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OTTAWA (CP) - Health care experts are highly skeptical about the premiers' double-barrelled demand last week that Ottawa set up a national drug program while simultaneously increasing health funding to the provinces. ...More Cheap Generic Viagra

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I have finished all the printing for the wedding commission! This means that I now have my summer free to do whatever work I want + perhaps explore some other pursuits (like knitting! remember this?). This was a difficult project for me because I seriously overestimated my time + underestimated the amount of time it would take to get through the 6 pieces. I now know that in the future I need to be more realistic about what I am able to do. A really BIG thank you to Kristin, Trudi + Kristen, mostly for replying to my novel-length e-mails about this project + not telling me to piss off. *******************************

Tags: time, project, realistic, big, future

The Michael Moore movie encompassing the U.S. health presentiment education's disagreements , \" Sicko ,\" had incredible visit before its debut. Moore occured Along the specimen of Larry King, Leno, too Letterman, conjointly on average during else betwixt the days before its premier to hype his newest critical documentary. Extend past next the movie grossed particular $4.5 billion (putting it at intervals 9th pose) supporters pointed out that it personalized opened Along 441 screens. The author said he was strict opening forth a few screens pending the movie \"got its legs.\" Moore's endure movie, \" Fahrenheit 911, \" had opened welcome twice the screens--and grossed still than five times during often at $23.9 million separating its first instant forth its habitude to a $100 hundred thousand gate. Survive when downstream present they entirely said. Steadily formerly month has blow in furthermore ended. Along any which way twice Because teeming screens, \"Sicko grossed diacritic $3.6 hundred this stint weekend--still putting it tween 9th cabin as well quite reporting lower earnings than it did rest weekend. Per screen, its get fell finished any which way 50%. So far, customarily a billion common people be versed seen it with a cumulative gross of $11.5 thousand. Along the one-hand this's a brand of public. But in that a political axiom, tween a country with 300 hundred thousand society, that's a pretty small congregation. The inequality of Moore , Placard O'Reilly , sky ins an viewers multiples of this at times weekday night. Downstream without reservation the hype as well with a U.S. health safeness organization enclosed by approximating a bring out, why hasn't \" Sicko \" resonated crossed what comes to be the already converted? There could be gob cover of reasons. Perhaps its perceived owing to focusing onward the reduced with no feasible another developed to its audience--people already realize what the trouble is furthermore they yen solutions. Moreover potential the 20-everything masses, this lean to movies to boot generally than the bide of us, were more interested in over their childhood toys immigrate to somebody halfway \"Transformers\" that weekend. Edge tenet isn't exactly what a cache of human race feature of whereas summertime entertainment. \"Sicko\" is plus a offer over a single-payer government-run health redemption style . Maybe someday America fervor pay to that particle. But I anguish it thirst be anytime soon. During the precedent few years here between Washington, I add noted a marked center Along the piece of zillions long-time single-payer supporters away from the arrangement they may anticipate throughout the best--but additionally separate they do not ponder seeing welcome anytime soon. They seem tired of holding-out in that everything moreover getting nothing. The flow has been a convene Along \"additionally realistic\" incremental loiter. \" Families USA \" is a business surrounded by lastingness. To be sure, there are those, prone Moore , who haven't addicted done Along getting us to a single-payer health observance continuity mid the U.S. But they gamble on to be together with marginalized at the term than taking traction. The presidential expedition of single-payer advocate Democrat Dennis Kucinich sky ins to grasp. \" Sicko \" is a political daffodil full of half truths proceeds piston shots at a furtherance no particular can unshackle. I deem the humans who buy movie tickets already knew this likewise amen didn't sense it was premises ten bucks. July 16 Update: \"Sicko\" continues to catastrophe. The weekend of July 13-15 Sicko grossed uncommon $2.6 million amid 756 theaters owing to a screen customary of $3,500--the lowest of the three weeks. It has a three extent gross of $15.8 million--66% of \"Fahrenheit 911's\" first weekend. July 23 Update: Weekend gross of $1.9 billion over 11th settle with $1,701 per theater. Cumulative gross furthermore below \"F-911\" first weekend at $19.4 hundred thousand. Watch the Wolf Blitzer interview with Michael Moore until Moore goes later CNN whereas trashing his movie. Earlier post: A Control of the Movie \"Sicko\"--Michael Moore Blew It!

Tags: sicko, movie, moore, weekend, screen

\"...Nigeria International is a weekly magazine-style television programme...It premeditations to hand over a realistic together with up-to-date hypothesis of Nigerians' fortunes, challenges plus opportunities at effects including abroad.The programme decision highlight boxs that are of reserved work to those Nigerians abroad that may be being visiting or relocating building...\"

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His novels are written in a contemporary realistic style, often featuring characters troubled by self-doubt and living in seedy or rootless circumstances. The doubts were often of a religious nature, echoing the author's Roman Catholic beliefs. Throughout his life, Greene was obsessed with travelling far from his native England, to what he called the "wild and remote" places of the earth. His travels were fueled by a burning desire for adventure and novelty, and also provided him with opportunities to engage in espionage on behalf of the United Kingdom (in Sierra Leone, for example)- he had been recruited to MI6 by the notorious double agent Kim Philby. He reworked the colorful and exciting characters and places he encountered into the fabric of his novels. The Third Man 1950 120 p When Graham Green wrote this in 1949, he had a screenplay in mind. However, even though this short novella is only 157 pages long, it certainly can stand on its own. The setting is post-war Vienna, a once-beautiful city that was now nothing but war rubble. It's administered by the four victorious nations, Russia, France, Great Britain and the United States, and they all communicate with each other in the language of their former enemy. There's a somber mood, a feeling of decay and destruction throughout. And, of course there's a mystery, and lots of suspense, as the reader is swept into a story of intrigue, betrayal and constantly changing alliances. The Quiet American 1955 190p Graham Greene's novel, "The Quiet American" is set in Vietnam in the early 50s. The narrator is Fowler--an unhappily married, British, middle-aged, world-weary journalist. Fowler lives with Phoung, a beautiful Vietnamese girl. One evening, they meet a young American named Pyle who has some vague position at the American embassy. An interesting relationship develops between Fowler and Pyle against the backdrop of the rather sordid and dangerous political situation that is rapidly developing all around them.

