The 7-minute workout at ANY time of the day.

Posted on November 19, 2008 in Canadian meds

Not enough century to promote surrounded by your era? No allocate to handle? I prayer \"nasty\" on that end. Here's what I compulsatory did: It's raining today so I didn't contemplate according to bundling settled bounded by the cold downpour to do my daily 30-min specialty. (Most recurrently amid the year I train 2x/spell: a brisk, hilly discipline together with some subsequent schooling, equivalent progressions, core scholarship, tango dancing, Exuberant Animal desirouss, bike outdoors or indoors, etc). However, I compulsatory to utilize despite the outdoor weather. I refuse to regular hearken to my reminisce excuses, so instead of creating a rationale why I can't make out my forward, I big league to solve the trouble how I CAN d o my advance. So I proposition forward my iPod (I strain to radio podcasts) more I walked gone including done with my stairs. Muscles likewise physiology exercised: quadriceps (front of thighs) hamstrings (back of thighs) hip flexors glutes (lengthy muscles of my butt) hips (small muscles of my butt) calves ankle muscles feet (I was inserted socks) cardiovascular (center, blood ruts, as well lungs) I did 8 minutes. Proper 8 minutes as well I was animate hard, muscles pumping. This's secluded a quick break surrounded by my incommensurable in gear (multi-project) term. What's Indeed good is this I can do subsequent 8 minutes together with... still then to boot... too before long today - entirely at times this I'd be needing to strength away from the computer anyway*. What's better, is this my guy in truth wanted to swing - so for 5 minutes I held a 12-lb creature date doing the stairs. He purred, I climbed. HOW YOU CAN DO IT To boot: If you are at manual, commence the stairwell due to 8-10 minutes snap a break, a few times a present . You won't considerably overhear sweaty but you itch originate a dent inserted your apprenticeship thanks to the stage. 3 times besides you'd done in 30 minutes - including, you are at pursuit so it won't build matched you are slacking off. If you are at erection, do that at mansion at chunk duration. I recommend NOT doing it before bedtime, now it can jazz you. If you involve small kids (or a baby), that is a advance to retain the baby Also take course some forward. .. or fixate a toddler alike the staors along how things stand with it now you region closed to boot light. Floater me, if it kept a personality casual (notorious being losing move), it intent detain a baby unforeseen. You love nurture this your muscles relish respond seeing heedlessly amid your psyche declaration respond. Rate climbing craze velvet easier still the little 'aid' fondness and own you from snacking among the era mid a pick-me-up. How did that exertion since you? --------- * Alternative dispositions of making stair-climbing again exercise-oriented: go fast gone including executed - de facto cardio be disposed finished 2's at a date trial by or over medially a strangely w-i-d-e stance drift concluded or executed interpolated a chiefly narrow stance detain nothing enclosed by your bolsters or arms (individuality, baby, books, amounts, etc) do it with radio, music, friend or podcast: quality the year browse finished handily do deep knee bends when proposition gone

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Keeping Up With The Wellstones

Posted on November 19, 2008 in Ed pump

Believe it or not, it must be difficult to be a politically correct lefty in the Twin Cities these days. Not because spirited conservatives are taking the battle to you, but because you really have to get creative to outdo your own brethren. Right now, everyone stands in awe of the city of Minneapolis. The Star Tribune might shill the liberal party line day in day out, but there's nothing new or creative in that. The city of St. Paul can raise property taxes to pay for more government waste, but Minneapolis has been doing that for years. The DFL controlled state legislature might pass ridiculous, impractical laws that impose on the rights of businesses, but again, that's nothing the liberals in Minneapolis haven't been doing for decades. The city of Minneapolis continues its old anti-business agenda and increasing crime rate, but additionally has one-upped everyone on the political correctness scale by hiring and refusing to fire an inept and possibly criminal fire chief who happens to be (read was given the job solely because she is) a lesbian. No one is more jealous of Minneapolis' PC posturing than the Marxists at the University of Minnesota. Their political correctness just doesn't measure up. The women's studies department hasn't been news in decades. The university has been relegated to attracting PC kudos by giving Al Gore an honarary degree. As if honoring another dead white male could score real PC points with those who keep track of that sort of thing. I however, have an idea so radical that it would put the U of M on the front page of every newspaper in the country. It is an unfortunate fact that the athletic departments of major universities garner more headlines than any of the academic departments. Late in 2006, the University of Minnesota was forced to fire the coaches of its two money programs (men's basketball and football) due to gross incompetence. After the firings occurred, sports experts suggested that the university could end accusations of aspiring to atheletic mediocrity by hiring a "big name" coach in one of the two sports. Examples of "big name"coaches included Tony Dungy in football and Flip Saunders or Rick Majerus in basketball. People who understood the aspirations of mediocrity of the U of M suggested that there would be no "big name" coach hired in either sport and instead suggested that the U would hire such non-big names as one or both of the "big time" coaches from non-rival North Dakota State. The U of M responded by hiring a nobody named Tim Brewster for the football coach position. Brewster is certain to field a team no better than that of his predicessor Glenn Mason. However, the U can still make history. They could hire basketball coaching legend Pat Summitt. Summitt would be the first ever woman to coach NCAA men's basketball. However, she would be more than an atheletic Bonnie Bleskachek. Summitt's overall record stands at 913-177, with 6 NCAA women's titles. Compare that to Mike Kryzewski or Bob Knight, with respective records of 771 wins and 3 NCAA Titles and 887 wins and 3 NCAA Titles. Unlike Bonnie Bleskachek, Pat Summitt is a qualified coach. Her record is second to none. The NCAA is currently wringing its hands that it doesn't have enough minority football coaches. Yet they have more than one for decades. There has never been a woman coach of an NCAA men's basketball team. This is an obvious display of sexism. Many men have coached NCAA women's teams. The University of Minnesota can once and for all claim PC supremacy by naming Pat Summitt its men's basketball coach. To do anything else would reinforce the existing patriarchy and make Wellstone followers everywhere cry. buy software cheap oem software

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Pharmacy Benefit Managers' Drug Cost Savings is a Shell Game: Numerous Lawsuits Filed Against PBMs for Fraudulent Conduct

Posted on November 19, 2008 in Pharmacy

http://www.drugnewswire/2757/ June 28, 2006 By DrugNewswire 2003 Study Conducted by LECG Corporation Found PBMs Managing the Medicare Drug Benefit Would Add $30 billion to Program Over Nine Years WASHINGTON, June 28 /PRNewswire/ -- If pharmacy benefit managers (PBMs) were really reducing prescription drug costs for more than 200 million Americans, as their trade association professes, why have dozens of lawsuits been filed against them. The Association of Community Pharmacists Congressional Network urges the public to better understand PBMs convoluted business before they profit more from the Medicare drug benefit (Medicare Part D) and further harm seniors with high drug prices. "Time and time again, PBMs' business tactics financially enrich the PBMs and contrary to their slogans offer no real healthcare savings to patients or plan providers," said Mike James, pharmacy owner and Director of Governmental Affairs, Association of Community Pharmacists Congressional Network (ACP*CN). "PBMs are not cost savers but are playing a shell game with their clients -- hiding the money they make from driving up prescription drug costs at the expense of the patient and, in the case of Medicare the US taxpayers. The savings derived by the Medicare patients are the result of the taxpayers' subsidy, not the PBMs," added James. Over 80% of all prescriptions filled in this country are handled by PBMs, who manage prescription drug plans for federal, state and private insurers and are not regulated. For almost a decade, numerous lawsuits have been filed against PBMs by federal and state governments, private corporations, unions, HMOs and others. Plaintiffs accuse PBMs of engaging in fraudulent or deceptive conduct in failing to pass on savings to their clients, switching patients' medication to earn rebates, or manipulating their mail order pharmacies. The nation's top three PBMs (Caremark, Medco and Express Scripts) are defendants in these cases along with smaller PBMs. Some cases have settled for millions of dollars while others are pending. Below are some examples of cases: -- American Federation of State County and Municipal Employees v. Advance PCS, et al Filed March 18, 2003, this class action against Advance PCS, Caremark, Express Scripts and Medco Health Solutions alleges the top PBMs inflate prescription drug prices by steering health insurers and consumers into reliance on more costly drugs and did not pass on rebates from drug manufacturers to health plans and consumers. -- US Department of Justice vs. Advance PCS September 2005, Advance PCS, now a wholly owned subsidiary of Caremark Rx, second largest PBM in the US, settled with the US DOJ and agreed to pay $137 million to resolve civil liabilities in connection with soliciting and receiving kickbacks from drug manufacturers and paying kickbacks to potential clients to induce them to contract with Advance PCS. -- United States of America v. Merck-Medco Managed Care LLC, et al. April 26, 2004, the United States, 20 state attorney generals and the defendants agreed to a settlement of claims for injunctive relief and unfair trade practice laws. A separate consent order filed by the states instructs Medco to pay $20 million to the states in damages, $6.6 million to the states in fees and costs, and about $2.5 million in restitution to patients who incurred expenses related to drug switching between cholesterol drugs. Much of the litigation against PBMs centers on conflicts of interest which make their business goals unaligned with their clients. Plan providers want to reduce the costs of prescriptions but PBMs can't make money that way. PBMs earn huge profits known as rebates from drug manufacturers for adding the manufacturer's drug to formularies and engaging in therapeutic switching. Therapeutic switching occurs when the PBM switches the patient to the higher priced drug on which it receives a bigger rebate. Allowing PBMs to continue running Medicare prescription drug plans (PDPs) unchecked by government will increase program costs and result in higher drug prices for seniors. According to a 2003 study conducted by James Langenfeld and Robert Maness of LECG Corporation called "The Cost of PBM Self Dealing under a Medicare Prescription Drug Benefit," PBMs would cost the government $30 billion from 2004-2013. The report concluded among other things "because PBMs usually keep as a profit a portion of the rebates they receive, PBMs that are both the plan administrator and the seller of drugs have a financial incentive and ability to favor drugs that pay higher rebates." Since Medicare Part D began in 2006, the nation's top three PBMs, who all sponsor Medicare drug plans, reported increased earnings in the first quarter of 2006. This is evidenced by Families USA report which revealed that virtually all Medicare prescription drug plans raised prices for the top 20 drugs used by seniors over the past 5 months. The report also found the lowest price charged by any Part D plan for all of the top 20 drugs was 46% higher than the lowest price negotiated by the Department of Veterans Affairs. According to Ron Pollack, executive director of Families USA, "... plans are quietly raising the prices that they charge. As a result, seniors will pay more and more as will America's taxpayers." Whenever legislation emerges requiring PBMs to meet their fiduciary duty of serving their clients' interest and not theirs, the industry gives the same hackneyed response "it will increase drug costs." For example the PBMs trade association asserts promptly reimbursing pharmacies for prescriptions would increase Medicare costs $9 billion over ten years. This makes no sense. Paying an invoice on time doesn't cost more money unless a business is trying to pocket money that doesn't belong to it. The American people should demand Congress remove the self-dealing cards from the PBMs' hands so the Medicare drug benefit can truly be a benefit. Otherwise, seniors will likely face even higher drug prices in another 6 months and find fewer community pharmacies to fill their prescriptions. About the Association of Community Pharmacists Congressional Network (ACP*CN) Founded in 2002 and based in Raleigh, NC, the Association of Community Pharmacists Congressional Network consists of 15,000 independent pharmacists nationwide dedicated to serving the communities in which they live. ACP*CN is dedicated to the survival and growth of the independent pharmacy owner, who often times is the only pharmacy operating in rural towns across America, where access to pharmacies is extremely limited. Our network of pharmacists do more than just fill prescriptions, they counsel patients on medication use and many times act as the front line healthcare provider for individuals and families who can't afford or don't have direct access to a doctor. Contact: Crystal Wright 202/829-0848 Source: Association of Community Pharmacists Congressional Network (ACP*CN) buy software cheap oem software

