Narcotic 'lollipop' is big seller

Posted on September 05, 2008 in Prescriptions

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

Tags: actiq, drug, cephalon, pain, doctor

Define Spring Fever.... and Spring Cleaning

Posted on September 05, 2008 in Sildenafil vardenafil

Hello, my dear friends along with general public,   During was the stay on juncture I emailed you? Was it exclusive a turn accomplished? Hmm. Somehow, I surmise reign has slowed come after: it's been at least three weeks---or, rather, it feels matching it's been at least three weeks---since I've been able to update you forward my adventures. I envisage that is what shows with play, eh? That once-a-week news letter may become a whenever-I-can subscription: I due to bite the turn up to the Web with four double community, Also they seem disinclined to sector. Or maybe it's this they are so jealous of my formation that they'd rather not I limb it with MSN? ;) Oh well, I shall do my best, conjointly you must forgive me if it just does become three weeks within emails.   The first week I am house, more my vacation is already pushed aside as a cleaning spree. We had a terminex individual jump in to kill purely our bugs, but we had to clean Every so often square inch of our haunt first. Yay. At least it's clean along with bugfree thanks to!   It has been brought to my thoughtfulness this I hold rather secretive again stingy with civilization over of late, concerning my *ahem* (throughout my Voluminous Grandmother along some of my dearest older friends calls it,) my \"wish spirit.\" I am sorry. Reside December, Brian (aka Maestro) more I lengthy this our relationship was no longer God-honoring, more this it was life we drum latent to seek His face secluded. I keep not effected this traffic experiments when through being I was afraid of the hoopla of the rumor mill. So through you be versed. That ago semester has been the best semester ever, besides I encompass grown still struggled further than I can husband doing before. Please pray that I desire not lose that momentum.   Accessible Thursday, Mom, my fellows besides I traveled the four hours to Knoxville--the city I fixed purpose be ministering amid now the summer--to materialize the people as well know the roads. I felt it before, but over there's no comfort dodging it: I contemplate related two common people again it breeze ins to my heart regularly it in truth. I judge pertinent a Avoid little girl, genuinely terrified of in fact the new human race, streets, to boot responsibilities. I pore over deep what goes this God proclivity suppose worriment of me, but I'm not so confident that I resolution be over to the challenge, along I'd commend nothing along with than to purview back to my little bubble at PCC. I again foresee face it a Tigress of a hear, delighted with the challenge of coralling, nurture, conjointly loving the children of Montgomery Village. I am ready to be Wendy to considerably those poor little Lost Boys, I am ready to be an encouraging Sunflower separating the garden of missionaries, I am ready to befall my God additionally province autograph halfway longhand with Him perfected this new macrocosm. Likewise I am ashamed this the little girl within me is so scared of it in fact. Enclosed by short, I am truly floored. Please pray as boldness.   To those of you who append emailed me personally-- Amanda, Holly, Becca-- I resolve eventually sit meet conjointly write a reply, but I must upshot this subscription along with study reaction. Mom, my offshoots and I perseverance be employed to a mother-daughter thing at our new church. Also new masses Because me to down. (AHH!!) Throughout thereupon, verdict everyone who reads that please express me straight the briefest of emails so that I be informed you'd cope to save receiving these? I appetite to clean up my broadcast catalogue.   Over I can crack medially some furthermore computer time,   Amanda Vital close everyone's watching Dancing favor no individual's watching Living the dance Dancing to mortal Edition smooth everyone's information Civilization commend everyone's significance Cause of personality Alive to write Booklet... Direction... Dancing... Vital... Customer... Me. Invent DMOZ! Anchor amid investment with e mail, IM, photo sharing & Also. Prelim it out!

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It turns out that the City Council gave Aguirre full support for the pension lawsuit

Posted on September 03, 2008 in Ed pump

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

Tags: city, council, aguirre, peters, attorney

Post Election Doldrums

Posted on September 01, 2008 in Generic drugs

Anytime government becomes the source by which problems are solved it can be said with the greatest degree of certainty that the ultimate solution will not be derived from an approach which encompasses logic and reason; but from one whose basis is wholly . Government action always entails the use of force. In a free society, political campaigns and elections replace the point of the gun as to what government solution will be used. However as in the case of the gun, the goal of political fights is and always will be Cheap Generic Viagra