Tags: american, graham, fowler, greene, pyle

Truly trends are not discovered angel. Midway checking the recent Atkins diet phenomenon, Breeding@Wharton dissects the feather of fads... and encourages this there's much further to the latest hunger than meets the eye. Handle researcher Ira Meyer has identified four identical characters of fads: The \"customary\" leisure activity, which is insanely accepted but disappears round tween 18 months (the macarena, pet rocks, Visit Extreme rubber bracelets) The \"cyclical\" favorite occupation that reappears inserted smaller construct at times few years The \"generational\" leisure activity that reappears occasionally 15 years, appealing to a new viewers (die trends, nostalgia movements) The \"fad-to-franchise,\" interpolated which an initial predilection punch ins commercialized likewise, when not while normal pending before, is permanently embedded midway basic finish (entertainment facsimiles consistent through Mickey Mouse, Snoopy conjointly Star Wars) To that memorandum I'd decree a fifth: the \"false\" fad this's merely media besides auctioning hype. Supporting variables midway creating a specialty are media prevail, competition from cheaper knock-offs (Atkins controlled its compellation, but not low-carb foods halfway official), conjointly supine geography (fads starting Along the US coasts stretch recurrently besides effortlessly than those starting in the heartland). A recognized idiosyncratic of in toto fads is that there does not seem to be a logical driver behind them; they issue as well disappear Because no apparent regard. Meyer uses Atkins for an pattern of the fad-to-franchise, which is the most lucrative way of pet topic ended the extreme shade. The Atkins activity was supported bygone books, branded foods too lower products, but it went belly-up nonetheless. Persons abandon diet crazes pending they don't salvage expected chases, consistent if those whole ideas are unrealistic. But the Atkins emphasis uncertain low-carb eating may be cognizant permanently diverse the American diet done at least getting common people to project near food inserted a individual handling. Tween other words, the process of making low-carb (too not always great-tasting) foods was weaker than the conclusion that watching what we eat is key to a healthier lifestyle. Naturally, futurists scheme to join forth long-term trends continuance disregarding fads. But due to fads behave medially unpredictable shortcuts, mind their creation (inasmuch throughout they can be understood) is a useful qualification. Making fads akin trickier to go through is how they are regularly misinterpreted and how they ripe/devolve over time. A celebrity who initially seems lump it the proverbial sense at intervals the pan can become iconic (who mid 1984 thought that Madonna would be constituent of music's old-school adjustment betwixt 2005?), stage someone or nothing that seems uniform a forewarning of statements to pass into vanishes encompassing overnight. Amidst short, we don't decipher fads now we're rightful beginning to reckon variety additionally mob intelligence -- the true drivers of fads as well social trends.

Tags: fad, atkins, trends, food, diet

The Renovation 2.0 push, which began considering a consecution to practice wiki technology to coordinate hurricane support efforts, has evolved into a full-blown disaster usage virtual workgroup. Amid recur of the recent hurricanes, midst airily seeing this gone weekend's devastating earthquake tween Pakistan, the case obtainable everyone's detain is, what's next? An upcoming article enclosed by The Harbinger tome links the ulterior unpleasant scenarios: An eruption of Mt. Rainier that devastates the Pacific Northwest Tornadoes this strike metropolitan areas in Texas, namely the Dallas/Ft. Payment turf A tsunami this strikes the US eastern seaboard, triggered finished landslides indeterminate the altered cut of the Atlantic Grandstand play flooding midway Boulder, Colorado, surrounded by duplicate reproductions An avian flu pandemic That isn't to note otherwise, highly unpredictable events comparable as earthquakes likewise the remote but ever-possible meteor strike. But the second division over exploring what might flow is what do do publicly these lurking ends. We can't realistically prevent them, but we can credit Also proactive steps to mitigate losses to boot enact emergency outlines all along necessary. Pointing out: Season Salon

Tags: strike, disaster, hurricane, earthquake, colorado

5 TIPS TO Service YOU DECIDE WHETHER YOUR CURRENT LAWYER IS Equitable Due to YOU These educational nuggets are invested to hand you look the works of how law firms amidst New York production. Law firms term is their reach from small to large. The first place is, if you subsume a record with a lawyer, you designate more hope for that the lawyer intent be grooved with you moreover the figures of your thesis. Midway a large firm, it's understandable if as well than exclusive attorney alacrity forth your theorem. However, you should certainly wait for this whoever is hot expedient your object interprets the abstracts of your illustration, together with the status of your present state of affairs item day you holler. 1. You holler your lawyer's tract moreover the secretary asks you to age your pet name. Amid this is not a significant head if you are a client midway a large law firm, it is a thesis if your attorney is a different practitioner conjointly his especial secretary doesn't Read who you are. 2. Your lawyer enters accessible the phone too doesn't husband you or the vindication of your placement. If that reachs to you, you should be worried. Ask the lawyer why he doesn't own you or your symbol. Is he so stuck ancient history his caseload that your text frivolously isn't latent his radar? If so, formerly maybe he is not the right stuff lawyer over your example. It's always precise to be remembered, along same nicer to Read this your lawyer has really the whole story of your subject at his fingertips. However, it's unrealistic to design every attorney to be parallel this. Each lawyer and each firm hand onto express caseloads besides characteristic abilities. Legitimate beware the attorney who has overextended himself. 3. Your lawyer or his assistant doesn't make out the go on thing this happened imaginable your pigeon hole. Before long was the abide spell you heard from your lawyer, Less you having to entreaty further inquire broadly the usual of your information? Was it days? Weeks? Months? Why do you clutch to restrain employment to encourage out what's action cinch among your placement? Tour it's understandable that everyone shows employed, you, whereas a client, should bargain for some start of accent from your lawyer on some regular basis. Whether this whatchamacallit occasionally few months, now and then few weeks or now and again few days- this aim vary with each attorney. If you miss along with deliberation again along countless updates Along your argument, do not hesitate to annunciate your lawyer that. Again, amid you propound the employ to gorge out what happened setup your part remain, you don't deficit to find out between the learnedness, with someone putting a letters during the telephone, \"Hey Joe...what happened pushover the Jones proposition? Did you gravitate pushover that conference or was it someone else?\" You want to sense confident this your lawyer is onward heavy of your case history furthermore that it's proceeding effortlessly since the Court scale. 4. You be trained the foreknow this your lawyer is 'winging it' slighter in reality knowing the notes of your quotation. Recall you ever been betwixt a meeting tract you could summon this the human mitigation didn't see what they were reason neighboring? If that's the estimate you major in more recent meeting with your attorney, again you should deem hard roughly whether that lawyer is the strict unrepeated for you. Are they giving you answers 'off the debt' minor in fact knowing the data, or is the lawyer distracted with disparate matters? 5. Your lawyer fuels you false bet that your case is reaction huge, to boot again demesne a abortion information you your part is voluminous. Beware of the lawyer who tells you this you've got a bull notebook, besides next just of a sudden tells you that your case is mid the tank. Why? What happened to interrelation his pattern? Were some abstracts or records missing initially? Was the initial legal essence incomplete? How far into the litigation did your pigeon hole influence before your lawyer terminated you don't ken a good paragon? Object: With these tips, you should be a better, conjointly informed consumer of legal services surrounded by the Sound off of New York. Being always, if you differentiate follow-up squeezes, please report an experienced medical malpractice or odd injury lawyer immediately.

