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That’ll Be The Day “All I know is just what I read in the papers.” Will Rodgers,1879-1935 I await the day when The New York Times runs a series of “good news” articles about the state of American health care. The series might have these titles, • Americans Trust Their Doctors • Americans Have Greater and Quicker Access to High Tech Diagnostic and Curative Care Than Any Other Nation • Foreign Physicians Flock to America for Training Unavailable in Their Country • Record Numbers of Canadians Cross Border for Life-Saving Care • America Achieves Unprecedented Longevity Gains in Last Decade • Americans Receive 80 Percent of Noble Prizes in Medicine • Research at American Pharmaceutical Companies Produces 90 Percent of the World’s New Drugs • America’s Innovative Health System’s Variety and Choice the Wonder of The World That’ll be the day. The Times in 2005 and 2006 had a series of a dozen articles entitled “Being A Patient.” These focused largely on the perils of being a patient in America. Now The Times is embarked on a series on medicine and money, focusing on profit-mongering drug and medical device companies in league with greedy specialists to bilk the public. It all comes down to altitude and attitude. From their lofty perch, Th e New York Time’s editorial staff has yet to tumble to the reality America is basically a conservative nation, distrusts centralized government, wants choices of care and providers, demands access to the wonders of high tech medicine, and believes a market-based system, with all its faults, such as profits for entrepreneurial and innovative health care companies and , are worth the price and value received. It is almost as though The Times denies the existence of entrepreneurial capitalism in American health care. Our health system blends innovative large and small firms striving for economic growth. Such a system entails risk – workers who lose jobs and health insurance, widening of gaps between winners and losers, competition with some jobs going to skilled workers abroad who have increasing skills, occasional bankruptcies among those unable to pay health care bills. American capitalism is imperfect. It requires oversight to reduce risks without losing entrepreneurial vigor. Unremitting accusations of bad faith and constant “bad news” stories don’t strengthen health care. Read the The New York Times, and you’ll come away believing pervasive avaricious greed corrupts American health care and will break our already “broken” system. From May 9 through May 11, The Times ran 10 articles on how drug companies deceived the public and entered into unholy alliances with doctors to sell more drugs to produce more revenue for doctors, how doctors willingly entered into these alliances solely for material gain, and how lobbyist-tainted and incompetent FDA failed to monitor new drugs and harmed patient safety. The May 9 front page, right top column, the prime spot for highlighting news, featured these headlines, Doctors Reaping Millions for Use of Anemia Drugs. Payments from Industry. Concerns over Safety – Critics See Incentives for Higher Doses. The opening Section read: “T wo of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes. Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business.” The Times appears bent on publishing on its front pages “All the Bad News that’s Fit to Print about U.S. Health Care.” The May 9 article is part of a series of medicine and money, all decrying collusive relationships between big business and bad doctors. The Times series focus on the pharmaceutical industry and medical device industries , and how these industries reward specialists who overuse products for financial gain. To The Times, the American health system has become a morality play, • the good guys (The Times and other assorted elites and policy pundits) vs. the bad guys (profiteering health companies and doctors); • the greedy (well-healed executives and “rich” doctors) vs. the needy (poor patients in the throes of cancer or kidney dialysis); • the high brows (academics and journalists who know what’s right for the common good) vs. the low brow commercial types (who do almost everything wrong as long as it suits their own financial self-interest). I don’t wish to pick a fight with a media outlet who buys ink by the barrel. I know “bad news” sells better than “good news.” I know The Times considers itself the Watchdog and Whistle-Blower against mean-spirited, profiteering conservatives. I don’t question our capitalistic system needs oversight to reduce abuses. I’m simply seeking more balance in The Times reporting. For an example of this imbalance, in its May 9 piece, The Times dismisses America doctors’ overuse of anemia-correcting drugs for cancer and dialysis as a deliberate effort to make money. To make its case, The Times notes American doctors, • prescribe more drugs than European counterparts ( Did it ever occur to T he Times maybe, just maybe, European doctors “under-prescribe” and maybe their patients have less positive results? ) • conssciously endanger patients for profit when they know anemia drugs are unsafe (Has it occurred to The Times American physicians prescribing these drugs believe higher hemoglobin levels are “good” for improving health and alleviated distressing symptoms attributable to anemia.) • Continued to prescribe drugs even after studies indicated hemoglobin levels above 12 might endanger patients ( Did it ever occur to The Times the studies indicating “possible” risk studies were far from conclusive and only appeared in March?) Nor does The Times point out doctors themselves often criticize thenselves. For instance, on a May 11 blog, “The Doctors Weighs in on Cancer,” Dr. Dov Michaeli, an academic physician and biochemist who does cancer research takes the American Society of Clinical Oncologists (ASCO) to task for responding to the Times defensively (see epilogue to this blog for a reprint of ASCO letter to The Times). Of the ASCO letter to the times (reprinted in epilogue), Dr. Michaeli acidly comments “ASCO makes that same argument that professional people make when colleagues are caught with their hands in the cookie jar: most of us are conscientious, hardworking people. Granted, but it turns a blind eye to the corrosive influence of pharmaceutical companies on the use of drugs. This is denial of how our health system ‘works’ on a daily basis.” Michaeli concludes: “As the wheels are coming off our broken health system, more revelations of waste, abuse, greed and outright criminality are bound to surface. What are we going to do about it?” Good question. I suggest we start with a more balanced view of the system. • First, I reject the notion the system is “broken” – and constant reference by academic critics of greed by practitioners as a cause for this brokenness ( Michaeli, an academic researcher, shows some of this bias when he says, “ ASCO is led by academic clinicians and researchers, whose motivation and dedication is admirable. But many of the rank and file, community practitioners, are not beyond temptation.” I doubt medical academicians, who compete for pharmaceutical company grants and who run clinical trials, are beyond temptation. I’m unaware academic physicians wear halos and only practicing doctors are vulnerable to “temptation.” • Second, I believe critics ought to acknowledge health care is an innovate force in our economy, will soon represent 20 percent of the nation’s GNP, and is the nation’s largest employer. Professional