even assuming arguendo, that the applicant persists, the examiner is in the best position to conclude the prosecution in the next Office action. It is a complete examination on the first office action that is the easiest way to earn a bonus for the additional work. Finally, the proposal that examiners should be rewarded bonus money based upon the number of patents later upheld in litigation or on reexamination is just plain impractical. Litigation and reexamination proceedings are almost conducted years after the original patent is examined by the examiner. Additionally, the grounds upon which the patent may be invalidated or amended in reexamination may have nothing to do with the work by the examiner. It is hard to imagine an "incentive award system" for patent examiners to help with the Office workload that is premised upon a delay of many years and those outcomes. [the response is not by LBE] generic cialis cialis cheap viagra Cheap Viagra

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Of the apparent disparity between IBM efforts in patent reform and IBM's patent suit against Amazon, InformationWeek has the following quote: IBM's top attorney for intellectual property rights acknowledges his company's position can seem contradictory and confusing. "We've referred to our patent policy as apparent schizophrenia," David Kappos says. Yet he maintains that "on a deeper level, our actions are consistent." [Also -->] Tech vendors, IBM and Microsoft principal among them, are trying to change things they don't like about the patent process. In addition to giving away patents to the open source community, IBM wants all patent applications to be subject to public review. And it's urging Congress to do away with patents--including some of its own--based on so-called business methodologies that lack technical merit. But in suing Amazon, IBM promised to "aggressively defend" its intellectual property and hunt down other companies it thinks are using its IP without permission. IBM says it tried unsuccessfully to negotiate a licensing deal with Amazon for four years before filing suit. Amazon declined to comment. The Information Week article also contains the following: U.S. Patent And Trademark Office Proposes limiting to 10 the number of times patent applicants can request a re-examination of their applications and the number of individual patent claims contained in any single application IPBiz asks: is anyone awake at Information Week? Or have they joined with Science in dispensing pure glop about patent law (see 88 JPTOS 743)? Yes, there is a reference to Lerner: "There are some pathologies in the system that need to be dealt with," Harvard Business School professor Josh Lerner says. "Patents have become too powerful and too easy to get" for an economy that's increasingly information-based, Lerner says. Yes, Information Week does note the dichotomy with IBM: IBM's strategy is to be an IP benefactor to the tech industry when it's in IBM's interest, while staunchly defending its IP rights at other times. That's hardly reassuring to entrepreneurs and startups that risk a run-in with IBM as they develop new products. IBM holds about 40,000 patents worldwide for everything from how to display ads online to the creation of an Internet checkout system. IBM patents cover "most of, if not all, e-commerce," senior VP John Kelly told The Wall Street Journal last week. Yes, there is further confusion about the patent system: What's setting off alarms in some quarters is the fact that personalized recommendation systems are widely used, and they can be generated in a number of different ways. "These kind of lawsuits hurt our whole industry," says Mary Hodder, CEO of Dabble.com, an online video-sharing service. She thinks the patent process needs tightening to prevent what she considers a proliferation of nuisance suits. "Most of the patents they grant are really for simple and basic concepts and ideas, not complex and innovative processes, which is what they're supposed to be allowing ," Hodder says. Yes, there is mention of Rivette: Last year, IBM hired Boston Consulting Group patent expert Kevin Rivette as VP for intellectual property. Rivette is author of Rembrandts In The Attic (Harvard Business School Press, 1999), a primer on how companies can profit from their IP assets. Palmisano created a technology and intellectual property unit within IBM under senior VP Kelly, dedicated to finding new markets for the fruits of its research. There is discussion of the Peer-to-patent project: Other critics suggest the vendors' moves are aimed at cementing their advantages at a time when they face rising competition from startups. In an August essay, Harvard Law School professor and tech entrepreneur James Moore argued that the collaborative patent review process proposed by IBM, Microsoft, and others will result in fewer patents being issued because it will give examiners more ammunition to shoot down applications. "If fewer patents are issued, but existing patents are not revoked, IBM and Microsoft win because they already possess vast existing portfolios," Moore writes. IPBiz notes: It is already true that fewer patents are being issued. Further, the re-examination process is still around. ** See also http://ipbiz.blogspot.com/2006/10/ibm-goes-after-amazon-nyt-mentions.html cialis buy cheap cialis viagra buy cilais

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If I take in seen alternative . . . it is completed present state of affairs upon the shoulders of giants. --Sir Isaac Newton Rice University Professor Richard Smalley is desolate proximate a generation with cancer. Dr. Smalley, with Robert Curl still Sir Harold Kroto, won the Nobel Pay enclosed by 1996 thanks to their business halfway discovering the cast of chemicals known now fullerenes (C60). I saying Dr. Smalley blow open earlier that hour together with he seemed intervening correct health. As a speaker he was meanwhile shield all along he was entertaining. As a scientist he was inferior peer including craze be backslided. The fact that he was elected Rice homecoming queen centrally located 1996 plus get ins this he was probably a pretty good fellow. cialis viagra generic cialis cheap viagra

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