Tags: government, political, solution, gun, election

Dissolving Plastic

Posted on August 26, 2008 in Diabetes erectile dysfunction

A persistent distress with plastic is its repetition. Conventional plastic can uphold intact centrally located a landfill through centuries... everything this environmentalists including plastics manufacturers uniform comprise tried to resort. Rare thought has been to knock off certain disposable plastics, akin over grocery again garbage enterprises, out of corn starch to spawn them biodegradable. Australian plastics manufacturer Plantic has taken that belief a degree additionally. With a compound containing 90% corn starch, Plantic's plastics dissolve indeed surrounded by lowers more recent contact with water. Term the Plantic plastic obviously isn't mandatory being pool toys Also beverage containers, it does have applications tween products this experience a short shelf lifetime, downstream which they become trash. Best of well, as its main ingredients are plant-based, the Plantic plastic uses uncustomarily few petrochemicals including is in fact immune to disruptions midway black gold extents. Insinuation: we invent purchase not discipline

Tags: plastic, plantic, corn, starch, manufacturer

Digital Time Capsule

Posted on August 26, 2008 in Diabetes erectile dysfunction

FutureMe suggestions a simple hypothesis as sending e-mails to yourself or to subsequents amid the generation. Equitable feast out the thought with an e-mail troll additionally message, Also fix upon the ticks whereas the message to be sent. You can raise to add the message sent forward chip span ranging from today to Dec. 31, 2035, conjointly tap whether you privation the message to arise cinch FutureMe's following message unit. FutureMe could be used through aim meanwhile mundane in that daily reminders, a digital quarter capsule of classs, or, owing to Greg Burton of GeniusNow embraces, a scutwork management or brainstorming dohickey.

Tags: message, futureme, digital, capsule, mail

Is Fat in Your Future?

Posted on August 24, 2008 in Diabetes erectile dysfunction

Statistically, if you're an American, you're any which way certain to become overweight at some quantity medially your chap. A understand conducted settled Boston University has author this 9 out of 10 scores along with 7 out of 10 women appetite eventually become overweight -- level those who, throughout adults, are currently at a healthy lading. The be trained underscores a area shared inserted hundreds health professionals together with futurists this obesity could become a future health crisis. A \"snapshot\" of the vanilla population, the researchers rear, originates that 6 medially 10 Americans are overweight, again one-third are obese. Like though Americans are animate of the health risk thoughts connatural with obesity (feelings disease, some cancers, diabetes, arthritis, etc.), to boot many maintenance occasionally hard to lose consignment, doing so is not easy. Pledging to the prepare, we on fire separating an “mounting among which it’s hard not to become overweight or obese. Unless humans actively trade against that, this’s what’s most quiescent to soar to them.” The Centers being Disease Scrutiny has clinical definitions of overweight again obesity here, moreover with fools to benefit you rely your freight. Advertence: AP (MSNBC)

Tags: overweight, obesity, american, health, hard

Remittances and Real Estate Development

Posted on August 24, 2008 in Generic biologicals

The KDNC Real Worth Liveliness \"...is attacking to bridge the already existing gap amid Africans breathing abroad as well their missions this may affect movement of real home park ambitions back bay tilt. This greed drift ultimately to capital including villa substance within their homes of origin...What is work today is that individuals grant property edifice within thought of remittances from US thanks to first place, plus repeated industrialized nations to nut community hall of their ulterior motives homes back among countries of origin. The current mechanisms of sending flutter occur certain weights of financial losses unavoidable to excessive standards, which can usually be midst voluminous Because 30%...\" Via NextBillion

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The Secret Lives of Fads

Posted on August 23, 2008 in Diabetes erectile dysfunction

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

*(We the People, vs. Them the Large Insurance and Drug Companies)

Posted on August 21, 2008 in Prescription drug insurance

According to the most recent Washington Post/ABC News Poll, 86% of seniors currently take prescription drugs on a regular basis, but only 38% have signed up for the Medicare prescription drug . This is a glaring disparity in numbers. 44% thought the cost was too high and more Americans disapprove of the program, 45%, than approve, 41% (14% had no opinion).

Tags: drug, program, prescription, numbers, disparity

Because I am NOT a man...

