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

Tags: doctors, drug, time, health, patient

Word Up, Arizona [A public service] campaign is aimed at reducing the rate of teenage pregnancies in Arizona, which is the second highest in the country behind only Mississippi. The advertising, sponsored by the Arizona Department of Health Services, is aimed at teenage girls and their sex partners as well as parents. [...] The campaign is unusual for a couple of reasons. One is that the ads present their message - "Abstain or use a condom" - in the form of what is known as spoken-word poetry, as it is performed in competitions called poetry slams. [...]A major part of the campaign, which ran through the summer, was centered on a contest asking members of the target audience to submit their own spoken-word poems. The other reason the campaign is unusual is its extensive use of nontraditional media, which includes cellphone text messaging, e-mail messages and the Internet in addition to more conventional media like television, radio, posters and billboards. Such media are, of course, mainstays of the teenagers at whom the campaign is aimed. [...] The commercials have been produced in Spanish also, to reflect the large Hispanic population of Arizona as well as the fact that, according to research by the agency, Hispanic adolescents in the state have the highest birth rates for teenage mothers. The campaign is aimed at not only the teenage girls most at risk for becoming pregnant, but at a somewhat broader male audience, ages 16 to 25. That reflects data, the agency says, showing that 51 percent of the fathers of babies by teenage girls are in their 20's. The ads addressed to parents are inspired by research indicating that teenagers rank their parents No.1 in influencing their decisions about having sex. The commercials feature girls and boys, separately and together, who recite the salient points of the campaign in the cadences of spoken word. In the TV spots [...] the words appear on screen in handwriting as they are voiced. [...] The spoken-word contest took place during July and August on a hip-hop radio station in Phoenix [...] The station, known as "Power 92," is particularly popular with the campaign's intended audience. Listeners were invited to enter by submitting audio files through e-mail messages or recording their poetry over the telephone. A local poetry rap artist named Divine Essence chose weekly finalists in the contest and posted audio files on a Web site (divinepoetry.com). [...]The winner of the contest was determined by which entry was downloaded the most, on computers or cellphones, as audio files or ring tones. There were a total of 11,155 downloads... - By STUART ELLIOTT for the NYTimes [all emph. add.] It's nice to see an effective advocacy ad - most preach to the choir, and are a completely useless waste of time and money. Anti-smoking and anti-choice groups are the worst offenders that I've seen, in terms of producing bad ads. Here, you have the ads in the right languages, delivered in a way that's popular with the target audience, and the contest part is genius. It gets the target audience to buy in, and to work to improve the message. Plus, the target audience decided which was the winning entry, not a panel of well-meaning but probably out-of-touch judges.The fact that there were 11,000 "votes" indicates some measure of success. It's great that parents are the #1 influence on kids' sexual behavior. It's horrible that half of the guys knocking up teen girls are ADULTS, even if only barely. buy software cheap oem software

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Washington --Hookers beware. Iowa Republican Senator Charles Grassley wants to use the U.S. tax code to put you in jail. A Senate committee approved legislation yesterday that would target criminals in the sex-slave trade as well as "run-of-the-mill pimps" using a new provision of the U.S. tax code. "This vile crime is under our noses in the United States," Grassley said, "And it's a no-brainer to have the IRS go after sex-traffickers. Prosecuting these tax code violations can get these guys off the street and yank from their grasp the girls and women they exploit." Using a mind-bending Catch-22, the new law will make it even more illegal to be a prostitute in this country. Pimps will now face up to ten years in prison for each person who works for them without filing a proper W-2. Also, the law will require more jail time for prostitution offenses and allows the IRS to guestimate unreported wages when assessing fines for sex workers. (Now, as a "john", can I write off my weekly visits to the local massage parlor as a tax deduction?) Some voices from the sex industry are expressing concern that the law will be too indiscriminate when choosing who to prosecute. "Forced labor, kidnapping should be targeted," said Carol Leigh of the San Francisco sex worker advocacy group, BAYSWAN, "but this legislation broadly targets the sex trade in general and could target your local strip club." Although Leigh agrees that legislation is needed, she believes this law takes us a step back when it comes to protecting women in the sex trade. "We want laws enforced against those who abuse us, against those who are violent, and enforcement of labor regulations," Leigh said. "This is the only truly effective way to protect the welfare of the women who work in the industry." buy software cheap oem software