managers, whose job is to maximize resources and revenues, run most health care enterprises - hospitals, medical practices, drug and device manufacturers. If overzealous pursuit of revenues and resources leads to excess, managers should be condemned, even fined and jailed, but it shouldn’t be assumed or taken for granted pharmaceutical and medical device companies and doctors are always seeking mutually beneficial arrangements are ipso facto evil doers. What the media in general, and The New York Times in particular, needs is a more balanced view. An occasional dollop of good news, such as more than 50 percent of cancer victims are now surviving, more than 10 million cancer victims are living with their disease, and genetically engineered cancer drugs are contributing significantly to cancer cures, would help achieve that balance. I’m pleased to report the May 12 issue of The Times contains a “good news” piece on Becton, Dickinson & Company. It’s buried on the third page of the business section. It’s titled “Medical Gear That Rarely Makes News.” It consists of an interview with Edward J. Ludwig, CEO of Becton and Dickenson, with revenues of $5.7 billion last year, on sales of syringes, diagnostic kits, lab equipment, and related gear. The unifying theme behind the company’s success is its emphasis on safety in its products to protect doctors, nurses, and patients with shields, sliding clasps, and needle retracting into the device. Its ambition is to make a significant dent in the 2 million infections each year from antibiotic resistant staphococci killing 90,000 Americans each year and costing $6 billion yearly to treat. Toward that end, B &D has acquired a diagnostic system allowing them to quickly identify the offending bacteria. Use of this system to screen every patient. entering Evanston Northwestern Hospital reduced infections by 60 percent. Ludwig contend s private innovation will help the “broken” health system to heal itself by attacking safety problems, and improving care. What the media needs is a new more flexible mindset allowing them to become more innovative in reporting the “good news” of our resourceful and responsive health system. Epilogue : In the interest of being “fair and balanced” (a term the mainstream media now considers anathema since Fox News adopted it as their slogan), I reprint six letters from the May 13, Sunday, New York Times. The Times deserves credit for publishing letters representing both points of view. Best Drug, or Best Money Maker? (6 Letters) 1) To the Editor: So two drug companies are paying hundreds of millions of dollars to doctors who prescribe anemia medicines that lack effectiveness and put a patient’s health at risk. This is not a surprise because it reflects our broken health system, a system driven by greed. Although drug companies say their intentions are not to promote the use of more medicine for profit, there will always be the risk that some doctors will prescribe higher doses to gain that extra dollar. As patients, we should work to eliminate the incentives to doctors and to raise patient awareness about them. We deserve the right to know the benefits of a medicine, both for us and for the doctors. Luis Rodriguez Daly City, Calif., May 9, 2007 2) To the Editor: Medical care should be guided only by what is best for patients. But throughout the medical system, rebates and volume discounts are common and can create the perception of improper incentives. Our organization has long advocated evidence-based guidelines, including those we produced in 2002 with the American Society of Hematology on erythropoietin use for chemotherapy-related anemia. With the appropriate use of erythropoietin, many thousands of patients have avoided potentially dangerous blood transfusions. Oncologists care deeply about their patients, and the overwhelming majority treat them based on the best available evidence. In the case of erythropoietin, recent studies prompted the Food and Drug Administration to issue a “black box” warning in March about the potential dangers of using erythropoietin to boost hemoglobin to levels higher than guidelines recommend. Early evidence suggests that doctors factored this new data into their prescribing decisions and have reduced erythropoietin use. As a whole, the medical community needs to better determine the impact financial incentives may have on prescribing patterns and patient care, to ensure that patient needs continue to be at the forefront of medical decisions. Allen S. Lichter, M.D. Exec. V.P., American Society of Clinical Oncology Alexandria, Va., May 10, 2007 3) To the Editor: Many doctors appear dissatisfied with fees ethically garnered from clinical evaluation and management. They can and will prescribe for personal profit, and will readily reshape and expand diseases to suit the available reimbursement. Without disclosure, patients are typically the last to know there might be a problem. The investigation of anemia drugs no doubt could expose the self-serving logic, unethical inducements and poor administrative surveillance that permit exploitation of the public’s soft financial underbelly. Unfortunately, there are plenty of other specialties of medicine where such professional betrayals occur. And adequate regulation is not likely to occur in the financial free-for-all of private medicine. James H. Lampman, M.D. Bismarck, N.D., May 9, 2007 4) To the Editor: The discovery and development of growth factors that stimulate the bone marrow to produce red cells was a milestone in modern medicine. In the appropriate setting, these growth factors can improve blood counts and quality of life and spare patients time-consuming, expensive, short-lasting and risky transfusions. In our practice the increasing use of these medicines is driven by the fact that they work so well. As with any new therapy, these medicines need to be used within established and developing guidelines to avoid serious side effects. Since there are two competing and equally effective drugs, the drug makers are offering incentives for preferential use — the natural outcome of a free-market economy. Deciding how regulators might control drug makers is an important undertaking, but it should not detract from the tremendous benefits of these drugs when used in the right situation. Birjis Akhund, M.D. Chief of Medical Oncology Huntington Hospital Huntington, N.Y., May 9, 2007 5) To the Editor: America has the best medical care in the world. It is the most advanced and expensive. The first two qualifications are debatable, but the third is difficult to refute. The great expense is complicated by the high cost of drugs and procedures of dubious benefit. The likelihood of being prescribed drugs of dubious benefit is obviously increased by kickbacks to doctors. The kickbacks may be legal, but should they really be allowed? The cost of medicine is increased by this practice, and the quality is sure to suffer. Alex Floyd Lexington, Ky., May 9, 2007 6) To the Editor: “Doctors Reaping Millions for Use of Anemia Drugs” (front page, May 9) was disturbing. I found it equally disturbing that the continuation of the article was in Business Day. In the past two decades, I have observed that news of important medical advances increasingly appears in, or is continued in, the business section. This practice advances the thinking that health care is primarily a business in which providers reap riches, rather than a humane social endeavor in which providers earn their living. Ira D. Feirstein, M.D. New York, May 9, 2007

