NO COMMENT!

OH

shiver me timbers, tis another tuesday and i’m not dead yet.

http://digg.com/political_opin…..ad_And_Die

thanks nahant

Oh, yeah. Forgot I was supposed to be pushing up daisies by now.
How’s the weather, Suz?

Any time :>) gotta keep he hole dug!

Who won?

tis wonderful – we hit the 60’s today and its forecast to be nice all week. sunshine tis a lovely thing

rbg,

pete sez “hi, loving the beautiful weather, the sun, hating Seattle…”

smells like Spring Fever to me….

got my fingers and toes crossed for one of those perfect spring days for sunday.

Dugg. Cute tune!

Maybe “cute” wasn’t the best word. How ’bout clever?

I love the Austin Lounge Lizards. Haven’t been able to find a utube of their song ‘industrial strength tranquilizers’ nor another fav of mine ‘jesus loves me but he can’t stand you’. The link in their name in my post goes to their web site where (iirc) you can listen to some of their music.

He always was reality based….or at least almost always.

loved it, Suz -

and a perfect match for the news box article – on the Supreme Corporation.

may every Justice who votes to exempt BigPharma be Impeached.

and then have their Federal and private pensions expropriated, their lifetime Fedral healthcare revoked, and be sentenced to spend the rest of their once-pampered lives as human footstools in an inner-city ER waiting room.

naked, kneeling on broken glass – the sort of torture the craven Supremes have already declined to strike down for the rest of us.

all under due Federal authority, of course.

So I’m not advocating violence against Federal officers…merely advocating they be subject to the violence they have loosed upon us.

in the nicest “legal” way, of course.

Fucking corporate tools – all who vote to exempt BigPharma.

Stains in robes.

WASHINGTON — Less than a week after issuing a sweeping ruling that bars most lawsuits against medical device makers, the Supreme Court heard arguments Monday in the first of two cases that could determine whether drug makers receive similar protection.

Justice Stephen G. Breyer said the fundamental question in the cases was who should make the decisions that will determine whether a drug is “on balance, going to save people or, on balance, going to hurt people?”

“An expert agency on the one hand or 12 people pulled randomly for a jury role who see before them only the people whom the drug hurt and don’t see those who need the drug to cure them?” Justice Breyer asked.

Normally a member of the court’s liberal wing, Justice Breyer came down squarely on the industry’s side when he answered his own question, saying Congress left the role of policing the medicine market exclusively to the Food and Drug Administration.

“What worries me is, what happens if the jury is wrong?” he said.

If the justice’s view prevails, most lawsuits against drug makers, thousands of which have been filed in recent years and settled in some cases for billions of dollars, would be barred. But the Supreme Court is likely to wait until next year to answer Justice Breyer’s question completely.

Hey, Suzanne
Hope your spine has forgiven you for the floor-waxing.

Speaking of not dead yet…maybe I should see if there’s a YouTube of that scene in Python’s Holy Grail.

FunnyDiva
I feel happy! I feel happy!

I was dead but that rousing debate brought me back to life.

That is one of the stupidest things I have ever heard. Fuckery. Fuckery again.

thanks funny – the showing today was for an engineer from santa barbara who is looking for a second place up here. was here for almost an hour

that must have been the part where they debated the difference between denounced and repudiated, or not.

suz – that’s great!

for more fuckery, check what just went into the news box

Now for more rousing debate on the PPA :)

kirk, what kinda cookies are ya thinking of making for the meetup?

ntu–

any comment on the debate? Just askin’?

Suz, fingers and toes crossed for you. Hopefully that Santa Barbara engineer fell in love with your place!

chocolate – of course!

whatcha bringing for everyone else (wink)

Just keep the candidates kids out of it, would be all.

Makes me wonder if once a drug is approved by the FDA if there are follow-up spot checks to see if the drug formula changes.

pete “ROFL….” he’s trying to set up a web site this week. went to the Kalakala bankruptcy hearing last week, and they kicked him out, even though he hadn’t said or done a thing.

Fingers and toes crossed. Santa Barbara’s nice, but there’s nothing like a cottage by the creek in the redwoods for relaxing on a hot summer day.
FunnyD

with the lack of oversight and transparency in all levels of government, i do not have confidence in the fda’s ability to police anything.

Good vid, Suzanne, I loves me dem lizards. I found one that deals with the constant evasion of the L word.

uhh….non-chocolate cookies?

yeah, dunno why i even asked, lol.

dood was here for almost an hour. of course, he asked his agent to ask my agent before the showing if there were blueprints or architectural drawings for the place.

we got a good snicker out of that. i figure he brought a fine toothed comb with him – i was told he was driving back to santa barbara today so… time will tell. my agent will call his agent in a couple of days for feedback.

oooh, i like that l word one. thanks kevin

Josh Marshall has posted a full-blown denunciation of Timmeh’s race-baiting.

speaking of cookies… has anyone seen tex?

Yer velcome. I like his song ‘Sleep Neat’ too.

Suz, yes — she just turned in for the night.

any comment on the debate? Just askin’?

Both did quite well, considering some of the silly questions that were asked. Obviously, Hillary was playing catchup and Barack was initially sort of running out that clock. Later he warmed up and was his usual self.

All in all, I suspect that Hillary diminished his momentum a tad, perhaps enough to hold onto Ohio but not enough to win Texas.

hmmm, i’m gonna have to rustle up a snack. dayam, let me see what’s in the pantry.

how about a brandy pineapple upside down cake pantry is kinda bare

Yep. I’m hungry again.