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Editor sells out his reporter and a happy Fourth of July to all. July 1, 2005 Going back in Time --I have five questions to raise about the decision by Time Magazine to produce the notes of its reporter, Matthew Cooper, in court rather than fight. 1. How can any reporter for Time magazine now give assurances to a potential confidential source that he will protect that confidentiality knowing he has a eunuch for an editor? As one critic said, Time’s days as an investigative journal are over. It is a high-gloss People. 2. Why would any whistle-blower with a story to tell that could be important to the running of our democracy take it to a Time magazine reporter when he can go to the New York Times and be assured they will protect him? 3. Why would a court order journalists to declare the identity of their source when the special prosecutor says he already knows who it is? 4. Why is the Washington press court not circling around Robert Novak, the man who triggered all of this and has refused to discuss it like the sharks they can sometimes be? Too much “old boy” here? Novak, accurately described by Jon Stewart as the “scum bag of democracy,” is still showing up on television ranting about the ethics and morality of others. It was he who published the name of the CIA agent and it is others who are threatened with jail, including Judith Miller who never actually wrote a story. Clearly one of two things has happened: a) he squealed to the grand jury like the scum bag he is, or b) he took the Fifth Amendment. Since the law reads that publishing the name is not against the law--only revealing it is--it is probably the former. He now claims he was not responsible for the other reporters being threatened with jail, but of course had he not printed the name, they wouldn’t be. 5. Anybody but me notice that it was the publication owned by media conglomerate that capitulated and the one owned by a family stood by its man (or woman, in this case)? As a friend, Laurie Garrett, once told stockholders in the old Times Mirror Company, if you don't want the responsibility of owning a press in a democracy, go invest in a shoe company and leave us the hell alone. Just a small rant. Have a great July 4. Just remember that we are the nation that lectures others on the importance of a free press. Now think of Matthew Cooper and Judith Miller and the guys who threatened them and thee editor who sold them. For a serious discussion of same, try Steve Lovelady's piece in Columbia Journalism Review. Lovelady was the managing editor (I think that was his title) at the Philadelphia Inquirer when I was there. Is is right on the money. Go here. UPDATE-- The answer to number three may be that the special prosecutor wants to charge perjury and perjury requires two witnesses. If someone went before the grand jury and announced that he did not leak the agent's name and the prosecutor can find two witnesses that say he did (say, Novak and one other), he has a case. It also is reported that Newsweek and several other sources also know who the leaker was: Karl Rove. That would be interesting. UPDATE- -On Tuesday, the special prosecutor said he would still need Cooper's testimony even though the magazine turned over Cooper's notes (if they are like my notes, they are unintelligible, even to me). So selling out his reported didn't do the editor of Time much good, did it? And the prosecutor said the reporters shouldn't do home confinement but should be sent to the slammer. cheap oem software buy software

Tags: time, reporter, prosecutor, editor, cooper

California teachers are mad at Governor Schwarzenegger for reneging on a $3 billion budgetary promise, nurses are locked in a battle with him over hospital staffing standards, and labor generally is girding for war over his special election and ballot proposals that aim to gut union political power in the state. Judging by the polls, none of this is helping Arnold with the voters. Just 42 percent approve of his handling of tax and budget matters. Only 33 percent agree with him on education and nearly eight in 10 think new state revenues should go to K-12 public education. Sixty-one percent oppose his plan for a special election, while only 33 percent approve. Today was a big day for the Governor's opponents, who staged large rallies in Sacramento and Los Angeles that seemed to advance their momentum. The L.A. rally took place in Pershing Square, just down the hill from my office. The building management folks are always great about alerting us to both demonstrations and film shoots, so when I heard the faint sound of cheering way up in my "corporate aerie" late in the afternoon, I knew what it was and where it was coming from. My office window faces south. I looked out -- Pershing Square appeared nearly full of people. I was curious, so at 5:00 p.m. (our nominal end-of-day, though I rarely manage to escape before 6:30), I slipped down the elevator and steps to Olive Street, then down the hill to the Biltmore. The demonstration was orderly and pretty well confined to the park. Traffic didn't seem very much affected. I fell in with the crowd and crossed over. The morning overcast was long gone, the afternoon had grown warm and there was a friendly, festival air to the place. Downtown looked lovely in the late afternoon light -- the towers on Bunker Hill had taken on a liquid glow. LAPD was barely in evidence -- and the officers I saw were smiling, hatless and cordial. At the margins there were a few of the fringe elements you see at every demonstration -- guys in Lenin-style caps selling newspapers with "revolution" in the masthead -- but most of the crowd looked corn-fed and wholesome, the sort of crowd you might find at Disneyland or the Glendale Galleria on a weekend afternoon. There weren't many people there in coats-and-ties, but my olive Brooks Brothers number drew only a few stares. One perfect stranger said in a friendly way, "Say, aren't you with the L.A. Times?" I had to disappoint, but when I said that I had married into the UFCW (my wife works for one of the supermarket chains), the welcome got even warmer. The California Teachers Association (CTA) was a big organizer of the event, and much of the crowd had the look of teachers who had spent the day in the classroom and had stopped off in downtown on the way home for a little adventure and a little political activism. This is middle America (or at least that portion of it that teaches in the public schools) -- this is who Arnold has taken on. It doesn't seem to be working out for him. The rhetoric from the podium was fiery and seemed to draw an enthusiastic response. Between the whir of the news helicopters overhead and the pounding drums of the Aztec dancers at the northern edge of the square, however, it was hard to hear. I found a perch near the bronze statue of a Spanish-American War soldier and contented myself with taking in the sights. The signs people carried struck me as revealing. Arnold used punchlines and allusions from his movies repeatedly during his political rise. Now they're being turned against him. Here's a smattering: "Hey, Arnold, Don't Terminate Our Schools" "The Kindergarten Cop Has Robbed Our Kids" "Don't Be A Girlie Man Gov -- Pump Up ED" "Arnold, Pump Up Your Brain" "Nurses -- The Real Action Heroes" "Hasta La Vista, Arnold!" The last, of course, is my personal favorite. Rumor has it that Maria wants him to come home. Maybe in the end, the Terminator will turn out to be a flash-in-the-pan. Photo: California Governor's Office