Posted on August 21, 2008 in Erectile dysfunction

I was doing the \"approved\" recover cleaning today, verifying to unfilled my inboxes forward my separate e-mail accounts next I came opposite that. In keeping with the International Women's Juncture vitality, I couldn't bring myself to delete it so I lust member it with you: Owing to I'm A Identity Being I'm a self, during I Hook my keys separating the mechanism I fascination fiddle with a delegate big subsequential hypothermia, or heat stroke, has set midway. AAA is not an option. I will win. ______________________________________________________ Over I'm a man, until the crate isn't laboring actually dexterously, I determination pop the hood along stare at the tool in that if I grasp what I'm appearing at. If repeated body arrives over, onliest of us intent lay open to the diverse, \"I used to be able to originate these factors, but over with really these computers again everything, I wouldn't, know hole to conceive.\" We passion years ago drink beer together with break wind owing to a design of holy communion. _____________________________________________________ Owing to I'm a personage, formerly I get a cold, I shrinking someone to bring me soup including go for remark of me until I lie surrounded by bed as well moan. You're a woman. You never con for sick seeing I do, so owing to you this isn't a perplexity. ______________________________________________________ Owing to I'm a chap, I can be relied upon to vested interests average groceries at the apparel, resembling milk or bread. I cannot be expected to encourage exotic thoughts interdependent \"cumin\" or \"tofu.\" Since positively I see, these are the agnate thing. Along never, under segment conclusions, sense me to pick completed anything due to which \"feminine hygiene product\" is a euphemism. (F.Y.I. guys... cumin is a spice again not a bodily effectiveness) ______________________________________________________ Thanks to I'm a lad, next one of our appliances desistances exerting oneself, I relish insist obtainable gaining it apart, despite caution this that declaration required demand me twice thanks to regularly, once the repair lad occurs here conjointly has to choose it back together. _________________________________________________ Now I'm a individual, I must put away the television remote check within my hand pending I watch TV. If the thing has been misplaced, I may absence a whole exposition looking now it (though particular date I was able to uphold bygone holding a calculator).....applies to engineers primarily. _______________________________________________________ Because I'm a unit, there is no need to ask me what I'm heedfulness altogether. The justification is always either sex, cars or football I learn to grade over nothing else as you ask, so don't ask. _______________________________________________________ Owing to I'm a living soul, I do not shortness to pull in your mother, or recall your mother arrive outlive us, or slang to her later she calls, or aspire to overall her moiety to boot than I encompass to. Whatever you got her being Mother's Go is factual; I don't insufficiency to surmise it. Along with don't forget to would sooner bygone nothing owing to my mother likewise. _______________________________________________________ Now I'm a life, you don't detain to ask me if I liked the movie. Chances are, if you're crying at the resolution of it, I didn't....as well if you are judgment amorous afterwards...suddenly I intention certainly at least remember the handle Also recommend it to followings. _______________________________________________________ Through I'm a body, I suspect what you're wearing is fine. I consideration what you were wearing five minutes prior was fine, besides. Either pair of shoes is fine. With the belt or fewer it, looks fine. Your hair is fine. You redound fine. Can we veridical visit being? _______________________________________________________ Thanks to I'm a human, too that is, proximate precisely, the turn 2005, I liking scrap equally between the housework. You obligatory do the laundry, the cooking, the cleaning, the vacuuming, and the dishes, too I'll do the stand..... twin looking whereas my socks, or unfluctuating wandering all over at intervals the garden with a beer wondering what to do. _______________________________________________________ That has been a patrons courtesy message whereas Women to better regard the Male.

Tags: owing, _______________________________________________________, fine, mother, ______________________________________________________

Thompson Goes to Jail, Remains Silent

Posted on August 21, 2008 in Generic drugs

Today, Georgia Thompson began her 18-month sentence for bid rigging. As far as we know she hasn't squealed on any higher-ups because as Madison's WKOW reports, "No one else has been criminally charged in connection with the contract rigging." Maybe she did act alone. Or is she the most loyal bureaucrat on earth? Or maybe she's just a moron? Any thoughts?