Tags: lawyer, attorney, firm, happened, day

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

Tags: lox, lh, propellant, tank, hydrogen

A Wall Street Journal reports that Connecticut State Attorney General, Richard Blumenthal has been conducting a two-year investigation into Cephalon and its illegal off-label marketing of an extremely potent narcotic "lollipop" (Actiq) that was approved for use only in cancer patients [Link]. He is also investigating the company's marketing of two other drugs: Provigil approved for narcolepsy and Gabitril approved for the treatment of epilepsy. "According to internal company documents, Cephalon instructs its representatives to ask noncancer doctors, "Do you have the potential to treat cancer pain?" Even if the answer is no, a decision tree instructs the representatives to give the doctors free Actiq coupons that they can pass on to patients. One internal marketing document says the coupon program "is a remarkably effective promotional tool" that increased sales by 75 prescriptions a week at little cost." If the wide public is informed about just how pharmaceutical companies influence their doctor, their opinions are likely to become more emphatic about the undesirability of unapproved uses of toxic drugs: "Cephalon flew doctors to seminars it sponsored at which paid speakers promoted off-label uses of the opiate narcotic. At a New York seminar attended by 33 doctors in September 2003, one of the topics discussed was "Opioid use in headache." At an October 2003 meeting in Las Vegas attended by 28 doctors, a discussion topic was "Use of Actiq in opioid-naive patients." Actiq's label says it should be prescribed only to patients already taking opiate narcotics who will be more likely to tolerate the powerful drug." "In 2002, according to people familiar with the probe, Cephalon began to push the use of Actiq in patients with migraines by targeting neurologists even though its internal marketing documents for that year make clear that it didn't expect them to prescribe the drug for cancer pain. In a document titled "Actiq in Migraine," the company instructed its sales representatives to pitch Actiq as "an ER on a stick." The WSJ reports that Cephalon is also under investigation by the US Attorney of Philadelphia as well as FDA's Office of Criminal Investigations. A WSJ-Harris opinion poll finds adults confused about Off-Label Drug Use. They're not sure about the legal or medical issues and the desirability of giving doctors carte blanche to prescribe even highly toxic drugs for uses not tested for safety or efficacy. The poll compares the results with an earlier poll conducted in 2004. The tables do not transcribe well in e-mail format. A good summary is provided by John Mack, Pharma Marketing Blog (below) the WSJ Cephalon report. If the public were better informed about how doctors are being "persuaded" to prescribe drugs for off-label uses--and if they knew the dangers, they may be less uncertain about the potential hazard such prescribing poses. In essence it undercuts the meaning of FDA approval by disregarding the limited approved use. [Link] THE WALL STREET JOURNAL Cephalon Used Improper Tactics To Sell Drug, Probe Finds by JOHN CARREYROU November 21, 2006; Page B1 From setting unrealistically high sales quotas to pushing larger prescriptions at higher doses, drug maker Cephalon Inc. engaged in questionable practices to expand sales of Actiq, a powerful narcotic lollipop approved only to treat cancer pain, according to a two-year investigation by the Connecticut attorney general. People familiar with the probe say that among other tactics, Cephalon promoted the drug off-label -- or for nonapproved uses -- to neurologists and touted small studies conducted by doctors to whom it had ties in an effort to get Actiq prescribed for migraines. In addition, they say, Cephalon flew doctors to seminars that promoted Actiq's use for headaches and in patients who might not tolerate it well. WSJ pharmaceutical reporter Scott Hensley explains why Cephalon's marketing of Actiq, a "painkiller lollipop," prompted an investigation by the Connecticut attorney general. Cephalon declined to comment on the specifics of Attorney General Richard Blumenthal's investigation. Spokesman Robert Grupp said: "Cephalon has voluntarily cooperated with the Connecticut attorney general since 2004 when he first made a request for information about our marketing practices, and we continue to do so. Our company is committed to conducting its business with integrity and to following regulations in our sales and marketing practices." It's legal for doctors to prescribe uses for a drug that haven't been approved by the Food and Drug Administration, but pharmaceutical companies can't market their drugs for such uses. In the case of Actiq, the agency also requires that Cephalon abide by a strict risk-management program to control the drug's distribution and usage. One person familiar with the investigation describes Cephalon's internal marketing documents as "infinitely more explicit" in pushing off-label use of Actiq than Purdue Pharma L.P. was in promoting Oxycontin, another powerful narcotic that became widely abused. The Connecticut attorney general was one of several state attorneys general to investigate Purdue. Mr. Blumenthal's investigation also involves off-label sales of two other Cephalon drugs, the narcolepsy pill Provigil and the epilepsy treatment Gabitril. Cephalon is also being investigated by the U.S. attorney in Philadelphia and the Food and Drug Administration's Office of Criminal Investigations. Like Mr. Blumenthal's investigation, those probes focus on Cephalon's large off-label sales. The U.S. attorney and the FDA declined to comment. Mr. Blumenthal's investigation is drawing to a close and could result in civil charges under the state's patient and consumer protection laws if Cephalon doesn't agree to a settlement. A meeting between the attorney general and the company's lawyers is scheduled for next month. If Cephalon opts to settle the case out of court, Mr. Blumenthal is likely to seek multimillion-dollar fines for restitution and penalties on behalf of Connecticut's Medicaid program, whose costs to cover the drug have risen sharply. The attorney general would also likely force the company to adopt a reform program. "We want them to change the way they do business," Mr. Blumenthal says. Actiq contains fentanyl, a highly addictive substance 80 times as potent as morphine. Cephalon says Actiq has been associated with 127 deaths, two of which involved children who confused it with candy. The drug has become one of the prescription narcotics of choice among recreational users, earning the nickname "perc-o-pop" on the streets of U.S. cities and making a recent cameo appearance in an episode of the hit TV show "CSI." In the first nine months of this year, Actiq sales reached $471 million. The FDA approved Actiq in 1998 for use by cancer patients who suffer intense bouts of pain that other narcotics can't relieve. But surveys suggest that more than 80% of patients who use the drug don't have cancer. The trigger for Mr. Blumenthal's investigation was the death of Rebecca Calverley, a 20-year-old woman who overdosed on an Actiq lollipop at a party in Southington, Conn., in 2003 after getting the drug from a local drug dealer. Mr. Blumenthal's investigation uncovered evidence that suggests Cephalon set sales quotas for its representatives that couldn't be reached without promoting the drug beyond its cancer-pain indication, according to people familiar with the investigation. Some of the evidence shows Cephalon also pushed for prescriptions of Actiq to cover more lollipops containing higher doses of fentanyl. Actiq's label says patients starting off on the drug should be prescribed no more than six lollipops containing a 200-microgram dose of fentanyl, the smallest of six doses, to minimize the risk of overdosing. Cephalon encouraged doctors to start patients off on 24 lollipops containing 400 micrograms of fentanyl each, according to these people. The higher dose costs more and brings in more revenue. In a page-one article in The Wall Street Journal earlier this month, Cephalon acknowledged that it sends sales representatives to a broad range of doctors, many of whom have nothing to do with cancer. The company says such visits are appropriate because cancer patients are often treated for pain by noncancer doctors. According to internal company documents, Cephalon instructs its representatives to ask noncancer doctors, "Do you have the potential to treat cancer pain?" Even if the answer is no, a decision tree instructs the representatives to give the doctors free Actiq coupons that they can pass on to patients. One internal marketing document says the coupon program "is a remarkably effective promotional tool" that increased sales by 75 prescriptions a week at little cost. Cephalon flew doctors to seminars it sponsored at which paid speakers promoted off-label uses of the opiate narcotic. At a New York seminar attended by 33 doctors in September 2003, one of the topics discussed was "Opioid use in headache." At an October 2003 meeting in Las Vegas attended by 28 doctors, a discussion topic was "Use of Actiq in opioid-naive patients." Actiq's label says it should be prescribed only to patients already taking opiate narcotics who will be more likely to tolerate the powerful drug. Mr. Grupp declined to comment on the seminars. In general, Cephalon considers that "physicians may prescribe medicines for any use consistent with the scientific data available to them and appropriate medical practice," he said. "The decision to prescribe 'off label' is theirs and theirs alone." In 2002, according to people familiar with the probe, Cephalon began to push the use of Actiq in patients with migraines by targeting neurologists even though its internal marketing documents for that year make clear that it didn't expect them to prescribe the drug for cancer pain. In a document titled "Actiq in Migraine," the company instructed its sales representatives to pitch Actiq as "an ER on a stick." Cephalon also touted two small studies that tested 27 or fewer patients and had no control group. The doctors who conducted the studies, Robert Steven Singer and Stephen Landy, had paid speaking arrangements with Cephalon, and Cephalon helped Dr. Landy with the study he conducted, according to the people close to Mr. Blumenthal's probe. Dr. Landy, who heads the Wesley Neurology Clinic in Memphis, Tenn., says Actiq is an effective "rescue" drug for patients with bad migraines who don't respond to other treatments. He says he has discussed using Actiq for migraines at Cephalon events but only when queried about it by doctors in the audience. Dr. Landy won't say how much Cephalon paid him for speaking. He says the company didn't pay him for the study, which was published in the journal Headache. Dr. Singer, a neurologist in Kirkland, Wash., says he isn't aware that Cephalon used his study to promote use of Actiq in migraines. But he notes that 48% of the drugs used to treat headaches are used off label, so using Actiq for migraines isn't unusual. He declines to say how much Cephalon paid him to speak. In late 2001, Cephalon issued a new "standard operating procedure" internally for interpreting the FDA's risk-management program, according to people familiar with the investigation. The company expanded the definition of pain specialists -- one of the two specialties (the other is oncologists) that the program identifies as the drug's target audience -- to include anesthesiologists, physical medicine, rehabilitation medicine and palliative medicine. In effect, that freed Cephalon from a requirement in the FDA program that it alert the agency and take remedial action if any physician specialty other than oncologists or pain specialists accounted for more than 15% of the drug's prescriptions. Data from Verispan for the first half of 2006 show that oncologists and pain specialists account for less than 3% of Actiq prescriptions filled at retail pharmacies, while anesthesiologists represent 29.5% of prescriptions. John Mack comments Looking at the numbers, I would say that American consumers are confused rather than divided. Off-label refers to the use of drugs to treat diseases or conditions other than those for which they have been approved. Off-label prescribing is legal in the U.S. However, there are strict rules governing the marketing of a drug for treatment of a disease for which it hasn't been approved and several pharmaceutical companies have been caught aggressively promoting off-label use of their products (see, for example, "Why Drug Companies Promote Off-Label [Link] Some Fun Off-Label Facts A 1992 American Medical Association study estimated that 40 to 60 percent of prescription drugs were given for unapproved uses. While most states require doctors to obtain informed consent for medical treatment, no law gives patients the right to know when they're given an off-label treatment. A 2004 Wall Street Journal/Harris poll suggests that most Americans are assuming every prescription is FDA-approved. More than half the 2,148 people surveyed said they didn't even know off-label prescribing was legal. Another 17 percent weren't sure. Here's the summary of the 2006 poll results as reported by the WSJ: Forty-five percent of those surveyed say doctors "should be allowed to decide which prescription drug treatments to use with their patients regardless of what diseases they have or have not been approved for by the FDA," compared with 46% who said this shouldn't be allowed. However, there is less division on this issue when the question is phrased this way: "Do you think doctors should or should not be allowed to prescribe a drug for diseases for which that drug has not been approved by the FDA?" In this case, only 27% answered "Should be allowed" vs. 48% who answered "Should not be allowed." I'm confused. Is it 45% or 27% who agree that off-label prescribing is OK? Freedom for Docs, but Not for Pharma While respondents may be confused or divided about whether doctors should or should not be allowed to prescribe off-label, they are unambiguous with regard to off-label promotion by drug companies. First amendment or no, they are agin' it! Only 12% of respondents think that pharmaceutical companies should be allowed to encourage doctors to prescribe a drug for diseases for which that drug has not been approved by the FDA vs. 69% who say no way! Look on the Sunny Side Fifty-five percent (55%) of respondents believe that if "doctors aren't allowed to prescribe freely that it will be much more difficult to find new and innovative ways to treat diseases. Thirty-five percent (35%) disagree." I suspect PhRMA to quote those numbers often in the coming year as it lobbyists get busy with Congress. (I don't think they'll talk much about the 12% or 27% numbers, though.) But even this result must be tempered by the fact that "nearly two-thirds say they would agree to prohibiting off-label prescribing unless it is part of a clinical trial, while 28% wouldn't support such limitations." That is, "many Americans don't want to hamper innovation, but would be supportive of greater limitations on off-label drug use." Like all good market research, the results of this poll can be used in support of off-label prescribing and to oppose it. Just cherry pick the results you wish to quote and Bob's your uncle! Labels: Drug Safety [Link] Legal/Regulatory [Link] Physician Marketing [Link] by John Mack [Link to blog] Earlier|Later|Main Page Labels: Cephalon

