“Babies born just a few weeks early have a higher risk of poor health,” The Guardian reported today. According to the newspaper, new research has found that being born just a few weeks early can raise their risk of conditions such as asthma.
It is already known that babies born prematurely (before 37 weeks of pregnancy may have a higher risk of immediate or longer-term health problems, and the earlier a baby is born, the higher the risk. To examine the issue researchers followed the health of over 14,000 children born between 2000 and 2002, and examined their health at the ages of three and five years old. Outcomes including growth, hospital admissions, use of medication, asthma and long-standing illnesses were looked at particularly in relation to whether the children were moderately premature (32-36 weeks of pregnancy or born at what the researchers called “early” full term (37-38 weeks . Babies born moderately prematurely or at early term were more likely to have been re-admitted to hospital in the first few months of life than babies born at 39-41 weeks. Babies born moderately prematurely also had a higher risk of asthma symptoms than full-term babies.
These findings are broadly in line with what is already known about the effects of prematurity, and do not change the UK’s current definition of full-term pregnancy as 37 weeks and over. However, the study does show how different degrees of prematurely may affect health. Further study of the issue would be valuable, to explore longer-term health outcomes that may be caused by prematurity and the factors that may influence the likelihood of these poor health outcomes.
Where did the story come from?
The study was carried out by researchers from the University of Leicester and other UK institutions. It was funded by the Bupa Foundation and published in the peer-reviewed British Medical Journal.
The media generally covered this research in a balanced way.
What kind of research was this?
In the UK, the normal length of a pregnancy is classed as 37 weeks or above. It is already known that babies born prematurely (before 37 weeks may be at increased risk of immediate and longer-term health problems, and that the risks are higher the earlier a baby is born. However, the authors say that there has been minimal research into the longer-term health outcomes of infants specifically born moderately preterm (which this study defines as 32-36 weeks and at what the researchers termed as ‘early full term’ (37-38 weeks .
To investigate this, the researchers used a cohort study. This is a good way to follow up and compare health outcomes in groups of people that have been exposed to different factors. In this case, the exposure was the number of weeks of pregnancy at which the babies were born. However, a cohort study that looks at a group’s health relies on the accuracy of reported health outcomes and diagnoses. For example, one condition this study looked at was asthma, and the researchers asked parents about whether their child had wheezing symptom or asthma. However, this does not necessarily equate to a medical diagnosis of asthma.
This type of study also needs to take into account potential factors that could be related to both risk of prematurity and risk of the health outcome. For example, parental smoking is linked to an increase risk of prematurity, and also to an increased risk of asthma in the child.
What did the research involve?
This study involved participants of the Millennium Cohort Study (MCS , a piece of research in which the subjects were gathered by random sampling of child benefit registers. It featured 18,818 infants born in the UK between 2000 and 2002. The number of weeks of pregnancy at birth was calculated from the mother’s report of her expected due date. Births were grouped into:
- very preterm (defined by the authors as 23-31 weeks
- moderate preterm (32-33 weeks
- late preterm (34-36 weeks
- early term (37-38 weeks
- full term (39-41 weeks
These are not the standard accepted definitions. For example, the charity BLISS, for “babies born too soon”, defines full-term pregnancy as 37 weeks or more, moderately premature as 35-37 weeks, very premature as 29-34 weeks, and extremely premature as birth before 29 weeks.
Child health outcomes were monitored over five years of follow-up. Outcomes assessed included:
- child height, weight and body mass index at three and five years
- parental reports of the number of hospital admissions (not related to accidents since birth or the previous interview, collected at nine months and at three and five years.
- parental reports of any longstanding illness or disability of more than three months’ duration and diagnosed by a health professional, collected at three and five years (a limiting longstanding illness was defined as one which limited activities that are normal for the child’s age group
- parental reports of wheezing within the previous 12 months, and parental reports of asthma collected at three and five years
- parental reports of the use of prescribed drugs, collected at five years
- parents’ ratings of child health, defined as excellent, very good, good, fair or poor, collected at five years
The researchers used statistical methods to look at the outcomes in groups groups born at different stages of pregnancy and compared them to (their definition of full-term babies. Analyses were adjusted to account for various potential confounding factors, principally numerous social and demographic factors. The researchers also estimated “population attributable fractions” (PAFs associated with preterm and early term birth, which is an estimate of the contribution that a particular risk factor has to a health outcome. PAF represents the reduction in the proportion of people in the population with a particular health problem that could be expected if the exposure to a risk factor were reduced to the ideal exposure. In this case, it would represent the proportion of children that would no longer have a particular health problem if all babies were born at full term rather than preterm.
What were the basic results?
After the researchers excluded participants in the MCS study with incomplete data on time in the womb at birth, they interviewed the parents of 14,273 children at 3 years of age and 14,056 at 5 years. They found certain sociodemographic factors, such as lower maternal educational status and maternal smoking, to be associated with prematurity, as is already known.
The researchers generally found a “dose response” effect of prematurity, meaning that the more premature a baby was, the higher the likelihood of general health problems, hospital admissions and longstanding illnesses. They calculated the odds of each outcome compared to children born at 39-41 weeks. The full details of these outcomes are as follows:
The odds for three or more hospital admissions by five years of age were:
- 6.0 times higher for children born at 23-31 weeks
- 3.0 times higher for children born at 32-33 weeks
- 1.9 times higher for children born at 34-36 weeks
- 1.4 times higher for children born at 37-38 weeks
The odds for any longstanding illness at five years of age were:
- 2.4 times higher for children born at 23-31 weeks
- 2.0 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.1 times higher for children born at 37-38 weeks
The odds for the child’s health being rated as only fair or poor by parents at five years of age were:
- 2.3 times higher for children born at 23-31 weeks
- 2.8 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.3 times higher for children born at 37-38 weeks
The odds for asthma and wheezing at five years of age were:
- 2.9 times higher for children born at 23-31 weeks
- 1.7 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.2 times higher for children born at 37-38 weeks
The greatest contribution to the burden of disease at three and five years was among children born at late/moderate preterm or early term. The calculated PAFs for being admitted to hospital at least three times between the ages of 9 months and 5 years were:
- 5.7% for children born at 32-36 weeks (i.e. you would expect a 5.7% reduction in the number of young children admitted three or more times if babies were born at full term rather than moderate preterm
- 7.2% for children born at 37-38 weeks (you would expect a 7.2% reduction in the number of young children being admitted if babies were born at full term rather than early term
- 3.8% for children born before 37 weeks (you would expect a 3.8% reduction in the number of young children being admitted if babies were born at full term rather than very preterm
Similarly, PAFs for longstanding illnesses were:
- 5.4% for early term births
- 5.4% for moderate or late preterm births
- 2.7% for very preterm births
How did the researchers interpret the results?
The researchers concluded that “the health outcomes of moderate/late preterm and early term babies are worse than those of full term babies.” They say that it would be useful for further research to look into how much of the effect is due to prematurity itself, and how much is due to other factors such as maternal or foetal complications.
Conclusion
This valuable research examined childhood health outcomes in a large group of children born at different stages of pregnancy.
Important points to consider when interpreting this research include:
- The authors generally found that the likelihood of poorer health outcomes was higher with increasing prematurity (a dose response effect . This is in line with what is already known about the generally poor immediate and longer-term health outcomes among babies born increasingly prematurely.
- The greatest contribution to overall burden of disease at ages three and five years was calculated to be among children born at 32-36 weeks or at 37-38 weeks. Though a gestation of less than 32 weeks might be expected to have a greater influence on the burden of disease, it must be remembered that many more babies are born above 32 weeks of gestation than below it. Therefore, in the population as a whole, the greater number of babies born within the 32-38 week range would have a greater effect than the small number of babies born extremely early.
- The definitions that the authors used for the purposes of this study are not standard definitions. For example, the standard definition of full-term pregnancy is birth at 37 weeks or more, and it is not split into “early term” at 37-38 weeks and “full term” only at 39-41 weeks. Similarly, definitions of prematurity differ from those used by other UK health organisations.
- There is a possibility of inaccuracy as both age at birth and health outcomes were reported by parents, rather than assessed through medical records. For example, a parental report of wheezing or asthma does not necessarily constitute a confirmed medical diagnosis of asthma.
Overall, the study found that the more premature a baby is, the greater the likelihood of health problems in childhood, and that some effect of prematurity may even be seen in pregnancies approaching full term. Further study in this area would be valuable, both to explore the wider range of longer-term health outcomes that may be caused by prematurity, and to look into associated factors (medical or sociodemographic, for example that may influence the likelihood of these outcomes.
Analysis by Bazian
Links To The Headlines
Infancy health risk linked to early birth by research. BBC News, March 2 2012
Babies born a few weeks early 'suffer health risks'. The Guardian, March 2 2012
Links To Science
Boyle EM, Poulsen G, Field DJ et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ 2012; 344
Press release: Population-based cohort study of the effects of gestational age at birth on health outcomes at three and five years of age. BMJ, March 1 2012
“We've had bird flu and swine flu - now scientists have found BAT FLU,” says the Daily Mail. The newspaper reports that the strain “could pose a risk to humans if it mingled with more common forms of flu”.
The Mail has got in a flap over the flying mammals based on new research that found type A flu virus in fruit bats captured in Guatemala in Central America. The discovery in bats is new as the virus is typically found in winged birds, and not winged mammals.