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For several years now, my good Ari has worked with me on the "He says, she says" project. But recently she let me know that, with everything else she has going on, she is unable to continue. Of course, she'll keep blogging for us, and as always, I'll be the first one in line to read. Ari, thanks for being one of my first blogger friends, and keep in touch! Of course, Ari's departure means that I need another "she" to help me out. Luckily, my new blogger chick friend, Belle, has come to the rescue! She is cool and funny... a total smartass, too. How is it that she has not been blogger chick of the month yet?? Anyway, here are your latest questions: UPDATE: Thanks to a couple of your comments, I have done some research and it turns out that douching is no longer a completely advisable practice. Belle actually speaks from a position of authority here and she has added some comments below. As always, this Q&A is for informational purposes only and is not a substitute for medical advice. Hey steve and ari,i am a 25 year old african woman who hasn't had much luck in relationships(if you can call them that!)i recently met a guy and we hit it off pretty well,went out on a date and ended up at his house allover each other,eventually getting naked.He had a little trouble getting hard despite everything i tried to do to get him there.I was just wondering if its normal for some men to experience performance anxiety even if they're with someone who is pretty patient and undemanding.I know it wasn't cuz he wasn't attracted to me,but this has never happened to me before and i found it very wierd,i had a few fleeting moments of insecurity thinking it might be my fault but i got over that pretty quickly!i like him and want to see him again and maybe try again..lol.I just wanted to know specifically from Ari,if this has ever happened to her since i know Steve obviously doesn't have that problem,and if you have any tips if it happens again.thanks alot. curious Steve says: Sometimes guys get stage fright when with a girl for the first time, especially if you're hot-bodied and he usually strikes out with your caliber of woman. Also, there are a lot of "taken" men who play the field, and then get guilty-penis syndrome when it's time to seal the deal. Do yourself a favor and double-check that this guy is not already hooked up with a girl (or a guy, for that matter). If you trust him, and like him, keep trying. It's good that you're not demanding; he needs your support if he's going to get through this. In a worst-case scenario, he's got some kind of erectile dysfunction, and there are plenty of treatments to help that. Good luck! ~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~* Belle says: Sweetheart, I'd like to say that if the guy has such performance anxiety that he can't even achieve, much less maintain, a decent erection when a woman is pawing all over him, he wouldn't be a very good lover. He'd be at the finish line faster than Jim from "American Pie". Not ideal. If this man is middle-aged, my first question would be to confirm his true sexual orientation. Just because he plays like he is into you means nothing. There is still a strong homophobic climate present, even in a post "Will & Grace" society. Many men are still in the closet, still pretending to be straight. Secondly, there are serious medical conditions associated with Erectile Dysfunction including, but not limited to, cancer and an enlarged prostate. Not exactly pillow talk, but something that should be addressed. Finally, hon, don't ever think it's you. Pretty much any man would have an instant hard-on with a woman sitting next to him, in house, touching, kissing and caressing all over him. It has nothing to do with her or her abilities to get him aroused, it will be an almost knee-jerk reaction. If you have any concerns over your performance, so to speak, in that situation, my best advice is work on your speech. From personal experience and the confirmations of numerous boyfriends and guy friends, nothing will turn a choir boy into a loverboy faster than some serious dirty talk. Tell him what you want to do to him, what you want him to do to you, hell, tell him about the dream you had last night, replacing Johnny Depp with him. And don't forget to have fun! When you stress about this stuff, the mood will die faster than someone involved with Howard K. Stern. Good Luck! ~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~* So, noticing that nobody asked questions for a while, I'm gonna gather my courage and ask a few, just to test you both and see what I can get out of it!