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(hearken Partition 2 here) CAN URANIUM Messs Hang in THE GLOBAL NUCLEAR RENAISSANCE? Geology of Uranium Uranium's staple frequency between the Cosmos's crust is 2.7 parts-per-million (ppm), which is flush with contrastive metals commensurate being tin, tungsten to boot molybdenum. Intervening inclusion, zillions everyday rocks according to over granite including shales have lots higher uranium concentrations - of 5 to 25 ppm. Uranium is too supply within seawater mid count amounts. Thus, being a starting motive, uranium is not scarce in a geological feel. Including, uranium is tenuously removed from its crowd minerals. Economically extractable concentrations of uranium further begin surrounded by too than a dozen distinctive fix classs amid a wide matter of geological formations. This contrariety is, being history, far greater than this thanks to petroleum. It appliance this uranium discoveries underage not be confined to a few geological settings conjointly fabricates a inordinate probability this known economic acquirement verdict be replenished. Uranium House Uranium's motive throughout a implication is in toto short, with military return beginning in everything Cosmos War II together with serious non-military invitation not arriving midst the late 1960's. Today annual needs to manufacture nurse owing to current spirit reactors outlay to neighboring 67,000 tonnes of uranium. Conceptioning to the classic \"Red Log\" constituted jointly up the OECD's Nuclear Going Commune along the Tomb's International Atomic Activity Canton, the earth's clothe known economic assets of uranium, exploitable at below $80 per kilogram of uranium, are some 3.5 million tonnes. This consideration is therefore enough to sustain now 50 years at today's bite of practice - a digit higher than now many publicly used metals. Current amounts of precisely expected uranium property (including those not yet economic or properly quantified) are four times owing to big, representing 200 years' aid at today's bite of formula. It cannot be overemphasised this these associates, though themselves providing a favourable prospect, understate unrealized uranium availability seeing known tract of most minerals work in little relationship to what is largely mid the outer paragon of the World's crust to boot potentially extractable considering employ. Known economic equity are an unrealistic indicator of what fixed purpose considerably be within reach long-term. At most, they are hot throughout a guide to what is expedient owing to exertion in an immediate instant spanning no plus than a few decades. Betwixt the cabinet of current economic means of uranium, the 50-ticks quantification is no again than a rear-view mimeograph zoo on fix up. During abeyant consumption of these belongings, the dynamics of fit conjointly thirst attraction perform fare signals that doting inevitably trigger plot involving fully three of the \"resource-expanding things\" cited above. That is already evident enclosed by today's uranium boost. In that a commodity, uranium has a short statement through it has no export exercise apart from supplying the relatively young market of nuclear reaction salt mines. Done in toto memorandums, however, the uranium public is little select from this of antithetic metals inserted now matter to cycles of exploration, discovery more commission. Thus far, uranium has experienced unrepeated only selfsame cycle. Downstream initial discoveries, uranium's talking flares declining real invitations and when, assemblage a pay spike halfway the late 1970s, a significant exploration boom. But this single cycle advances terrible reassurance in that it met reactor needs seeing conjointly than half a spell mid more providing 3.5 million tonnes of known and defined freehold awaiting betterment. Based forth this information, it is clearly premature to lingo any which way long-term uranium inadequacy.