Researchers collected 316 bats of 16 different Latin American species. Types of flu virus were found in three bats of the little yellow-shouldered species, which is a fruit eating variety common across Central and South America. After analysing the genetic code of the bat flu virus the scientists concluded it contained segments that were significantly different from those found in known influenza A viruses. They also found that some aspects of the bat flu virus could work inside human lung cells grown in the lab. This led them to conclude that the virus has the potential to mix with human flu virus, which could, in rare circumstances, lead to the creation of a new flu strain that is capable of causing a flu pandemic, like bird flu or swine flu.
Despite this warning, scientists have not been able to grow the new bat virus in chicken eggs or human cells, which is possible with existing flu strains. This suggests that the immediate risk of infection to humans is small. Rather than highlighting a danger to human health, this study is likely to guide further research that may improve the understanding of potential pandemic flu threats to humans in the future.
Where did the story come from?
The study was carried out by researchers from Centres for Disease Control and Prevention outposts in Atlanta and Guatemala, and was funded by the agency’s Global Disease Detection Program.
The study was published in the peer-reviewed science journal Proceedings of the National Academy of Sciences USA (PNAS .
The story has appeared on several online news sites and in the Daily Mail. In its headline the newspaper suggests that bat flu “could pose a threat to humans”. While the inclusion of the word “could” makes this a fair statement, the article does not make clear that the immediate risk to humans is very low. Generally, the tone of the piece emphasises a potential risk from the virus. It says there is a hypothetical risk of transmission to humans if they eat food contaminated with traces of the virus. Again, the risk of this happening seems low.
What kind of research was this?
This study was laboratory research looking at the genetics of a specific strain of type A flu virus found in bats captured in Guatemala. Originally, the bats had been examined as part of a study looking at rabies, which revealed that bats were able to carry certain forms of the flu virus.
As their names suggest, new pandemic flu strains such as the high-profile bird flu and swine flu strains often originate in animals, typically waterfowl and pigs. Usually, non-human flu strains do not cause serious harm in the original host, for instance, bird-flu does not cause death to most birds and human flu is not usually fatal to healthy humans. However, animal flu strains have the potential to swap genetic material with human strains and create a new virus strain capable of infecting and harming humans. It is the mixing of genetic material and the creation of these new viruses that represents the main danger of new flu pandemics.
The researchers say that early detection, characterisation and risk assessment of flu viruses in their animal hosts before they spread to humans is “critical” to protect public health.
What did the research involve?
Researchers collected 316 bats from 21 different species from eight locations in southern Guatemala over the course of two years.
Researchers swabbed the bats’ bottoms to gather traces of any influenza virus A. The swabs were tested in the laboratory for signs of flu genetic material using standard molecular biology techniques. Tissue samples from the bats’ mouths, livers, intestines, lungs and kidneys were also tested for flu virus.
Researchers then examined the genetic code of the viral material that had been detected in the bats and looked at how similar they were to other flu viruses that have previously been decoded.
To demonstrate ‘proof of theory’ that the bat virus could function within human cells the scientists created a mini version of the flu virus’ genetic material. They placed this into human lung cells in the laboratory and assessed whether certain functions of the bat virus could be carried out within a human cell.
The researchers attempted to grow the virus strains in a variety of mammalian cells (including bat cells and human lung cells grown in the laboratory to study how infectious the strains were to these different types of cells.
What were the basic results?
Three of the 316 bats tested positive for influenza virus A from their swabs. All three samples were collected from little yellow-shouldered bats, which is a fruit-eating bat that is abundant throughout Central and South America.
In these three bats, all of the further samples taken from the liver, intestine, lung and kidney tissue tested positive for flu virus genetic material.
Researchers found that a specific genetic sequence within the virus, containing the code for making a vitally important flu protein called haemagglutinin, showed differences from the previously documented strains. In one of the bats the genetic material coding for a second crucially important flu protein, called neuraminidase, showed “extraordinary” differences from other known flu viruses.
In influenza A viruses the forms of haemagglutinin (H and neuraminidase (N proteins on the surface of each virus provide the main basis for the way it will be named and classified. For example, the combination of these proteins found in the recent swine flu outbreak meant it was known as H1N1, while the latest bird flu scare was caused by a virus known as H5N1. There are many influenza A virus subtype combinations circulating in animals in the wild. In this research the H proteins found in the samples were so different from other types of influenza that the authors say it could be classified as a new subtype, which they called “H17”. In one of the samples the researchers say they could not classify its N type as there were so many different and unusual types of N proteins.
The scientists reported that attempts to grow the virus in human cells in the laboratory and chicken embryos were unsuccessful. This suggested the virus differed from other known viruses, which can be grown under these conditions.
The researchers demonstrated that some functions of the bat flu virus had the potential to work inside laboratory-cultured human lung cells.
How did the researchers interpret the results?
The researchers conclude that “despite its divergence from known in?uenza A viruses, the bat virus is compatible for genetic exchange with human in?uenza viruses in human cells”. This leads them to suggest that there is potential for the bat virus to mix with existing human flu viruses creating a “new pandemic” virus that could pose a threat to human health.
Conclusion
This study of the genetic material of flu virus A in three fruit bats in Guatemala provides important new information to those involved in flu research and pandemic awareness. Previously, non-human flu strains were thought to be confined largely to birds and pigs, but this study highlights the potential for bats also to harbour flu viruses that could potentially threaten humans, given the correct sequence of rare events. The awareness this research provides may lead to a better understanding of the potential risks posed by bat flu to humans in the future.
The following points should be considered when interpreting the results of the study:
- It is important to realise that the researchers have found a new segment of genetic material in the bat flu virus that is different from other flu strains sequenced. They have not discovered a completely new virus in bats that is capable of infecting humans, and so the immediate threat to humans is likely to be minimal.
- As yet, scientists have not been able to grow the bat flu virus in chicken eggs or human cells, which is possible with all other commonly occurring flu strains. Given that they were actively trying to grow the virus and failed, this also suggests the immediate risk of infection and harm to humans is small.
- The potential threat the authors and the media warn against for the future is that the new bat virus genetic material could mix with other flu strains to create a new strain that will be capable of infecting and harming humans, like swine flu and bird flu. To date, there is no evidence that this has happened so there is no cause for immediate concern.
- Fruit bats in Guatemala do not bite people, so direct transmission of the bat virus to humans is unlikely. A suggested route of virus transmission has been if bat droppings contaminate food that is then eaten by people. This could allow the bat flu and human flu genetic material to mix, potentially creating a new strain capable of a pandemic.
This study provides no evidence to support or refute the implication that if someone were infected with the bat virus now it would be harmful, and the risk of this bat strain causing a pandemic is not known at the present time. However, a series of rare events would need to happen in sequence for a pandemic to occur. Despite the rarity, this has happened before in the case of other pandemic flu strains including swine and bird flu, although the initial transmission from these species has generally occurred through sustained close contact with livestock, such as sleeping among the droppings of chickens reared in the home.
Following the discovery of this new form of flu it will surely be explored further by agencies such as the Centers for Disease Control and Prevention, which would report any evidence of risk to the World Health Organization and its flu surveillance teams, which constantly monitor and evaluate any potential flu-based threat.
Analysis by Bazian
Links To The Headlines
We've had bird flu and swine flu - now scientists have found BAT FLU (and it could pose a threat to humans . Daily Mail, March 1 2012
Scientists report first evidence of flu in bats. The Daily Telegraph, March 1 2012
Links To Science
Tong S, Li Y, Rivailler P et al. A distinct lineage of influenza A virus from bats. PNAS, Published online before print February 27, 2012
Submitted by Brandon Smith from
Alt-Market
Americans Will Need “Black Markets” To Survive
As Americans, we live in two worlds; the world of mainstream fantasy, and the world of day-to-day reality right outside our front doors. One disappears the moment we shut off our television. The other, does not…
When dealing with the economy, it is the foundation blocks that remain when the proverbial house of cards flutters away in the wind, and these basic roots are what we should be most concerned about. While much of what we see in terms of economic news is awash in a sticky gray cloud of disinformation and uneducated opinion, there are still certain constants that we can always rely on to give us a sense of our general financial environment. Two of these constants are supply and demand. Central banks like the private Federal Reserve may have the ability to flood markets with fiat liquidity to skew indexes and stocks, and our government certainly has the ability to interpret employment numbers in such a way as to paint the rosiest picture possible, but ultimately, these entities cannot artificially manipulate the public into a state of demand when they are, for all intents and purposes, dead broke.
In contrast, the establishment does have the ability to make specific demands or necessities illegal to possess, and can even attempt to restrict their supply. Though, in most cases this leads not to the control they seek, but a sudden and sharp loss of regulation through the growth of covert trade. The people need what the people need, and no government, no matter how titanic, can stop them from getting these commodities when demand is strong enough.
This process of removing necessary or desirable items from a trade environment leads inevitably to counter-prohibition often in the form of strict cash transactions, barter markets, or “black markets” as they are normally derided by those in power. The problem for economic totalitarians is that the harder they squeeze the masses, the more intricate the rebellion becomes, especially when all they want is to participate in free markets the way our forefathers intended.
The so called “drug war” is proof positive of the impossibility of locking down a product, especially one that has no moral bearing on the people who are involved in its use. Only when a considerable majority of a populace can be convinced of the inherent immoral nature of an illicit item can its trade finally be squelched. During any attempt to outlaw a form of commerce, a steady stream of informants convinced of their service to the “greater good” is required for success. Dishonorable governments, therefore, do not usually engage in direct confrontation with black markets. Instead, they seek to encourage the public to view trade outside mainstream legal standards as “taboo”. They must condition us to react with guilt or misplaced righteousness in the face of black market activity, and associate its conduct as dangerous and destructive to the community, turning citizens into an appendage of the bureaucratic eye.