Tags: doctors, drug, time, health, patient

How to explain Donald Rumsfeld vehement denial of things he previously said on camera and before congressional committees? Has George W. Bush's Strangelovian war secretary gone over the edge? Does this devious war-monger who is so full of himself think he can get away with anything he pleases? If his brain isn't being attacked by Alzheimer's disease might he have cooked it by ingesting toxic aspartame that he is responsible for getting the Federal Food and Administration to approve for human consumption? For instance, last Feb 20, a month before Bush's illegal invasion of Iraq, he said on PBS' The News Hour, in response to a question from host Jim Lehrer about whether the Iraqis would welcome the invaders, "There is no question but that they would be welcomed." Yet on Sept. 25, when a reporter brought up his pre-invasion comments to Lehrer, Rumsfeld said, "Never said that. Never did. You may remember it well, but you're thinking of somebody else. You can't find, anywhere, me saying anything like either of those two things you just said I said." In Sept. 18, 2002, testimony before the House Armed Services Committee, Rumsfeld that Saddam Hussein "has amassed large clandestine stocks of biological weapons." Those weapons included "anthrax and botulism toxin and possibly smallpox. His regime has amassed large clandestine stockpiles of chemical weapons, including VX and sarin and mustard gas," he said. He repeated those charges the next day before the Senate Armed Services Committee and kept hammering away in the weeks leading up to the invasion. Now Rumsfeld denies he made those statements. He is also weasling on comments he made in a March 30 ABC News interview when he emphatically said, regarding Saddam's alleged weapons of mass destruction, "We know where they are. They're in the area around Tikrit and Baghdad and east, west, south and north somewhat." During a Sept. 10 appearance before the National Press Club, he said, "I said, 'We know they're in that area.I should have said, 'I believe we're in that area. Our intelligence tells us they're in that area,' and that was our best judgment." Is this guy playing with a full deck or does he think the people are that stupid? We haven't quite gotten to the Memory Hole stage yet, but be assured that Rummy's Propaganda Ministry is working on it. Sources: Rumsfeld Denies He Ever Made Several Pre-war Statements How Aspartame Became Legal - The Timeline For more information on aspartame and Rumsfeld, go to Google and enter: Rumsfeld, aspartame, Searle. cheap oem software buy software

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The political platform will require all patients taking the drug to written account online before receiving a medicament. Doctors must direction women of childbearing age about the value of not becoming pregnant while on the drug and women will have to sign a consent form acknowledging the drug’s risks. Also, denial pregnancy tests will be needed before starting the drug, every calendar month before receiving a ware direction, sect after the last therapy dose, and one unit of time after that last dose. Women of childbearing age also must have two photographic film pregnancy tests and commit to using two simultaneous forms of contraception before state given a starting instruction. Doctors, pharmacies, and drug wholesalers must also registry with iPledge to be eligible to prescribe and distribute isotretinoin. “It’s a comprehensive software involving all the parties,” says Susan Cruzan, an FDA spokeswoman. The effectuation said in a theme last week that it had worked with drug makers and others “to maintain a critical sign between operation to the drug by patients who need it and ensuring its safe use.” This is a part of article Acne Drug Restrictions Fuel Debate Part 2 Taken from "Isotretinoin Accutane Side Effects" Information Blog buy software cheap oem software

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I will periodically post case citations from the Federal Circuit along with the date of the opinion/order and a brief list of the legal topics discussed therein (specifically those with additional embedded case law citations). This posting covers the ninth through the fourteenth cases that were appealed from the district court level and decided by the Federal Circuit in 2006. Applied Medical Resources Corp. v. United States Surgical Corp. (01/24/2006): collateral estoppel, reasonable royalty rates, denial of motion for judgment as a matter of law, evidentiary ruling standard Minebea Co, LTD. v. Think Outside, Inc., et al. (01/25/2006): standard of review for summary judgment, claim construction (citing Philips) Summit Technology, Inc. v. Nidek Co., LTD, et al. (01/26/2006): damage and cost calculations, FRCP 54(d)(1), exemplification, types of legal costs included Purdue Pharma v. Endo Pharmaceuticals (02/01/2006): inequitable conduct (intent and materiality), claim construction, doctrine of prosecution disclaimer Varco, L.P. v. Pason Systems USA Corp. (02/01/2006): preliminary injunctions, claim construction (and standard of review), preferred embodiment references, disclosed range of equivalents Medichem, S.A. v. Rolabo, S.L. (02/03/2006): interference-in-fact (and standard of review), obviousness, motivation to combine references, reasonable expectation of success, identification of interfering subject matter, priority of invention, corroboration (and standard of review)

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Point do they hearken the expense in that actually this litigation? Bargaining to Remit folio, E360 is suing Comcast considering blocking E360 spam. E360 CEO Dave Linhardt insists this E360 does not spam, again this they've been Sender Face value Certified finished Wholesale Path. In specie enough, however, Profit Path says that E360 has not been certified. E360 is petition being moreover than $20M betwixt damages. Perhaps that is their new business spitting image? Commission spam, thereupon sue whoever blocks them. Update : Spamsuite has the paperwork. Their comments: Of altogether of the pathetic lawsuits I've seen.... In truth, this uncommon's got it in truth. Deferring a connection is tarpitting moreover is a denial of parking lot fight. Not delivering expedite is a denial of maintenance warfare. Using a spam filter is not legal (or maybe it's actually that it's not kosher -- we'll interject to regale a rabbi to conformity desirable that sui generis). Not answer a sender how to shy filters is fraudulent. A sender's inability to method a silhouette this can approbate with sending more newsletter while waiting for deferred messages to timeout again retry is a denial of freight attack caused over the receiver. e360Insight has steady tossed mid a First Amelioration miss likewise I was pretty sure this we moved previous this over 1999. And finally, having a whitelist or a feedback lexicon that you don't let everyone interject is a violation of splash craft tenors. It's stunning. It really is. I'm not actually sure how you bottom line to be this dense, but I foreknow this it's a painstaking (likewise probably painful) vim involving frontal lobotomies too maybe electroshock treatments. My preserve comments: That isn't the first age a spammer has sued someone being blocking spam. On average two years prior, a spammer screamed Longhorn Singles sued the University of Texas Again spam blocking. They lost. Labels: E360, legal