Oh boy Suz, that looks great.

So we are going to let political appointees make these decisions? Now then just who has more motive to lie?
An honest jury whose only fault is they don’t know the issues involved yet can learn the issues just like we learn new subjects here at the Lake when they come up. Justice Breyer apparently does not trusts the intelligence of a Jury.
Instead Breyer suggests that we trust the political hacks who run government agencies and whose job’s depend on keeping the big Pharma donors to the GOP happy.
We have to start impeaching the Supremes, BAD lies like this embarrass our nation. Its like the Supreme Court does not even care anymore about pretending to follow the law.

doesn’t it look yummy. i’m gonna have to hunt down that recipe.

hey things – they are just following boosh’s lead about no longer even pretending to follow the law.

My mom used to make them all the time (not with brandy, though) — wish I had her recipe.

I have to move to Canada unless we get better healthcare.

I can’t trust the American Drug companies anymore thanks to the Supremes.

i must sadly admit that the thought of moving out of my country has crossed my mind more and more lately.

don’t know about canada tho. i hear they have that ’snow’ stuff up there.

may every Justice who votes to exempt BigPharma be Impeached.

naked, kneeling on broken glass – the sort of torture the craven Supremes have already declined to strike down for the rest of us.

These judges or in this case justices, and their law clerks don’t think at all like you do in a medical situation. They have next to no experience in them. That’s why they shouldn’t be making these decisions.

Here’s the thing Kirk. It’s up to the medical profession to set up a platform so that the Supremes or any other appellate panel aren’t making medical decisions for you. Doctors are the ones with clinical experience who worry about patients for much of their waking moments. They are the ones trained in the nuances of the meds, the side effects, the procedures,and use of the devices. They are the only ones who should be really making these decisions. And when the Supremes rule, and I’ve watched this closely for years, they can make a helluva sea change in medical situations once they do.

These kinds of opinions are in the cards now that Alito and Roberts have settled in. Believe me, it is a huge wave or trend on this S.Ct. I saw it coming, but in fairness, they were confirmed 10-9 by a strictly party vote because the thugs controlled Senate Judy.

As with most things, it is up to doctors to control safety in medical devices and as to meds. Maybe you’ve seen them, but I could show you a whole line of Med Tronics cases for the last 10 years in your circuit the 9th and others that wouldn’t make you very happy.

My philosophy is simply that no offense to anyone–lawyers should not be deciding what is medically safe for people.

Doctors should always be making those decisions. I don’t want whether a drug/device can be regulated hinging on a standard or review, or parsing of the Federal Rules of Evidence or “legislative history” parsed in an appelate opinion by some law clerk a year or two out of law school–and believe me that’s who writes the opinions in any Circuit and with the Supremes– who doesn’t have a clue about clinical medicine and hasn’t seen patients. It’s that damn simple IMHO Kirk.

Alito has a guy for a clerk that was a lawyer for years but that’s an exception, and he hasn’t practiced medicine.

Skim these. Compare what they look for and what you’d be looking for and you’ll see exactly what I mean.

Transcript Warner Lambert v. Kent Oral Argument

Analysis of Riegel v. Medtronic

Because § 360k(a) prohibits the imposition of “requirements” that are either different from or in addition to those established by the federal government, the first question the Court addressed was whether the FDA pre-market approval (PMA) process for medical devices establishes “requirements.” Distinguishing the 1996 case of Medtronic v. Lohr, in which preemption was not found for devices that had been approved under a grandfathering process, the Court found that the PMA process constitutes a “rigorous” review “specific to individual devices,” thereby imposingfederal “requirements” on the devices so approved.

Not exactly the way you were trained to look at things at UCLA or wherever is it?

I agree with Josh. I was appalled by Russert’s line of questioning regarding Farakahn. Even though Obama dad said that he denounced he denounced the things that Farakahn had said about Judaism, Russert insisted on quoting them and insisting Obama give a yes/no answere to the question “Do you reject them?” Somehow “denounce” wasn’t good enough, he had to jump through the hoop of “rejecting,” which to my disappointment he did.

Doctors should always be making those decisions

that has always been my basic argument for being pro choice. it is a decision best left to the patient and the doctor.

I must have really been asleep at the switch. Those questions hugely inflamed everyone and have caused tons of Russert emnity on blogs, and I missed them but I had the debate on. Maybe it was because I was expecting Hillary to mud wrestle–kitchen sink and all– and it didn’t happen.

Didn’t blip my radar either but I shrugged at an endorsement by Farakahn too.

I gotta admit – i laid down to take a nap at 4pm (having to get up at the unheard of hour of 10am today) expecting to be up before KO started. I woke up at 7pm and missed not only KO but the debate.

I wonder if those questions were Timmeh’s own, or were they at someone else’s behest? Pretty reprehensible either way.

Still why push for this now…unless something big is coming down the road.
I wonder if or how we can find out if the Supremes have any advanced knowledge of any future lawsuit trouble for Big Pharma?
That or do any of the Justices have any stock in these companies?
Funny how the Supremes are the only court in the Country where a judge does not have to remove themselves from cases where they have such obvious conflicts of interests.
I look forward to reading real history books on the Supreme Court of this time period in the future.

What little I saw of the debate left me with no small affection for Hillary – I wish her well in Ohio and Texas. David Schuster post debate comments about Hillary reveal his misogyny quite dramatically, imho.

what was that disclosure during the libby trial about cheney liking to go onto meet the press because they can control the message.

hey npb

Belize warm living is cheap they speak English

Yep Suz, that’s like Teddy always says!