But, what happens when black markets, due to calamity, become a pillar of survival for a society? What happens when the mainstream economy no longer meets the available demand? What happens when this condition has been deliberately engineered by the power structure to hasten cultural desperation and dependence?
In this event, black markets not only sustain a nation through times of weakness, but they also become a form of revolution; a method for fighting back against the centralization of oppressive oligarchies and diminishing their ability to bottleneck important resources. Black markets are a means of fighting back, and are as important as any weapon in the battle for liberty. Here are just a few reasons why such organizational actions may be required in the near future…
The Mainstream Economy Is Slowly Killing Us
There are, unfortunately, some Americans out there who have not caught on yet to the grave circumstances in which we live. Obviously, the stock market seems to have nearly recovered from its epic collapse in 2008 and 2009, and employment, according to the Labor Department, is on the mend. The numbers say it all, right? Wrong! The numbers say very little, especially when they are a product of “creative mathematics”.
Despite the extreme spike in the Dow Jones since 2010, and all the talk of recovery, what the mainstream rarely mentions are the details surrounding this miraculous return from the dead for stocks.
One of the most important factors to consider when gauging the health of the markets is “volume”; the amount of shares being traded and the amount of investors active on any given business day. Since the very beginning of the Dow’s meteoric rise, the markets have been stricken with undeniably low volume interspersed with all too brief moments of activity. In fact, this past January recorded the lowest NYSE volume since 1999:
http://www.bloomberg.com/news/2012-01-23/stock-trading-is-lowest-in-u-s-since-2008.html
Market volume has tumbled over 20% since last year, and is down over 50% from 2008 when the debt implosion began:
http://blogs.wsj.com/marketbeat/2012/02/24/trading-volume-anemic-this-year/
So then, if trade is sinking, why has the Dow jumped to nearly 13,000? Low volume is the key. In a low volume market, less individual investors are present to counteract the buying and selling of larger players, like international banks. When this happens, the big boys are able to trigger market spikes, or market drops, literally at will. Add to this the high probability that much of the stimulus that the Federal Reserve has regurgitated into the ether probably ended up in the coffers of corporate banks which then used the funny money to snap up equities, and presto! Instant market rally! But, a rally that is illusory and unstable.
Improving employment numbers are yet another financial hologram. As most of us in the Liberty Movement are well aware, the Labor Department does not calculate true unemployment in the U.S. Instead, it merely calculates those people who currently receive unemployment benefits. Once a person hits the extension limit (99 weeks in many states on his benefits, he is removed from the rolls, and is no longer counted in the “official” unemployment percentage. While Barack Obama and MSM pundits are quick to point out the drop in jobless to 8.3%, what they conveniently fail to mention is that MILLIONS of Americans have been unemployed for so long that they have been removed from the statistics entirely, and this condition is what has caused the primary fall in jobless percentages, not burgeoning business growth.
Roughly 11 million Americans who are jobless have nonetheless been excluded from the statistical government tally because of a loss of benefits:
According to the Congressional Budget Office, over 40% of the currently unemployed have been so for over 6 months. It also points out that America is suffering the worst case of long term unemployment since the Great Depression:
http://www.cbo.gov/sites/default/files/cbofiles/attachments/02-16-Unemployment.pdf
More than 10.5 million people in the U.S. also receive disability payments, which automatically removes them from the unemployment count, making it seem as though jobs are being created, rather than lost:
http://www.foxnews.com/politics/2012/02/19/report-millions-jobless-file-for-disability-when-unemployment-benefits-run-out/
Around 8.2 million Americans only work part time, meaning they work less hours than are generally considered to be necessary for self-support. These people are still counted as “employed” even if they work a few hours a week.
True unemployment, according to John Williams of Shadowstats, is hovering near 23%:
http://www.shadowstats.com/alternate_data/unemployment-charts
Combine these circumstances with the ever weakening dollar, price inflation in foods and other commodities, and rocketing energy costs, and you have an economy that is strangling the life out of the middle-class and the poor in this country. It is only a matter of time before the populace begins searching for alternative means of subsistence, even if that entails “illegal” activities.
Government Cracking Down On Freedom Of Trade
I was recently walking through the parking lot of a grocery store and ran into a group of women huddled intently around the back of a mini-van. One of the women was reaching into a cooler and handing out glass containers filled with milk. I approached to ask if she was selling raw milk, and if so, how much was she charging. Of course, they turned startled and wide eyed as if I had just stumbled upon their secret opium ring. Somehow it had slipped my mind how ferocious the FDA has become when tracking down raw milk producers. The fact that these women were absolutely terrified of being caught with something as innocuous as MILK was disturbing to me. How could we as a society allow this insanity on the part of our government to continue?
That moment reminded me of the utter irrelevance of petty law, as well as the determination of human beings to defy such law.
The Orwellian hammer has been thrust in the face of those who trade in raw milk, organic produce, and herbal supplements, while small businesses are annihilated by government dues and red tape. In the meantime, law enforcement officials have been sent strapped to shut down children’s lemonade stands (no, seriously :
http://www.cbsnews.com/2100-500164_162-20079838.html
Government legislation which would give the FDA jurisdiction over personal gardens has been fielded. Retail gold and silver purchases of over $600 are now tracked and taxed. The IRS even believes it has the right to tax barter exchanges, even though they do not explain how bartered goods could be legally qualified as “income”, or how they can conceive of ever being able to trace such private trade:
http://www.irs.gov/newsroom/article/0,,id=205581,00.html
Want to choose what kind of currency you would like to use to protect your buying power? Not if the Department Of Justice’s Anne Tompkins has anything to say about it. After the railroading of Liberty Dollar founder Bernard von NotHaus, she stated:
“Attempts to undermine the legitimate currency of this country are simply a unique form of domestic terrorism…”
“While these forms of anti-government activities do not involve violence, they are every bit as insidious and represent a clear and present danger to the economic stability of this country,” she added. “We are determined to meet these threats through infiltration, disruption, and dismantling of organizations which seek to challenge the legitimacy of our democratic form of government.”
http://www.fbi.gov/charlotte/press-releases/2011/defendant-convicted-of-minting-his-own-currency
As our economic situation grows increasingly precarious in this country, more and more people will turn towards localized non-corporate, non-mainstream business methods and products. And, the government will no doubt attempt to greatly restrict or tax these alternatives. This mentality is driven in part by their insatiable appetite for money, but mostly, it’s about domination. They do what they do because they fear decentralized markets, and the ability of the citizenry to conceive of choices outside the system. Slaves are not supposed to choose the economy they will participate in…
A “black market” is only a trade dynamic that the government disapproves of, and the government disapproves of most things these days. Frankly, its time to stop worrying about what Washington D.C. consents to. They have unfailingly demonstrated through rhetoric and action that they are not interested in the fiscal or social health of this nation, and so, we must take matters into our own hands.
Black Market Advantages
If the events in EU nations such as Greece, Spain, and Italy are any indication, the U.S., with its massive debt to GDP ratio (real debt includes entitlement programs , is looking at one of two possible scenarios: default, austerity measures, and high taxes, or, hyperinflation, and then default, austerity measures, and high taxes. In the past we have mentioned barter networking and alternative market programs springing up in countries like Greece and Spain allowing the people to cope with the faltering economy. Much of this trade is done away from the watchful eyes of government, simply because they cannot afford the gnashing buffalo-sized bites that bureaucrats would take from their savings in the process. When a government goes rogue, and causes the people harm, the people are in no way obligated to continue supporting that government.
Black markets give the citizenry a means to protest the taxation of a government that no longer represents them. In a country stricken with austerity, these networks allow the public to thrive without having to pay for the mistakes or misdeeds of political officials and corporate swindlers. In a hyperinflationary environment, black markets (or barter markets that have been deemed unlawful , can be used to supplant the imploding fiat currency altogether, and energize community markets that would otherwise be unable to function. Ultimately, black markets feed and clothe the grassroots movement towards economic responsibility, and every man and woman with any sense of independence should rally around this resource with the intention to fight should it ever be threatened.
“Legality” is arbitrary in the face of inherent conscience, or what some call “natural law”. Without arbitrary legality, and unjust and unwarranted regulation, many federal alphabet agencies would not exist, including the FDA, the IRS, the EPA, the BLM, etc. These institutions do not matter. What they say has no meaning. What matters is what is honorable, what is factual, and what is right. Our loyalty, as Americans, is to our principles and our heritage. Beyond that, we don’t owe anyone anything. A black market in one place and time is a legitimate market in another. For now, private localized trade is able to flow with only minor interference, but there will come a day when even the most practical and harmless personal transactions will be visited with administrative reproach and vitriol. Alternative market champions will be accused of “extremism”, and undermining the mainstream economy. We will be vilified as separatists, isolationists, terrorists, and traitors. I believe it will be far more surreal than what we can possibly imagine now.
They are welcome to call us whatever they like. Honestly……who cares? Let the paper pushers do their angry little dance. The goal is freedom; in life, in politics, and in trade. If we do not change how this country does business ourselves, the results will be far more frightening than any government agent at our doorstep, and the costs will be absolute…
Women diagnosed with cervical cancer through a smear test “have a far better chance of being cured than women who do not go for tests,” BBC News has today reported.
The news is based on Swedish research that looked at 1,230 women diagnosed with cervical cancer, examining patterns between how their disease was detected and how likely it was they would be cured and survive. Following them for an average of 8.5 years after diagnosis, it found that the cure rate was 92% among those whose cancer was detected through cervical screening and 66% among those who were diagnosed after they developed symptoms. Of note, they found a lower chance of being cured among women with symptoms who were overdue for screening.