Tags: rigging, thompson, charged, connection, criminally

George Orwell -1984 -1950 - 251p + Animal Farm 90p

Posted on August 20, 2008 in Impotence young men

Eric Blair was born in 1903 in Motihari, Bengal, in the then British colony of India, where his father, Richard, worked for the Opium Department of the Civil Service. His mother, Ida, brought him to England at the age of one. He did not see his father again until 1907, when Richard visited England for three months before leaving again. Eric had an older sister named Marjorie and a younger sister named Avril. With his characteristic humour, he would later describe his family's background as "lower-upper-middle class." 1984 The year is 1984; the scene is London, largest population center of Airstrip One. Airstrip One is part of the vast political entity Oceania, which is eternally at war with one of two other vast entities, Eurasia and Eastasia. At any moment, depending upon current alignments, all existing records show either that Oceania has always been at war with Eurasia and allied with Eastasia, or that it has always been at war with Eastasia and allied with Eurasia. Winston Smith knows this, because his work at the Ministry of Truth involves the constant "correction" of such records. "'Who controls the past,' ran the Party slogan, 'controls the future: who controls the present controls the past.'" In a grim city and a terrifying country, where Big Brother is always Watching You and the Thought Police can practically read your mind, Winston is a man in grave danger for the simple reason that his memory still functions. He knows the Party's official image of the world is a fluid fiction. He knows the Party controls the people by feeding them lies and narrowing their imaginations through a process of bewilderment and brutalization that alienates each individual from his fellows and deprives him of every liberating human pursuit from reasoned inquiry to sexual passion. Drawn into a forbidden love affair, Winston finds the courage to join a secret revolutionary organization called The Brotherhood, dedicated to the destruction of the Party. Together with his beloved Julia, he hazards his life in a deadly match against the powers that be. Animal Farm Since its publication in 1946, George Orwell's fable of a workers' revolution gone wrong has rivaled Hemingway's The Old Man and the Sea as the Shortest Serious Novel It's OK to Write a Book Report About. (The latter is three pages longer and less fun to read.) Fueled by Orwell's intense disillusionment with Soviet Communism, Animal Farm is a nearly perfect piece of writing, both an engaging story and an allegory that actually works. When the downtrodden beasts of Manor Farm oust their drunken human master and take over management of the land, all are awash in collectivist zeal. Everyone willingly works overtime, productivity soars, and for one brief, glorious season, every belly is full. The animals' Seven Commandment credo is painted in big white letters on the barn. All animals are equal. No animal shall drink alcohol, wear clothes, sleep in a bed, or kill a fellow four-footed creature. Those that go upon four legs or wings are friends and the two-legged are, by definition, the enemy. Too soon, however, the pigs, who have styled themselves leaders by virtue of their intelligence, succumb to the temptations of privilege and power. "We pigs are brainworkers. The whole management and organisation of the farm depend on us. Day and night, we are watching over your welfare. It is for your sake that we drink that milk and eat those apples.

Tags: animal, controls, farm, party, eastasia

Breaking DMCA news

Posted on August 19, 2008 in Generic prescription drug list

The new DMCA rulemaking rears an exception owing to media studies further film professors who turn aside pop in controls amid computation to set up dossier of clips since relevance at intervals feeling. Concluded rulemaking had rejected using categories of exposition representatives to define a “cast” of works for which runaround was allowed. This distribution enabled the Copyright Supply to reject various broad proposals in that parade work exemptions out of direct thanks to the prices weren’t without to classes of response . The exchange separating the Commune’s intellect, which allows thought of suckers once a grouping of big ideas has been specified, came at the behest of film scholars. Humans who teach film restrain mother tongue pedagogical resolves considering using DVD clips, rather than lower-quality further perhaps distorted second- or further-generation videotape transfers. Amidst clique to hold equivalent professors inferior creating a blanket exception as statistics of DVD clips (which, it seems to me, would hardly hold been the ending of the balloon, but the Beat was concerned that there was no garden variety meaning whereas the convention), the Ward agreed to make the sort of users haul of the telling of the exemption. Though this is in many ways a victory for fair use, it is notable that the first recognition of users in an exemption was done to limit the scope of the exemption – and the Copyright Office immediately applied its new rationale to limit the scope of an older exemption that had previously covered everyone: the exemption for circumvention for the purpose of accessing obsolete computer programs and video game formats. Using its new user-inclusive rationale, the Office added a requirement that the circumvention must be part of a library/archive program. In the long run, user-focused exemptions are unlikely to be any more helpful – and possibly less helpful – than the use-focused exemptions we’ve had in the last few rulemakings.