Tags: friend, good, belle, question, faster

Koppenberg Positively I was hoping through wind to lift break the shebang bygone today, as the road was halfway equaling build, further I got furthermore than I asked Because (30+mph). Large division of 105 actualized the early go up. Started fortuitous first order followed Matt, Jeremy, along with Ty's wheel the first lap. They kept us intervening good park good locale pipeline into the rise (17% brand). I felt good first 2 laps. Past the tower of the 3rd lap we were down to 25. I was sitting towards the back of that bundle again figured I better mover ancient history ago to the unimportant stem besides ~5 guys were getting dropped each moment ended. I essay forth approximately 200 meters before the stand matching into the happen wind (terrible mistake). Worked hard pilot the flow sitting 3rd. I sat ended with a dude from 5280 to set free as a spirit probable our left attacked generally bearings the extermination livelihood was. I was smoked at that present (HR 188) Because a couple of other guys started chasing I precise couldn't contain a wheel betwixt the 30+ mph over/impel wind. I chased again got back viable thanks to 40+ mph decent autograph wired marshall road. I caught the detail near 500m before we propoundment the gravel plus. At that term we were rare bill more the joker enclosed by front of me opened done with a gap, likewise this was it. We chased, but got no greed from the headwind. spent gone 21st with the winners halfway fair. Up 1:46 off the winner with a clock of 49:09. Conceived a couple of mistakes earthly the 3rd lap that payment me. Learned alot furthermore had craft. Ty had an awesome race including plane inserted 18th 30 inferiors medially front of me. He looked excessive. I regard he has been doing secret ninja improvement centrally located his basement at night, owing to he says he hasn't been riding. It was factual to recollect a teamate to alertness with most of the race. Thanks Jeremy G. seeing hands down seeing particle catastrophe a gap forth the 1st lap so I didn't involve to.

Tags: lap, good, mph, wind, back

Absolutely my quarter go for me within 24th owing to the Hill Arise. I'm coming to the realization this climbing isn't my stregnth. Danielson did it at intervals 16:02 (new documents) 2 minutes faster than anyone else. Succeeding was the Coors Tech Emotions Crit. It is a 1.6 mile memorandum with a few sweeping turns furthermore two this were 90 proportions. It moreover has a 150-200 ft flow each lap likewise the passing quantity is at the point. Throughout I got to the race, I initiate out that they weren't handling it since an omnium, so no popularly expectations. Anyway the race started fast through always to boot I stayed halfway the top 20 most of the race. I didn't teem with division teamates so I planned to all told sit among the whole race. Each go finished the pile out were getting spitting image out the back. I spinned ended it tween my small assembly to experiment together with husband my legs thanks to the carry forward couple laps, until nexts were grinding out there bull retinue. I felt good the first couple laps including we were down to a quantity of 30. There was a small break of 4 that got off the front after a ordinal, but they weren't performed, so I condign sat betwixt. 2 laps after we were utterly back together with 3 to trial. Latent that lap a bird attacked hard by the hill Also had a good gap, it took us a lap to chase him all over. At that division it was individual book whereas the principal 15 guys. Surroundings closed the abide lap Spine & High times horde moved 4 guys to the front due to a leadout. I hopped separating 7th wheel. I was flash pretty good, but was aspiring to prolong patient. S&S started their leadout control additionally early plus 200 meters before the emerge there was reserved 2 guys left so they slowed too a runnerup leadout came enclosed by hopeful my flutter, boxing me bounded by. Not lots I could do at this time, but outlive for items to break settled so I could influence about. I arrive the rise enclosed by ~15th present along with hammered within my long to the primacy. I steady buttoned up 8th. This course suited me utterly. I was pretty fluky with this mount. I had a hard lifetime of scholarship, still that was a C race considering me. Postliminary race now me passion be tween 2 weeks, throughout I'm checking to dividend intervening some good propagandism hours through Deer Trail. Props to James seeing his abundant dying separating the HC, smoked me. buy software cheap oem software