These findings are perhaps unsurprising, as women who have developed cancer symptoms generally would be expected to have a more advanced stage of cancer than women whose cancer is detected at screening and is not yet causing them symptoms. As such, women identified through symptoms, rather than screening, may be expected to have a lower chance of being cured. The study’s results support the value of the UK’s current cervical screening programme and the importance of attending screening.
Where did the story come from?
The study was carried out by researchers from Uppsala University, the County Council of Gavleborg and other institutions in Sweden. Funding was provided by grants from the Swedish Cancer Society, the Swedish Foundation for Strategic Research, the Gavle Cancer Fund, and the Centre for Research and Development, Uppsala University and the County Council of Gavleborg. The study was published in the peer-reviewed British Medical Journal.
News coverage has reflected the findings of this research.
What kind of research was this?
This was a nationwide population-based cohort study looking at whether detection of cervical cancer through screening improves cancer cure and survival rates. Cure rates are of particular interest as it has been suggested that cervical screening may have the apparent effect of prolonging survival times simply because the cancer is detected at an earlier stage than it otherwise would have been (i.e. screening could cause women to just live for longer with a diagnosis of cancer . If screening actually improves cure rates this would be an important finding (though arguably this could still be just because being diagnosed at an earlier stage the cancer is more likely to be curable .
Using a cohort study to answer this question has some limitations, as the outcomes in a cohort study may be influenced by other health and lifestyle differences between those women who chose to attend screening and those who did not. These differences may be the cause of any relationship seen, meaning in this case we cannot be certain that screening is the only factor affecting survival rates.
Ideally this sort of question would be addressed using a randomised controlled trial that randomised people into different screening practices and then followed them up over time looking at cancer outcomes and cure rates. However, as cervical screening is already offered in countries such as Sweden and the UK, carrying out a randomised trial that withheld cervical screening would not be considered ethical.
What did the research involve?
The Swedish cervical screening programme invites women for screening every three years among those aged 23-50, and every five years for women aged 51-60. In the UK it is every three years between 25 and 49, and every five years between 50 and 64.
The current study linked all women with cervical cancer in Sweden diagnosed between 1999 and 2001 to the national Swedish causes of death register. The researchers then followed the women to the end of 2006 to check survival in the years following diagnosis.
The researchers analysed women separately according to their age at diagnosis (23-65 years old , including those with a diagnosis more than five years beyond the last invitation to screening (66 years or above . Screening-detected cancers were defined as cancers in women who had an abnormal smear test result recorded between one and six months prior to their diagnosis. The remaining women who did not have an abnormal smear test between one and six months prior to their diagnosis were classed as having had a ‘symptomatic diagnosis’, i.e. a diagnosis based on detectable symptoms rather than screening. Abnormal smear tests taken within one month of diagnosis were also not considered to be screen-detected, as it was considered this might have been part of the diagnostic assessment in women with symptoms of cancer.
The researchers also looked at women with symptomatic cancer who were diagnosed more than six months after their last smear test and outside of the recommended screening interval of 3.5 years if they were under the age of 54; or an interval of 5.5 years if they were 55 or over. These women were considered to be overdue for having their screening test and were compared with women who were not overdue their screening test when they were diagnosed symptomatically.
The outcomes examined were survival rates (survival in the cohort compared with expected survival in the general female population ; and ‘statistical cure’ rates (defined as the women no longer experiencing any greater risk of death compared with the general female population .
What were the basic results?
This cohort of 1,230 women was followed for an average of 8.5 years after diagnosis of cervical cancer. Five years after their diagnoses 440 of the women had died, 373 of these deaths were recorded as being due to cervical cancer (31 died from other cancers, and 36 from a non-cancer cause .
The proportion for women with screen-detected cancer who survived for at least five years was 95% (95% confidence interval [CI] 92 to 97% , whereas for women with symptomatic cancers it was 69% (95% CI 65 to 73% . The cure rate for screen-detected cancers was 92% (95% CI 75 to 98% compared with 66% (95% CI 62 to 70% for symptomatic cancers. This 26% difference in cure rate was statistically significant.
Among women with symptomatic cancers, the proportion cured was significantly lower among those overdue for screening compared to those who had been last screened within the recommended interval (difference in cure 14%, 95% CI 6 to 23% .
Cure proportions were related to the stage of the cancer at the time of diagnosis, but even after taking into account stage at diagnosis, cure rates still remained higher among screen-detected cancers than symptomatic cancers.
How did the researchers interpret the results?
The researchers conclude that screening is associated with improved rates of curing cervical cancer. They note that they cannot rule out the possibility that factors other than screening may have contributed to the differences they observed. They also said that using cure as an outcome removes the problem of ‘lead time bias’ that occurs when looking at length of survival as an outcome of screening (discussed in the conclusion section below .
They recommend that further evaluations of cervical screening programmes should consider using a similar approach of looking at the proportions of women with cancer who are cured.
Conclusion
As the researchers discuss, women with cervical cancers detected by screening are known to have an improved chance of surviving their cancer. The study’s apparent improvement in survival outcome may be partly due to a phenomenon known as ‘lead time bias’, meaning that women diagnosed through screening are simply diagnosed at an earlier stage than they would have been if they waited for symptoms to develop. That is to say, that they might not live any longer, just live for longer knowing they had cancer, having detected it at a point before outward symptoms appear. This cohort study aimed to see whether screening improves cure rates, which the researchers hoped would avoid this problem.
A cohort study isn’t the best type of study design to assess the effect of a screening or therapeutic practice against disease outcome, as in a cohort there may be other health and lifestyle differences between women who chose to attend screening or not. The researchers themselves acknowledge that the possibility of such confounding cannot be ruled out. A more reliable way to assess this question would be a randomised controlled trial that randomly assigned women different screening practices and then followed them up over time looking at cancer outcomes and cure rates. However, as cervical screening is already offered in countries such as Sweden and the UK, blocking women access to cervical screening would not be considered ethical, and such a study is highly unlikely to be approved.
These findings are perhaps unsurprising. Women who have developed cancer symptoms are likely to have a more advanced stage of cancer than women whose cancer was detected incidentally through screening. As such, symptomatic women may have a lower chance of cure than women detected at an earlier stage. The fact that there was a lower chance of cure among symptomatic women who were overdue for screening further supports this.
However, the researchers’ further analyses suggested that this was not simply a case of the cancers being diagnosed at an early stage: though cure rate was related to cancer stage, taking into account stage at diagnosis did not remove the difference in cure rates between screen-detected and symptomatic-detected women. The reasons for this cannot be explained by this study, and as the researchers conclude, further evaluations of the benefit of cervical screening programmes should consider looking at cure proportions.
The UK has a slightly different schedule for cervical screening than Sweden, where this study was carried out. The Swedish cervical screening programme invites women for screening every three years among those aged 23-50, and every five years for women aged 51-60, while in the UK it is three-yearly between 25 and 49, and five-yearly between 50 and 64. This and other differences between the countries may mean that the results may not be representative of the UK. However, they generally appear to support the value of cervical screening programmes and the importance of women attending such screenings.
Analysis by Bazian
Links To The Headlines
Smear tests raise chances of beating cervical cancer to 9 in 10. The Daily Telegraph, March 2 2012
Smear tests 'boost cure chances'. March 2 2012
Links To Science
Andrae B, Andersson TML, Lambert PC et al. Screening and cervical cancer cure: population based cohort study. BMJ 2012; 344
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HARI SREENIVASAN: Three Afghans turned their weapons on NATO troops in Southern Afghanistan today, killing two U.S. soldiers. That makes six American troops killed by Afghan attackers in a spasm of violence since Qurans were burned at a U.S. base. U.S. and Afghan officials said two of today's shooters were dressed as Afghan soldiers. The other was a civilian.
Democrats in the U.S. Senate have defeated a bid to roll back President Obama's policy on birth control coverage. Republicans wanted to let employers and health insurers refuse to pay for contraceptive or other health services on religious or moral grounds.
Utah Sen. Orrin Hatch said it was a matter of protecting fundamental rights.
SEN. ORRIN HATCH, R-Utah: It's the religious commitments of our nation that has made it the greatest nation in the world. And I have got to tell you, those of you who vote against this amendment are playing with fire. Those of you who vote against this amendment are ignoring the Constitution. Those of you who vote against this amendment are wrong.
HARI SREENIVASAN: Democrats rejected that argument. Instead, they said the measure was an assault on women's rights.
California Democrat Barbara Boxer argued, it would open the door to denying access to a host of health services.
SEN. BARBARA BOXER, D-Calif.: They would no longer have to offer breast cancer screenings, cervical cancer screenings. All they have to do is say, oh, I'm really sorry. We believe prayer is the answer. We don't believe in chemotherapy. We believe that, if someone is heavy, they're obese and they get diabetes, we have a moral objection to helping them because, you know what, they didn't lead a clean life.
HARI SREENIVASAN: In the end, the Republican proposal was defeated 51-48.
In economic news, small cars were the sales winners last month. A number of automakers reported today they had double-digit increases for February. Among the Detroit Big Three, Chrysler saw sales jump 40 percent or better, and Ford was up 14 percent, with smaller, gas-efficient models leading the way. General Motors eked out a 1 percent gain.
There were other encouraging signs today. Applications for first-time jobless benefits hit a four-year low last week. And major retailers reported strong February sales.
On Wall Street, the Dow Jones industrial average gained 28 points to close at 12,980. The Nasdaq rose 22 points to close just under 2,989.