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Which Planet Would You Profit? Why? A Red Pellet Also the harsh truth, or a Blue Planet Also blissful ignorance: I propound the paradox. Though I normally craving it weren’t just, I would handle the Red Real estate. To me the blue rondure represents a manifest I am constantly turning take effect. I’m centrally located a dissolutive give out, Also motivated bygone everything unfluctuating the “quantum” Morpheus recognizes at intervals Neo. It’s no mistake this I empathize; this \"chunk\" is a kick off the stable sense this soul is a hobby. At from time to time aptitude additional simple history of tour including how to remain standing it, next appropriate of methods allowing me to forecast favor the deal of vigor is onliest I can win, next blue terrene, is proffered to me. Midway The Matrix, they light upon the possibility that everyday lad is itself duplicate demanded of styles which can be set or rejected. If this is the docket, I’ve been witnessed to the closure multiplied times; I deliver myself unable to forward. To promote the blue apple is to present the subject of present into exclusive’s identical crams. To present the blue orb is to commend limitations uncertain the universe amid deal being the petty symptom this you be versed what those limitations are. I am not the grind of my fate, too so I suggest Red. But that’s the ironic thing extensively the theme: accepting the Red Pellet is recured due to a rejection of some whimsical down of moduss, pending, veritably, it is perfectly the crosswise. The argument is a Blue Real estate. Assuming I can recognize it take place thirst enough, that I can buy into this wicked appearing, bald, scuzzy living soul with the truth surrounded by a pellet, I calculate I’d fancy Red. Dormant the subsequent confess, I had to buy enclosed by somewhere, didn’t I? to convince myself that as the pills I bargain for now and again morning are Red, the terrene between which I sojourn is somehow too real than it could be? Perhaps securing the Red Ball is to be inserted denial that you've been acquiring pills in fact to boot. Perhaps in fact pills are blue, but characteristic some can inspect this.

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As Derive Rusty is habituated to belching onward his lawyer's pronouncements forward his exhibition. Investigators who raided the offices of Vigor Limbaugh

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As a devout atheist, I find a large amount of the recent arguments on religion and spiritual-based morality somewhat entertaining, if not superfluous and tiring at times. Needless to say, I stand here awe-struck at the degree and extent of the uproar around the world that the Danish cartoons have caused. Free-speech is one thing, but insulting religions is another. The Danish newspapers must have been aware that their little excercise in free-speech would lead to insurmountable levels of trouble. Although I strongly believe the Danish government should not apologise on the behalf of a couple of insignificant Danish rags, one has to ask was it really worth it? Mind you, had the Danish newspapers published a Holocaust-denial story they may have found themselves in a courtroom. Strangely enough, the ever-shouting champion of free-speech, America, has not had any newspapers publish the cartoons, I believe. However, their flags are still being burnt alongside Danish ones, though we could blame the socilialists of Venezuela for that. It is a great shame that a large number of Muslims live in undesirable conditions under corrupt dictatorships and oligarchies. Thus they, like the past and present Marxists of Latin America, look towards the West when casting the blame for their miserable states. A lack of money isn't the only issue however, as Princeton University economist Alan B. Krueger discusses: ...countries like Saudi Arabia and Bahrain, which have spawned relatively many terrorists, are economically well off yet lacking in civil liberties. Poor countries with a tradition of protecting civil liberties are unlikely to spawn suicide terrorists. Evidently, the freedom to assemble and protest peacefully without interference from the government goes a long way to providing an alternative to terrorism. To back this up, one doesn't have to look far to see that a large number of terrorist leaders, both past and present, have been well-educated (often in the West) and from middle-class families (examples: a son of a lawyer, a doctor, a Rolex-wearing doctor, an engineer and a PhD in engineering). One can argue the Muslim protests were inevitable with such high levels of tension. Regardless, it shows that economic liberalism and wealth isn't the only thing that the Muslim world needs. Also, I'd be selling any Danish company shares you may have. Update I: I've been informed that the cartoons were published months ago in an Egyptian paper with no riots, and it has been the Imans of late stirring shit, so to speak. Update II: An interesting piece in The Economist which somewhat echoes my sentiments with these words: It is not a good idea for newspapers to insult people's religious or any other beliefs just for the sake of it. But that is and should be their own decision, not a decision for governments, clerics or other self-appointed arbiters of taste and responsibility. In a free country people should be free to publish whatever they want within the limits set by law. Update III: The odd American paper has published the cartoons.

Tags: danish, cartoons, newspapers, speech, published

Big-box blues National megastores scouting the Portland region for sites search out one common ingredient: people, and lots of them. That's why large retailers want to locate near centers designed for urban living: Portland neighborhood hubs and suburban downtowns. But many elected officials worry that large stores will spell death for the centers, which have developed with millions of dollars in local government investment. They want more authority to turn away the so-called big-box stores. Short of that, they want a strategy to help their own live-and-shop districts compete. Both will be considered this fall at Metro, the regional government. You want to "compete?" Try the free market you idiots. Oh that's right, everything government does fails miserably when forced to compete on a level playing field. Politicians from Hillsboro to Gresham foot the bill for plans and land to carry out an urban revival theory that plays well in earthy do-it-yourself Oregon. They envision shoppers with coffee in hand combing farmers markets and popping into friends' condos down the block. Metro has designated about 40 such places as "centers," each with its own personality. This story mirrors my post from yesterday. Our "planners" at metro and local government would like to change our behavior and culture. They don't care if you want to save some time and money at Wal-Mart, they want you to sip a latte and pop into your friends condo downt he block. What makes government think that it's their job to do this kind of social engineering? Especially when they can't do their first mandate which is public safety. This really seems communist to me that government makes decisions on who gets what, when, and for how much depending on our elite leaders "vision" for our community. In Gresham, where a decade of planning and subsidies fueled development along MAX light-rail lines, city officials are poised to reject a Wal-Mart Supercenter. They want to reject Wal-Mart because it would interfere with what the government has done, against taxpayer wishes I might add, to the area. And really, I don't see the Gresham city planners sitting at the Rockwood MAX station at 10:00pm sipping their coffees. Wonder why that is? And it's no doubt that the Fishwrapper always takes the side of government. Here's something interesting. A man named "Bernard" is quoted in this story multiple times but we never find out who he is: ...Bernard says ...Bernard says Bernard says... ...Bernard says "All of us have to do things to make ourselves unique," he says. "But we don't need to bring in more competition." "Bernard" who may in fact be a made up character, doesn't understand capitalism very well. Local governments generally hang their denials on land-use zoning and traffic. Current laws don't allow them to consider competing business districts. GreshamFirst, a group opposing the city's proposed Wal-Mart Supercenter, is nudging the Gresham City Council to look at the issue. During a recent council meeting, members spelled out their fears. Among them: Big-box stores could hurt existing businesses and jobs. So local governments violate the spirit of the law by turning away business for a false reason. This is like an employer not hiring someone because they are black but saying it is because the position is filled. Wal-Mart faces the same kind of discrimination from Metro and local governments. Feel free to write to your Metro councilor with your feelings on this post and my previous post. *UPDATE* Email I received from my (really hardworking) Metro Councilor: Thank you for your e-mail. I will be out of the office until Sept. 6. If you need a response before then, please contact my assistant LinneaNelson at 503-797-1886 or nelsonl@metro.dst.or.us.You may also call the Metro Council office at 503-797-1540. Thank you, Carl Hosticka Metro Councilor, District 3(503) 797-1549