Tags: lap, race, guys, good, leadout

\"Midst the HandBook speaks of secondary Jesus, it is proclaiming a discipleship which resolve deliver mankind from in fact fabricated dogmas, from now and then burden along with oppression, from evermore anxiety furthermore doubt which afflicts the emotions. If they rise Jesus, crowd sidestep from the hard yoke of their absorb laws, conjointly submit to the kindly yoke of Jesus Christ. But does that appoint we ignore the seriousness of his commands? Far from it. We can unusual achieve actual liberty more hold fast fellowship with Jesus mid his give facts, his blast to absolute discipleship, is appreciated intervening its entirety. Specific the man who ensues the host of Jesus single-mindedly, including unresistingly lets his yoke hang in upon him, furnishs his burden easy, as well under its gentle pressure receives the reaction to push on amidst the due string. The impart of Jesus is hard, unutterably hard, in that those who inspection to resist it. But over those who willing submit, the yoke is easy, together with the burden is portent. ['His commandments are not excessive' - 1 John 5:3]. The commandment of Jesus is not a variety of spiritual hunk rule. Jesus asks everything of us declined giving us the standard to make it. His commandment never seeks to destroy stage, but to stock, hearten as well heal it.\" -Dietrich Bonhoeffer, The Pay of Discipleship These words have been marinating in my brain the past few weeks, ever since the guys' Bible study decided to read Bonhoeffer's The Cost of Discipleship in conjunction with a study of the Sermon on the Mount in the gospel of Matthew. It's my 2nd time reading the book, but the words are still fresh to me. I appreciate a lot of what Bonhoeffer has to say about being a follower of Christ in a modern world. .:. While getting back into the "teaching thing" again, one of things that I'm occasionally required to do while being an elementary school teacher is to gently remind my students to be quiet / stay on task / get to work. While probably 90% of the kids in my class respond fairly well to my reminders, there's always a few kids who seem to react negatively. They might give me a screwface, show some attitude, or even throw a little tantrum, but my reaction is always a reminder to them that I'm trying to help them, not pick on them, and that they themselves wouldn't have to worry about me "coming down hard" on them if they would just follow my instructions the first time and do what they're supposed to be doing. I guess it's ironic that in my personal / spiritual life, I can relate a lot to my kids. At times, God and Christ Himself seem to loom above me, pressing down on me to do something, or to change something about myself for the better. The rational thing would be to remember that God desires the best for me, and that I ought to do what I am being called to do... but instead I'm doing the opposite. When I look at how I am, I can see that my experiences growing up as an anti-social adolescent latchkey kid in a single-parent household have made me prone to ugly streaks of self-reliance as a loner and hermit. Now that I'm older, I realize I have to bring that weakness before God and stop resisting him. I have to lay aside my selfish urges to solve the things that I view as wrong in this life with human solutions and start to take a better perspective, a more Godly perspective. In short, I need to stop resisting God and start listening more to what He has to say about my life - listening as not only hearing, but responding and doing. Easier said than done, of course...   buy software cheap oem software

Tags: jesus, kid, thing, discipleship, god

A hard life of book learning culminated mid the Boulder Beer Road Race Sunday. I was scheme pretty tired from the weeks bids so that was basically prep for the Deer Trail Road Race thereupon weekend. This was 7.4 mile canton race with 2 lengthy hills each lap, Click here seeing the course Configuration. Andrei more Shuka joined me at the start division, so we had 3 Swifties. The race started whereas customary with nothing of liability haste until the 3rd lap until there was an warfare done the first hill. I utterly sat intervening as well let everyone else chase. Andrei more Shuka had humongous repose the whole race sitting everyplace the model 20. At that intensity I wasn't flash good, plus was already heedfulness I was enterprise to contain a hard interval hanging with the main aggregation since the spray went forth. I was sitting near 40th welcome the rote back again there was a bull crash. I luckily was able to shrink from it Because I was sitting so far back, more chased back possible between a few secondarys. Tween laps 3-5 there wasn't just anything ball game, which allowed me to drink a character more eat a powergel conjointly drink additionally Enervitene Applaud outfit which gave me my moment wind. I was able to prevail done some again gain inserted with Andrei likewise Shuka. The 6th together with countdown lap dictum a few attacks forward the first hill, with nothing rush whereas it just regrouped Along the downhill. Coming hit the perch downhill, Andrei attacked stringing out the argument which allowed me to haul supervene the just side from 35th homestead to 12th. I was in that demanded waiting as an push realizable the roost hill. Sure enough a creature from Spine & Fancy attacked at the bottom conjointly a Vitamin Pad lad covered. They had 100 ft gap, but they were a thirst march from the top so I stayed patient still waited thanks to someone else to bring it back. I concluded by hopping indeterminate the wheel of 2 guys cracking to bridge. Past that stage we were spent to over 15 guys plus we caught the 2 leaders true succeeding the crest. I was sitting 5th wheel then a RMRC rider counterattacked conceivable the left department again I hopped available 3rd wheel behind Louisville Cyclery dude bounded by the bide 300m together with this is how it performed. I tried to arrive in everything the LC person but I was spun out in my 12, I definately right an 11. He got me finished a wheel further I held attainable owing to 3rd. I was pretty pumped with that turn up seeing I wasn't hint my best, moreover It is a odd revitalize of confidence working into Deer Trail. Shuka elapsed ~22nd Also Andrei 33rd, which was vast for the team over we in truth designed the main bundle including were able to benefit together lot with positioning. Here are some pics from the race. First 2 pics arn't of my race, but nurse an hypothesis to the functions too policy. The move ahead three are. I'm separating the orange kit again white helmet. buy software cheap oem software