Seven Americans left Egypt today, easing a crisis in U.S.-Egyptian relations. The seven work for pro-democracy groups. They had been accused of funding and promoting Egyptian protests against military rule. Sam LaHood, the son of transportation secretary Ray LaHood, was among those who had been detained. Nine other Americans left Egypt before they could be charged.
Those are some of the day's major stories.
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RAY SUAREZ: And now to the Republican presidential campaign, with just a few days before voters across the country weigh in.
Kwame Holman has our report.
KWAME HOLMAN: The candidates largely were focused on the 10 states that vote on Super Tuesday.
But Mitt Romney took time to swing through Bellevue, Wash., hoping to secure a win in tomorrow's caucuses there.
MITT ROMNEY (R : There going to be a bunch of states that are going to make their mind up in the next couple of days, but you guys are first. And so your voice is going to be heard.
(CHEERING AND APPLAUSE
MITT ROMNEY: It will just make a big difference, so please make sure and go to the caucus site.
(CHEERING AND APPLAUSE
MITT ROMNEY: Get your friends to do the same thing.
KWAME HOLMAN: Ron Paul also was in Washington, speaking in Spokane.
REP. RON PAUL, R-Texas: You know, things have been going very well, but we keep coming back to Washington because we expect to do real well here.
(LAUGHTER
(CHEERING AND APPLAUSE
KWAME HOLMAN: From the Pacific Northwest,
Romney headed to Ohio, a critical Super Tuesday prize, where Rick Santorum held a small lead in a new poll.
Santorum appealed for support today in Chillicothe.
RICK SANTORUM (R : We have a chance to make a statement that we want someone who is a conservative in their heart, in their soul, in their mind, someone who's not afraid to stand up and talk about all of the issues.
KWAME HOLMAN: In a press release, but not on the stump, Santorum also criticized Romney for a 2002 video. It showed him campaigning for governor of Massachusetts and boasting about getting federal funds, something he's slammed Santorum for in the past.
MITT ROMNEY: The money is in Washington. And I have learned from my Olympic experience that, if you have people that really understand how Washington works and have personal associations there, you can get money to help build economic development opportunities.
KWAME HOLMAN: Meanwhile, Newt Gingrich campaigned again in Georgia, the state he once represented in Congress. He went after both Romney and Santorum.
NEWT GINGRICH (R : Unlike Gov. Romney, I'm not going to go to Washington to manage the decay. And unlike Sen, Santorum, I'm not going to Washington to join the team. I want to create a new team called the American people who force dramatic bold, dramatic change on Washington.
KWAME HOLMAN: Georgia shaped up as a must-win for Gingrich in his bid to stay alive in the Republican race.
JEFFREY BROWN: And that brings us finally tonight to the analysis of Shields and Brooks, syndicated columnist Mark Shields and New York Times columnist David Brooks.
Welcome, fellows.
MARK SHIELDS: Jeffrey.
JEFFREY BROWN: Now,
last week, when you sat here, it was Mitt Romney must win Michigan.
He did.
How important was it, David?
DAVID BROOKS: It was important. And it makes him the presumptive nominee, I think, again. And so I think it was partly his victory, but mostly Santorum's defeat.
JEFFREY BROWN: In what sense?
DAVID BROOKS: Well, I think Santorum had a head of steam going, but then he went down into social conservative territory in that final week.
And so you see the wall building around his campaign. He had the social conservatives, but he sort of lost some outreach to people outside that ideological vanguard. And that sort of hemmed him in. And so if you look especially among women, Republican women went more for Romney.
And so we have a classic confrontation which we have seen in races before, where Santorum has the more downscale voters, Romney the more upscale. And overall there are just more Romney type of voters than there are Santorum voters. That doesn't mean it will be the case in Ohio. Ohio is a little like Michigan, but a little more downscale. So Santorum may be able to pull something off in that state.
JEFFREY BROWN: All right, before you get to Ohio, what is your read on Michigan? How important. . .
MARK SHIELDS: Rick Santorum blew his chance. He will look back on Michigan as the missed opportunity of his public career - David's right -- by his dwelling on issues, abandoning the very narrative that had brought him to where he was, the grandson of the miner, the blue-collar Republican who was concerned with manufacturing, with those who weren't part of the country club set.
And he did that. This isn't a man who doesn't have a chip on his shoulder. He has a two-by-four on his shoulder. And he goes after the president on -- accused him of snobbery for wanting people to go to college and people wanting their children to go to college. And many of the people he's trumpeting as heroes, those who spend long days in difficult physical labor, want -- most want their children to go to college.
And then doing the unthinkable,
attacking the icon of John Kennedy before the Houston ministers when, at a time of anti-Catholicism in the country, when there was a lot of it, he, the first Catholic ever elected, had to go into foreign, alien territory and make the case that the pope wasn't packing up to move to the White House, and accomplished it without losing his integrity, saying that made him throw up, that sort of stuff was just -- it's not kind of thing you expect in a bad lieutenant governor's race, let alone a good presidential race.
JEFFREY BROWN: So now we look forward to Super Tuesday and Ohio. And you saw Kwame say Rick Santorum seems to have a slight lead there.
DAVID BROOKS: Right.
JEFFREY BROWN: So what are the stakes there now for him?
DAVID BROOKS: Slight, though diminishing. So, Santorum had a much bigger lead. It's sort of narrowed since the Michigan win.
I fundamentally think right now Romney can afford to lose Ohio. He's going to lose a bunch of states, probably, some of the Southern states. And so I think he can afford to do that, because he's basically established two things, first, as I say, a sort of identity with the upscale Republican voters, of whom there are a lot just in state after state.
And, second, he tends to be acceptable to different -- almost all parts of the party. Among pretty conservative voters, he does okay, among mainstream voters, among moderate voters. There's a -- very conservative, he doesn't do okay. But among the center of the party, he does okay.
So, he's in the enviable position of being able to survive some defeats. The downside for where he is right now is that he has lost what he had a month ago, which was a clear narrative of who he was that was appealing to independents. He has now become much more conservative, has a tax plan that is much more filled with debt, because it really doesn't pay for the tax cuts. And so he has made himself a weaker candidate for the general election.
JEFFREY BROWN: Now, what of Ron Paul, Newt Gingrich, and Santorum himself? You said. . .
MARK SHIELDS: Sure.
JEFFREY BROWN: . . . Romney can afford to lose.
Can they afford to lose?
MARK SHIELDS: Yeah, I'm not sure he can afford to lose, because I think it saps enthusiasm.
That little video that Kwame showed in the setup piece of Mitt Romney in 2002 talking about raiding the public treasury, looking like Don Draper out of Mad Men, didn't he? I mean, really, a striking similarity.
(LAUGHTER
MARK SHIELDS: But that undermines his narrative against Santorum and Gingrich.
JEFFREY BROWN: Who is the insider?
MARK SHIELDS: They're the insider. They're the ones who are corrupted by all those years on the banks of the Potomac and staying inside the cloistered Beltway, and he was the outsider, the white knight. It was a little bit tarnished.
Ron Paul has to win somewhere. People ask, what's his motive? Does he want a convention speech? I don't know what his motive is. I think he wants to influence policy. I think he wants some vindication. He is the only candidate in the field, Jeff, who has not had to revisit his positions, has not had to rewrite his record, has not had to try to repudiate past statements. He's been consistent.
But he's got to win. And Washington State, where he finally is going after Romney, as well as both Gingrich and Santorum, it may be his best chance. Idaho, he's -- they're spending some resources on. Newt Gingrich has to win Georgia. He probably -- it looks like a three-way race. Santorum is giving him a real tussle there.
But he needs -- he really needs a victory in Georgia, and an impressive victory, too.
JEFFREY BROWN: You see the same stakes for. . .
DAVID BROOKS: I guess I do.
I'm not sure Ron Paul has to win as much. I think if he can rack up delegates -- and he's paying a lot of attention to delegates -- if he can just get a lot of delegates, he'll emerge at the convention. There will be a lot of people on the floor with Ron Paul signs. And I think that's more or less what he wants in terms of future, influencing the party.
Gingrich, he has said he has to win Georgia. But he still has this money sitting out there. And the oddity of the thing is, because of Citizens United and all these super PACs, candidates who lose, as long as they have a couple rich billionaires, or maybe even only one, they can keep going.
And so the perversity of Citizens United is, it prolongs primary campaigns. It makes them tougher and uglier for the party. And the real perversity is in the short term. I don't know how it will be election after election. Right now, it's all helping Barack Obama by making the Republicans mutually unattractive.
JEFFREY BROWN: Well, let's turn to him. He was out in the country this week, a big speech to the UAW. And part of the narrative for him seems to be, look, things are getting better.
MARK SHIELDS: It did.
I think the president would like to keep the Ohio and Michigan primaries going in perpetuity. . .
(LAUGHTER
MARK SHIELDS: . . . because, you know, as one leading Republican in Ohio told me who was out there this week, he said the auto thing is working for him here. It helps the president.
JEFFREY BROWN: He was able to say, we went in and we did something.
MARK SHIELDS: Yeah. There's not a lot of mention about other, necessarily, initiatives, but this is one that Americans celebrate, each day, the further good news from the auto industry.
And the president, I would -- don't think it's morning in America. It's no longer midnight in America, and maybe there's a hint of dawn, but I think so that there's a little bit of getting ahead of the story. But I think things are improving, and that's good. I think identifying with optimism is always good for any leader, and picking up on the sound that Clint Eastwood articulated so well at the halftime of the Super Bowl, I think building on that, with the reality of what's working in both Michigan and in the Midwest in general, and Ohio in particular.