I couldn’t agree more. And make no mistake Suzanne, state legislatures are setting up laws that would make your hair stand on end including the death penalty for docs who perform abortions even when the safety of the mother is crucial. They are doing this because they want Roe to get in front of this current S. Ct. so it can finish choice. Laws that are now before state legislatures this year are unbelievable.

What has bothered me tremendously is that we are losing a lot of ground in embryonic stem research for cancer cures, new organ development, and hopefully spinal paralysis because of the argument that stem research promotes abortions by the evangelical base and their puppet Boosh. We have lost about 20 of the top stem cell researchers in this country to Singapore including a Dean from one of your California med schools and his wife who were among the top stem cell people in the country.

It wasn’t the money as I said a while ago–it was the supportive climate for research in Singapore compared with here. And two of them left California which if I remember did pass a stem cell initiative, but I’ve read it hasn’t made that much difference. I’d have to pull those articles.

I think Karl has been writing for the media all the media.

I’ll have to go back and look at it but I thought I heard Obama refuted Russert pretty well.

the TMP link above dissects it well.

TPM*

Josh’s article at TPM said he did but Russert kept going.

And HRC sorta piled on later, saying that all the Middle East is at odds with Israel in a violent way, not in any way due to Israel’s past or present actions or policies.

But there was a subtext to what HRC was doing in her statement.

Tomorrow’s – Wednesday’s papers will carry articles about a meeting Obama had with 100 Cleveland Jews. The WaPo carried a blog about the meeting earlier today, but, apparently, it has since been removed.

Phil Weiss is on it, though.

What is most interesting to me about the way Obama answered questions in the meeting, is his combination of knowledge about the history of Israel’s relationship with South Africa and his ideas about solutions for this tricky and fatal paradigm Zionist neoconservatives have us trapped within:

“Frankly some of the commentary that I’ve seen which suggests guilt by association or the notion that unless we are never ever going to ask any difficult questions about how we move peace forward or secure Israel that is non military or non belligerent or doesn’t talk about just crushing the opposition that that somehow is being soft or anti-Israel, I think we’re going to have problems moving forward.”

and:

“There was a very honest, thoughtful debate taking place inside Israel. All of you, I’m sure, have experienced this when you travel there. Understandably, because of the pressure that Israel is under, I think the U.S. pro-Israel community is sometimes a little more protective or concerned about opening up that conversation. But all I’m saying though is that actually ultimately should be our goal, to have that same clear-eyed view about how we approach these issues.”

Must. get. sleep. Good night all.

g’nite LL

That or do any of the Justices have any stock in these companies?

Funny how the Supremes are the only court in the Country where a judge does not have to remove themselves from cases where they have such obvious conflicts of interests.

The S. Ct. is the only federal court where the judges have the final decision on that but believe me they recuse themselves when they have stock in a company that is remotely close to a litigant.

As to their philosophy and an agenda they take to the court–well that’s a whole other thing.

They have been pretty meticulous about recusing when they do have stock in companies that are litigants. They know the appearance can be devistating. It wasn’t so with Scalia hunting with Cheney and the energy iformation decision, but as to stock holdings they’ll recuse very quickly.

There is a Blackwater investigation on the Discovery channel I think?

Interestingly though, a few months ago the Judicial Conference tightened rules over what they have to financially disclose to the public on the web/filings about their holdings allegedly because of security considerations after their was violence against a federal judge’s husband.

” It wasn’t so with Scalia hunting with Cheney and the energy iformation decision, but as to stock holdings they’ll recuse very quickly.
reply “

Under Bush maybe the Supremes are feeing like they can get away with more after all Bush owes them EVERYTHING.

Good thinking LoudounLib and sleep well. I’m off to bed too – have an awfully early meeting in the morning. Looking forward to the Sunday Boulder Creek pup meetup. Be there or be square! ;~)

Probably Tim has a staff who helps write his questions.

g’nite npb

i believe his question writer is named dick cheney’s staff

I gotta say, pups – after having an iPhone now for 12 days – there’s no turning back.

Seems like a thoughtful approach to minefield topic to me.

I denounce and repudiate Farrakhan’s anti-semitic remarks, Obama’s minister’s praise of Farrakhan, Timmeh’s stupid questions on the subject, and Sen. Clinton’s adding fuel to the fire with her comments.

et, its a gateway drug

That reminds me suz, i rsvp’d on facebook but i think i should have started driving yesterday to make it time :)

ET, do you mind my asking what your monthly bill is for the service?

so’s the lake, suz….

hahahahahaha

Showoff!
Congrats, ET!
I’ve heard the ATT bill comes in a box.

YES, perhaps if they directly own the gilts. but, if their family members own them, not such alacrity to recuse.

and of course, that is how the grafting works.the family members get the stock stake. perhaps via nominee accounts. if not outright.

it is the reason that many pols like having large families. it allows for more graft to be disbursed within a family, leaving the family paterfamilias to appear untainted.

i think of fdr in this regard. he was able to see to it that his sons wet their beaks.

the most interesting crooked son of fdr was jimmy. who became the acolyte of ios, bernie cornfeld.

the press really doesn’t care to follow the money. why would that be? as far as the roosevelt family is concerned, i think it could be because so many owners of the influential press where also players in the game of corruption.

john kwitny wrote about this at length before his death. i recommend his investigative books to you.