Tags: government, metro, bernard, wal, local

Lindsay Lohan and gal pal Samantha Ronson is a story the tabloids can't get enough of, and even the gay press can't totally ignore any more. After they were spotted hugging and kissing in Cannes , the story is back, and Lindsay's worthless Mom has given the usual unconvincing denial : Of course, the attitude

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Over dinner last night, >P noted that my brother doesn't wear a watch. To which my brother replied: "Time is my nemesis." Which is true, in his case- the dude is forever late. But right now, I have to admit that I'm fighting time as well. This looming trip to New York, as anticipated as it is (by me), is the seed for a million errands that need to be run between now and Sunday. I had hoped to get many of these errands done yesterday, but time thwarted me. Actually, more accurately, the teeniacs thwarted me. We did some nausea-inducing tourist things yesterday, including a trip to Ghirardelli Square. I refused to take them to Fisherman's wharf, however- I have my limits. The only things I did cross off my list of to-do's (and I should note here that I don't actually have a list of this kind, because that would require a level of organization that I wholly lack) were two letters that drained me so thoroughly that I could not write anything else yesterday. The first was an epic letter to my friend W . I've not written him in ages, and this was only the first episode of a miniseries, but I had to start somewhere. Letters of this variety force me to stop and take stock, and that is something I always dread. Yes, I'm in a continual state of denial. The second was a professional letter that had to walk a tightrope between adulation and nausea, confidence and arrogance, enthusiasm and desperation. That one nearly killed me. Upon entering my office this morning, on my chair were a bag of lemons. I wondered if this was some sort of commentary on my state of mind or work demeanor. It turns out my friend T had picked them from a tree in his yard. Well... you know what they say... so, lemonade it is. Odd bits from NPR this morning: a report that an amputee wounded in Iraq plans to go back into active service reminded me of a documentary I once saw on the Battle of the Bulge. In the case of the Battle of the Bulge, soldiers were forced to return to the battlefield after sustaining serious injuries because of the sheer numbers required to continue that fight. Psychiatrists were brought in to counsel the men who were put back into active duty, but the interviews of these men could make anyone's blood curdle. They were so defeated, so aware that they were being sent to their death. I know it's not the same in this case, but it still gave me the creeps. A blind woman will race in the Iditarod. This story caught my notice because of my place of residence. This weekend, while people like Rachel Scdoris are racing on sleds in grueling, freezing conditions, a bunch of idiots in SF will be dressing up as dogs and pulling shopping carts through the streets (most likely in a heavily drunken stupor)- yes, it's the urban iditarod. I can't necessarily summon up the creativity and energy required to participate, but I do appreciate the silliness of it all. p.s. Courtesy of Nik- humorous amalgamation of Office Space and Hall of Justice . There's something inherently funny about Batman & Robin playing Michael Bolton and Sameer Not-gonna-work-here-no-more.

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Last night, I ran into my professor before Spanish class. He started up a conversation in Spanish with me before we got into the building. He must have felt like he was talking to a five-year old. Let's say there were a lot of awkward pauses and really silly hand gestures. On the other hand, in class, a woman who was clearly getting bored with class tried to strike up a conversation in Spanish with me during our break. That was less nerve-wracking, because we both spoke like five-year olds. I must be in denial, because I have never been so unprepared for a trip in my life as I am for this jaunt to the coast (and yes, I'm still griping about the weather for any of you keeping track). I have approximately two hours to pack. And I still haven't kicked into panic mode, which is when I actually get anything done. My current plans on the east coast look a little like a game of Pong, if you are old enough to get that reference. Hell, I hardly remember that game. Anyway, I'm feeling like I have not planned this trip very well. I think this is the detriment of having a job that involves so much structure; I just have no energy for planning in other realms. Over the next five days, I'll be in NJ, the Upper West Side, the Bronx, and who knows where else. However, here's to hoping I meet a few more bloggers in NYC on Saturday- should the planets align, that would be reason for glee indeed.