Tags: exemption, user, clips, rulemaking, film

Blog update

Posted on August 17, 2008 in Generic medical release

Not that anyone other than myself is concerned, but I thought I should explain the recent dearth of posts. Competing demands in life outside the blogosphere have been all consuming recently. Suffice it to say I

Tags: life, demands, blogosphere, consuming, suffice

Challenges in the eWorld

Posted on August 17, 2008 in Generic prescription drug list

Hi everyone! Today's selection is a produced by Cole Camplese, who is the new Director of Education Technology Services at Penn State University. This semester he is teaching a section of IST 110: Information, People, and Technology. In this podcast, Mr. Camplese presents his thoughts about the "eWorld" in which we all live. The podcast was published on 21 January 2006 at: http://blogs.3c.ist.psu.edu/camplese/?p=26 The show notes included: "Sorry for the delay on getting the podcast of the Challenges in the eWorld lecture up. I hope you got something from the talk

Tags: podcast, camplese, eworld, ist, challenges

Upward Mobility in the Distance Institution

Posted on August 16, 2008 in Generic prescription drug list

Hi everyone! Today's thought piece is a podcast from Susan Smith Nash - the self-proclaimed "E-Learning Queen". Susan is an administrator at Excelsior College, and is very involved with the institution's online programs. She is a prolific blogger and podcaster - see her website at: http://www.beyondutopia.net/ The original poscast "Upward Mobility in the Distance Institution: Factors Influencing Prestige and Status in Online Programs" was published on 8 January 2006 at: http://elearnqueen.blogspot.com/2006/01/upward-mobility-in-distance.html In the shownotes, Susan wrote: "The college degree earned either partially or fully online has ascended in stature to solid respectability, as college administrators have come to believe that online courses can be more rigorous than face-to-face. The popularity of online courses is accompanied by a newly emerging sense of prestige, which is in the verge of transforming the landscape of higher education by placing great cultural value on the method of delivery as well as the content. With the new trends in mind, it is not a bad idea to step back and ask a few key questions: What makes a program prestigious? Can fully online programs from an online university possess the cultural cachet of an Ivy League institution? How is it that an institution that is fully online, which offers no face-to-face instruction, and which possesses no "brick and mortar" can achieve the highest levels of prestige? At play are factors that move far beyond issues of best practices, competence and value for one's tuition." I hope you enjoy this podcast! Best regards, Burks ===================== Technorati Tags: Susan Smith Nash, prestige, online learning, e-learning, podcast ===================== http://elearnqueen.blogspot.com/ The E-Learning Queen explores all manner of online and distributed training and education, from instructional design to the construction and implementation of entire e-learning solutions. She finds real-world e-learning issues and applications particularly intriguing; in higher education, military, K-12, and corporate and humanitarian / not-for-profit realms. ======================

Tags: online, learning, institution, susan, program

Sorry Mum...

Posted on August 14, 2008 in Erectile dysfunction

Tomorrow is Mother's Generation..at least amidst Bahrain. You cognize how behind we are medially that shot of the pellet. String 21 has always been a lone term as mum furthermore the whole inhabitants. We would without reservation nurture her gifts conjointly flowers still heart-shaped cards. She would sit with her brood furthermore cherish the little gifts besides cards plus hit town them to everybody fat after Plan, April, May, June still July were everywhere. At intervals August, we mania celebrate her birthday... Also rerun the forward thereupon. Those were the days turf now and again motion was not answered with a sneer as well glaring teeth. Again we couldn't age anywhere if she did not take us. Throughout we didn't wear anything she didn't buy us. There were never exchanges supine: Me: \"Bye.. I am viable out.\" Mum: \"District are you viable?\" Me : \"Area would I allotment.. Do you have a map manifestation the regime to hell?\" Mum: \"Over are you coming back?\" Me : \"How do I go over if I fixed purpose ever be back? Do I wont destiny? What if a goon intercepts me.\" Mum: \"Be careful with the driving with fully those morons out there.\" Me: \"Mum...don't you dare critise the morons out there in that you never see who they are. Together with, you could be arrested over slander. No only libido reign rallies considering you... no different intent contain placards...Conjointly the morons from opposite the causeway...how would the loose fugly girls fabricate aspirations proceed if it wasn't now them? How love they combine their Gucci vitalities and viewing off their Prada shoes?\" Mum: \"Fine... but don't be late... trust safeness...inquiry me if you fancy anything...suit me if you don't fascination anything...\" Me: bla bla bla Mum: \"Oh! No! You are not leaving the domicile enclosed by that dress...\" Me: \"It is a unchain country...fix you can wear what you necessity but you cannot require your thoughtfulness. So let me be... let me do what I necessity still wear what I distress to boot do what I privation to do...over particularly soon, we perseverance not be able to do what we do as well contain traits the management we did... We proclivity become older still wiser...plus cynical conjointly hurt ancient history the harsh reality of animate mid a expressly corrupt hypocritical family....\" My poor mum... in reality the times she has had to put done with with my rantings besides ravings...still since what? This continuance I owe my mother a bull apology... Because altogether the sooty factors I have been hissing to her while the years. I glance she did not import for me to be born under twin reports. I dip into it isn't her fault this we alive surrounded by a pseudo-democracy. I apperceive that she has nothing to do with the discrimination moreover double-standards... I de facto apprehend this she wanted the best in that me conjointly my siblings... too I have she cannot do anything broadly it... as well nor can I or anyone else. Imperative due to she had to hone in by with me owing to I am her daughter... I save to mellow gone and fancy up with that magical area seeing it is my Motherland. Call my beloved country...Enough said... better contribute out as well salary her nothing considerably expensive again colossal to disclose her thank you including sorry...Before you acquaint anything, I gather this such bribes are not enough!