Here is a link to the transcript of that meeting: http://elections.jta.org/2008/…..-leaders//

And here is the money quote by Obama:

I think there is a strain within the pro-Israel community that says
unless you adopt a unwavering pro-Likud approach to Israel that
you’re anti-Israel and that can’t be the measure of our friendship
with Israel. If we cannot have a honest dialogue about how do we
achieve these goals, then we’re not going to make progress. And
frankly some of the commentary that I’ve seen which suggests guilt
by association or the notion that unless we are never ever going to
ask any difficult questions about how we move peace forward or
secure Israel that is non military or non belligerent or doesn’t
talk about just crushing the opposition that that somehow is being
soft or anti-Israel, I think we’re going to have problems moving
forward. And that I think is something we have to have an honest
dialogue about. None of these emails talk about the fact that on the
other side, members of my national finance committee, like Lester
Crown, are considered about has hawkish and tough when it comes to
Israel as anybody in the country. So, there’s got to be some balance
here. I?ve got a range of perspectives and a range of advisors who
approach this issue. They would all be considered well within the
mainstream of that bipartisan consensus that I raised or that we
talked about in terms of being pro-Israel. There’s never been any of
my advisors who questioned the need for us to provide Israel with
security, with military aid, with economic aid. That there has to be
a two state solution, that Israel has to remain a Jewish state. None
of my advisors would suggest that, so I think its important to keep
some of these things in perspective. I understand people’s concern
with Brzezinski given how much offense the Israeli lobby raised, but
he’s not one of my central advisers.

I found it very interesting because I had a rare argument with one of myss main political correspondents this afternoon on the topic of whether or not Obama will get coopted by and start pandering to the Israel Lobby. His claim was that Obama had bowed to The Lobby’s pressure in taking Brzezinski off his list of advisors.

yeah, crossing the rockies takes time no matter which way ya go

I miss SnarKassandra.
Hugs across the miles to Snarky!

for two iPhones, 700 minutes a month worldwide, unlimited data access, 7p.m. to 7a.m. and weekends free, rollover – $110.00. The free unlimited data seemed OK before we got the phones. but I didn’t realize then that they automatically go to satellite for web or e-mail if you can’t hook up to a faster local wifi – for free. They do.

So far, our experience with the tech people has been excellent.

i hear she is having a life offline margot.

Pete,, I sure agree with you. (and yep, the text you quote is the antithesis of what I was taught in traning).

FDA used to be staffed by MD’s/PhDs who really understood the science – I’m told teh legal folks simply established the decision-making structure (implementing legislation) and then stood back.

Now at FDA/CDC/NMFS/NWS/EPA/DOI et al – the intrinsic scientific/medical context is just shuntewd aside – the decisions are made on politics ( a fancy way of saying delivery on campaign/contribution bribes), and the data/concepts are simply excluded.

Our regulatory agencies have simply become captives of teh industries they supposedly regulate.

As a doc, I now know NEVER to start patients on a new drug (unless all other options have been totally exhausted AND the patient is at very real risk of suffering/death).

The FDA now slams though new drugs with so little long-term assessment that – even if what they approve is ultimately shown to be effective – the piss-poor evaluation system means long term (or even low-probablitiy short-term) side effects only show up in “post marketing” phases (after the damn drug is in on the market).

And the “post-marketing” reportinig sytem is (at industry behest) so poorly funded that effective reporting (and f/u to assure the FDA hasn’t lost/butied the initial report) is so time consuming as to be well-nigh impossible for practicing docs.

Since Reagan took office, the US has gone from having the best drug safety iin the known unicverse to a sorry excuse for oversight.

I hate what the repressed Rethugs (and their compensation for their obsession about “manliness” – aka their gleeful, fawning proto-fascism) have done to our food and drug safety, our health, our democracy, and our nation.

Wish the OSS had turned Gehlen and his fellow Nazis back to the Russians after Berlin fell.

By incorporating the tools of fascism (and teh wounded victims like Kissinger, so damaged they spent their adult lives in thrall to State Power, mindlessly seeking to compensate for the helplessness that darkened their boyhoods) into the core of our national goverment, our nation’s Federal “leaders” – the elected and the permananent, unlected village – have become what my father’s generation set out to defeat: the fascist frontmen for corporate rule.

We no longer live in a democracy: we live and suffer under the rule of despots who sacrifice us, our health, and our freedoms to the megacorps – and call out the tear gas, guns, and grand juries when we peaceably assemble for the redress of grievances.

Thanks, ET. I’m very seriously thinking of getting iPhones for my wife and myself. You’re input helps clarify some of my questions.

My apple computer does not I think get satellite reception.

I think he’s fairly and accurately portraying Brzezenski’s role.

What is most important about Obama’s meeting in Cleveland – and I’m sure it made an impression on those people who were there – is how nuanced and informed and different his ideas are for a top tier American political candidate when talking about this issue set.

albert – jonathan kwitny is dead? I am so sorry. His “Endless Enemies” is the most incisive book I’ve ever read on our “endless war” footing.

Ha…

Thanks for your views, kirk. So when I go to the doctor to get a new prescription, how long a period of time should I ask him to make sure it has been on the market for? 5 years? 10 years?

Ms ET, who loved the idea of an iPhone, but was leery of how much this was gong to cost, is an even bigger fan than me. That probably has to do with her work schedule and how it relates to being able to message, text, and deal with e-mail on the move, and when – in Alaska – you can’t hook into a wireless system or plug your laptop into a particular school’s secure internal system.