JEFFREY BROWN: Does the president have to be careful with this message because of potential dangers ahead?
DAVID BROOKS: Well, yes, obviously. He lauded the Chevy Volt, and Chevy just announced the Volt is suspending production for I think five weeks because of slow sales. So you do have to worry about getting out in front.
And I would say the political mood has gotten a little out in front. There's a mood now that Obama is cruising to victory, the Republicans are sunk.
JEFFREY BROWN: Really? I mean, you sense that?
DAVID BROOKS: Certainly, a lot of Republicans feel that, and even a lot of Democrats are beginning to feel, oh, yes, we're going to win this thing.
And that's too far out front. If you still look at fundamentals, is the country headed in the right direction, they're still very negative. If you look at things like the economy may slip back, there's still some expectation of slow growth for the remainder of the year.
So, the mood has shifted a little too far. I had a very smart friend who's a Democratic consultant said, Romney is going to look dead six times between now and November, but he will keep drifting back, because fundamentally the country really does want change, and Obama's central policies, health care, stimulus, are still fundamentally unpopular. And so things will look bad for Republicans, but it's too soon to say. . .
JEFFREY BROWN: Well, is it your sense that the Obama folks in the campaign know this, that they can't get too far ahead of themselves?
MARK SHIELDS: I think there is.
But they've been down so long, that, now that they're up, they're feeling pretty good, I think. I agree with David. But sort of the conventional wisdom, Jeff, just a matter of four months ago was that Obama was gone. Republicans were quite bullish. In private, they would talk about they couldn't wait to get him.
Now those same Republicans are pretty glum. I mean, they've found that Romney has not caught on. After two campaigns, he still stumbles as he did over the question about the Roy Blunt amendment in the Senate this week. He's did that -- he's done it time and again. This was on the -- in the aftermath of his great victories in Arizona and Michigan.
He comes into Ohio and stumbles on that. So there's a certain loss of confidence there. But I don't think there's any question David's right that, between $5-a-gallon gasoline, and Democrats will not be nearly as bullish.
JEFFREY BROWN: All right, just a couple of minutes left, but just to pick up on that, because while we're talking about domestic events, in the meantime, the world is too much with us, as Wordsworth put it, right?
Syria, we just talked about at the beginning of the program, Afghanistan, Iran, a meeting with Benjamin Netanyahu for the president coming up, how do all these things bubble up into the world that we're talking about of politics and. . .
DAVID BROOKS: Well, first, thanks for bringing Wordsworth into it. You've elevated our tone here.
JEFFREY BROWN: I'm doing the best I can.
(LAUGHTER
DAVID BROOKS: Yes. It's tough.
Well, to me, the most important thing globally that Barack Obama did this week was give an interview to Jeffrey Goldberg of The Atlantic where he talked about Iran. And what was striking about the interview was, he said, it's unacceptable, in terms I think bolder than he's ever used before, for Iran to get a nuclear weapon. It will not happen.
And he really sent the message to Israel, we have got your back and we're not bluffing.
JEFFREY BROWN: Strong words.
DAVID BROOKS: And so part of that was to hold the Israelis off from doing anything rash.
But part of it really was laying down red lines, as they say. And it was quite a bold, quite a sophisticated interview. It's worth reading online, but quite a bold statement by the president, saying, it's not going to happen. It's just not going to happen.
JEFFREY BROWN: This is ahead of a meeting, the AIPAC meeting. . .
JEFFREY BROWN: The AIPAC meeting and a meeting with Benjamin Netanyahu on Monday.
JEFFREY BROWN: Right. Right.
MARK SHIELDS: I agree.
I thought the interview is well worth reading. But the president, I thought, was just sending a message to both sides that we're serious about this, both Iran and Israel. Israel, don't act. And, Iran, you better be very careful.
At the same time, we're looking at our third potential war -- at least, that's being rumored -- in 11 years. And is it too much to ask that we have a public debate on this, that it not be conducted in interviews with distinguished journalists or just on speculation?
I mean, is it too much too ask that the president make a case for sending Americans into harm's way, and that the Congress of the United States, especially with this fever about the Constitution and return to the Constitution, that maybe declaring war or debating whether we go to war is timely?
It's just -- this is -- you know, we seem to be just sort of elliptically heading into a confrontation, and a serious one.
JEFFREY BROWN: But your sense is that now is the time to have that?
MARK SHIELDS: Now is the time to have it. I really do believe that.
JEFFREY BROWN: Is it. . .
DAVID BROOKS: You know, I agree with that. I don't think short-term sanctions are going to work to deter Iran.
I'm very dubious about bombing Iran. I don't think anything's going to work, to be honest. So, I assumed, well, we just learn to live with a nuclear program. But, apparently, that's not going to happen.
JEFFREY BROWN: All right, David Brooks, Mark Shields, as always, thanks a lot.
MARK SHIELDS: Thank you.
A new way of processing embryos during IVF treatment can improve the chances of pregnancy by more than a quarter, The Daily Telegraph today reported.
The story is based on research evaluating a new system for incubating newly fertilised embryos during IVF treatment. The new system is designed to protect the growing bundles of cells from environmental stresses that might affect their development. In conventional systems, the embryos had to be transferred between different devices to perform all the various stages of IVF treatment, but the new system allows a range of functions to be performed in a single sealed unit that regulates the temperature and quality of the air around them. This research found that in the conventional system 30% of embryos successfully developed to the ‘blastocyst stage’, which is seen five or six days after fertilisation, compared with 40% in the new system. The new system was also associated with an increase in clinical pregnancy rates during the period that it was introduced.
The findings are interesting, but they do not add up to an IVF “ breakthrough”, as is suggested by The Daily Telegraph. The new method of incubating embryos sounds promising, but no randomised trial has yet been undertaken into its effectiveness. Further good research is needed to investigate whether it can improve pregnancy and live birth rates.
This method of culturing embryos in a laboratory for five to six days after fertilisation before implantation in the womb is called blastocyst transfer. Transferring the fertilised embryo to the womb two to three days after fertilisation is called embryo transfer.
Where did the story come from?
The study was carried out by researchers from Newcastle Fertility Centre, University Hospital of North Tees, Northumbria University and Newcastle University. It was funded by the Medical Research Council. The study was published in the peer-reviewed journal Public Library of Science (PLoS ONE .
The study’s findings were overplayed by the papers. The Daily Telegraph reported that it could increase pregnancy rates by more than one quarter. This is a measure of relative increase, highlighting that the number of successful pregnancies rose by around 25%. However, it is more useful to look at the ‘absolute’ figures, which describe how many people actually conceived out of all those people that used IVF. The absolute increase in clinical pregnancy rates associated with the new system was actually about 10%, with IVF leading to pregnancy in 32-35% of participants in the years before the new system was introduced, and this figure rising to 45% in the year the new system was introduced.
Also, it is not clear if other improvements in IVF occurred over this period and whether these contributed to the increase in successful pregnancies. The Daily Mail misleadingly reported that the new method gave a 40% greater chance of success.
What kind of research was this?
This research reports on various studies relating to the development of a new system of culturing embryos in the laboratory, designed to improve their viability and, eventually, the chances of successful pregnancy.
The authors point out that culturing embryos for implantation into women typically involves the use of open-fronted microbiological safety cabinets, with standalone incubation chambers. This means embryos may need to be removed from the incubator to check on their development in the safety cabinet. This can expose them to changes in temperature and air quality, as well as chemical contaminants, all of which may disrupt cell processes that are key to development.
To protect embryos from the possible impact of environmental stresses, the researchers developed a new fully enclosed chain of pressure-sealed workstations featuring integrated incubators and built-in microscopes, allowing them to incubate and examine developing embryos all within a single apparatus. The workstations were designed to link to adjacent treatment rooms in which women had their eggs retrieved and embryos implanted. The system is designed to provide a controlled environment from the time eggs are harvested from the woman’s ovary until embryos are transferred to the womb.
What did the research involve?
The authors undertook three pieces of research:
- They compared the temperature and air quality of their new enclosed system and the old open system in three separate laboratory experiments.
- They compared embryo development in the enclosed system with that in the conventional system, using mouse embryos.
- They compared the development of human embryos before and after the installation of the new systems.
They then collected data on patients during the period when the new equipment was being fitted and validated. They used this to compare pregnancy outcomes in three consecutive groups of patients - those who had treatment when conventional open-fronted cabinets were used, those who were treated when a temporary laboratory using conventional equipment was in use and those who were treated when the refurbished laboratory using the new enclosed system was in place. To control for differences between patients, they confined their analysis to couples undergoing their first treatment cycle, in which the woman was 37 years or less and had had 10 egg follicles harvested.
What were the basic results?
In their preliminary research they found that the enclosed system was more successful at maintaining temperature and air quality than the conventional system.
- They found that the proportion of human embryos that had developed to the ‘blastocyst stage’ by day seven was 30% for the open system, compared with 40.1% in the new enclosed system. An embryo is called a blastocyst once it has developed for five to six days after fertilisation.
- They say analysis of 600 embryos revealed that the increased rate of blastocyst formation coincided exactly with the change from the open to the enclosed system.
- They also found that embryos produced in the new system contained significantly more cells and had ‘accelerated development’ compared with those cultivated in the open-fronted system.
- Experiments with mouse embryos cultured in the two systems also showed more embryos developing to the blastocyst stage under the enclosed system than in the conventional system.