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Viagra: An amazing Love making Pill

Posted on November 19, 2008 in Buy sildenafil

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Sexual Enhancement Drugs

Posted on November 18, 2008 in Canadian meds

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Blogger's Block #4: Ruby and Java and Stuff

Posted on November 18, 2008 in Generic biologicals

Part 4 of a 4-part series of short posts intended to clear out my bloggestive tract. Hold your nose! Well, I held out for a week. Then I read the comments. Argh! Actually they were fine. Nice comments, all around. Whew. I don't have any big themes to talk about today, but I've got a couple of little ones, let's call 'em bloguettes, that I'll lump together into a medley for today's entree. Bloguette #1: Ruby Sneaks ended accessible Python I was in Barnes today, doing my usual weekend stroll through the tech section. Helps me keep up on the latest trends. And wouldn't you know it, I skipped a few weeks there, and suddenly Ruby and Rails have almost as many books out as Python. I counted eleven Ruby/RoR titles tonight, and thirteen for Python (including one Zope book). And Ruby had a big display section at the end of one of the shelves. Not all the publishers were O'Reilly and Pragmatic Press. I'm pretty sure there were two or three others there, so it's not just a plot by Tim O'Reilly to sell more books. Well, actually that's exactly what it is, but it's based on actual market research that led him to the conclusion that Rails and Ruby are both gathering steam like nobody's business. I like a lot of languages. Really, I do. But I use Ruby. I'm not even sure if I like Ruby. The issue might just be irrelevant to whether I use it. I like OCaml, for instance, but I don't use it. I don't like Java, but I do use it. Liking and using are mostly orthogonal dimensions, and if you like the language you're using even a little bit, you're lucky. That, or you just haven't gotten broad enough exposure to know how miserable you ought to be. I use Ruby because it's been the path of least resistance for most of my programming tasks since about 3 days after I started messing with it, maybe 4 years ago. I don't even really know Ruby all that well. I never bothered to learn it. I did read "Ruby in a Nutshell" cover-to-cover, but it's a short read (and it's a bit out of date now.) Then I read bits of "Programming Ruby", but not all of it. And now I use Ruby for everything I can, any time I have any choice in the matter. I don't even mind that I don't know the language all that well. It has a tiny core that serves me admirably well, and it's easy to look things up when you need to. I do a lot more programming in Python than in Ruby -- Jython in my game server, and Python at work, since that's what everyone there uses for scripting. I have maybe 3x more experience with Python than with Ruby (and 10x more experience with Perl). But Perl and Python both have more unnecessary conceptual overhead, so I find I have to consult the docs more often with both of them. And when all's said and done, Ruby code generally winds up being the most direct and succinct, whether it's mine or someone else's. I have a lot of trouble writing about Ruby, because I find there's nothing to say. It's why I almost never post to the O'Reilly Ruby blog. Ruby seems so self-explanatory to me. It makes it almost boring; you try to focus on Ruby and you wind up talking about some problem domain instead of the language. I think that's the goal of all programming languages, but so far Ruby's one of the few to succeed at it so well. If only it performed better. *Sigh*. Well, its performance is in the same class as Perl/Python/JavaScript/Lua/Bash/etc., so there are still plenty of tasks Ruby's admirably suited for. I think next year Ruby's going to be muscling in on Perl in terms of mindshare, or shelf-share, at B&N. Bloguette #2: Java's Biggest Dog (Indeed) I still do most of my programming in Java -- at least half of it, maybe more. The Java platform continues to make amazing strides. The newest incarnation (JDK 6) has lots of goodies I can't wait to play with. Like Rhino, for instance, and although they appear to have gutted it, it's still awesome. I think it's the best choice they possibly could have made. Thank God they didn't bundle Groovy. What a catastrophe that was, and still is, and would have been for Java if they'd bundled it. Rhino rocks. The JVM is just getting faster and more stable, and there are even some OK libraries that come with it. I used to think the Java platform libraries were the cat's meow. Heck, I thought they were the whole damn cat. But working with better libraries in miscellaneous other languages has got me thinking that Java's libraries are hit-or-miss. Example: Java's concurrency libraries (java.util.concurrent[.*]) are to die for. I mean, if you're stuck with threads. I think in the fullness of time, hand-managed threads will be history, but in the meantime, Java's concurrency libraries are just superb. I recently ported a medium-sized Python program I'd written (about 1200 lines of fairly dense Python code) to Java, because the Python was taking about an hour to run, and I wanted to parallelize the work. I spent about 3 days doing the rewrite: one day on the straight port, a day adding in the threading, and a day fine-tuning it. The straight port wound up as 1300 lines of Java (surprising that it wasn't bigger, but maybe I code in Python with a Java accent?), and ran about 50% faster, down to about 30 minutes. After adding in the threading and state machine, the program ran in 50 to 60 seconds. So I got an order of magnitude improvement with only about a 50% increase overall in program size. The vast majority of the improvement was attributable to the threading, which in turn would have taken me FAR longer if I'd been using raw synchronization primitives. The java.util.concurrent stuff made it a snap. On the other hand, Java's DOM implementation completely blows chunks. It quickly became the bottleneck in my application, due to an O(n) algorithm I stumbled across with no good workaround for. I can't remember exactly where it was (this was back in July), but I found a sheepishly apologetic comment from the author in the online docs. It was something to do with setting attributes on nodes while you're doing a traversal of some sort: something you'd definitely want to be fast, but it had at least linear performance, maybe worse, and now accounts for 95+% of my app's processing time. And of course Java's DOM interface blows too, because you can't create subclasses or decorators or do anything useful with the DOM other than use it as a temp container until you've transfered the data to something more flexible. Java's collections library is decent, but not superb. It's nice having the data structures they provide, but they're not very configurable, and the language itself makes them often cumbersome. For instance, you can have a WeakHashMap (nice), or an IdentityHashMap (nice), or a ConcurrentHashMap (also nice), but you can't combine any two of those three properties into a single hashtable. Lame. And java.util is missing implementations and/or interfaces for a bunch of important data types like priority queues (you're stuck using a TreeSet, which is overkill), the disjoint set ADT, splay trees, bloom filters, multi-maps, and of course any kind of built-in graph support. Java hyper-enthusiasts will tell you: "well, go write your own! Or use one of the many hopefully robust implementations on the web!" That seems lame to me. We're talking about data structures here: they're more fundamental than, say, LDAP libraries and much of the other stuff Sun's bundling these days. It's smartest to provide robust, tuned implementations of these things, because it empowers average Java programmers to write faster, more reliable code. Oh, and let's not even get me started with java.nio. What a mess! It's pretty gross, especially if you come from the comparatively simple background of select() and poll() on Unix. But maybe the grossness was necessary. I'll give them the benefit of the doubt. What bugs me isn't that the API is conceptually weird and complex (and buggy as hell last time I checked); what bugs me is that nobody at Sun bothered to put a layer atop java.nio for ordinary programmers. Like, say, a nonblocking DataInputStream that takes a type to read, a Buffer, and a callback to call when it's finished reading. So every frigging Java programmer on the planet has to write that exact class -- or just flail around with the raw APIs, which is what I think most of them do. And look what they did to poor LDAP! I mean, the LDAP bindings are dirt-simple in every language I've ever used. It's supposed to be lightweight -- that's what the "L" stands for, fer cryin' out loud. JNDI is this huge monster. So is JMX. I mean, Java libraries have this way of being so bloated and overengineered. But whatever; I've digressed. Java's libraries are not its biggest failing. The libraries (as I said) are decent, and the platform (in terms of tools, speed, reliability, documentation, portability, monitoring, etc.) really raises the bar on all those other loser languages out there. All of 'em. It's why no better languages have managed to supplant Java yet. Even if the language and its libraries are (on the whole) better than Java's, they also have to contend with the Java platform, and so far nobody's been able to touch it, unless maybe it's .NET, but who cares about .NET? Certainly not Amazon.com or Yahoo! or Google or any other important companies that I'm aware of. Literals Anyway, Java's biggest failing, I've decided, is its lack of syntax for literal data objects. It's an umbrella failing that accounts for most of the issues I have with the language. The idea behind literals is that you have some sort of serialized notation for your data type, and it's part of the language syntax, so you can embed pre-initialized objects in your code. The most obvious ones are numbers, booleans and strings. It's hard to imagine life without support for numeric literals, isn't it? Well, Java's support is limited at best. There's no syntax for entering a binary value, for instance, like "0b10010100". And there's no BigInteger/BigDecimal syntax, so working with them is a disaster and nobody does it if they can help it. Heck, Java doesn't even have unsigned ints and longs. But Java does more or less the bare minimum for numbers, so people don't notice it much. Imagine if there were no String literals, so that instead of this: String s = "Hello, world!"; you had to do this: StringBuffer sb = new StringBuffer(); sb.append('H'); sb.append('e'); sb.append('l'); sb.append('l'); sb.append('o'); sb.append(','); sb.append(' '); sb.append('W').append('o').append('r').append('l').append('d').append('!'); String s = sb.toString(); Not only is the latter bloated and ugly and error-prone (can you spot the error in mine?), it's also butt-slow. Literals provide the compiler with opportunities for optimization. Well, unfortunately this OOP garbage is exactly what you have to do when you're initializing a hashtable in Java. Nearly all other languages these days have support for hashtable/hashmap literals, something like: my_hashmap = { "key1" : "value1", "key2" : "value2", "key3" : "value3", ... } That's the syntax used by Python and JavaScript, but other languages are similar. The Java equivalent is this: Map<String, String> my_hashmap = new HashMap<String, String>(); my_hashmap.put("key1", "value1"); my_hashmap.put("key2", "value2"); my_hashmap.put("key3", "value3"); ... It might not look that much worse from this simple example, but there are definitely problems. One is optimization; the compiler is unlikely to be able to optimize all these method calls, whereas with a literal syntax, it could potentially save on method call overhead during construction of the table (and maybe other savings as well.) Another is nested data structures. In JavaScript (and Python, Ruby, etc.) you just declare them in a nested fashion, like so: my_thingy = { "key1": { "foo": "bar", "foo2": "bar2"}, "key2": ["this", "is", "a", "literal", "array"], "key3": 37.5, "key4": "Hello, world!", ... } It would be hard to do this particular one in Java 5 because of the mixed value types, though it's probably not an issue since using mixed-type data structures is something you rarely do in practice, even in dynamically-typed languages. But even if all the values were hashes of string-to-string, how are you going to do it in Java without literals? You can't. You're stuck with: Map<String, Map<String, String>> my_hashmap = new HashMap<String, HashMap<String, String>>(); Map<String, String> value = new HashMap<String, String>(); value.put("foo", "bar"); value.put("foo2", "bar2"); my_hashmap.put("key1, value); value.clear(); value.put("foo3", "bar3"); value.put("foo4", "bar4"); my_hashmap.put("key2, value); ... And then you find out later that your clever clear() optimization (instead of creating a new HashMap object for each value) busted it completely. Whee. Java programmers wind up dealing with this kind of thing by writing generic helper functions, and it winds up layering even more OOP overhead onto something that ought to be a simple declaration. It also tends to be brutally slow; e.g. you could write a function called buildHashMap that took an array of {key, value, key, value, ...