I had not thought of that ET. I’m so used to being connected or able to get connected down here just over the hill from silicon valley. there is a wifi coffeeshop in town, cell reception is good here at the house but there are small areas where no signal exist. nothing like the vastness that is alaska.

Are you up all night? Or do you some shut-eye in-between?

May the three biggest a-holes on the Supremes get poorly designed pacemakers and find out they have no recourse.

6.4 quake in Bonin Island, Japan

What is most important about Obama’s meeting in Cleveland – and I’m sure it made an impression on those people who were there – is how nuanced and informed and different his ideas are for a top tier American political candidate when talking about this issue set.

And, hence, his dead-last Israel-Factor rating at Haaretz. ;-)

Shut eye soon

just curious, since at this point I have the option of just staying up or having a one-two hour shutdown before I have get up to work….

LL, sleep well.

Pups, I’m falling asleep here too – but as we’ve opened up discussion of the Supremes’ stock holdings, I’d be tickled if Pete or toher folks here (coome on out, lurkers!) could share what we all know of the Megacorps’ resort bribes seminars for Federal judges.

The seminars – held at uber-fancy resorts far beyond Federal Judicial salary ranges – just happen to feature “lecturers” spouting the newest Univ Chicago/Libertarian/Federalist religion – uh “theories” – that amazingly enough find regulating the Big Greedballs who pay the foundation that pays for the resort…

amazingly enought, the Federal Bench hears brand spanking new theories on how to gut any legislation (or Constitutional provision) the Lords of the Megacorps find inconvenient.

And then – as numerous reports ahve demonstrated – the well-rested Federal jurists come back and just happen to vote for theindustry that bought their pricy trip.

By voting against our health, safety, or economic needs.

I wish I could beleive our Federal jusidicairy were not corrupt. I onve did – I no longer do.

WHen I learned of the “seminars”, I understood that the judges who attend are taking thinly disguised bribes, and calling it an education.

Sure educated me.

That’s amazing. I wondered how that thing would work in dead spots. Very cool. Now if only you could pick cell service from someone other than Cingular…

Killer Robots are what we are supposed to fear next?

sleep well kirk

Hillary will be in my town tomorrow.
It’s snowing like anything right now, and is supposed to snow all night.
Our town has a Hillary debate watching tavern, and an Obama debate watching tavern. Only “tavern” is way too upscale for either of them.;)

Earthquake in England too. Weird.

Are they Islamofascist Killer Robots?

Up here, AT&T Alascom is in a partnership with iTunes for the service.

In Alaska, we call ‘em “dives.”

I wonder if the satellite service is even available on the mainland. I’d never heard of it before tonight, so maybe not.

The Beeb’s take on what went down tonight across the pond:

The two main Democratic presidential candidates, Hillary Clinton and Barack Obama, have accused each other of negative campaigning in a TV debate.

The two White House hopefuls also attacked each other’s policies on health care, trade and foreign policy, including the Iraq war.

It was their final face-to-face encounter before next week’s crucial primaries in Ohio and Texas.

Mr Obama has won the previous 11 primaries and caucuses.

Analysts say Mrs Clinton needs to win a majority of delegates in both states to stay in the race to choose the Democratic candidate at the national nominating convention in August, ahead of the November elections.

aha.. i have my world notification set for 5.0 or higher, us 4.0 and ca 3.0. missed that one. thanks

I did read the article. It said terrists, but it did not specify whether the terrists were Islamofascist.

Of course, we know they all are.

isn’t it included in the u.s.’s defination of terrorist, neuro?

See ya early tomorrow…I’m in for a shut-eye as well…

ohmystars, how will i know the difference between a roomba floor cleaner and a terrorist?

bingo!

g’nite biodun

i wonder if it is some R plot to keep women home cleaning and waxing floors instead of outside where they could be unduly influenced…

hughesnet. handy if you can’t get dsl or cable.

of course, i was up until 4am waxing floors and cleaning so i could be a wee bit biased.

Gawd neuro – great question.

And a tough one.

As a doc, I look to assess:

1) what other, older tools are out there?
2) if we don’t treat at all (on this visit/this day in the hospital), what’s the worst thing that will happen?
3) if we treat with older tools and they are ineffective/partially effective, what’s the worst thing that can happen?

Depending on what I’m asked to look at, I may be OK with meds that were just released (say for acute infections of the eye that could destroy vision, and have not responded to other available treatments)…

or I may calculate (say with a slow-growinng fungal infection of a toenail) that we’ve got months to either simply observe or use other treatments.

When the situation isn’t acute/emergent (example: someone with a 30 pack year history of smoking and no apparent signs of emphysema/COPD – but wants the “new” anti-smoking drug du jour) I’d tend to want to have the new drug out for at least a couple of years – perhaps shorter if the drug is very widely used – perhaps longer if the drug is very seldom used.

When we have the luxury of waiting, I tell my patients that we’re waiting for other docs’ patients to be the guinea pigs.

One thing that has always amazed me over the years is that some drugs get approved by one vote margins and it there has been a ton of evidence that there have been some real errors in the approval process during this administration, and although I’m hazy on this tonight, there have been recent revelations by physicians who were high up in the FDA and other areas in this administration that they were coerced not to talk about the lack of scientific approaches in a lot of situations–I know that’s sloppy but given time I can come up with the scenarios.

My approach to starting patients on new drugs might startle you, but over the years I’ve been an early adopter and a pretty voracious reader of the journals that count clinically to me, so by the time a drug can get in my hands I’ve usually read about it. That’s not true of all of them to be sure because there are so many, and some are in areas I’d never have to use.