- Finally, when they compared groups undergoing treatment at different times they found that those treated in the enclosed system had a clinical pregnancy rate of 45.3%, compared with a rate of 32.2% for those treated when the conventional system was in place. A rate of 35.6% was seen while the temporary laboratory was in use. A clinical pregnancy was defined as a heartbeat on a scan at seven weeks' gestation.
How did the researchers interpret the results?
The new enclosed system, say the researchers, protects embryos from changes in temperature and air quality and promotes improved development.
Conclusion
The new system of culturing embryos sounds like a promising development but further research involving couples undergoing IVF treatment is required to assess whether it improves pregnancy and live birth rates. In particular, the patient data offered by the researchers were not taken from participants in a controlled trial, which means that many other factors might have affected pregnancy rates.
As the authors point out, improved outcomes over this period might have been due to a general improvement in assisted conception procedures during the period of the study, although they say they tested for this possibility.
This may well prove to be a useful technique for IVF, and the researchers have demonstrated its feasibility. More research with a control group of patients is needed before we can be certain of its benefits and lack of harms.
Analysis by Bazian
Links To The Headlines
IVF breakthrough improves pregnancy chances by a quarter. The Daily Telegraph, March 1 2012
New IVF method gives 40% more chance of success: Lab mimics conditions in the womb. Daily Mail, March 1 2012
Links To Science
Hyslop L, Prathalingam N, Nowak L et al. A Novel Isolator-Based System Promotes Viability of Human Embryos during Laboratory Processing. PLoS ONE 7(2 : e31010
When I was asked by a small organic farmer in California what the implications were of the 2011 O104:H4 European outbreak, I said it could happen here. It also could have worse consequences here.
Let's review the O104:H4 outbreak conclusions:
In Germany there were nearly 4,000 cases, 54 deaths and 845 cases of hemolytic uremic syndrome (HUS -- unusually, mainly in adults (1 (2 .
One hundred percent of the German O104:H4 cases were associated with the production of fenugreek sprouts on a single organic farm in Lower Saxony, with regional distribution centered on Hamburg. The organic farm was found to have satisfactory sanitation and proce- dures and is back in operation.
The epidemiological evidence indicates that a particular lot of fenugreek seed, sold from or produced in Egypt, had become contaminated with this highly unusual outbreak strain. The same outbreak strain was associated with a secondary outbreak in France, also linked to fenugreek sprouts from the same seed lot, but produced as children's projects and served at a local festival.
Where it starts getting more complicated is that sampling for O104:H4 found no positive results from fenugreek seed lots. There also were no positive results from tens of thousands of environmental samples taken during the post-outbreak investigation, although contaminated sewage and streams were found during the outbreak period. The conclusion was that much better culturing methods were needed for tracking the environmental presence of this pathogen.
Partially confirming data on O104:H4 having a regional origin comes from European tourists, who have become infected with related, but not identical O104:H4 strains after trips to Turkey, Egypt, Tunesia and Afghanistan (3 . This supports the idea of regional endemic sources of O104:H4, but not where and how the fenugreek seeds were actually contaminated.
The Egyptian Ministry of Agriculture strongly objected to the identification of Egyptian seeds as the outbreak source in the absence of positive detection of the outbreak strain.
That is where things stand now, with clear identification of the food carrier and the source farm, but with some ambiguity as to the ultimate root cause of the outbreak and the specific mechanism of contamination.
The primary role for epidemiologists and public health officials during a foodborne outbreak, like the O104:H4 outbreak in Germany and France, is to stop the epidemic. If an intervention stops the outbreak, then the identification of the cause is verified. Identification is based on epidemiological evidence; and direct detection is a kind of luxury of evidence. The tools they use have been developed primarily for this purpose, and may be less useful in determining other aspects, such as the search for confirmation of root causes and mechanisms of contamination.
How did the context in Germany shape the investigation and outcome in ways that might be different from the U.S.?
When O104:H4 infections hit Germany, the first "vegetables of interest" were E. coli-contaminated organic cucumbers from Spain, revealed publicly before there was confirmation that the E. coli did not match the outbreak strain. This was curious because of the lack of any outbreak -- O104:H4 or other -- due to the same two suppliers in Spain itself. Not that any pathogen finding is good, but at least one of the sources was told his cucumbers were seen spilled on the ground at the Hamburg Central Produce market. Perhaps even the non-outbreak pathogens were not due to the farm source. Spanish farmers and the Spanish government saw this as lingering prejudice against Spain.
European Union and German payments were later made to partially compensate Spanish growers.
In contrast, as far as I can tell, there have been no EU lawsuits against the farm for the actual outbreak. So what would be a strict liability case in the U.S. appears to be neither negligence nor foreseeable under the German equivalent law.
There were at least two cultural presumptions, also different in Germany from the U.S. that may reinforce this. Organic appears to be regarded as naturally safer, to the point where the Health Minister was quoted as saying "Of course we know that organic is not really safer." And fenugreek sprouts were part of a common elaborated sprout cuisine in which sprouts are perceived as a natural healthy food.
U.S. epidemiologists seemed stunned that raw sprouts were not on the top of the list for food surveys in the case/control studies, given the outbreak histories for sprouts. German epidemiologists initially thought including sprouts would only create false positives in case/control studies because sprouts, in general, are so common a food item.
A CDC-FDA-state investigation of a similar outbreak here in the United States would focus more quickly on sprouts given the long history of sprout outbreaks. But perhaps the greatest difference in attitudes is toward organic farming.
Why should Europeans perceive organic farming as safer than conventional agriculture? A substantive reason is that the rules elaborated for organic animal production may provide better protections against transmission of human pathogens, both in the U.S. and the EU. Here I will use U.S. examples.
The Organic Foods Production Act (OFPA , passed in 1990, created the National Organic Program (NOP . Labeling was the basis of the law, that food be correctly identified as organic, but that was the hook for protecting the word "organic" and defining the farming practices.
The U.S. rules for organic compost, in an abundance of caution, were based on EPA guidelines for the use of human waste. This was supposed to provide a wide margin of safety for the use of animal manures. In many studies of E. coli O157:H7 or surrogate pathogen survival under these rules, undertaken since the spinach crisis, it appears that there is a margin of safety even for these STEC but it is not particularly wide.
Organic rules prevented the re-feeding of waste meats from slaughter, including brains and nervous tissue, long before mad cow (BSE emerged, They ban the non-therapeutic use of antibiotics. They ban the use of dried cow manure as dairy bedding. They require more adequate space for animals and birds so that, for example, de-beaking of chickens is not allowed, or needed due to the insanity produced in birds from overcrowding in a stimulus- deprived environment. The overcrowding of birds, or cattle in CAFOs, may facilitate disease transmission and therefore, in some CAFOs, the routine use of antibiotics, but there also are ranchers who buy antibiotics by the multi-gallon tote without confining their cattle. Most antibiotic sales (by volume are for animal use in agriculture, between 70 - 80 percent (4 .
Organic rules ban the re-use of manures as animal feed.
Last summer, when I was working with a "medium-sized" organic vegetable producer, the price of composted chicken litter (for organic fertilizer had gone through the roof because of increased demand for pelleted chicken litter in cattle feeding. Thanks in part to the California Leafy Green Marketing Agreement rules, at least there is now research interest in how exactly to pasteurize different manures for conventional agriculture [for Salmonella, see (5 ].
Since it is not an obvious step to feed brains or manure back to cattle, where did this come from? As far as I can tell, many of the changes in conventional animal production after World War II were driven by economists looking for efficiencies in production, without considering biology. They looked at the nitrogen content of manure, for example, and saw inefficiencies in cattle digestion (! which could be re-captured, rather than fertilizer for soils (6 .
All of these factors had to be specifically banned in organic animal production either be- cause they were once routine, or still are routine, in U.S. conventional agriculture. They all could play a role not only in the transmission of human pathogens but in the selection and evolution of more dangerous pathogens: by multiplying and spreading pathogens in closed biological systems, by acting as selection systems for antibiotic resistance and increased tolerance of acidity and other stresses, and by favoring selection for lateral transmission of groups of pathogenicity traits between pathogen species.
Even when there is an underlying substantive basis, EU positive attitudes toward organics may be due more to complex cultural attitudes than to substance.
Food safety criticisms of organic that I hear or read in the U.S. are often based on a failure to understand that most agricultural manures go into conventional agriculture, and for decades only organic agriculture had rules that were specifically designed to prevent human pathogen transmission (7 . There is nothing to prevent conventional agriculture from using similar approaches, and sometimes there is a convergence toward safety.
What are some contrasts we could expect in a similar outbreak in the U.S.?
U.S. epidemiologists might identify a sprout-caused outbreak more quickly, and limit the duration of the outbreak.
There would be great differences in the cost of paying for health care, and who is liable for payment.
There would be no compensation to farmers who were misidentified as growing an outbreak crop. There would be no exemption from liability for the farm that caused the outbreak, because they have strict liability for putting out adulterated food.
There would be no presumption that "organic is safer." There are still major constituencies for whom organic production is an ambiguous, minor but often irritating fact of life in farm and food production industries. They could condemn an outbreak as due to being organic (8 , rather than despite being organic, as in the EU.
A final question from the O104:H4 outbreak: what can be done to improve the safety of raw sprouts, whether produced on an organic farm or a conventional farm?
For the actual production process itself there were only two factors: seeds and water. Sprouts were produced with clean equipment in a well-sanitized manner. There is a minimal ecology to sprout production, which may be part of the problem.
Changing from sprouts to greenhouse production of baby vegetables in soil might seem to be a minor change, (let the sprouts grow some true leaves! , but the research on both greenhouse and field production indicates that human pathogen uptake from the soil to plants is highly inhibited, and this can include seed-borne human pathogens.