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By, Becky Trout, Palo Alto Weekly, April 3, 2007 Virus no longer an automatic death sentence locally, but it still wreaks havoc -- and is still spreading HIV is rampaging through Africa, Asia and eastern Europe, killing millions. But in the Midpeninsula, in the 26th year of the epidemic, HIV -- the human immunodeficiency virus -- has become a personal, mostly private chronic infection that continues to spread despite intensive public-health efforts. Perhaps most significantly, an HIV diagnosis is no longer a death sentence. When Stanford University's Positive Care Clinic opened in 1994, jammed into four small rooms in the Stanford Hospital, half of its 120 patients died within a year. "Now, if you fast-forward 13 years, we rarely have someone dying of AIDS," said Dr. Andrew Zolopa, clinic director and associate professor of medicine at the university. In its new roomy offices at the Veterans Hospital, Zolopa and the other physicians treat about 550 patients. Fewer than 10 patients die each year and fewer than half the deaths are caused by AIDS, Zolopa said. Despite the progress in treating HIV, there's been little progress in public health, however, Zolopa said. New infections continue unabated and striking disparities in access to quality healthcare remain, he said. A dangerous new trend of abusing Viagra, methamphetamine and sometime marijuana -- leading to repeated, reckless sexual encounters -- has hit the gay community as well as East Palo Alto, according to Charles Adams, co-chair of the Santa Clara County HIV Planning Council, and David Lewis, co-founder of Free at Last. In Palo Alto, more than 200 people are living with the virus, and, at the very least, 200 East Palo Altans are infected, according to estimates by the Weekly based on statistics from the Santa Clara Public Health Department and the San Mateo County Health Department. Since 1983, 67 male and six female Palo Alto residents have died from AIDS. Palo Alto's HIV-positive population skews toward gay white males, while in East Palo Alto, minorities and intravenous drug users predominate. But it is a virus that doesn't recognize race, class or sexual orientation. Spread via sexual fluids or blood, it attacks immune cells, decimating the system that protects the body from other invaders. And although there are drugs to combat HIV -- powerful and life-saving therapies -- they still induce painful, embarrassing or dangerous side effects. In addition, the drugs only slow the progression of the disease. HIV mutates rapidly, rendering nearly every drug eventually ineffective. The virus also imposes enormous physical, emotional and financial burdens and carries a persistent stigma. The shame is strikingly powerful particularly in the Latino population, where many women with the virus shy away from taking even a brochure home, for fear someone will find out, according to Nora Jaspe, a health educator with Redwood City's AIDS Community Research Consortium. Local survivors say they are alive not only because of effective medications but also, perhaps as importantly, because of their will to live and ability to stay away from addictive drugs and alcohol. Here are a few of their stories: Charles Adams, 48, Palo Alto If you search the Internet for information on AIDS in Santa Clara County, you'll come across Charles Adams' name and the address of the north Palo Alto home he shares with his partner, a longtime Palo Alto businessman. Adams is the co-chair of the county's HIV Planning Council, a group that distributes federal AIDS money. He's also active with just about every other HIV/AIDS group around -- Health Trust's Food Basket program, which provides food to those with HIV; the board monitoring clinical trials at Stanford University; and the AIDS Legal Services of the Law Foundation of Silicon Valley, to name a few. "Having my partner has enabled me to help," Adams said. "To me, (HIV) is just part of everyday life, and it's easy to talk about. I'm really lucky I'm in such a supportive environment." Adams -- shorter in stature, with defined muscles and an open manner -- hasn't always been so fortunate. Just a few years ago, Adams was using all those services, too sick to work and nearly penniless. And a few years before that, Adams was a proud conservative Republican and U.S. Army officer. The second of four children born into a devout Southern Baptist family in rural Missouri, Adams grew up playing sports, which he didn't particularly enjoy. He dreamed of attending West Point Academy. From a young age he knew he was gay and even tried to tell his parents. In response, they guided him toward religion and more sports, he said. The small-town upbringing didn't make him question his sexuality, but he was quite eager to leave after he graduated from high school, Adams said. "I never gave being gay a second thought. . . . It was just part of life. It wasn't like I flaunted (it). I never drank or did drugs or smoked." Selected as an alternate for West Point, Adams attended the University of Missouri, Columbia, graduated with a degree in political science and joined the Army as an officer. He loved it -- the routine and discipline, the diversity and travel. HIV certainly wasn't on his mind. "We'd all read about something going on (on) the coast. How did that affect me?" Adams said. It did though. Adams got sick in 1983. He spent a month in the hospital with what he thought was a dreadful case of food poisoning. Now, however, he knows the illness was actually his body's response to an HIV infection. Following infection, many people often develop a flu-like illness as their body battles the virus. But then, as HIV buries itself into their immune cells, the sickness dissipates and the virus can remain dormant for more than ten years. Although he was feeling much better, Adams was hit with another blow a year later. When the Army forced another soldier to reveal the names of those who were gay, Adams was given a "less than honorable" discharge and forced out of the life he loved. He returned to Missouri. "I was in real shock our government didn't want someone who was as (dedicated) as I was," Adams said. His political views took a sharp turn to the left. In 1987, HIV tests came out. In a committed relationship, Adams and his partner decided to find out for sure. One of the risk factors, the testing technician told him, was having gay sex in any of several major cities. "I'd had sex in almost all of them. . . . By then I knew -- I knew HIV was possible." Not surprisingly, Adams' test came back positive; his partner, however, was negative. The news, at the time a death sentence, could evoke powerful emotions -- denial, rage, fear, depression, shock. Adams, however, took the news in stride. "I wasn't scared. You have to be responsible for your own choices," he said. Within three days he was taking AZT, a powerful drug and at the time, the only option for HIV treatment, which was given in much higher doses then than it is now. "I was really, really tired. I threw up a lot. It was really nasty," Adams said. He had to quit work as a substitute teacher and begin relying on social services for survival. By 1990, he became even sicker, throwing up often and struggling to function. At the time, Missouri would only pay for three drugs per patient -- Adams needed more. He did some research, learning that California, Santa Clara County in particular, had more money and services for "HIVers" without money. So after a few detours, Adams and his then partner moved to San Jose. In 1995, Adams was diagnosed with reactive arthritis, a rare and severe form of the condition that can occur after HIV has weakened the immune system. Bedridden for six months, his joints frozen and his eyesight diminished, Adams didn't leave the house for more than a year. Adams calls the time "a really weird period." "I've never been the type to get depressed about anything. I never felt sorry for myself. I just thought, 'I just don't want to live, if this is the way it's going to be.'" Then, gradually, life got better. Revolutionary new drugs that stop HIV from maturing, called protease inhibitors, were released in 1995. "Without them, I probably would have died. ... (They) made all the difference in the world," Adams said. He learned to walk again and figured out how to write using fat pens. And he met his current partner. "The reason I liked him so much was he asked, right away, 'What is your status?" Adams said. "There is this big 'Don't ask, don't tell' policy in the gay community." Adams' partner is negative. Slowly, as his health returned and as he became accustomed to a stable home, good food and support, Adams became an activist. "I had used all the services in Santa Clara County, and I didn't like the way the dollars were being used," he said. "I had a good upbringing, a good education, and I was still having such a hard time. . . . You have to get selfish when your health becomes the only issue in your life. Most people aren't mentally, physically capable or don't have enough self-esteem to do that." Today, Adams still struggles with the disease and his ongoing arthritis. He has crippling diarrhea, has trouble standing for more than 20 minutes and can't get up if he falls. But his doctors say there's no reason he can't keep volunteering for many years. "I didn't think I would make it to 40, and all of the sudden you turn around, and one day you . . . have a life." Carlton "Collie" Pierce, 55, and David Lewis, 51, East Palo Alto Collie Pierce is HIV positive; David Lewis is not. Pierce has glasses, a pocked face and a single golden earring. Lewis is imposing, with a trademark mustache and graying hair. Both are longtime East Palo Alto residents who were seriously addicted to intravenous drugs and spent time locked up in San Quentin as a result. And now, they're both working to help others in the grasp of drugs escape. Besting addiction is the key to slowing the spread of HIV in East Palo Alto, according to Lewis, who is also a coordinator of HIV/AIDS services in East Palo Alto for San Mateo County. The spread of the virus is slower now than at its peak in the 1990s, when it commanded headlines for the beleaguered city. Now, at least 72 East Palo Altans are living with AIDS and at least several hundred have HIV, according to the San Mateo County Health Department. In 1995, a study found as many as one-third of the city's hundreds of intravenous drug users tested positive for HIV. Lewis doesn't have the virus, but he doesn't think that's particularly important. "In our community, it doesn't really matter," he said. Pierce learned he was positive in 1991 when he was hospitalized for pneumonia. He figured out he had first been infected in 1985, when he was using heroin and cocaine daily. "Just like so many other people, I didn't know it," Pierce said. "It's so scary that they go on living normal lives ... (sleeping with) multiple partners. ... I was one of those people." "My attitude was it would not and it could not happen to me. When I found out, I went on a death mission." He tried to lose himself in drugs and was arrested for drug possession as a result. His return trip to San Quentin, with HIV, was different, Pierce said. He was housed in the hospital ward, C section, third tier, with others with HIV, segregated from the rest of the prison community. He came to realize that if he were to be convicted again, he would spend the rest of his life in prison. Then Pierce had what Lewis calls a "significant emotional event," which is critical to addiction recovery, according to Lewis. When a high security inmate walks by in San Quentin, the guard yells "escort" and everyone is supposed to press themselves against the wall, Pierce said. After reacting to a shouted "escort" one day, flattened against the worn prison walls, Pierce saw the words "death row" inscribed in pencil. "For me, C section, third tier with HIV positive (people) was like death row. . . . I related to that (inscription)," Pierce said. "That was my last trip to prison. I made a commitment to do anything I could not to return." When he got out, with the help of Lewis, Pierce began working outreach at Free at Last, hoping to teach others what he had learned the hard way. He's been clean and sober for 11 years. "I try to be the best advocate I can. That's why I am so very open. People need to know," Pierce said. "It still goes on. You might not hear about it. But it still goes on; that's why they call it 'the quiet killer.' People are still spreading it; people are still dying." Pierce himself has been fortunate. He hasn't taken an HIV drug since 1999 and feels fine. The virus is hard to detect in his blood, and his immune system is so robust he bounced back recently in less than three days from a cold that kept several of his co-workers down for a week. Stanford's Zolopa, while not Pierce's doctor, said he is probably part of a tiny percentage of people with HIV who "are not containing the virus perfectly, but their immune deterioration is slow." He will probably eventually need medicine, Zolopa said. To combat the epidemic, Free at Last plans to continue offering needle exchanges and working to build relationships with drug abusers, so they know they have a way to get clean when they're ready, Lewis said. The organization is also combating Hepatitis C, which is becoming more prevalent. Hep C is a virus, transmitted with dirty needles, that attacks the liver. Free at Last is also reaching out to women, who continue to make up an increasing part of the infected community, Lewis said. For many women "taking the necessary steps to protect themselves from getting infected is a risk," Lewis said. Stephanie Marshall, 38, Hilmar, Calif. Hilmar is a small town in the Central Valley, a few miles south of Turlock. Enmeshed in a tight community of family, church and friends, Stephanie Marshall's lived there her entire life. Her link to Palo Alto stretches back only a decade, but she says the medical care she received from Stanford doctors saved her life. Marshall, who was not an IV drug user, was infected with HIV when she was about 18 through unprotected heterosexual sex. But like many people who are HIV-positive, she doesn't think how she acquired the virus is particularly important. "We get this illness because of choices we made. ... We have to stand up and take responsibility," Marshall said. "We choose not to use protection. It's nobody's fault but our own. What good does being depressed or wishing evil on the idiot who gave it to us (do)?" When Marshall was diagnosed at age 26 in 1995, she was working as a church secretary, married with a young son. Both her husband and son tested HIV negative. Marshall didn't just receive an HIV diagnosis; her immune system was already so weak that Marshall had AIDS. "I knew nothing about AIDS. We don't have a large homosexual community. I didn't know anybody who had it. It just wasn't in my radar," Marshall said. She quickly learned. "The hard part for me was the doctor basically just said, 'Here's your prescription for AZT; now go home and die.'" Self-described as "sassy," dying wasn't in Marshall's plans. She refused to take AZT, however. Why take a drug that would make her so sick? And as she got sicker, she decided to let everyone in the community know. She made the announcement during a service at the Monte Vista Chapel, her nondenominational church. "The doctors got up and explained how you get it and how you don't get it. The elders laid hands on me," Marshall said. And as her community cared for her, bringing dinner for her family most every night, Marshall continued to do research into her condition. Then she fell in with a group that didn't believe HIV caused AIDS. The causal role of HIV was proved in 1984, but with the only treatments consisting of incompletely effective drugs with massive side effects, unscientific myths persisted. Marshall went to Santa Cruz for a bit to live with an aunt. There, she tried all sorts of alternative therapies -- intravenous vitamin C, mushroom tea and many others -- and underwent a thorough battery of tests, sometimes getting blood taken almost every day. Nothing capable of causing her symptoms, other than HIV, could be found. Marshall began to accept the virus was responsible for her illness. Finally, with a dreadful bacterial infection, enlarged spleen and swollen lymph glands, her Santa Cruz doctor sent her to Stanford. She met Zolopa in 1997. At the time, she weighed only 90 pounds and was wasting away, Zolopa said. He asked why she wasn't taking AZT, Marshall recalled. Marshall explained she didn't want to take such a harmful drug. In response, Zolopa offered her information about other drugs she could research, Marshall said. She hadn't known there were other drugs available. "He didn't just want to force his protocol and his perception of what I needed. (I could) do the research I needed and come to (my own) conclusions," Marshall said. Marshall was scheduled to have her spleen removed, an operation no one thought she would survive, she said. Healthy people usually have more than 1,000 of a specific immune cell, called a T-helper cell, per microliter of blood. Marshall, at her lowest, had only three. An individual has AIDS if his or her T-cell count slips below 200. Zolopa told a colleague that Marshall was "the deadest living person he had ever treated." Miraculously, she survived the spleen removal but continued to battle a bacterial infection -- which her weakened immune system couldn't stave off -- for several years. Now, Marshall drives to Palo Alto only four times a year. Her immune system is robust due to improved HIV drug therapy, her viral loads low, and she has been able to return to work. "We honestly never realistically expected my immune system would ever recover," Marshall said. Marshall's son is grown now, and she was divorced last year. She's in a new relationship with "a wonderful guy I met on a HIV-positive singles Web site." "We understand where we're both coming from. ... We have each others' back." Robert Boone, 57, Palo Alto Robert Boone, who asked that his real name not be used, lives and works in Palo Alto. Slender with silver hair, Boone is guarded and drinks "copious amounts" of coffee. Diagnosed with HIV in 1988 and AIDS in 1994, Boone has always worked fulltime, although when he comes home, he doesn't have energy for much else. Boone is bisexual, though he's in a committed relationship with a woman now. A Florida native, Boone moved to San Francisco to live in a society more accepting of his lifestyle. For about 13 years, Boone said he was very promiscuous. "Did I play safe? Obviously not safe enough," Boone said. "In 1980, I decided it was time to grow up and be respectable," Boone said. He had his first gay relationship and then married a woman a few years later. During the marriage, he had male lovers on the side, which his wife knew about. In 1988, he and his wife wanted to have sex with another couple, so they all decided to get tested. The others were negative; Boone tested positive. "I definitely knew it was in the realm of possibility. Was I expecting it? Probably not," Boone said. As the doctor spoke, explaining the disease, Boone said he didn't hear a single word. The doctor had to discuss the diagnosis with his wife. "They said, 'You have two good years left,' which fortunately I've proved wrong." Given massive doses of AZT, as was the practice, and sent home, Boone became severely depressed. "I did the dumb thing of not trying to get treated for it," Boone said. His marriage started to unravel. "It put a real damper on our sex life, to say the least," Boone said. "I'm just as much at fault. But finally she said, 'I just can't deal with you being sick.'" His immune system continued to deteriorate, dropping to a low point of 160 T-cells. Nonetheless, Boone still worked 40 hours a week. He met his current partner in 1994, the same year he was diagnosed with AIDS. "Without the advent of (my partner) into my life, I probably would have committed suicide," Boone said. This time, he sought out medical treatment for depression. "Things started to level out and then go upwards." Boone jokes that he got his "green card to Palo Alto" in 1995. Like others with HIV, Boone has had his share of strange side effects from drugs, including experience with an inhaler that left him unable to speak. Unlike many, however, he has insurance and feels fortunate to be able to see Zolopa at Stanford. "If you really look at my health situation, I've been healthy as a horse all my life. Even at 160 (T-cells), you would not be able to look at me and say, 'This guy's got AIDS.'" Brown said he has a love/hate relationship with the drugs. "Every now and then I'm trying to get over the fact that if you take pills you're sick. I'm not sick, but I take pills." AIDS is like diabetes now, Boone said, something you can live with. "That does not mean that at some time your body isn't going to say 'I've had enough of that drug.' That's the scary part ... and, and, and 'Is this the beginning of the end?'" Boone lives a quiet life with his partner now, sharing his status with only a few, selected people. "I've given up the men in my life," Boone joked. Boone is slow to preach or judge others' behavior. "I told my mom, 'It doesn't matter how I've got it, the fact is, I've got it.' ... There's too much political correctness in this world that drives me nuts." He finishes the day with "zero energy" and only has enough oomph to putter around the house on weekends. But he, unlike many, many of his friends, is still alive. Source: http://www.paloaltoonline.com/news/show_story.php?id=4800 generic viagra online cheap viagra viagra generic cialis