It isn’t that I like to use a drug becaue it’s new; but if I can establish a pedigree of enough multi-center trials with big patient numbers, and the drug offers a specific advantage that I think will benefit the patient that another drug can’t offer, then I’ll use it.

There are plenty of situations where drugs have been out for a good while, and we find out that we didn’t know near as much as we thought. For example, I saw a study that I skimmed in this week’s JAMA that surprised me a little bit concluding only 60% of adolescents with depression respond to SSRI’s although I’m not treating that group of people much at all for depression, but I’m sure you may be.

I would have guessed that there would have been a higher percent efficacy, but that’s not a major area for me.

What I always am hungry for are head to head comparisons of a new drug with other leading drugs in that class or area, but it can take years for those studies to emerge and you dont’ have the luxery of having them early on.

It’s always sad and frustrating if you have to get to post-market to find out there is a serious side effect problem with a drug that you had no idea from the NDAs would emerge.

I remember an ANSAID I used a lot years ago when it came out, Zomax, and postmarket it fatally necrosed livers in some patients. There weren’t many, but one was enough and it was taken off the market.

You bring a wide range of literature and situations to your headlines about medicine and the environment, and sometimes analogies or metaphors, and I enjoy them.

I’ve watched the same drug safety deterioration over the years that we’ve had a concommitant explosion in new drug releases.

I’ve also noticed some major drugs in the pipeline in the last month that were stopped because after millions of dollars were spent, independent studies from the drug companies were showing that they either 1) weren’t working to achieve their clinical objective or 2) they were harming more people than they were helping.

We west coasters tend to a pay a lot of attention to quakes, don’t we? Every time I look at the mountains I try not to think of how many earthquakes it took to create them.

bonne nuit…a toi aussi…

I’m told that around here iPhones use AT&T’s EDGE network for wide-area wireless digital service. Per the Wikipedia:

Enhanced Data rates for GSM Evolution (EDGE) or Enhanced GPRS (EGPRS), is a digital mobile phone technology that allows increased data transmission rates and improved data transmission reliability. Although technically a 3G network technology, it is generally classified as the unofficial standard 2.75G, due to its slower network speed. EDGE has been introduced into GSM networks around the world since 2003, initially in North America.

EDGE can be used for any packet switched application, such as an Internet connection. High-speed data applications such as video services and other multimedia benefit from EGPRS’ increased data capacity. EDGE Circuit Switched is a possible future development.

back to local stuff. GOP Corrupt bastards http://community.adn.com/adn/node/118363

See you tomorrow, pups. Back to killing these vampires…

I know. I have studied fault lines and historic quake info to help me try to figure out where i’m gonna move up there.

fixed it. later…

g’nite et

Thanks suz – good sleep to you and all the other pups at the Lake.

And to our Founding Fathers – may they have one night’s relief from years of tossing in their graves.

A Republic, if you can keep it.

How sad for men of such vision to lie helpless and moulderig, all the while watching our generation(s) destroy the beautiful gift they fought and dies to pass on create and pass on to us.

Hope we can all find the refuge of sleep tonight.

We had a Republic – and we threw it away. ‘Cause the TeeVee told us to.

Tomorrow brings another waking nightmare.

That’s what I call them. The emails called them “taverns.” I just had to laugh.

How cool! And reasonably priced too. Good to know, tw3k, thanks.

“You Know that She’s Half-Crazy, and that’s why you want to be there…”

http://www.youtube.com/watch?v=xFHKIyfXf5g

dayam, my secret is out

EPU-ed:
In response to EdwardTeller @ 283

ahoy, et!

Here’s tw3k’s McCain cow grazing atop Hugh’s scroll, set atop stencils from anti-Fascist posters we’re making.

dang trouble maker!
keep it up.

tw3k’s design for McCow the totally bought and sold out
Maverick Branded
Build your Own!
Make ‘em, Trade ‘em, Swap ‘em with friends.

imagine …

Ten Million McCows March on Washington to Stamp Out Mad McCain Disease!

here’s mine.

here’s epu’s (gush alert!) pup.

sweet dreams

Yeah. The fentanyl recall is causing some havoc with some of our patients at my pharmacy. Of course, a lot of the problems with that is incorrect use, which is a given considering how strong a narcotic that really is in the first place.

But it’s not all the patients’ fault either. They are rushing a lot of things out when they shouldn’t, and other times conducting really bad studies. Like that of Vyt*rin. Nothing wrong with it, but the study was going for the wrong result in a very low percentage of the population. So of course it didn’t come out all that positive. But it STILL works for it’s original purpose. Just not that new listing that the PharmaCo wanted to use.

Also, i see an insane amount of MedWatch’s about things found not to be well labeled right out of the gate, or belated warnings when something else is found out. Drives me nuts. But we pay attention and keep an eye out to counsel patients when they ask us and work with the Doc otherwise.

hey certified alias

kirk and PetePierce,
being neither doc nor lawyer but as economist and stat person, the FDA process seems so abstracted from real world decision making, using artificial criteria, that it is too easily manipulated. I would prefer a system that has a more realistic and formal cost-benefit or cost-effectivness criteria. And I don’t mean that a snealy way to run everything according to some infernal inflexible decision making machine, but simply as a way for forcing the players to put more of their cards on the table. I dunno if that makes sense. But the safe and effective rule just doesn’t make sense for a lot of situations.