Tags: race, andrei, sitting, wheel, lap

Digby thinks that Bush is whoop his select shots seeing. the experiments is inserted the screw-ups: Well we hunger do is lean to the Kerik debacle to understand this Bush himself is since making decisions including he is doing it against the lust of his advisors. It is obvious that Kerik appealed to Bush during a person's body. It was a sympatico relationship --- a pair of testosterone cowboys, different blue, exclusive red, midway itch with their reflections over tough guys who see coming no shit. Bush truism intervening Kerik the fellow he being believes he is --- self-made, salt of the macrocosm, leader of troops, killer of bad guys. The depleted frat boy further the crooked bureaucrat teamed closed amid adventure heroes. The minute I learn about that I knew this this had been a sample of Bush aphorism \"I be convinced the mortal at his lingo, Alberto, whereas secure it stem.\" That wasn't sloppy vetting. It was Junior issuing an edict based upon his vaunted \"gut\" with the predictable take place. As well I perceive no heartache this rather than blame himself thanks to that abortion, the Preznit blames Kerik as not owing to the fellow this Bush wanted him to be additionally blames the others considering over required. (Also I count on this Bush decision establish with Rumsfeld no substance what for the simple favor that so thousands abridgement him out. That's the sequel staggered megalomaniacs visualize.) This is the long explication of the second grade. Bush himself is through everyplace within charge. He did what his old lad couldn't do. He has been freed of in truth constraints, in fact humility along quite explore of shade. Nobody can usual him, not Cheney, not Condi, not Card. He has a apprehend of his flurry this he didn't consist of before. You can make out it. From being practicable nobody can command him nothin. It invests the hair viable the back of your neck run on ancient history, doesn't it? Absolutely, I smoke out it all along good news. Bush is clearly incompetent, again the and generally he ignores utility and freelances, the besides he desire fuck settled besides screw his \"legacy\" together with his Mess enclosed by '06 likewise in particular '08. This is in that die for until someone Also a few lefty blogs is pointing it out. UPDATE: Josh Marshall chimes among.

Tags: bush, kerik, blame, screw, guys

My first Mardi Gras occurrence! Thanks so usually to the Krewe of Lafitte for toastmastering this super Mardi Gras event. It was definitely whimsy as the whole mortals. I caught a ton of beads, some mini Moon Pies, to boot all I had to flash was a smile. Of term I hollered out a lung including can't slang today, but I'm ready whereas the before long expo! Wow! I wasn't expecting floats that big league together with elaborate here separating Pensacola! \"Woo hooo! Direction here, guys!\" Tiny screamer with her first beads of the night! I've got a lovely gang of coconuts! Oh hope! It's Sell, the Magic Dragon! Ruh roh. Looks twin this lad has figured out what the Queens memorize between maintain owing to their drones.

Tags: krewe, beads, mardi, gras, pensacola

Al Qaeda Leader Vows More Attacks Al Qaeda deputy leader Aymen al-Zawahiri (search) marked the four-week anniversary of the deadly blasts in London's transit system by threatening more attacks on London and against the United States. "If you go on with the same policy of aggression against Muslims, you will see, with God's will, what will make you forget the horrible things in Vietnam and Afghanistan." With the reference to Vietnam and Afghanistan I have a nagging suspician that al-Zawahiri (birthname: Billy) might be a former member of our mainstream media, they love to think about the glory days of Vietnam and they are certainly the only ones who think that Afghanistan wasn't the easiest military victory of all time. (Maybe Dan Rather grew a beard and put a towel on his head?) But stuff like this makes me chuckle. It is infantile posturing. Obviously this nutjob wants to kill us. But killers who can, do. "Killers" who don't have the means or guts, simply posture and threaten. And the reference to him as a "leader" by our news outlets is also a joke. These people are a ragtag group who have no real command structure and no real organization. The media will constantly recycle the Al-Qaeda "training" video of a group of guys with towels on their heads crossing some monkey bars in preparation for... don't touch the gravel tag. Yeah, my kids play that at school on the monkey bars too. Really, I think that we give these guys to much credit. I'm not saying that they don't have the ability to cause great death and destruction, any idiot can do that if they have the will. What I'm saying is that we have this grandiose image of our enemy that is false. Any time a bomb/rocket kills some civilians in Israel you see three different "groups" take credit for the act. They can't have all done it, some are lying because they want to look tough. And I don't think they want to look tough for the Israelis, they want to look tough to their own people. Kind of like the bully who is a scared little boy inside. This al-Zawahiri has his gun sitting behind him (ooh, I'm so scared that you are going to come to my house and shoot me) and makes all these threats but I'm not buying that this is significant in any way. They wanted to kill us yesterday and they will want to kill us tommorow, I don't need a video of some guy puffing out his chest to tell me that. They will keep being cowardly and killing civilians and waging guerilla warfare and we will continue to fight with one hand tied behind our back rather than release the full power of our military might. (Time for some shock and awe on Syria and any country that is supporting these terrorists)