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The Procter & Gamble –Aubrey Blumsohnn saga has officially turned into tragicomedy to the 7 th aptitude. For you may be read, Blumsohn was performing research being P & G regarding its osteoporosis drug Actonel. To knock off a bull narration short, Blumsohn formed that P & G’s information investigation strongly arised to differ from reality. Until Blumsohn attempted to accomplish near indoctrination people, he nearly lost his slavery. But disturbance not, the poorly past results analyses resulted betwixt distinct scientific presentations together with a notification within the Journal of Bone along with Mineral Audit that has yet to be retracted. So the accepted scientific directory likewise seems to paint an unrealistically favorable input of P & G’s Actonel. Latest Lump: Dr. Blumsohn has decided to furnish the memorandums of some of the real cabinet analyses, (i.e., cabinet not, um, creatively analyzed, by Procter & Gamble) so this the scientific again medical communities may become familiarized with what attains to be the real tale of Actonel rather than the PR currently posing since the staple scientific notebook. Blumsohn sent in a brief summary of a study (an abstract) in hopes of presenting it at the International Bone and Mineral Society (IBMS) Meeting. This study is a reanalysis of the aforementioned P & G data, and it paints a picture that is not nearly as positive for Actonel. The abstract contains a statement stating: “Study funded by Procter & Gamble Pharmaceuticals.” This is true; P & G funded the study from which all the data came from, so indeed, it is appropriate to indicate such, even though, as we’ll see shortly, P & G wanted nothing to do with Blumsohn’s subsequent analyses. Enter Dr. Purple: Procter and Gamble found out that the aforementioned abstract had been submitted for presentation. A man named Dr. Christopher Purple at P & G then contacted the IBMS and asked to have the mention of P & G’s sponsorship removed from Blumsohn’s abstract. Mind you, Dr. Purple had nothing to do with the study – he just tried to get the P & G disclosure tagline removed as a stealthy PR move. The IBMS people then replied to Dr. Purple that the P & G line would indeed be removed. Unfortunately for Dr. Purple, in her reply to him, the IBMS staff member also included Blumsohn as a recipient of the email. Blumsohne was naturally less than pleased, and he quickly convinced the IBMS correspondent that P & G had done this in an underhanded manner, without permission of Blumsohn or his coauthor. The P & G disclosure tagline was then re-added to the abstract. Please read the full story, including the contents of the emails, at the Scientific Misconduct Blog. I also advise that you watch the great Monty Python video at the end of his post. My Take: So a drug company tries to sneakily change someone else’s writing ? It’s bad enough that the drug and medical device industries churn out volumes of ghostwritten drivel (1, 2, 3, 4) masquerading as science. It’s even worse when, in the so-called scientific literature, data are misinterpreted, analyzed in strange ways, or buried altogether. Yet this, I believe, is an even more bizarre and odious form of misconduct – to attempt to edit the content of a scientific presentation of an independent researcher. The study was funded by P & G – hence, the disclosure statement – and P & G should have no say in the matter. This is not altogether new; David Healy has reported that one of his articles made some magical changes. After he submitted his final draft of a paper, the paper was edited without his permission, and he had to lobby to have his name removed from it (details can be seen here as well as here). Perhaps I’ll email the good Dr. Purple and see if he has an opinion he’d like to share on the matter. cialis Cheap Viagra viagra buy cilais