As for post-marketing surveillance -what a mess. I have given real world data sets to MD and pharm students and said try your intermediate stats on that and watched them go crazy. I have gotten the sweats the night before a workshop trying to figuer out what I could do with those lousy numbers.

Those are a big problem Kirk. When we have more time we can talk about them. There have been lawsuits filed to try to stop them, and Congress has had (and this is in the area of things I’ve read but can’t recall in great detail) laws proposed greatly curtailing these seminars that the federal judges have reacted against fiercely. I think this came up at the Judicial Conference (which you may know about) but meets once a year to make rules for judges that have to be approved by Congress but are almost always rubber stamped. It’s composed of different judges from different Circuits, and I think Kozinsky is on it from the 9th with some others but I’d have to look it up.

There have been some obvious conflicts of interest and George Mason which is a very right wing oriented University has sponsered a good many of these junkets with corporate sponsers where judges get flown to spiffy golfing resorts and fed well and treated like kings. I don’t have a problem with them getting CLE like docs combine CME at nice places, but these aren’t ayk CLE oriented specifically. There are websites that cover these well, and one group in particular that wins a lot of common cause cases that has focuses on these.

Given a couple-three days I can come up with some very specific accounts of these via links for you.

This is a much more rad version:

http://www.youtube.com/watch?v=kFDynsY9_tQ

Nerds, be sure to check out http://www.radionetherlands.nl/

CITIZENS! Fight Anglo-American Imperialism with your every breath!

We will fight for bovine freedom
And hold our large heads high
We will run free with the buffalo – or die
Cows with guns.

there are always these

love that song kirk

here’s the cows with guns video

thanks for a thoughtful answer.

heh, cow tse tounge

Re:

As for post-marketing surveillance -what a mess

I got a feeling you are trying to say something. V.I. Lenin would say “Capitalists and Landlords are here to intercourse you mere working class people.”

Would you be saying something similar?

watch out for chicken in copters

I don’t know about Kirk, but I didn’t get a lot of stat training, and although I think I took a course as an elective I remember very little of it. Once I was supposed to read a book I bought on the NDAs (the approval steps of drugs that was highly stat driven and not very easy or fun reading for me). I understand the stats that make a multicentered trial a lot better but not techinical nuances of stats by any means.

What I look for as to drug performance and safety are articles (now many on the web) but from some of the major journals that I have found or thought to be very high quality that have done clinical trials that have included top teriary centers or private hospitals that I know something about. But it’s not always easy.

The word should have been tertiary. Every body have a good night or morning.

bad cow pun

you an md pete?

Gawd Pete – at your convenience, I’d love to see those linkies (as time allows).

Oh -a nd I hope my observation at the end of 138 doesn’t seem like a slam at the early adopting you describe in 139.

The nice part about psych (or treatinng psych problmes in seriously medically ill folk) is that I’ve almost got an older option to use while the tools are still under assessment. I’m quit emindful my colleagues in other specialites don’t always have that luxury.

And wesgpc, I so share your wish to have verything on the table.

When I read your learned (sincere, no snark) take on post-marketing dats, my worst fears are realized. You are confirming exactly what I heard from really smart ethcial University PharmD’s who sought to assess the same data.

Jeebus – what a mess.

ANd now I really must nod off.

G’nite, all!

Oh my gawd. I hit the motherlode.

So what kind of drug were Spanky and Our Gang on? Jeez. What a mess. The second video is pure nostalgia. I could this as a better thing for Roger Clemons to shoot up his ass. But I digress…

yeap, my post the next day featured what was i thinking

Its not the stats that are the problem, in my opinion, it is the unrealistic things that in the FDA decision making framework that stats are expected to do. Stats, or high sounding slogans about safety and effectiveness (you say efficacy I say effectiveness etc.) that are the problem. This leads to abuse of statistics and decision making criteria to jump through mighty fine sounding slogans and high toned loops.

Lot of stuff is games. That is what the pharmacist (?) referred to about ‘lot of bad studies’ I think.

alias, congrats on your certification! your patients are lucky to have you.

(and now to bed)

Cows? Who cares about cows when you got balls?

http://fig.cox.miami.edu/~cmal…..n.blue.jpg

Such a closely-held secret too….
;-)

Before I go to sleep, I will note that the law and economic crowd sold many of new FDA procedures on idea that the process was inefficient. THey said that US could get quicker AND safer approval process. Not sure it turned out that way.

Watch out for those Islamofascist Killer Robots, people (I know, that’s reduntant)…

Maybe we will have to suspend the 2008 election so that boosh can remain in office to Make Us Safe from them.

On second thought, I’m sure McCrazytrain is up to the job.

On a good day.

Thanks, Docs, for doing your best to get it right. I was given Zomax by the J&J company doctor for a back injury incurred at work. Not good. Anaphalactic(sp?) shock. My own doctor sent in a report to FDA and suggested hot showers and BenGay. He made me start carrying an Epi-pen.

i’m so confused. are we supposed to want crazy train st john or the huckabee as the r candidate – and what about mittens – is he back in the game again? did any of them invent the roomba or was that some liberal terrorist who did that?

OK. So having broken the ice, I’m interested in the latest jokes.

This is old:

GENRE: Yo Mama
YEAR: 2008

Description:

Chelsea Clinton attended a recent event on her mama’s behalf in Ohio. She was impressed enough by a hunk in the audience that she walked up and introduced herself and he said that he was an Iraq War vet in the regular Army. She asked him, “Are you afraid of…. anything?”