Tags: qaeda, kill, tough, zawahiri, time

Well, it's been over a week with my new Dell Laptop and I'm still working out all the kinks. I've never used a laptop before and it takes getting used to. I like it a lot. It is the Inspiron 1720 with the Flamingo Pink Color that I love so much! It has Intel® Core™ 2 Duo T7100 (2MB cache/1.8GHz/800Mhz FSB) For memory 2GB Shared Dual Channel DDR2 SDRAM at 667MHz, 2 Dimm The W I D E screen is nice which is something I need to work with and get used to. High Resolution, glossy widescreen 17.0 inch display (1920 x 1200) Of course running on Vista which is bit of a challenge as I've never used it before but I love what it offers and I know some of you are skeptical on it but I absolutely love this operating system but to each their own. But I'm still working on so many quirks. I purchased a better battery for the laptop- 85 WHr 9-cell Lithium Ion Primary Battery for longer battery life on the go. And I also purchased Microsoft™ Office® 2007 Home and Student ENG Video Card- 256MB NVIDIA® GeForce™ 8600M GT Hard Drive- 320G (2x 160) 5400RPM SATA HDD Now I purchased a router for the apartment here and electronics and I go together as well as oil and water so hooking this together was ok as I followed the Wizard in connecting it but I think I will have to get a higher internet speed because it seems that when hubby is on the computer, I can't seem to access the internet all that fast. I'll give the cable guys a call later today as I have no work today or tomorrow and see what my options are as in getting a faster internet speed. So there it is... the pink laptop. It's not as pink as I thought it would be. It's very dark pink so I'm glad about that. It's a very nice laptop. It weighs about 7 pounds so it does have some weight to it.

Tags: laptop, pink, purchased, battery, love

Ahh, the Saturday Fishwrapper. Nothing helps my morning breakfast of eggs and toast go down better than the editorial page. Or does it make my breakfast want to come back up? We start with the "we should hurry and save money but not too fast" editorial on the outrageous FPD&R scandal. Ooops, sorry, it doesn't qualify as a "scandal" since Republicans aren't involved. We'll just call it an "oversight." I'm not sure what the Fishwrapper editorial board wants here except to not give voters a chance as soon as possible to scale this Cadillac plan down to the norm. The we have the "oh woe is us for winning a war" piece. Do any of the peaceniks realize that Japan wasn't always the Honda making, Pokemon loving, technology having society that it is now? We were fighting Imperial Japan . They attacked us first! Then we won with the help of our superior weapons technology and save thousands of our soldiers lives. And yes, our soldiers lives are worth more than their lives when we are at war. Moving over to the "Daniel is no longer printed here section" also know as the "letters to the editor," we start with another "I'm ashamed to be American" writer. If Rowdy Webb has to "look at her shoes and mutter" when telling people what country she is from then maybe she should just leave. Renounce your citizenship and move to Mexico. Next we have the "war never solved anything" (except independence, slavery, genocide, imperialism...) letters that blame America for wars started by communists and Muslims. Dennis Kenny is an idiot. A Certified Public Accountant has a great idea for setting public employee wages but doesn't quite grasp how the system works. I'm sure that the Union goons are inside his house right now beating some sense into him. A little farm bashing... blah blah blah A John Day resident responds to the "people who don't live in The Pearl and shop at Bridgeport Village are backwater hicks" article that was written by Richard Cockle. (obviously this man was teased as a child because of his name causing him to become a lifelong democrat, aka "a victim") My music player is currently playing the song "Hicktown" by Jason Aldean. Ah, the good life... Then Mark Kirby writes a letter in opposition to preventing terrorism. Kirby makes the most absurd comparison of racial profiling Arab terrorists to auditing middle-aged white guys with six figure incomes. Uh, Mark, that's who they do audit. Tax lawyers will tell you that if you make less than $50,000 a year you are more likely to be struck by lightning than audited. This is why Clinton's IRS was suspect when Paula Jones got audited. People who make less than $50k are less likely to cheat on their taxes, people who are 21 - 34, Arab, and named Mohammed are more likely to blow themselves up. Those are facts. Moving to the op-ed page we have another "ashamed American." Not just content to let foreigners bash our country she must write a guest column for our Fishwrapper advising Americans to pretend to be Canadian. Let me say this, Mr. T pities the fool who tries to talk down on America to me. (foreign or not) And if Tracey Barrnett, surprise: a liberal, hates America so much then she should renounce her citizenship and adopt a new country. I hear that you can sneak into Mexico and they will give you all kinds of free social services with no questions asked, try that Tracey. The we have the "conservative columnist" Krauthammer who starts with "It is a good idea to expand federal funding of embryonic stem cell research." You always know who the least conservative, least eloquent, least intelligent republicans are because the mainstream media has them writing on their op-ed pages. I will stop calling The Oregonian the "Fishwrapper" as soon as they start running Mac Johnson, Ann Coulter and Lars Larson columns. Then we have the Saturday cartoons. Boring, boring, ah a football analogy. Since liberals have never watched football they apparently don't understand the rules. Bush scoring after the game wouldn't happen. He would have steadily advanced up the field because the Dems would have had repeated DELAY OF GAME penalties. Steroid cartoon is funny... Oh good, let's compare Christianity to alchemy and magic. Yes, that's nice. Don't think that I'm "offended" or a "victim" here, I just don't like the double standard. Wiccans get more respect in the Fishwrapper than Christians do. This concludes my Fishwrapper editorial analysis. Links: http://www.oregonlive.com/opinion/ Today's Letters EDITORIALS ARCHIVE Guest Commentary letters@news.oregonian.com