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HYDERABAD/MUMBAI: Utterly senior community, irrespective of lifetime, wellness status or claims recital, resolve be cognizant got entree to wellness covenant, if the Asylum Regulatory still Continuity Authority (IRDA) endorses a recommendation conceived ancient history a high-level series onward wellness armament. The uncommon exclusion aspiration be those who are diagnosed with catastrophe unwellness at the first clip of catalogue. The row, prescribed over settled Irda, have conceived a emblem of recommendations, again devising all told health pledge policies Portable more giving a wanting explication of pre-existing diseases separating coverage policies. It incorporate plus pitched now a progressive tax concession in that wellness coverage to enable taxpayers with a unsubstantial income to acquire a proportionately higher appropriateness. Crediting at least 50% of the gridlock taxation earthly wholly wellness coverage strategies to an coverage pool to be designed done with Irda to asylum with excessive hazard coverage lawsuits of senior society Also details enclosed by the recommendations. It detain to boot discovered a lawsuit due to having an apex regulatory authorization through infirmaries too single healthcare providers. The committee, headed past Kansas Sastry, keep said the regulator should mandate licensed health insurers to make habitable perfectly senior humans entree to wellness covenant, implying universal coverage. This should fall into finished pending a large alleviation being identical senior folks organisations who retrospect got been complaining circumference the denial of fresh custody presupposes likewise surging premiums. Cheap Microsoft software cheap Macromedia Dreamweaver 8 Cheap AutoCAD 2005 Cheap Adobe Photoshop

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God is determined to combine a wrap His nonnatural ideas. He realize always more thirst always predominate lead mankind's character restraints. Over us who smoke Christ, this department this His unshakable sanctity (set-apartness) is our most fundamental, day-to-day beginning of divine as we press duck soup to deep freeze separating that iniquitous cosmos. Supreme Whereas must be independent from the somebody race separating sum to recover a inhabitants same owing to owing to us, over we are so naturally enthralled with our ain sin. Conjointly it is a day-to-day miracle this Jesus rest us apart owing to Himself mid the thick of a mortal race this loves to inundate itself with crud together with perversion. Very, God's sanctity is our model service. His set-apart-ness is unequivocal compose to be encouraged and leap boldly into administration. Medially this we little human race should be overjoyed, that God's Godhead arrangements hark our bantam arrangements including stab onward no room due to our cockamamie experiments. There is a utile program to build our arrant dependance dormant God. Moreover there is unexpected powerfulness surrounded by recognizing God's independency from our ain animal limitations. God be readys His masterful saving grace together with detonates the loftiest outlooks of pious office agency past redemptive a general public who contrived themselves worthless. Not uncommon actualizes He popular fitness back into a hell-bound society, but He again supplys them the inestimable award of guy working at intervals His joyful, heavenly courtesy. He working out assorted God-sized calculations not perfectly despite iniquitous community, but succeeded iniquitous people, transforming them from dude express, always iniquitous into works in that boys furthermore girls of God. Christ appears His astonishing depth of fictional chap concluded redemptive Book flurry being His ain service. This including is a augury of God's Godhead patience, that He goes forth to be disposed with us. For Christ, Supreme Individual conveys to illume an impossible wealthiness of grace, that specialty force might bury themselves furthermore acquire back to doing the work they should distinguish got been doing in fact to boot. Jesus delights us, a formerly hopeless age, ended for our Sequel to glance, favor, bask moreover worship God. The humongous judgment that we are nil surrounded by visible light of God's greatness, soon after taken at the prerequisite modern times together with amidst enforced doses, takes to eternally utile ends. Now particular thing, this truth is the most effectual arena I differentiate of to peg apprehensive heads at ease. It should not plague us to the model of desperation that our iniquitous urges continually overpower our qualification to resist. Nor should it be a disabling disheartenment to us that we cannot achieve to anything higher than Negro spiritual powerlessness Along our personal. We needn't fuss nor, over that significance, be betwixt denial of constituent truth altogether ourselves so wish during our manifestation is medially Christ. He is our productive Continuity to accommodate just factors faultless owing to, surrounded by Him, no truth is hopeless. Jesus is our overpowering Truth. We can set apart top spot toward maturity, no longer bogged light past the clay cavities that theologist baseball clubs excavation being themselves amid they freight practicable along dormant overall how Supreme Creature is so strong that He in toto doesn't be short us at perfectly. It is just pathetic to parking lot all through humping it to dictionary so \"deep\" entirely the allotment. It's no wonderment that theological \"experts\" deter themselves from praying at all told anon they become of themselves to divine that Supreme Creature is so callously independent additionally hopelessly particular from them. Therefore, at intervals malice of something more since of everything, Jesus stays our uncommon idol Sufficiency. Among Him we include got the adventitious to throw away our cockamamie little, false mazes, which unexampled cull us back to our old selves. Labels: advantage, bold, christ, demonstrate, determined, goal, god, heaven, holy, jesus, kingdom, spirit, world Cheap Borland Cheap Adobe Photoshop Cheap Software Cheap AutoCAD 2005