He replied, “Yup. Three things. Osama, Obama and Yo Mama.”

***
Top that. :)

ray, i kinda like to keep the candidates children out of the debate about the candidates. even the jokes about them set my teeth on edge.

and i must add, it has been my experience that all the jokes i’ve seen or heard seem to only target one candidate’s child.

Completely OT- watching David Letterman, Courtney Cox is the guest. She’s had work on her face, cheek implants or something. And a lot of botox. Too much.

What a shame.

Thank you!

‘Night Kirk!

i switched channels only to find commercials. is her segment over?

So, I’d do the same, Suzanne, except that there is a quid pro quo in American politics. When the Clinton pater familias said Chelsea was off limits, she was a kid. She wasn’t hustling votes in a most unfeminine fashion just as Hillary wasn’t screwing poor people on behalf of Sam Walton and Don Tyson and the the Stevens Family of Little Rock while she was getting well compensated on their corporate boards to destroy the people for rich folks.

But things have changed. Now Chelsea is just as vulgar as her parents are, and what royal right do you think you have to keep the people in the dark about who is screwing them?

But I digress… I like this version: http://www.youtube.com/watch?v…..re=related

HALLELUJAH!

There’s a pattern there, Suzanne.
Amy and Chelsea were similarly targeted.
As much as some of the Goopers hate McCain’s guts, they have never to my memory set upon his daughter. They save this shit for the “liberals.”

The fratricide here, though, is the absolute worst.

I guess my royal right comes from the fact that I am a moderator here and have been for more than a year now.

It is exactly that type of argument you used that has led me to say that ray.

The Austin Lounge Lizards are my faves! A few choice hits in my book:
*I’m from the shallow end of the gene pool
*Get a haircut, Dad!
*Half a man

It’s been too long… I know there are more…

Bob in HI

Pharmacy Technician actually. But i work with the drugs and get most of the same reports as the Pharmacists i work with do. I talked with one of them about that Vyt*rin study. He debunked it outright and told me how and why. Definitely made me breath easy, because my dad’s on that med right now. I had read the report but couldn’t figure out exactly how it pertained to what they wanted, and after his translation of all the terms that i hadn’t been exposed to in my own training? It helped.

There’s still a lot i have to learn! At the moment i’m seeing a lot of med terminology i’ve got to catch up on. We see a lot of common terms on ’scripts, but the Continuing Education is chock full of them. >_< I have to keep up with that now to keep my Certified status.</p>

i’m fond of Jesus Loves Me But He Can’t Stand You

I’m a slow typer. Yup, she finished just as I hit “submit.” Sorry bout that. :P

i figured it was just my usual bad luck.

From the sound of it, good luck may have been more appropriate.

true dat, newton. (laughing) whatcha bringing to the meetup?

4.2 quake near wells, nevada

Oh, and the stats that are peppered all over a lot of those reports on studies? Make my eyes cross. I’ve never taken a Statistics class in my life, and if i did i have a feeling i’d sleep through it or go mad after 1 week. I can handle the pharmacy math, but numbers that i can’t translate make my head explode.

I work in science but i’m an intuitive musician, pretty much. I can work with numbers but not on a calculation level, oddly. When i do? I take more time to double check it and work slowly, and do that in my work obviously. I want to be right and my patients count on that. Higher math and i don’t get along, otherwise. Meanwhile my relative pitch is insanely good, and i learn anything by ear from almost the first hearing.

Well, Teddy squashed me last time with great Arabic food. But I have a suitable alternative – similar “genre”, but a slightly different take :)

excellent. teddy is bringing the same thing he brought last time.

The whole world’s shakin. Do. Not. Want.

Good night, pups. Back at it tomorrow!

i had a friend who got her masters in math while attending part time. she said that the statistics class was worse than some of the advanced calculus stuff she was taking.

nite toWA

g’nite TOW – i think of it as releasing stresses (and hopefully preventing an imminent big one in my local)

I’m fading fast Suzanne. Yep I am.

I like the way you think! Thanks, and sweet dreams.

g’nite pete

Good nite folks

g’nite neuro

If you ever had an episode of anaphylaxis, by all means you should have epipen with you. And the earlier you use it, the better off you are. If you had anaphylaxis to a specific drug, you may or may not have the reaction to other drugs in its “class” or similar drugs meaning if Zomax caused that, you might not get it from other subclasses of anti-inflammatory drugs–so-called Ansaids.

Zomax was withdrawn from the market in 1982.

Anaphylaxis from a drug or an ingredient in food, like say MSG can be a very individual thing–and allergic reactions can run the gamut from mild itching or some other symptom to very quick, severe, and very life threatening (hypotension and loss of blood to the brain and rapid dizziness and rapid narrowing of the airways. In some people it can literally happen in 30-90 seconds.

See ya Suzanne.

fork, is everyone asleep?

zzzzzZZ-
wha?
zzzzz

time to bail
nite suzanne

g’nite newton, guess i should bail too.

thanks to everyone for hanging with me tonight.

wheeeee! Fun staying up this late and hanging out in late late again :D

???

Just checkin’.
No new post.
Last comment was 1:07.
hmmm

I went down in about a minute. Good husband called Doctor who asked if we had epinephrine in the cattle drugs we keep. Sure enough, we did, John shot me in the leg with a 16 gauge needle. Ambulance came in 15 minutes, but without the shot, I’d have been gone. Sometimes, vet meds and human meds are the same. Country doctors learn which is which.