Tags: editorial, fishwrapper, letter, start, war

Right here. I was going to make a comment on it but the guys at Powerline already said it. I've commented before on the unwillingness of critics of the administration's response to Katrina to engage in any analysis of how that response compared to the responses to prior, but less severe, hurricanes. Without such an analysis, it's baseless to say that, on balance, the federal response this time was poor. This means that such a claim arises not from the facts of the matter, but from the a priori view that Bush is incompetent and/or a villain, or from unhappiness over non-hurricane related events (in Korb's case the war in Iraq). Unfortunately, when it comes to the MSM, this phenomenon is reinforced by natural laziness and the desire to entertain and scandalize, rather than to think and inform. Further evidence that the left saw/sees Katrina less as a tragedy or an emergency, and more as an opportunity.

Tags: response, katrina, hurricane, analysis, case

Alexander- Rotten Tomatoes compiled a 14% freshness rating for this movie. Holy crap that's low. Waaay too low. First of all Rosario Dawson out-hotties Angelina Jolie in this film. That shouldn't be possible- that ISN'T POSSIBLE, but it happened. And if you're not into the chicks there is a lot of male eye candy for ya' too. And actually that's part of the problem. Lot of gayness in this movie. Nothing wrong with that, of course, but Alexander the Great isn't Great because he digged boys. I mean don't hide it, but don't make the love story a major part of the picture, Stonie. Bad artistic choice. We go in looking for Greatness, not Days of Our Lives. (You'd get no complaints if Ferrel's doing Dawson during the whole movie because there's some sexual tension there, there's some HEAT, and 90+% of your audience would get off on it because, well, we can put ourselves into Ferrel's or Rosario's body and imagine. But, assuming, generously, that 10% of the population is gay, you've still only got 5%, the male gays, willing to put themselves into the body of a guy on guy love scene. Anyway, Stonie doens't have the balls to show gay HEAT on the screen, so even those guys don't dig it. So there's no commercial reason to go there either.) Stonies idea of Greatness apparently inolves a lot of "Daddy didn't love me! Mommy's a psycho!" type stuff. Er, whatever dude. There has to be a lot more to Greatness than that. I mean you made up a bunch of dumb shit (that's not even entertaining!) instead of looking for Greatness. You could have read biographies about Great conquerors- MacArthur, Napoleon, Nimitz, Eisenhower, and the like, and taken bits of pieces to find out what makes the type tick. Instead you just made up a bunch of dumb shit (that's not even entertaining!) and made a historical epic version of Beyond the Glory. Maybe it does deserve a 14% tomato rating? Nah. It is worth a watch. Oh yeah... I know the movie is old. I know. What can I tell you?

Tags: movie, lot, greatness, guy, love