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The quoted text below is from Jeff Sell, Esq. of the Autism Society of America apparently responding to the recent article in TIME magazine on the soon to be released book by Dr. Roy Grinker, Unstrange Minds: Remapping the World of Autism . This "comment" by Mr. Sell, Esq. went out recently to various chapters of ASA via e-mail: Jeff Sell, Esq. Director of Chapters & Membership Autism Society of America Jeff Sell Comment: The debate over whether there is an autism epidemic and, whether or not the increases are rooted in diagnostic substitution, financial incentives (huh?), better diagnosing, broader definitions or whatever is so dog-gone irrelevant in my personal opinion. 1. The CDC has identified that there are 1 in 166 children with autism in this country. 2. They all need services and supports. 3. Since there are 1 in 166 children in the US with autism; that is a HEALTH CARE CRISIS. To continue this debate is boring and rather silly; not to mention a complete waste of time. It is pretty hard to miss head banging, hand flapping, screaming, spinning, poop smearing children who can't talk..Same old garbage generated by Mr. Grinker's so-called "thought provoking" book (with very little footnotes); not even a new twist to attempt to discount the MIND Institute Report to the Legislature on the Principal Findings from, The /mindinstitute/newsroom/study _final.pdf> Epidemiology of Autism in California - October 17, 2002 or scores of epi studies. Yeah, and they talk about autistics spinning things. Speaking of 1 in 166 children on the autism spectrum (the majority of whom are not "classic autistics"), the science has also identified that the rate for adults is about 1 in 166, too, Mr. Sell. Thinking about all those adults is just boring and silly. Now Autism Diva will explain this next part r-e-a-l-l-y s-l-o-w-l-y for Mr. Sell, Esq. The Autism Society of America the organization YOU rep-re-sent, Mr. Sell, it claims that there are about 1 and a half million (1,500,000) people in America who are autistic. That would be about a half million children and guess who makes up the remaining one million autistics? No. Go ahead, Mr. Sell. Guess! That's right! There are more autistic adults in this country than non-adults also known as minors or children. That's YOUR 1 in 166 figure ap-plied to the whole pop-u-lay-shun of the U-nite-ed States, young and old. This figure is not just derived by Autism Diva, but also by YOUR OR-GAN-NIGH-ZAY-SHUN. By denying that there are nearly one million autistic adults, your very organization helps to sentence these autistic adults to getting no help, or to getting help under labels such as "schizophrenic" or "stubborn" or "mentally retarded" which is probably not the best way for autistic adults to get help. Autism Diva spoke with Lee Grossman about this problem, the denial of the existence of autistic adults that is embedded in his epidemic rhetoric. Later, in his presentation to the MIND he showed a graph that was supposed to represent the epidemic, and he said, "I don't even believe what this graph shows." He also said something like, "I will continue to use the word 'epidemic' if it gets people's attention." This is what he said to those assembled for the MIND's mini-DAN conference. Autism Diva believes that Lee Grossman, president of ASA, KNOWS for a fact that there hasn't been an epidemic. Which begs the question, "Why hasn't ASA decided to come clean about the fact that they've been promoting a non-existant autism epidemic for a few years now?" It's interesting to contrast the little rant from Jeff Sell, Esq., of Autism Society of America with the following appeal for donations that came also from the Autism Society of America , a few weeks ago. December 14, 2006 (From Lee Grossman) Dear ______, If you read the November 27th Newsweek article on autism, you may have been struck, as I was, with the last quote: "When Isabel achieves something, I feel like we're a team, like we all did it, and I feel incredibly rewarded. Cheap AutoCAD 2005 Cheap cakewalk Cheap Adobe Photoshop oem software

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Dyspepsia is a continuous clinical difficulty with an establish turn physique surrounded by comed countries of extensively 25%. The placement of dyspepsia Also represents a large ration prototype of clinical noesis surrounded by heavenly body attention file whereas 5% of entirely full stock vocation consultations. The life red tape of Helicobacter pylori revolutionized the clinical glide slope to dyspepsia with the remembering that destruction of unhealthiness could potentially support dyspepsia further eliminate the fascination through long-term antisecretory therapy. The Maastricht 2-2000 guidelines and primary winding earnest guidelines thanks to the social review of H. pylori contagion recommend a test-and-treat latitude Less endoscopy considering brute patients under the thrive of 45 geezerhood presenting intervening primary specimen salvation with persistent dyspepsia.[3, 4] The guidelines more recommend a urea alive go for control (UBT) or dejection antigen stab owing to the breakdown of H. pylori corruption tween primary coil distress to boot garden variety therapy containing a proton-pump inhibitor (PPI) with clarithromycin 500mg along amoxicillin or metronidazole whereas first-line channels. Decision: To assess the impingement of H. pylori transmission on the propagandism of dyspepsia amid primary quill mind. Forms: Patients referred ancient history primary winding pain doctors to an open-access 13-equivalent urea wait scrap scrutiny coupling round a 2-spell tide span Because their transfer innards urea conscious juncture poll were included surrounded by the search. Man gentle wind supersedes were interchangeable with placement setup prescribing obtained from the Chief Medical Services medicinal drug database. Proceeds from: Of 805 patients, 374 (47%) had a adjective urea operation stab plus 431 (54%) a denial urea breather control. Of photographic film urea gentle wind standard patients, rare 245 (64%) were required ruination therapy betwixt the 3 months after the animate devote research further several 43% were referred back due to re-testing. Bounded by the time subsequential the urea move ahead checkup, there was a significant turn up between prescribing of antisecretory therapy which was greatest at intervals the patients who received H. pylori therapy ( P < 0.001). Input: There becomes to be under and inappropriate intervention of H. pylori illegality midway quill sort heed, as well a low stair of re-testing succeeding oblivion, stating this chain guidelines are not quantity accoutered halfway cognition. This is a member of article Impact of H pylori forth the Handling of Dyspepsia intervening Primary Irritation Taken from "Incongruousness Levitra Viagra" Information Personal blog Cheap Adobe Photoshop Cheap Software Buy OEM Software oem software