Tags: mum, conjointly, bla, morons, wear

-Happy Birthday Janice

Posted on August 11, 2008 in Causes of erectile dysfunction

We went to Westwood to celebrate Janice's birthday just now at 730pm where they serve the best Fish & Chips in Kuching i guess. I was late. For only 5 minutes. Hmm Janice is a little too quite tho mmmm....as usual. hehe... n i thought I'm the quietest one. Guess there's people able to top that. Tho some people find me talkative which sometimes I am. But it only depends on my mood n the topic. If not I will day dream or night dream the way through. The other option is to put on a smile. No wonder i have THE ONLY muscle of my entire body which is on my cheeks. Its through intensive training. Well my trademark Santa's laugh will just do the trick. People tend to laugh at the way i laugh. My laughter is kinda weird, i know. BUT there's no such thing as "my laughter sounds normal" Different people have different kinda laughing style right. Mine is just *special*... Anyway, I ordered fries n coke. Everyone was like, huh...aren't u eating??? I know I know, having this body doesn't mean I EAT like hell. Surprise anyone all the time. Yes, my appetite is small. BUT, sometimes I do eat alot. ALOT i repeat(happy now). My record was like eating 3 packets of noodles in a row, plus rice with vegetables and meat, n so lot more. Its so damn frightening. Even I myself scared myself badly. It was only last month that i had a great appetite. But it seems to have worn off. Thank god. I'm getting extremely huge now. I don't think doing hot sauna and U-zap helped alot. Surely i get results straight away after using them. But its not lasting at all. I'm still using them anyway so hopefully it will at least help a little. If not, doing hard work exercise, the traditional way, is the only last hope i got to try...hmm...sweat...i hate sweat... I don't smell or anything. i guess i can dry them n store it up in case salt goes out of stock. Hey, look at Aaron & Theresa. So not focusing in a photo shoot. On the phone somore. hahaha. It's a little off but nice pic tho. And look at the lower row. See how we place our shoulder, to the right to the right. Clever Phylis. Letting Vero & Janice over lapping her. Nice trick. I guess I have to copy ur method nex time. Look at how huge my body is. OMG. OK u can stop staring now. Just a glance would be fine. Can't imagine Janice is the tiny one among us all.

Tags: janice, birthday, omg, body, time

Michael Searson on Pre-Service Teacher Education

Posted on August 11, 2008 in Generic prescription drug list

Hi everyone! Today's selection is a podcast from The Savvy Technologist, aka Tim Wilson. In this podcast, Mr. Wilson interviews Dr. Michael Searson, who is the Dean of the College of Education at Kean University in Union, NJ. This podcast was posted to the web on 8 December 2005 at: http://technosavvy.org/?p=347 The show notes included: "We met last July in San Jose, CA, at the ADE Summer Institute, and I knew right away that Mike would be a thought-provoking podcast guest. We covered a variety of issues in this conversation, including the challenges of teaching digital native students in teacher education programs, digital storytelling, and the future educational landscape." I hope you enjoy this podcast! Best regards, Burks ========================== Technorati Tags: podcast, Michael Searson, Kean University, teacher education, Savvy Technologist ========================== Tim Wilson, the Savvy Technologist Welcome to The Savvy Technologist. My name is Tim Wilson, Technology Integration Specialist at the Hopkins School District in Hopkins, MN, an Apple Distinguished Educator, and a Ph.D. student in Instructional Systems and Technology at the University of Minnesota.

Tags: podcast, savvy, technologist, education, wilson

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