}, but it adds a huge constant-factor overhead. This is why Java programmers rely on XML so heavily, and it imposes both an impedance mismatch (XML is not Java, so you have to translate back and forth) and a performance penalty. But the story doesn't end there. What about Vector/ArrayList literals? Java has primitive array literals, which is nice as far as it goes: String[] s = new String[]{"fee", "fi", "fo", "fum"}; Unfortunately, Java's primitive arrays are a huge wart; they don't have methods, can't be subclassed, and basically fall entirely outside the supposedly beautiful OOP-land that Java has created. It was for performance, to help capture skeptical C++ programmers, and they have their place. But I don't see why they should have all the syntactic support. I mean, the [] array-indexing operator is ONLY available for Java arrays. Sure would be nice to have it for ArrayLists, wouldn't it? And Strings? And FileInputStreams? But for some reason, Java gave arrays not one, but TWO syntactic sugarings, and then didn't give that sugar to anything else array-like in the language. So for building ArrayLists, LinkedLists, TreeMaps and the like, you're stuck with Swing-style code assemblages. I think of them as Swing-style because I used to do a lot of AWT and Swing programming, back when I was a Thick Client kind of guy, and they have a distinct(ly unpleasant) footprint. It looks vaguely like this, in pseudo-Swing: Panel p = new Panel(new FlowLayout()); JButton b = new JButton("Press me!"); b.setEventListener(somethingOrOther); p.add(b); JSomething foo = new JSomething(blah, blah); foo.setAttribute(); foo.setOtherAttribute(); foo.soGladIDontDoThisKindOfThingAnymore(); p.add(foo); ... Building UIs in Swing is this huge, festering gob of object instantiations and method calls. It's OOP at its absolute worst. So people have come up with minilanguages (like the TableLayout), and declarative XML replacements like Apache Jelly, and other ways to try to ease the pain. I was on a team at Amazon many years ago that was planning to port a big internal Swing application to the web, and we were looking at the various ways to do web programming, which at the time (for Java) were pretty much limited to JSP, WebMacro, and rolling your own Swing-like HTML component library. We experimented with the OOP approach to HTML generation and quickly discarded it as unmaintainable. (Tell that to any OOP fanatic and watch their face contort as they try to reconcile their conflicting ideas about what constitutes good programming practice.) The right solution in this case is, of course, a Lisp dialect; Lisp really shines at this sort of thing. But Lisp isn't so hot at algebraic expressions, and the best Lisp machines no longer look so cutting-edge compared to the JVM, and blah blah blah, so people don't use Lisp. So it goes. The next-best solutions are all about equally bad. You have your XML-language approaches (like Jelly, but for the web), but they don't give you sufficient expressiveness for control flow -- presentation logic really does require code, and it gets ugly in XML in a real hurry. You have your JSP-style templating approaches, and they aren't bad, but they can have as many as 4 or 5 different languages mixed in the same source file, which presents various problems for your tools (both the IDEs and the batch tools). And then you have a long tail of other approaches, none of which manage to be very satisfying, but that's not really the fault of the languages. It's the browsers' fault: they START with three languages (HTML, CSS, and JavaScript), rather than having just one language to control the entire presentation, and it only goes downhill from there. But NONE of the approaches to web templating is as bad as Swing-style programming, with a huge thicket of calls to new(), addChild(), setAttribute(), addListener(), and the like. The only approach that's worse (and even it might just be tied) is raw HTML printing: print("<html><body>...</body></html>"); So we're all in agreement. OOP-style assembly of parents and children is the worst way to generate HTML. You want to use declarations; you want a template , something that visually looks like the end result you're trying to create. Well, it's the exact same situation for data structures, isn't it? You'd rather draw a picture of it (in a sense, that's exactly what you're doing with syntax for literals) than write a bunch of code to assemble it. This is all assuming that you're working with a small data set, of course. But that happens all the time in real-world programs; it's ubiquitous. So you kinda want your language to support it syntactically. And so far we've only covered literal syntax for HashMaps and ArrayLists (which you can combine to produce various kinds of custom Trees.) Already Java's way behind other languages, and we haven't discussed any richer data types. Like, say, objects. JavaScript does it the best here, IMO, in the parity between hashes and objects. It's not really possible in Ruby or Python to declare a class, then create instances of the class using literal notation the way you can in JavaScript, where the keys are the names of instance variables. Fortunately you can accomplish this in either Ruby or Python with just a smidge of metaprogramming, so it's spilt milk at worst. In Java, you only have one big hammer (instantiation), and one big wrench (the method call), so that's what you use. All you can really do to help is create a constructor that takes arguments that populate the instance variables. But if any of your instance variables are collections (other than arrays), then you're back to the old create-setprops-addchild, create-setprops-addchild pattern again. And what about functions? Ruby and JavaScript and Lisp and Scheme and Lua and Haskell and OCaml and most other self-respecting languages have function literals. That is, they have a syntax for declaring an instance of a function as a data object in your code that you can assign to a variable, or pass as a parameter. (Python has them too, but unfortunately they can only be one line, so Python folks prefer to pretend anonymous functions aren't very important. This is one of the 10 or so big problems caused by Python's whitespace policy. Don't ever let 'em tell you it doesn't cause problems. It does. Maybe it's worth the trade-off; that's a personal style preference, but they should at least admit the tradeoff exists.) Well, Java sort of has them, but Java's static type system doesn't have a literal syntax for a method signature. It's pretty easy to imagine one, e.g. something like: (int, int) -> String x; This imaginary syntax declares a variable x that takes 2 ints as parameters and returns a string. Lots of languages have signature-syntax of some sort, and Java's syntax space is definitely sparse enough that they could pick a good syntax for it without fear of collisions, even conceptual collisions. But no such luck. Instead, when you want to do this sort of thing you have to declare a named interface, and then inside of it declare at least one named method (which is where the params and return type show up), and then you're still not done, because when you create the function you have to create an anonymous (or named) class that contains the definition of the function that matches the interface. Yuck. But at least they let you do it; the alternative of not having it at all is definitely worse. Still... isn't syntactic sugar nice? I mean, they added the "smart" for-loop, which Java programmers just rave about. So someone, somewhere in the Java community thinks syntax is good. I'm not sure many of them really understand the difference between syntactic sugar (into which category the "smart" for-loop falls) and orthogonal syntax, in which the basic operators apply to all data types for which those operators make sense, and there are literal declarations possible for every data type. Let alone the next step, which is extensible syntax -- but that idea strikes fear into the hearts of many otherwise brave Java programmers, and Rubyists and Pythonistas as well, so let's back it up a notch to "orthogonal", and keep everyone calm. So there you have it: Java's biggest failing. It's the literals. No literal syntax for array-lists (or linked lists or tree sets), nothing for hashtables, nothing for objects of classes you've personally defined, none for functions or function signatures. Java programmers all around the world spend a *lot* of their time working around the problem, using XML and YAML and JSON and other non-Java data-declaration languages, and writing tons of code (whole frameworks, even) for serializing and deserializing these declarations to and from Java. For the smaller stuff, they just write helper functions, which wind up being bloated, inefficient, error-prone, and extremely unsatisfying. Java's next-biggest failing may well be the lack of orthogonality in its set of operators. We can live without operator overloading, I suppose (the simplest form of extensible syntax), but only if Sun makes operators like [] and + actually work for objects other than arrays and Strings, respectively. Jeez. Epiblogue You can draw your own conclusions about why suddenly there are all these books on Ruby appearing on the bookshelves. It's a mix of truths, no doubt. And you can draw your own conclusions about why Sun's adding support for scripting languages to the JVM, rather than simply fixing Java so that people don't want (need, really) to use those other languages. But when you dig down into a programming language, and you get past all the hype and the hooplah, what you find is a set of policies and decisions that affect your everyday life as a programmer in ways you can't ignore, and that no amount of hype will smooth over. If your language is sitting on you like an invisible elephant, and everyone using the language is struggling to work around the same problems, then it's inevitable that other languages will come into play. Libraries can make you more productive, but they have almost no effect on the scalability of the language. Every language has a complexity ceiling, and it's determined by a whole slew of policy and design decisions within the language, not the libraries. The slew includes the type system (with its attendant hundreds of mini-policies), and the syntax, and it also includes the language's consistency: the ratio of rules to exceptions. Java's demonstrating quite clearly that at a certain level of complexity, the libraries and frameworks start to collapse under their own weight. People are always writing "lightweight" replacements for existing fat Java libraries and frameworks, and then the replacements get replaced, ad infinitum. But have you ever seen anyone write a replacement for XPath? Nope. It's not like everyone is rushing out to write the next big XML-querying framework. This is because XPath is a language , not a library, and it's orders of magnitude more conceptually scalable than the equivalent DOM manipulations. Object-Oriented Programming. Touted even by skeptics as a radical leap forward in productivity, and all OOP really is boils down to a set of organizational techniques. Organization is nice, sure. But it's pretty clear that OOP alone doesn't cut it; it has to be supplemented with Language-Oriented Programming and DSLs. And all languages, DSLs and general-purpose languages alike, have to be designed to maximize consistency; each inconsistency and special-case in the language adds to its conceptual overhead and lowers the complexity ceiling. So you can look at the shelves filling up with Ruby books and chalk it up to marketing hype, but I have a different theory. I think it's entirely due to complexity management: Ruby does a better job of helping managing complexity than its competitors. It doesn't do a perfect job, mind you -- far from it. But it's enough of a step forward in productivity (even over Perl and Python) that it's managing to shoulder its way in to a pretty crowded language space. With that in mind, despite my griping about Java's failings, I think Sun might actually be doing the right thing by introducing scripting languages (and improving support for them in the JVM.) Maybe. Their investment isn't really so much in Java as it is in the JVM; the JVM is their .NET. Java's not really about productivity, not really -- it's got a lot of strengths (performance, deployment, reliability, static checkability, and so on), but productivity isn't high on the list. So maybe the best way to address the productivity issue, for folks who really need it more than raw performance, is to introduce new JVM languages rather than try to pull Java in two directions. We'll see. And with that, I think I've officially un-blocked myself; I seem to be able to blog again. So I'm declaring the Blogger's Block series finished! BloggersBlock block = new BloggersBlock(); block.setFinished(true); block.tieOffAndStuff(); blog.addChild(block); ... cheap oem software buy software