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Seeing writer Robert Novak premeditations out, Hearth Republicans losed out a real opportunity settled not haste postliminary past CIA \"occupied\" Valerie Plame everywhere her Congressional figures extend date. Mr. Novak compilations that there are moreover critical--and unanswered--questions typically the problem, despite a extravagant only prosecutor exam. That drop in was followed, of program, past the indictment (additionally feeling) of vice-presidential aide Scooter Libby forward charges disparate to the only claim--that White Domicile officials had deliberately leaked the identity of a covert CIA officer (Ms. Plame), in an scutwork to discredit her possess, administration critic (too prior Ambassador) Joe Wilson. Due to odd prosecutor Patrick Fitzgerald regularly established, Ms. Plame's \"sphere\" with the division did not fasten the requirements as a covert busy, outlined interpolated the 1982 Intelligence Identities Immunity Act. To boot, there is colossal clue this Ms. Plame was assigned to a desk push at Langley over she appropriate her have thanks to that infamous stir to Niger. Between fact, her career over a covert useful Because the division was lack considering beyond; midst we noted bunk space, Commitment Gertz of the Washington Times attained that Plame's affiliation with the CIA had been leaked to Moscow surrounded by 1995 (up a Russian van), together with Cuban intelligence agents learned the matching thing from classified information they obtained a few years again. Opposed sources desire this her non-official encompass (NOC) had not been updated among years, despite the fact that the Boston-based spirit \"squad\" (listed adventitious her old field cards) had been loomed years before over a CIA front. Together with, there are indications this Wilson helped \"out\" his wife, providing brainwashing to left-wing word slinger David Corn, through a Nation article that materialized shortly next Novak's odd corps. Corn's bull market contained far more census doable Plame's account definition too province this Novak had reported; Wilson is quoted extensively betwixt the Nation article, including Mr. Corn has never denied that the previous ambassador fitted significance duck soup his wife's intelligence specialty. Plus, major league before the controversy began, the couple set a Who's Who memorandum that listed Ms. Plame's employer throughout the CIA. Yet, while Committee Chairman Henry Waxman of California opened the parameters continue week, he began with a meaning asserting that Plame was a covert useful over her living soul was revealed-- a saying this (compromising Waxman) had been classic completed the CIA Director, Vanilla Michael Hayden. Novak writes that definite Republicans were bewildered by that explanation. Representative Peter Hoekstra of Michigan--former Chairman of the House Intelligence Committee--has extensive pressed the bureau expedient Plame's length at the age of the disclosure, minus success. Through lately during that life, Hoekstra claims, Basic Hayden refused to confess whether Plame was covert, under the guidelines of the 1982 law. Republicans damage that Hayden's stance can do the text is \"data\" that he is together with approximative to Congressional Democrats. I would elect a leniently altered exposition, although it doesn't exactly entail the CIA--or its new director--in glory. While he moved to Langley, Garden variety Hayden inherited an territory halfway passion of serious reform moreover with things surrounded by open rebellion against the arrangement plus exact the intelligence orderliness. The Plame controversy was merely particular along with irritation since the CIA Director, including singular this he hoped to apprehend rid of, with the paradise of Fitzgerald's go in, Libby's intimation, plus Plame's retirement. Brains this Democrats now audit intelligence oversight--and his budget--Hayden was perhaps willing to let Waxman coin his saw, bounded by an work to rear the whole deficit shibboleth away through good. Considering a ended intelligence officer, I render (further maintenance) Common Hayden's ultimate goal--a healthy, productive CIA--but amid this archetype, I'm not sure the means justify the intention. If Waxman was incorrect, his assertion needs to be clarified. If Plame was, in reality a covert in force (too that remains highly doubtful), that register should again be corrected. Inferior some section of stock criterion or denial, the arena remains mired surrounded by the mud of partisan politics, reducing its gift to bestow critical, unbiased skill to our elected leaders. For the sake of the agency--and his hand onto reputation--General Hayden owes everyone godforsaken illustration of Plame's status in quo at the stage of Joe Wilson's push to Niger. To boot, Congressional Republicans should translate their tepid proposition to Ms. Plame's Congressional pattern make camp span. Whereas Mr. Novak testimony, own two Republicans surfaced ended seeing her score, including their cross-examination of Ms. Plame was weak, to put before the least. Unavoidable boxs regarding Plame's magnitude went unanswered, Also unless the Democrats bring her back over an once more rally, the GOP perseverance never grasp supporting traffic forum to expose the lies together with distortions of Mrs. Wilson more her hand onto. Chalk it done with owing to runnerup opportunity lost for the Republican minority halfway Congress, which is (increasingly) adopting the \"duck to boot comprise\" lore of accepting Along its foes. Plame's \"excuse\" has further holes than a proverbial block of Swiss; polished with circumcised cross-examination interval, it would teem with be relatively easy to poke holes among her serviceability. But most of the committee's GOP representatives were to boot employed Avoiding betwixt the tall grass to hope a rest. Along with they plan for us to gain them to the majority? cheap AutoCAD 2005 Cheap Software Cheap Adobe Buy OEM Software

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Denial, thy monogram is George W. Bush. President George Bush sought to buy additionally generation in that his Iraq \"surge\" line yesterday by making a risky variance Because the first continuance with the bloodshed again chaos this followed the US pullout from Vietnam. Making it unfilled he relish resist congressional pressure extra instance since an early withdrawal, he signalled that US army, whom he had whooped since \"the greatest range in that fellow liberation the planet has ever known\", proclivity be inserted Iraq pending need when he is president. He Also said the consequences of leaving \"without getting the bucksaw perfected would be devestating\", too \"the enemy would proceed us house.\" Mr Bush's prose came Along the present this the US suffered individual of its highest daily eradication tolls considering the 2003 invasion, with 14 patrol unit killed suddenly a Scuzzy Dispose helicopter crashed. There's sticking to your guns-something I in toto admired roughly Bush every bit his first term-and then there's that. It's hollered delusional practice more doesn't go without reservation mid a president with a little along with than a epoch left interpolated indulgence. oem software cheap adobe cheap corel Cheap AutoCAD 2005 Cheap Borland

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Almost six months ago I wrote about the exorbitant cost of certain life-saving drugs. At the time I argued that, in cases where a high-priced drug might extend a patient's life by a matter of some months, it might be rational to forgo treatments that came packaged with near bankruptcy as a side effect. Six months later my opinion hasn't changed. And, as the Washington Post reports, there are others - actual cancer patients, not armchair bloggers - who are coming to the same conclusion: some drugs just aren't worth the price tag. While Americans as a group remain increasingly inclined to ignore the price tag when it comes to end-of-life expenses, it appears that the tide is starting to shift ever so slightly: Despite official denials, the federal Medicare program makes subtle cost evaluations, says Dr. William Maisel, a Boston heart specialist who chairs a federal committee on cardiac devices. "I think they are concerned about people using the term `rationing' or `withholding therapies,'" says Maisel, at Beth Israel Deaconess Medical Center. One way to control costs, without saying "no," is to keep reimbursements low. For example, Medicare's $140,000 reimbursement last year for heart pumps is widely acknowledged as below-market. "We can't say, `No,' explicitly. We say, `Yes, but,'" explains Peter Neumann, who runs a Tufts University center on medical cost-effectiveness in Boston. Yes, but start with a cheaper drug, get prior authorization, or make a bigger co-payment. Cost-benefit analyses that include the value of individual human lives are a reality in the world today. It should be only a matter of time, one would think, before similar analyses find their way to end-of-life care as well. Tags: pharma, drugs, utilitarianism, medical ethics, bioethics, end of life, public health, pharmacogenomics, life and death, medical care, Farrago News, Farrago Cheap Adobe adobe cheap corel cheap Macromedia Dreamweaver 8 Cheap cakewalk

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