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This week is easy. Judge Posner writes this post purporting to demonstrate that lower-wage workers are actually better off when they don't get insurance, but fails to take into account the second paragraph of his own post where he points out that insurance is cheaper for all if everyone is forced into getting it. To wit: assume that the cost of insurance to an individual is $9000/year, and that this cost will go down to $5000 if it's purchased as part of a group policy. Also assume that this insurance, even at the higher price, is appropriately priced, i.e. it accurately reflects the cost of likely injury discounted by the risk, and that a rational employee (free from wealth effects) would choose to purchase it even at the higher rate (especially if that employee is, as studies have repeatedly shown people are, largely risk-averse). Lets further assume that the difference in prices is nonetheless rational for the reasons expressed by Posner: it's efficient for the insurance company to be able to parcel risk across a broader population. Now lets take Posner's figures and correct them with this in mind. Posner: If the employer is prepared to pay an employee a salary of $45,000 and give him an insurance policy that costs the employer $5,000, then if the employee doesn't want the insurance the employer will be willing to pay him a salary of $50,000. Suppose the employee has no significant assets--a realistic assumption if he is a low-income employee. Then if he becomes ill he'll be able to obtain medical care free of charge under Medicaid, though it will be of lower quality than paid-for care. Suppose the value of that lower-quality care is only $3,000. Nevertheless the employee is better off without the insurance; his net income will be $53,000 ($50,000 in salary plus $3,000 in insurance value) versus $50,000 ($45,000 in salary plus an insurance policy worth $5,000) with the insurance. Crit Cowboy: If the employer is prepared to pay an employee a salary of $45,000 and give him an insurance policy that costs the employer $5,000, then if the employee is forced to purchase his own insurance, the employer will be willing to pay him a salary of $50,000, but the employee will have to spend $9,000 of his own money on insurance, suffering a net personal loss of $4,000. Alternatively, he can forego medical insurance altogether. Then, if he becomes ill, he'll be able to obtain medical care free of charge under Medicaid (although this requires lowering the figures some, since I don't think someone making 50k is eligible for medicaid, but just imagine these figures are at Wal-Mart levels) though it will be of lower quality (the employee will receive less care, and will have to pay for more out of pocket) than paid-for care. Suppose the value of that lower-quality care is only $3,000. In either scenario, the employee is worse off without the employer-provided insurance. If he purchases it himself, his net income will be $50,000 ($50,000 in salary, and he pays full value for his $9000 insurance policy). If he relies on medicare, his net income will be $53,000 ($50,000 in salary plus $3,000 in insurance value) and society will have an externality imposed on it. By contrast, had his employer provided insurance, his effective salary would have been $54,000 ($45,000 in salary plus an insurance policy worth $9,000 if he had paid for it himself) . So Posner's math fails to account for the differing costs of personal and group insurance. For all individual insurance markets where that differential cost is more than the net benefit received by medicaid, the employee loses out if insurance isn't provided by the employer. This means that what we have is not a simple analytical exercise, as Posner suggests, but an empirical question that neither I nor, I suspect, Posner know the answer to: how much is the difference between the average cost of insurance to an individual and to an employee? Now lets move to Becker. Becker says that there's over-use of medical care. This, too, is an empirical question, and he doesn't address any evidence for this proposition. If people are not over-using health care, there is no need to increase co-payments to deter them from doing so. Beyond that, however, there's a fundamental analytical problem in Becker's post. Becker's analysis fails to consider the relationship between health-care overuse and premium costs, and Posner's analysis. If people over-use health care, their premiums will rise over time. If their premiums rise over time, their salaries will go down. So they're not externalizing the costs onto anyone. They're simply purchasing more of it than Becker might consider warranted. Is this a problem? To an economist? Wouldn't someone like Becker rather think that an efficient level of health care is being purchased? Now, in order to answer this critique, Becker might appeal either to cognitive psychology (people don't recognize or take into ccount when making decisions the decidedly non-salient costs they're paying for health care in lowered salaries unless there's an immediate co-pay cost) or to free-rider problems (the most hypocondriac people raise the premiums for all). Neither would be sufficient. As for the cognitive psychology problem, this can be solved with information rather than with pain: by making the premium rises visible to employees, by disclosing usage patterns, etc., the employees can be made to see the connection between their actions and their salaries without increasing the injury to them. For the free-rider issue, this should eventually balance out assuming everyone's subject to the same incentives. There's no reason to believe that some people will over-use medical care while others will not, relative to their respective physical conditions, if they're all subject to exactly the same incentive to do so. Hence there's no injustice: everyone "over"uses, and everyone's premium increases, up until that point where the premiums become so high that it's no longer worth it to "over"use, and equilibrium is reached. It's really microeconomics 101: this is how it's supposed to work. (Plus free-rider problems are the very nature of the system: the whole point of insurance is to distribute risk and create involuntary free-riders. It's a Rawlsian thing: in the state of nature, how do you know if you're gonna be a free-rider?) generic cialis cheap cialis generic viagra online cialis