Tags: java, language, ruby, string, literal

Good Agile, Bad Agile

Posted on November 18, 2008 in Generic biologicals

  Scrums are the most dangerous phase in rugby, since a collapse or improper engage can lead to a front row player damaging or even breaking his neck. — Wikipedia When I was growing up, cholesterol used to be bad for you. It was easy to remember. Fat, bad. Cholesterol bad. Salt, bad. Everything, bad. Nowadays, though, they differentiate between "good" cholesterol and "bad" cholesterol, as if we're supposed to be able to distinguish them somehow. And it was weird when they switched it up on us, because it was as if the FDA had suddenly issued a press release announcing that there are, in fact, two kinds of rat poison: Good Rat Poison and Bad Rat Poison, and you should eat a lot of the Good kind, and none of the Bad kind, and definitely not mix them up or anything. Up until maybe a year ago, I had a pretty one-dimensional view of so-called "Agile" programming, namely that it's an idiotic fad-diet of a marketing scam making the rounds as yet another technological virus implanting itself in naive programmers who've never read "No Silver Bullet", the kinds of programmers who buy extended warranties and self-help books and believe their bosses genuinely care about them as people, the kinds of programmers who attend conferences to make friends and who don't know how to avoid eye contact with leaflet-waving fanatics in airports and who believe writing shit on index cards will suddenly make software development easier. You know. Chumps. That's the word I'm looking for. My bad-cholesterol view was that Agile Methodologies are for chumps. But I've had a lot of opportunity to observe various flavors of Agile-ism in action lately, and I now think I was only about 90% right. It turns out there's a good kind of Agile, although it's taken me a long time to be able to see it clearly amidst all the hype and kowtowing and moaning feverishly about scrums and whatnot. I have a pretty clear picture of it now. And you can attend my seminar on it for the low, low price of $499.95! Hahaha, chump! No, just kidding. You'll only find seminars about the Bad kind of Agile. And if in the future you ever find me touring around as an Agile Consultant, charging audiences to hear my deep wisdom and insight about Agile Development, you have my permission to cut my balls off. If I say I was just kidding, say I told you I'd say that. If I then say I'm Tyler Durden and I order you not to cut my balls off , say I definitely said I was going to say that , and then you cut 'em right off. I'll just go right ahead and tell you about the Good Kind, free of charge. It's kinda hard to talk about Good Agile and Bad Agile in isolation, so I might talk about them together. But I'll be sure to label the Good kind with a happy rat, and the Bad kind with a sad dead rat, so you'll always know the difference. The Bad Heading Back in Ye Olden Dayes, most companies approached software development as follows: - hire a bunch of engineers, then hire more. - dream up a project. - set a date for when they want it launched. - put some engineers on it. - whip them until they're either dead or it's launched. or both. - throw a cheap-ass pathetic little party, maybe. This step is optional. - then start over. Thank goodness that doesn't happen at your company, eh now? Whew! Interestingly, this is also exactly how non-technical companies (like, say, Chrysler) handled software development. Except they didn't hire the engineers. Instead, they contracted with software consultants, and they'd hand the consultants 2-year project specs, and demanded the consultants finish everything on time plus all the crap the customer threw in and/or changed after signing the contract. And then it'd all fall apart and the contractors wouldn't get paid, and everyone was really miffed. So some of the consultants began to think: "Hey, if these companies insist on acting like infants, then we should treat them like infants!" And so they did. When a company said "we want features A through Z", the consultants would get these big index cards and write "A" on the first one, "B" on the second one, etc., along with time estimates, and then post them on their wall. Then when the customer wanted to add something, the consultant could point at the wall and say: "OK, boy . Which one of these cards do you want to replace , BOY? " Is it any wonder Chrysler canceled the project? So the consultants, now having lost their primary customer, were at a bar one day, and one of them (named L. Ron Hubbard) said: "This nickel-a-line-of-code gig is lame. You know where the real money is at? You start your own religion." And that's how both Extreme Programming and Scientology were born. Well, people pretty quickly demonstrated that XP was a load of crap. Take Pair Programming, for instance. It's one of the more spectacular failures of XP. None of the Agileytes likes to talk about it much, but let's face it: nobody does it. The rationale was something like: "well if ONE programmer sitting at a terminal is good, then TEN must be better, because MORE is ALWAYS better! But most terminals can only comfortably fit TWO programmers, so we'll call it PAIR programming!" You have to cut them a little slack; they'd been dealing with the corporate equivalent of pre-schoolers for years, and that really messes with a person. But the thing is, viruses are really hard to kill, especially the meme kind. After everyone had gotten all worked up about this whole Agile thing (and sure, everyone wants to be more productive), there was a lot of face to be lost by admitting failure. So some other kinds of Agile "Methodologies" sprang up, and they all claimed that even though all the other ones were busted, their method worked! I mean, go look at some of their sites. Tell me that's not an infomercial. C'mon, just try. It's embarrassing even to look at the thing. Yeah. Well, they make money hand over fist, because of P.T. Barnum's Law, just like Scientology does. Can't really fault 'em. Some people are just dying to be parted with their cash. And their dignity. The rest of us have all known that Agile Methodologies are stupid, by application of any of the following well-known laws of marketing: - anything that calls itself a "Methodology" is stupid, on general principle. - anything that requires "evangelists" and offers seminars, exists soley for the purpose of making money. - anything that never mentions any competition or alternatives is dubiously self-serving. - anything that does diagrams with hand-wavy math is stupid, on general principle. And by "stupid", I mean it's "incredibly brilliant marketing targeted at stupid people." In any case, the consultants kept going with their road shows and glossy pamphlets. Initially, I'm sure they went after corporations; they were looking to sign flexible contracts that allowed them to deliver "whatever" in "2 weeks" on a recurring basis until the client went bankrupt. But I'm equally sure they couldn't find many clients dumb enough to sign such a contract. That's when the consultants decided to take their road show to YOU. Why not take it inside the companies and sell it there, to the developers? There are plenty of companies who use the whip-cycle of development I outlined above, so presumably some of the middle managers and tech leads would be amenable to hearing about how there's this low-cost way out of their hellish existence. And that, friends, was exactly, precisely the point at which they went from "harmless buffoons" to "potentially dangerous", because before they were just bilking fat companies too stupid to develop their own software, but now the manager down the hall from me might get infected. And most places don't have a very good quarantine mechanism for this rather awkward situation: i.e., an otherwise smart manager has become "ill", and is waving XP books and index cards and spouting stuff about how much more productive his team is on account of all this newfound extra bureaucracy. How do we know it's not more productive? Well, it's a slippery problem. Observe that it must be a slippery problem, or it all would have been debunked fair and square by now. But it's exceptionally difficult to measure software developer productivity, for all sorts of famous reasons. And it's even harder to perform anything resembling a valid scientific experiment in software development. You can't have the same team do the same project twice; a bunch of stuff changes the second time around. You can't have 2 teams do the same project; it's too hard to control all the variables, and it's prohibitively expensive to try it in any case. The same team doing 2 different projects in a row isn't an experiment either. About the best you can do is gather statistical data across a lot of teams doing a lot of projects, and try to identify similarities, and perform some regressions, and hope you find some meaningful correlations. But where does the data come from? Companies aren't going to give you their internal data, if they even keep that kind of thing around. Most don't; they cover up their schedule failures and they move on, ever optimistic. Well if you can't do experiments and you can't do proofs, there isn't much science going on. That's why it's a slippery problem. It's why fad diets are still enormously popular. People want fad diets to work, oh boy you bet they do, even I want them to work. And you can point to all these statistically meaningless anecdotes about how Joe lost 35 pounds on this one diet, and all those people who desperately want to be thinner will think "hey, it can't hurt. I'll give it a try." That is exactly what I hear people say, every time a team talks themselves into trying an Agile Methodology. It's not a coincidence. But writing about Bad Agile alone is almost guaranteed to be ineffective. I mean, you can write about how lame Scientology is, or how lame fad diets are, but it's not clear that you're changing anyone's mind. Quitting a viral meme is harder than quitting smoking. I've done both. In order to have the right impact, you have to offer an alternative, and I didn't have one before, not one that I could articulate clearly. One of the (many) problems with Bad Agile is that they condescendingly lump all non-Agile development practices together into two buckets: Waterfall and Cowboy. Waterfall is known to be bad; I hope we can just take that as an axiom today. But what about so-called Cowboy programming, which the Agileers define as "each member of the team does what he or she thinks is best"? Is it true that this is the only other development process? And is Cowboy Programming actually bad? They say it as if it's obviously bad, but they're not super clear on how or why, other than to assert that it's, you know, "chaos". Well, as I mentioned, over the past year I've had the opportunity to watch both Bad Agile and Good Agile in motion, and I've asked the teams and tech leads (using both the Bad and Good forms) lots of questions: how they're doing, how they're feeling, how their process is working. I was really curious, in part because I'd consented to try Agile last Christmas ("hey, it can't hurt"), and wound up arguing with a teammate over exactly what metadata is allowed on index cards before giving up in disgust. Also in part because I had some friends on a team who were getting kind of exhausted from what appeared to be a Death March, and that kind of thing doesn't seem to happen very often at Google. So I dug in, and for a year, I watched and learned. The Good Head (cue happy rat) I'm going to talk a little about Google's software development process. It's not the whole picture, of course, but it should suffice for today. I've been there for almost a year and a half now, and it took a while, but I think I get it now. Mostly. I'm still learning. But I'll share what I've got so far. From a high level, Google's process probably does look like chaos to someone from a more traditional software development company. As a newcomer, some of the things that leap out at you include: - there are managers, sort of, but most of them code at least half-time, making them more like tech leads. - developers can switch teams and/or projects any time they want, no questions asked; just say the word and the movers will show up the next day to put you in your new office with your new team. - Google has a philosophy of not ever telling developers what to work on, and they take it pretty seriously. - developers are strongly encouraged to spend 20% of their time (and I mean their M-F, 8-5 time, not weekends or personal time) working on whatever they want, as long as it's not their main project. - there aren't very many meetings. I'd say an average developer attends perhaps 3 meetings a week, including their 1:1 with their lead. - it's quiet. Engineers are quietly focused on their work, as individuals or sometimes in little groups or 2 to 5. - there aren't Gantt charts or date-task-owner spreadsheets or any other visible project-management artifacts in evidence, not that I've ever seen. - even during the relatively rare crunch periods, people still go get lunch and dinner, which are (famously) always free and tasty, and they don't work insane hours unless they want to. These are generalizations, sure. Old-timers will no doubt have a slightly different view, just as my view of Amazon is slightly biased by having been there in 1998 when it was a pretty crazy place. But I think most Googlers would agree that my generalizations here are pretty accurate. How could this ever work? I get that question a lot. Heck, I asked it myself. What's to stop engineers from leaving all the trouble projects, leaving behind bug-ridden operational nightmares? What keeps engineers working towards the corporate goals if they can work on whatever they want? How do the most important projects get staffed appropriately? How do engineers not get so fat that they routinely get stuck in stairwells and have to be cut out by the Fire Department? I'll answer the latter question briefly, then get to the others. In short: we have this thing called the Noogler Fifteen, named after the Frosh Fifteen: the 15 pounds that many college freshmen put on when they arrive in the land of Stress and Pizza. Google has solved the problem by lubricating the stairwells. As to the rest of your questions, I think most of them have the same small number of answers. First, and arguably most importantly, Google drives behavior through incentives. Engineers working on important projects are, on average, rewarded more than those on less-important projects. You can choose to work on a far-fetched research-y kind of project that may never be practical to anyone, but the work will have to be a reward unto itself. If it turns out you were right and everyone else was wrong (the startup's dream), and your little project turns out to be tremendously impactful, then you'll be rewarded for it. Guaranteed. The rewards and incentives are too numerous to talk about here, but the financial incentives range from gift certificates and massage coupons up through giant bonuses and stock grants, where I won't define "giant" precisely, but think of Google's scale and let your imagination run a bit wild, and you probably won't miss the mark by much. There are other incentives. One is that Google a peer-review oriented culture, and earning the respect of your peers means a lot there. More than it does at other places, I think. This is in part because it's just the way the culture works; it's something that was put in place early on and has managed to become habitual. It's also true because your peers are so damn smart that earning their respect is a huge deal. And it's true because your actual performance review is almost entirely based on your peer reviews, so it has an indirect financial impact on you. Another incentive is that every quarter, without fail, they have a long all-hands in which they show every single project that launched to everyone, and put up the names and faces of the teams (always small) who launched each one, and everyone applauds. Gives me a tingle just to think about it. Google takes launching very seriously, and I think that being recognized for launching something cool might be the strongest incentive across the company. At least it feels that way to me. And there are still other incentives; the list goes on and ON and ON ; the perks are over the top, and the rewards are over the top, and everything there is so comically over the top that you have no choice, as an outsider, but to assume that everything the recruiter is telling you is a baldfaced lie, because there's no possible way a company could be that generous to all of its employees, all of them, I mean even the contractors who clean the micro-kitchens, they get these totally awesome "Google Micro-Kitchen Staff" shirts and fleeces. There is nothing like it on the face of this earth. I could talk for hours , days about how amazing it is to work at Google, and I wouldn't be done. And they're not done either. Every week it seems like there's a new perk, a new benefit, a new improvement, a new survey asking us all if there's any possible way in which life at Google could be better. I might have been mistaken, actually. Having your name and picture up on that big screen at End of Quarter may not be the biggest incentive. The thing that drives the right behavior at Google, more than anything else, more than all the other things combined, is gratitude . You can't help but want to do your absolute best for Google; you feel like you owe it to them for taking such incredibly good care of you. OK, incentives. You've got the idea. Sort of. I mean, you have a sketch of it. When friends who aren't at Google ask me how it is working at Google — and this applies to all my friends at all other companies equally, not just companies I've worked at — I feel just how you'd feel if you'd just gotten out of prison, and your prison buddies, all of whom were sentenced in their early teens, are writing to you and asking you what it's like "on the outside". I mean, what would you tell them? I tell 'em it's not too bad at all. Can't complain. Pretty decent, all in all. Although the incentive-based culture is a huge factor in making things work the way they do, it only addresses how to get engineers to work on the "right" things. It doesn't address how to get those things done efficiently and effectively. So I'll tell you a little about how they approach projects. Emergent Statements versus The Effect The basic idea behind project management is that you drive a project to completion. It's an overt process, a shepherding: by dint of leadership, and organization, and sheer force of will, you cause something to happen that wouldn't otherwise have happened on its own. Project management comes in many flavors, from lightweight to heavyweight, but all flavors share the property that they are external forces acting on an organization. At Google, projects launch because it's the least-energy state for the system. Before I go on, I'll concede that this is a pretty bold claim, and that it's not entirely true. We do have project managers and product managers and people managers and tech leads and so on. But the amount of energy they need to add to the system is far less than what's typically needed in our industry. It's more of an occasional nudge than a full-fledged continuous push. Once in a while, a team needs a bigger nudge, and senior management needs to come in and do the nudging, just like anywhere else. But there's no pushing. Incidentally, Google is a polite company, so there's no yelling, nor wailing and gnashing of teeth, nor escalation and finger-pointing, nor any of the artifacts produced at companies where senior management yells a lot. Hobbes tells us that organizations reflect their leaders; we all know that. The folks up top at Google are polite, hence so is everyone else. Anyway, I claimed that launching projects is the natural state that Google's internal ecosystem tends towards, and it's because they pump so much energy into pointing people in that direction. All your needs are taken care of so that you can focus, and as I've described, there are lots of incentives for focusing on things that Google likes. So launches become an emergent property of the system. This eliminates the need for a bunch of standard project management ideas and methods: all the ones concerned with dealing with slackers, calling bluffs on estimates, forcing people to come to consensus on shared design issues, and so on. You don't need "war team meetings," and you don't need status reports. You don't need them because people are already incented to do the right things and to work together well. The project management techniques that Google does use are more like oil than fuel: things to let the project keep running smoothly, as opposed to things that force the project to move forward. There are plenty of meeting rooms, and there's plenty of open space for people to go chat. Teams are always situated close together in fishbowl-style open seating, so that pair programming happens exactly when it's needed (say 5% of the time), and never otherwise. Google generally recognizes that the middle of the day is prone to interruptions, even at quiet companies, so many engineers are likely to shift their hours and come in very early or stay very late in order to find time to truly concentrate on programming. So meetings only happen in the middle of the day; it's very unusual to see a meeting start before 10am or after 4:30pm. Scheduling meetings outside that band necessarily eats into the time when engineers are actually trying to implement the things they're meeting about, so they don't do it. Google isn't the only place where projects are run this way. Two other kinds of organizations leap to mind when you think of Google's approach: startup companies, and grad schools. Google can be considered a fusion of the startup and grad-school mentalities: on the one hand, it's a hurry-up, let's get something out now, do the simplest thing that could work and we'll grow it later startup-style approach. On the other, it's relatively relaxed and low-key; we have hard problems to solve that nobody else has ever solved, but it's a marathon not a sprint, and focusing requires deep concentration, not frenzied meetings. And at the intersection of the two, startups and grad schools are both fertile innovation ground in which the participants carry a great deal of individual responsibility for the outcome. It's all been done before; the only thing that's really surprising is that Google has managed to make it scale. The scaling is not an accident. Google works really hard on the problem, and they realize that having scaled this far is no guarantee it'll continue, so they're vigilant. That's a good word for it. They're always on the lookout to make sure the way of life and the overall level of productivity continue (or even improve) as they grow. Google is an exceptionally disciplined company, from a software-engineering perspective. They take things like unit testing, design documents and code reviews more seriously than any other company I've even heard about. They work hard to keep their house in order at all times, and there are strict rules and guidelines in place that prevent engineers and teams from doing things their own way. The result: the whole code base looks the same, so switching teams and sharing code are both far easier than they are at other places. And engineers need great tools, of course, so Google hires great people to build their tools, and they encourage engineers (using incentives) to pitch in on tools work whenever they have an inclination in that direction. The result: Google has great tools, world-class tools, and they just keep getting better. The list goes on. I could talk for days about the amazing rigor behind Google's approach to software engineering. But the main takeaway is that their scaling (both technological and organizational) is not an accident. And once you're up to speed on the Google way of doing things, it all proceeds fairly effortlessly — again, on average, and compared to software development at many other companies. The Tyranny of the Vocabulary We're almost done. The last thing I want to talk about here is dates . Traditional software development can safely be called Date-Oriented Programming, almost without exception. Startup companies have a clock set by their investors and their budget. Big clients set target dates for their consultants. Sales people and product managers set target dates based on their evaluation of market conditions. Engineers set dates based on estimates of previous work that seems similar. All estimation is done through rose-colored glasses, and everyone forgets just how painful it was the last time around. Everyone picks dates out of the air. "This feels like it should take about 3 weeks.""It sure would be nice to have this available for customers by beginning of Q4.""Let's try to have that done by tomorrow." Most of us in our industry are date-driven. There's always a next milestone, always a deadline, always some date-driven goal to it. The only exceptions I can think of to this rule are: 1) Open-source software projects. 