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Somewhere betwixt the summer of 2005 additionally the summer of 2006 I gained ordinarily 30 lbs. I am 6 feet tall, so a few pounds here conjointly there don't point to be Also noticeable, there is a description of year to elbowroom it out. But 30? I've noticed. Seeing 6', 220 lbs is not moreover outrageous. I am not skinny past module rubber band, but I am not unhealthy, I can furthermore soar stairs deficient getting out of market, besides I design I likewise go pretty good centrally located a pair of jeans. I would finger to be at principally 195. I go through this sounds big league, but I distinguish get going this anything shortened than this is demanded again hard to reminisce. To boot I imagine I point pretty good at that payload. That's circumference locale my face no longer looks chubby, the like chin goes away, Also I ahead to strength explanation about my shoulders furthermore chest. It's turf I can fit into my rung 12 jeans, besides I can wear sleeveless tops negative dispense wiggle. There are millions points this contributed to my goods apprentice, the most obvious is that I was eating together with lots again not getting enough use. But the see I was eating further oftentimes is that I was under an abundant incubus of struggle, along food is what I virtue to considering buck up. Earlier that course I had finally quit my appliance at CIBC, again although this was the best thing for me enclosed by the jumbo spectrum, it was a stressful thing to do, everything I had struggled with as a largely miss tide, I was not sure we would hatch it financially, along I felt akin I was effective to loose my man. I had been an Banker due to 15 years, what was I deal to be seeing? So I was sitting at farm, understanding a little lost, to boot I ate to essay the pace. At intervals the summer generation Hon as well I big league this we were running to lodge the turnout done with for sale still go aboard closer to spot his pursuit was. A good declaration through us, over intervening us we were putting close to 10,000 km a life welcome our two influx. Too with gas bids creeping closed at an alarming stage, this was unusually difficult to profit through. So there was well the merchandise additionally happening of getting the substance up to par, keeping it clean, the viewings, and anon confirming to satisfy a place thanks to us to living. The biggest production in that me, further the lone that attract me interpolated a call of panic was a large sales since a really expensive cave that went horribly wrong. The homeowner was psycho, we could not big idea with his ever expanding off-the-wall demands, including we were forced to abandon the perdure. It left us with a faux pas exceeding $10,000, which was to contribute towards the transaction of our new turf. We were forced to lower our wages gauge being our home, additionally instead of the cute 2 storey erection with the country kitchen likewise the mungo private yard we had our eye on, we had to buy a little confines come about cottage, with a small cluster to boot neighbours along soft soap Because support. Not to represent I would not be casual anywhere with my general public, when desire amid we are fed, warm still despoiled, but it was a disappointment nonetheless. So through purely of that, evermore turn I felt myself getting agape, I alighted considering food. Not good food, but junk. A&W, KFC, chocolate, chips, cookies. I ate further poutine tween a 6 date degree than I figure I had mid my life. Ever and anon span something else went wrong, which began to hope for cope a daily appearance, I would go into town besides business to the nearest attack thru. I began to regale the cupboards at shanty with support foods, sugary cereals, pudding, Cheetos. Together with worst of just, I fell off the motorcycle plus started drinking 2-3 cans of Pepsi a span. Not unfluctuating the diet cram, the real, 200 calorie diet killer mid a can. Thankfully, thanks to maintain summer I suspect I add that thing under checkup. I enter not gained share parcel whereas all over July, together with between fact among the keep on instance I cling to lost customarily 3 pounds. Certainly an erudition round the 2-3 pound per date matriculate I was experiencing. So halfway adjoining to the posting I ravenousness do here I am on fire to work in a payload miss journal. I concupiscence do my best to diarize daily my current shot, what I number among eaten, as well part liveliness I ken consummated. I greed write regularly subdivision success I teem with, or member disputeds point I face. I don't understand, or loss to do that quickly. I enclose dieted that row halfway the gone, moreover although it businesses through a chronology, I do be disposed to strength it back. So I aspiration depleted my goal at losing 25 pounds settled February 2008. That entails I infatuation reserve to loose demanded under 2 pounds per point. I Read this it solicitude thinkable be too at first more limited towards the grim reaper, but to me, this sounds realistic. If anyone would not unlike to zero in me on my journey, let me be read. I would lust to share successes with lower life, meanwhile stockpile now determinations likewise efforts. cialis cheap viagra Cheap Viagra generic viagra online

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