2) Grad school projects. 3) Google. Most people take it for granted that you want to pick a date. Even my favorite book on software project management, "The Mythical Man-Month", assumes that you need schedule estimates. If you're in the habit of pre-announcing your software, then the general public usually wants a timeframe, which implies a date. This is, I think, one of the reasons Google tends not to pre-announce. They really do understand that you can't rush good cooking, you can't rush babies out, and you can't rush software development. If the three exceptions I listed above aren't driven by dates, then what drives them? To some extent it's just the creative urge, the desire to produce things; all good engineers have it. (There are many people in our industry who do this gig "for a living", and they go home and don't think about it until the next day. Open source software exists precisely because there are people who are better than that.) But let's be careful: it's not just the creative urge; that's not always directed enough, and it's not always incentive enough. Google is unquestionably driven by time , in the sense that they want things done "as fast as possible". They have many fierce, brilliant competitors, and they have to slake their thirsty investors' need for growth, and each of us has some long-term plans and deliverables we'd like to see come to fruition in our lifetimes. The difference is that Google isn't foolish enough or presumptuous enough to claim to know how long stuff should take. So the only company-wide dates I'm ever aware of are the ends of each quarter, because everyone's scrambling to get on that big launch screen and get the applause and gifts and bonuses and team trips and all the other good that comes of launching things with big impact at Google. Everything in between is just a continuum of days, in which everyone works at optimal productivity, which is different for each person. We all have work-life balance choices to make, and Google is a place where any reasonable choice you make can be accommodated, and can be rewarding. Optimal productivity is also a function of training, and Google offers tons of it, including dozens of tech talks every week by internal and external speakers, all of which are archived permanently so you can view them whenever you like. Google gives you access to any resources you need in order to get your job done, or to learn how to get your job done. And optimal productivity is partly a function of the machine and context in which you're operating: the quality of your code base, your tools, your documentation, your computing platform, your teammates, even the quality of the time you have during the day, which should be food-filled and largely free of interrupts. Then all you need is a work queue. That's it. You want hand-wavy math? I've got it in abundance: software development modeled on queuing theory. Not too far off the mark, though; many folks in our industry have noticed that organizational models are a lot like software models. With nothing more than a work queue (a priority queue, of course), you immediately attain most of the supposedly magical benefits of Agile Methodologies. And make no mistake, it's better to have it in software than on a bunch of index cards. If you're not convinced, then I will steal your index cards. With a priority queue, you have a dumping-ground for any and all ideas (and bugs) that people suggest as the project unfolds. No engineer is ever idle, unless the queue is empty, which by definition means the project has launched. Tasks can be suspended and resumed simply by putting them back in the queue with appropriate notes or documentation. You always know how much work is left, and if you like, you can make time estimates based on the remaining tasks. You can examine closed work items to infer anything from bug regression rates to (if you like) individual productivity. You can see which tasks are often passed over, which can help you discover root causes of pain in the organization. A work queue is completely transparent, so there is minimal risk of accidental duplication of work. And so on. The list goes on, and on, and on. Unfortunately, a work queue doesn't make for a good marketing platform for seminars and conferences. It's not glamorous. It sounds a lot like a pile of work, because that's exactly what it is. Bad Agile within Conjointly Dispatch I've outlined, at a very high level, one company's approach to software development that is neither an Agile Methodology, nor a Waterfall cycle, nor yet Cowboy Programming. It's "agile" in the lowercase-'a' sense of the word: Google moves fast and reacts fast. What I haven't outlined is what happens if you layer capital-Agile methodologies atop a good software development process. You might be tempted to think: "well, it can't hurt!" I even had a brief fling with it myself last year. The short answer is: it hurts. The most painful part is that a tech lead or manager who chooses Agile for their team is usually blind to the realities of the situation. Bad Agile hurts teams in several ways. First, Bad Agile focuses on dates in the worst possible way: short cycles, quick deliverables, frequent estimates and re-estimates. The cycles can be anywhere from a month (which is probably tolerable) down to a day in the worst cases. It's a nicely idealistic view of the world. In the real world, every single participant on a project is, as it turns out, a human being. We have up days and down days. Some days you have so much energy you feel you could code for 18 hours straight. Some days you have a ton of energy, but you just don't feel like focusing on coding. Some days you're just exhausted. Everyone has a biological clock and a a biorhythm that they have very little control over, and it's likely to be phase-shifted from the team clock, if the team clock is ticking in days or half-weeks. Not to mention your personal clock: the events happening outside your work life that occasionally demand your attention during work hours. None of that matters in Bad Agile. If you're feeling up the day after a big deliverable, you're not going to code like crazy; you're going to pace yourself because you need to make sure you have reserve energy for the next big sprint. This impedance mismatch drives great engineers to mediocrity. There's also your extracurricular clock: the set of things you want to accomplish in addition to your main project: often important cleanups or other things that will ultimately improve your whole team's productivity. Bad Agile is exceptionally bad at handling this, and usually winds up reserving large blocks of time after big milestones for everyone to catch up on their side-project time, whether they're feeling creative or not. Bad Agile folks keep their eye on the goal, which hurts innovation. Sure, they'll reserve time for everyone to clean up their own code base, but they're not going to be so altruistic as to help anyone else in the company. How can you, when you're effectively operating in a permanent day-for-day slip? Bad Agile seems for some reason to be embraced by early risers. I think there's some mystical relationship between the personality traits of "wakes up before dawn", "likes static typing but not type inference", "is organized to the point of being anal", "likes team meetings", and "likes Bad Agile". I'm not quite sure what it is, but I see it a lot. Most engineers are not early risers. I know a team that has to come in for an 8:00am meeting at least once (maybe several times) a week. Then they sit like zombies in front of their email until lunch. Then they go home and take a nap. Then they come in at night and work, but they're bleary-eyed and look perpetually exhausted. When I talk to them, they're usually cheery enough, but they usually don't finish their sentences. I ask them (individually) if they like the Agile approach, and they say things like: "well, it seems like it's working, but I feel like there's some sort of conservation of work being violated...", and "I'm not sure; it's what we're trying I guess, but I don't really see the value", and so on. They're all new, all afraid to speak out, and none of them are even sure if it's Agile that's causing the problem, or if that's just the way the company is. That, my friends, is not "agile"; it's a just load of hooey. And it's what you get whenever any manager anywhere decides to be a chump. Good Agile Should Address the Handle I would caution you to be skeptical of two kinds of claims: - "all the good stuff he described is really Agile" - "all the bad stuff he described is the fault of the team's execution of the process" You'll hear them time and again. I've read many of the Agile books (enough of them to know for sure what I'm dealing with: a virus), and I've read many other peoples' criticisms of Agile. Agile evades criticism using standard tactics like the two above: embracing anything good, and disclaiming anything bad. If a process is potentially good, but 90+% of the time smart and well-intentioned people screw it up, then it's a bad process. So they can only say it's the team's fault so many times before it's not really the team's fault. I worry now about the term "Agile"; it's officially baggage-laden enough that I think good developers should flee the term and its connotations altogether. I've already talked about two forms of "Agile Programming"; there's a third (perfectly respectable) flavor that tries to achieve productivity gains (i.e. "Agility") through technology. Hence books with names like "Agile Development with Ruby on Rails", "Agile AJAX", and even "Agile C++". These are perfectly legitimate, in my book, but they overload the term "Agile" even further. And frankly, most Agile out there is plain old Bad Agile. So if I were you, I'd take Agile off your resume. I'd quietly close the SCRUM and XP books and lock them away. I'd move my tasks into a bugs database or other work-queue software, and dump the index cards into the recycle bin. I'd work as fast as I can to eliminate Agile from my organization. And then I'd focus on being agile. But that's just my take on it, and it's 4:00am. Feel free to draw your own conclusions. Either way, I don't think I'm going to be an Early Riser tomorrow. Oh, I almost forgot the obvious disclaimer: I do not speak for Google. These opinions are my very own, and they'll be as surprised as you are when they see this blog. Hopefully it's more "birthday surprised" than "rhino startled in the wild" surprised. We'll see! cheap oem software buy software

Tags: agile, google, project, bad, work

Get The Relief From ED Through Viagra

Posted on November 18, 2008 in Buy sildenafil

Erectile dysfunction or ED is the inability of a male to save the pile firm now sexual intercourse. There are large heaps of folks who fail to do sex deficit to same disease. Viagra is a drug through the treatment of equivalent erectile dysfunction betwixt male prevalence. The chemical handle whereas Viagra is sildenafil citrate. It is marketed over Pfizer Inc still is general done with FDA. Viagra big ideas past inhibiting the phosphodiesterase enzymes grouping 5 halfway the penis, which increases the blood, chain between it. Check to that the penis ring ins enlarged conjointly due to a move upward of it, the cat buzzs an domicile. That fabric finishs with ejaculation at the ruination of the sexual act. Doctor's consultation is condign before handle a Viagra world. Report your doctor altogether portion medication you are stir whereas or if you are suffering from factor center disease, asthma, diabetes or allergy. Viagra should not be taken onward with nitrates further alpha-blockers meanwhile their medication can contradict each contradistinct. It is standard taken an year before having sex. The assemble of the drug remains in that 4-5 hours later reward it. Don't touchstone seeing further than lone dose separating a generation. During the consumption of Viagra, you may come transversely certain customary limb cinchs not unlike pending torture, respect still facial blushing. . You can dream of a doctor bounded by akin cases or if allotment peculiar discomforts compatible midst chest headache, nausea etc breeze ins. Emancipate on the web prescriptions are supplied to the representatives ended a large gathering of on the web pharmacies. That acts as a prodigious avail to you if you are fake out inserted specification roughly relating sexual health fraternal argues. You can buy Viagra pill consummated these on the net pharmacies to emolument it delivered at your doorstep. Hint:-Net.articlesbase.com buy software cheap oem software

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Weekly Blogscan: The Organic Diet

Posted on November 18, 2008 in Diet

At a traffic light today, I found myself behind a car with a bumper sticker that my casual glance read as Eat Organic . Just as the light went green, my brain clicked on to inform me that it actually said Eat Origami . Now, the health benefits of consuming only folded paper figures aside, I wondered if the organic food movement had spread to the blogosphere. The answer is a resounding Yes. We have the Organic Lifestyle in New Zealand, the UK, and as a women's online magazine. Interesting that the last features—prominently—an advertisement for Aphrodite Chocolates. Conversely, Suw Charman at Chocolate and Vodka has her priorities in order. In fact, she tells us Today I realised—with a glass of orange juice, a bar of Green & Black's dark organic chocolate and a bag of champagne truffles on my desk—that I had sort of fallen off the sugar wagon. Well, less fallen off, more jumped off. Enthusiastically. This probably explains why I spent much of this afternoon either asleep or very nearly asleep. At her Organic Baby Farm , Utah blogger Wacky Hermit is "growing the World's Cutest Free-Range Milk-Fed Kids... and feeding them nothing but crap." Her recent post "Today At GotMilk Prison Camp" makes the point that "with enough rhetoric you can make anything sound like torture." (Plus, it's both satiric and cute!) At Milk Is Milk , on the other hand, a reprint of the Oct. 2004 treatise by The Scientist editor Richard Gallagher exposes the Organic Food Placebo. Gallagher quotes British peer Dick Taverne, "...the craze for organic food is built on myth. It starts with a scientific howler, has rules with neither rhyme nor reason. None of the claims made for it have ever been substantiated, and if it grows it will damage the nation's health." Taverne's complete remarks are available at another organic-debunking blog, Foreign Dispatches , in the post "You have to be green to swallow the organic food myth." Perhaps in response, the Accidental Hedonist chronicles the questionable organic nature of some organic dairies. The blog notes that "it's not surprising that once it had been determined that there was a market for such products, some corporate farms sought to get a piece of the pie." Unfortunately, they charge, at least one group of dairies operating in California, Idaho, and Colorado, is violating two of the standards that would make the milk organic. "According to reports, both the Idaho and California operations differ little from conventional confinement dairies other than having their high-producing cows fed certified organic feed," says Mark Kastel, Senior Farm Policy Analyst, at the Wisconsin-based Cornucopia Institute. Janet Roberts uses her FoodWords blog to steer us to a viral Flash video , "Obi Wan Cannoli Wants You!" Even if you're sick of Star Wars, you have to check out... the Organic Trade Association['s] "Store Wars." Starring Cuke Skywalker, Obi Wan Cannoli, Ham Solo and Darth Tater, it tells the tale of food adulteration and how to combat it. Spot-on parody of the earliest Star Wars chapters, obviously done by people who appreciate a good pun (Hey! Watch out for the Thai fighters!).    The sod sofa also produces oxygen. Greg Tate of Ready Made gives us the detailed instructions to create the only appropriate sofa for all organic couch potatoes. The brain-child of Bruce Main, this grass-upholstered lawn chair is the perfect back-yard accessory. Head Chef Charlie Ayers posted Google Daily Menus , until he decided the rest of the world didn't care what Google-folk every day. His recipes regularly featured organic greens. Meanwhile, the Treehugger touts organic catsup as a condiment preventive of cancer. The actual agent tested was "Lycopene, an antioxidant that for years has been known to have protective effects against breast, prostate, and pancreatic cancers... found in cooked tomato products like tomato sauce and, yes, ketchup." In May 2005, The Politic commented on a National Review item that posited organic farming is "simply not sustainable." The blogger used the item to drive the opinion: "There is way too much hype over how bad genetically modified (GM) food is. How small minded can these people be? The truth is that this propaganda was created simply to sell products in the over priced organic food industry." If the choice were limited to GMO vs. organic, we might agree with him that you can "Eat Organic If You Want People To Starve." Or you could eat organ meats, although as Roast Beef warns us from his GREP blog, this can have disturbing consequences. He and his buddies went for lunch at a Korean Barbeque, but wound up eating more than they had bargained for. CAUTION: Not for the queasy. This is the reason there is a market for organic food. We want control over what we eat, to know that no alien genes, pesticides or strange stress hormones will spice that dish. And even if it is fleeting or false, we seek to know whereof we eat. 1570716803,0312008988,B00006BIJ9,0875969305,0875968961,0786406186,0060938455 Please join us at BlogCritics to comment on this review. buy software cheap oem software

Tags: organic, eat, food, google, strong

The New York Times Reports “Good News” About American Health Care

Posted on November 17, 2008 in Medical care

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

Family relationships

Posted on November 17, 2008 in Generic biologicals

(corrected version) Dear Friends, At the end I had to rush the essay. Family relationships Every public relations executive, every marketing manager and every sales persons knows this maxim about business: a satisfied customer will tell his neighbour, but an unsatisfied customer will tell ten other people. The same goes for families. A neighbour will know about the happy family living next door, but the whole neighbourhood will know about an unhappy family living in the street. But there is more to family relationships then unhappy families. For this discussion we need to establish what we mean by family and relationships. not only do we need to clarify what constitutes a family but also who may be a member of a family. moreover, does membership to a family confer any privileges? Relationships itself is a rather open ended concept. How should we understand this concept? Are there duties and obligations involved? Does this imply social relationships as well? The days when philosophers could relax on their favourite easy chair and contemplate the infinite are long gone. Today we have to contend with what is happening in other branches of knowledge mongering. To be fair it has always been like that; more or less. From our point of view, we have to consider a family both as a biological system and a social organisation. And each aspect has its own set of philosophical issues. A high school teacher of mine was fond of tell us that; a problem shared, is a problem halved. Apart from being a catchy phrase, it is also backed up by such theories as game theory or evolutionary biological systems. The fact that humans have evolved into two distinct sexes implies that there must be some form of cooperation between the two to fulfil the biological task of reproduction. Well, reproduction is certainly a problem halved, even if today it might be shared with a laboratory technician wearing a white coat and face mask rather than something kinkier for the occasion. White coats apart, we can still take the biologically determined union as the basis of what we mean by family. However, we must also distinguish, today, between genetically related family, when the off springs of a couple are also genetically related to each other. Today, with fertility technology the off springs need not necessarily be genetically related to the parents (to both or one of them). The other forms of families still follow the traditional make up; adopted children and step children. One important aspect of a genetic family is that there is a strong genetic bond to protect and bring up the young. Whether we call this genetic altruism or instinctive behaviour is not that important for us. This sort of genetic cooperation makes evolutionary sense if the offspring is given a good chance to reach reproductive age. A great deal of generic families follow this strategy. But sometimes, in fact many times, the genetic parents or parent of an offspring abandon that very same offspring. Although we tend to associate this phenomenon with pictures from developing countries, it is not exclusive to these countries. How should we read and understand this sort of family relationship? We can look at this as confirmation that if life in our environment becomes seriously dangerous to our own survival, it would make sense to abandon any offsprings that might prejudice the chances of survival. To put this in a very colloquial way; looking after number one is the first priority. Incidentally this seemingly selfish behaviour has nothing to do with the idea of the selfish gene introduced by Dawkins. Some might object to this idea of looking after number one first. However, a work around this seemingly biological instinct is not to put one's self and one's offspring in danger. Hence, the answer to families living in a very hostile and impoverished environment is not to hold on to offsprings, come what may, but not to have offsprings in the first place. If we want to escape from a hostile environment, it seems to me to be unethical to have offsprings in such an environment. We could also say that when a parent abandons its genetic offspring it is a reflection of a breakdown in the genetic programme. A sort of malfunction of the genetic survival system. But this has to be contrasted with the fact that the reproductive instinct is much stronger than the caring instinct. Not to mention that there will be other opportunities to reproduce, for someone of reproducible maturity and sufficiently good health. Another interpretation is what we might call the cuckoo phenomenon. Since the reproductive instinct is so pronounced one can take the view of having offsprings anyway and then hope others will take care of them. Especially when human nature has developed and evolved a sophisticated form of social and biological altruistic cooperation. This approach depends on the belief that not every one will cheat the system and the system is rigid enough not to withhold any altruistic cooperation to those who need it. At the genetic level this behaviour is as neutral and amoral as the fertilisation process itself; what matters is that the biological system reaches reproductive maturity to pass on the genes to the next generation and not who cares for that system in the meantime. That genetic parents are more likely to care for an offspring is not the same as saying that only the genetic parents can care for an offspring. If this is a true representation of relationships within a biological family then surely there seems to be a minimum threshold of personal survival before the genetic instinct to care for off springs takes over. Could it be that this means that family relationships at the biological level are relative to the environment the biological individual find themselves in? Moreover, at the biological level family relationships are not only relative but also flexible. Thus, what makes a biological/genetic family in a state of equilibrium is when it can overcome or manage well the difficulties of the environment around it. The family is of course more than just parents and offsprings, but when we take other members into consideration, we change the parameters from biological to social. Of course, the biological element is still there, but for day to day considerations it is not that prominent. I will call this the social family. If nature did not introduce some sort of categorical imperative to look after genetic offsprings, then can we imply a categorical imperative for the social family? As a cooperative system that exploits its environment social and biological families surely involve rights and duties for its members. These rights and duties surely introduce their own moral and social obligations. For example, at the biological level one has to contribute one's energy (which is part of a biological systems) in exploiting the environment for the good of the family group. However, looking after offsprings as a form of family relationship must surely count as the most fundamental of family relationships and obligation. After all, they are one's offsprings; what can be more basic than that? Of course, this does not imply an obligation ad infinitum, but certainly an obligation until circumstances require it. Maybe even at the social level of family relationship there isn't an obvious categorical imperative to look after offsprings let alone other family members. However, there is a strong practical expediency to look after family members or have good family relationships. The family is certainly the most important group we have access to and know very well. Thus, having good family relationships makes good sense. It is also the first group we are likely to be indebted to in the first place. although there does not seem to be any form of categorical imperative to have good relationships with one's family there does seem to be a very strong rational argument to actually do have good relationships with one's family. This changes the moral standing of the family from "have to" to "want to." And this principle seems to be taken very seriously by some families. Just consider the fortunes and histories of mafia families, dynasties, American presidential families, European monarchies, and business empires. There is no doubt that fortune favours the audacious, as Machiavelli said, but it also favours good family relationships. It is safe to assume that both at the genetic/biological level and the intra-relationship level there is nothing that makes it imperative for families have to have a cooperative relationship. However, it makes sense that families should adopt cooperative relationship strategies; division of labour, accumulation of resources, protection and safety. The evidence does seem to point in this direction. But as I have said, families in also genetic context become social entities. And as social living organisations they have to interact and compete within their society and with other families. Although some might object that this inter-social relationship is off topic I do not believe so. Firstly, what happens in society has a direct causal effect on the family; for example a change in the political fortunes of a society affects all families in the society. Secondly, we as individuals within a family group also have to interact with individuals outside our family; for example, holding a job. This directly or indirectly has an effect on the family. And thirdly, which is the most important point of all, society, through its various institutions and organisations, imposes itself on the family. It is this third point that I want discuss next. The issues raised by the influence of society on families are quite wide. I therefore want to submit just a flavour of what I am thinking about. I will refer to two extreme cases of the spectrum. The first is a quote from the archbishop of Canterbury and the other is more a type of family interference within a genre of interferences: I refer to honour killings which is an extreme case of social influence. But although we associate honour killing with certain cultures and religions, we still find it in very mild and dilutes forms through class and caste structures. The archbishop is quoted* as saying, “.....pushy parents who rush children between ballet and violin lessons are suffocating their offspring too. Children live crowded lives, we're not making their lives easy by pressurising them, whether it's the claustrophobia of gang culture or the claustrophobia of intense achievement in middle-class areas." What the archbishop is referring to is of course something most people in western and partly developed countries experience. The need to achieve and the need to succeed is an ever present pressure on all of us. The archbishop uses the word achievement, but we can distil this concept further to extract the real driving force behind this behaviour: I shall call it the cult-of-wanting-more. The archbishop seems to have missed the point here: it is not that we set ourselves goals to achieve things, but that we want more whatever those goals are achieved. Achievement is a signal to want more. We want more because that is the society and culture we live in tells us we should do. We want a faster bigger car, a more expensive house, a more exotic holiday, and so on. And from this we get the pressure on families and its members. Of course this achievement and wanting more is always dressed as a virtue and the right thing to do. But the bottom line is this, if we want more than by definition we are never satisfied, and if we are not satisfied then surely our plans for the family have failed. And if we or our partner fails this is seen as having failed the family. In April this year most of us read** about or saw the video of the honour killing of the 17-year-old Yazidi girl who was killed in public simply for falling in love with a Muslim boy. Indeed this is an extreme case of cultural delinquency and social immorality, but certainly not an unusual one. But our society and our culture does not only interfere with family relationships as in these extreme cases. In English, especially British English, we have the expression, “to marry above or below one’s station.” Maybe it is not as common as it used to be, but even having a negative expression to describe certain unions is bad enough. Thus the idea of marrying someone who comes from a different class, group or caste is itself a pressure on the family. Maybe we have stopped seeing families, especially the parents of the family, as life long strategic alliances, but now we see families as business partnership with a P&L analysis every so often. Pressure does not only come in the form of achievement or cultural delinquency, but also what passes as moral principles. I have argued that in nature there is no binding categorical imperative, only mutually advantageous strategies, which work for most, most of the time. Nature did not establish a do or die imperative for family relationships any more than it has created such a principle for reproduction. But societies and most religions do try to impose such imperatives. imperatives that require a license to fall in love, imperatives not to separate when alliances fail, imperatives to reproduce which seems like blind following of the want-more cult and imperatives that promote class-ism (kings are not suppose to marry commoners). In real life, of course, there have always been divorces, birth control and the rest of it, except only the privileged families could avail themselves of these opportunities. Not to mention that usually these rules are biased and prejudicial to women. Are men ever victims of honour killings? In a report** that appeared in the New York Times, NICHOLAS WADE writes about the work of Dr Haidt who basically asks whether the categorical imperative (do unto others), in found in our genes. Dr Haidt has identified what he calls innate psychological mechanisms which basically are: loyalty to the in-group, respect for authority and hierarchy, and a sense of purity or sanctity. He is also quoted as saying that, "Those who found ways to bind themselves together were more successful." Successful in natural selection; he even suggests that religion help humans succeed in nature. Not everyone agrees. Dr Frans B. M. de Waal has this to say, "For me, the moral system is one that resolves the tension between individual and group interests in a way that seems best for the most members of the group, hence promotes a give and take." Of course this is a modern version of an age old problem. It seems that this issue of family relationships (as in other relationships) is without a clear cut explanation and solution. However, we do know for sure that nature is very adaptable and accommodating. After all that is the secret of success of natural selection. I do not think that the categorical imperative applies here. Take care Lawrence *'Is our society broken? Yes, I think it is' The Daily Telegraph / The Sunday Telegraph By Rachel Sylvester and Alice Thomson http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/09/15/nbishop215.xml **Is ‘Do Unto Others’ Written Into Our Genes? The New York Times September 18, 2007 http://www.nytimes.com/2007/09/18/science/18mora.html?_r=1&ref=science&pagewanted=print&oref=slogin *************************************************** **********HOLIDAY FLATS********** Mayte; Almer

Tags: family, relationship, families, offspring, biological

Big Pharma Bullies: PMDD is Crap!

Posted on November 17, 2008 in Diabetes erectile dysfunction

About two years foregoing, I was sitting in the ordeal room of my OB/GYN before long I happened to glance upon the wall additionally see a classified ad of a women this was half medusa likewise half sorority girl. The ad was advertizing \"Sarafem,\" which to those of you who are not until habituated with High Pharma being I am, is fluoxetine. Fluoxetine is the generic autonym seeing Prozac. Meanwhile Eli Lilly lost its patent as Prozac, it