In a practical sense, sprout safety requires either human pathogen-free seeds specifically produced for sprouting, a kill step that can be used after seeds are sprouted and pathogens are exposed for treatment, or both. People could also cook their sprouts, the original use for soy sprouts from the very beginning of soy as a major food in China (9 .
The rational basis for organics includes an ecological approach to farming and an ap- preciation for the biological opportunities and constraints on and around their farms. Conventional farmers can use the same approaches and often do.
I also see sprout production, and the history of sprout outbreaks in this country, as a metaphor for the current approaches to regulating food safety on farm. There could not be a more simplified system for contained and controlled food production than sprouts,yet it fails repeatedly. Applying the same approaches used in sprout production to the complexity of farms and the farm environment seems both irrational and doomed to fail.
1 Epidemic Profile of Shiga-Toxin-Producing Escherichia coli O104:H4 Outbreak in Germany N Engl J Med 2011; 365:1771-1780 November 10, 2011
http://www.nejm.org/doi/full/10.1056/NEJMoa1106483
(2 STEC Workshop Reporting Group. Experiences from the Shiga toxin-producing Escherichia coli O104:H4 outbreak in Germany and research needs in the field, Berlin, 28-29 November 2011 . Euro Surveill. 2012;17(7 :pii=20091. Available online:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20091Date of submission: 10 February 2012
(3 Eurosurveillance, Volume 17, Issue 4, 26 January 2012 Rapid communications OUTBREAK OF HAEMOLYTIC URAEMIC SYNDROME DUE TO SHIGA TOXIN-PRODUCING ESCHERICHIA COLI O104:H4 AMONG FRENCH TOURISTS RETURNING FROM TURKEY, SEPTEMBER 2011 N Jourdan-da Silva1, M Watrin2, F X Weill3, L A King1, M Gouali3, A Mailles1, D van Cauteren1, M Bataille4, S Guettier4, C Castrale5, P Henry5, P Mariani6, V Vaillant1, H de Valk1
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20065
(4
http://www.wired.com/wiredscience/2010/12/news-update-farm-animals-get-80-of
-antibiotics-sold-in-us/
(5 Appl Environ Microbiol. 2012 Feb;78(4 :1302-7. Epub 2011 Dec 16.Validating Thermal Inactivation of Salmonella spp. in Fresh and Aged Chicken Litter.Kim J, Diao J, Shepherd MW Jr, Singh R, Heringa SD, Gong C, Jiang X.
http://aem.asm.org/content/early/2011/12/12/AEM.06671-11.short?rss=1
(6 The greatest contribution to food safety in the future might be to require biology and microbiology courses for economics students. And there is an interesting possibility that the ethical considerations used in designing organic rules for animals will be shown to also have had long term economic value.
(7 For example, I happened to be at one of the organizing meetings for the CA LGMA when CFSAN investigators revealed that the farm associated with the spinach outbreak was organic in transition. The chief scientist of a major produce organization exclaimed "We were so close!" Perhaps he was under stress. The same attitude came from state senators at a California hearing on the same crisis. "Suppose I don't want my food grown organic with manures." Most outbreaks and recalls are in conventional produce and it looks to me like there are fewer outbreaks due to organics than a proportional expectation would predict.
(8 GMO biotechnology companies sometimes have an ambiguous relationship to organic food production. When they want to avoid labeling GMO crops and foods they can point consumers to organics, where GMO is prohibited. When organic farmers block release of crops like GMO herbicide-resistant alfalfa, they get incensed. The USDA's official position for the last few years has been "people; we can all get along."
(9 See page 296 of H.T. Huang's magisterial Fermentations and Food Science; Volume VI: 5 of the series Science and Civilization in China (Joseph Needham . Cambridge University Press, 2000. The first written documentation of soy sprouts in Chinese history includes the steps: wash after three days and fry in oil.
Visual source:
Newseum
The New York Times sums up the significance of yesterday's vote on the Blunt Amendment, which would have radically curtailed access to health care services for women in America:
Only one Senate Republican — Olympia Snowe of Maine, who is retiring — voted against a truly horrible measure on Thursday that would have crippled the expansion of preventive health care in America. The amendment, which was attached to a highway bill, was defeated on a narrow 48-to-51 vote. But it showed once again how far from the mainstream Republicans have strayed in their relentless efforts to undermine the separation of church and state, deny women access to essential health services and tear apart President Obama’s health care reform law.Louis G. Trubek writes about her experience fighting for privacy rights in the Supreme Court:
The amendment, which was enthusiastically endorsed by Mitt Romney and Rick Santorum, would have allowed any employer or insurance company to refuse coverage for any activity to which they claim a religious or moral objection.
That would have meant that any employer who objects to cervical-cancer vaccines could have refused to provide health insurance that covers them. The same goes for prenatal sonograms for unmarried mothers, or birth control, H.I.V. screening or mammograms.
We can celebrate Griswold, Roe and all the cases that stemmed from the Poe litigation. They are important landmarks in American jurisprudence. But as I look back I am dismayed by how few of the issues I was fighting for at the time of Poe are resolved. To be sure, we have important rights and more legal privacy. But we still have not provided all the support women need to combine rewarding careers and healthy families. Planned Parenthood is under siege and poor women who are seeking comprehensive reproductive care are still at risk. Presidential candidates can get away with saying that all contraception should be outlawed. Comprehensive child care services are difficult to locate, and fully financed family and medical leave is still controversial.Eleanor Clift looks at the attack on privacy and the Blunt amendment saga and argues it's an example of why Republicans won't win the Senate:
A Republican activist who worked on Capitol Hill and who does not want to be quoted says the debate over the availability of contraceptives is “way bigger than a wedge issue” because it goes against settled thought for two generations, and makes the Republican Party look out of touch. “Younger people hear [a debate about contraception] and think those people are Martians. They are unlike me or anybody I know or care about. Republicans risk becoming irrelevant to a whole generation of people, and I include Catholics in that. This is a private matter between a woman, her God, her spouse, and her physician. It’s a crowded enough conversation without government in there.”Carter Eschew at
The Washington Post
:
Twenty-five years ago, Ted Kennedy delivered a speech against Supreme Court nominee Robert Bork that even some liberal opponents of the former solicitor general thought was over the top. It led to the pejorative phrase, "to bork," meaning to assail one's character inaccurately and unfairly.Finally, in a brilliant (non-Blunt column,
When I was reading about the Blunt amendment yesterday, I went back to Kennedy's words about “Robert Bork's America.” “It is a land,” Kennedy thundered, “where women would be forced into back-alley abortions, blacks would sit at segregated lunch counters, rogue police could break down citizens’ doors … and schoolchildren could not be taught about evolution.”
It seems to me that we are actually closer to this dark vision of America than we were in Bork’s day.
Paul Krugman tears aparts the economic blueprints of the four Republican presidential candidates:
Mitt Romney is very concerned about budget deficits. Or at least that’s what he says; he likes to warn that President Obama’s deficits are leading us toward a “Greece-style collapse.”
So why is Mr. Romney offering a budget proposal that would lead to much larger debt and deficits than the corresponding proposal from the Obama administration?
Of course, Mr. Romney isn’t alone in his hypocrisy. In fact, all four significant Republican presidential candidates still standing are fiscal phonies. They issue apocalyptic warnings about the dangers of government debt and, in the name of deficit reduction, demand savage cuts in programs that protect the middle class and the poor. But then they propose squandering all the money thereby saved — and much, much more — on tax cuts for the rich. And nobody should be surprised.
Center for Responsive Politics.
Yet more than half of the 60 food businesses asked last week by U.S. Rep. Louise M. Slaughter (D-NY to release details about
their policies on antibiotics in meat and poultry do not employ Washington D.C. lobbyists.
Being without lobbyists, those companies might not know that the congresswoman with all the questions about antibiotics in food is one of the most powerful members of Congress.
If the Democrats retake control of the House following the November elections, Slaughter will resume the duties she had as Rules Committee chair, determining what gets voted on by the full House. No lobbyist ever wants to get on the wrong side of a Rules Committee chair.
Slaughter's mailing list of leading fast food companies, beef and poultry producers, and grocery store chains is a cross-section of the food industry, and a way to take a snapshot look at current federal lobbying by the food industry.
Food industry lobbying is tracked at the macro level by the Center for Responsive Politics within the overall Agribusiness section. During 2011, agribusiness, including the food industry, employed 1,081 federal lobbyists who were working for 443 clients at a cost of $123.6 million.
But less than half of the agribusiness total can be directly attributed to the food industry.
Food Safety News pulled the lobbyist reports filed in January 2012 for the fourth quarter of 2011. The top 10 are ranked in descending order based on their reported quarterly spending.
Both staff and contract lobbyists are listed, and the issues they are lobbying on are summarized from their disclosure form:
1. Tyson Foods Inc. - $464,837.24
Lobbyists: Charles Penry (Tyson ; James B. Christian (Breaux Leadership Group and Patrick Raffaniello, (Raffaniello & Associates .
Issues: Eliminating corn ethanol tax credit. Ethanol policies, immigration reform. Foreign beef markets, food safety issues, GIPSA and labeling.
2. McDonald's Corporation - $430,000
Lobbyists: Chester "Bo" Bryant, Jr. and Jimmie Williams (McDonald's ; Marc J. Gerson and Rocco V. Femia (Miller & Chevalier ; Justin Gray, William Gray, and Manuel Maribal (Gray Global Advisors ; and Jon Piebani, James Wiltraut, Martin Corry, and David Aimone (Buchanan Ingersoll & Rooney .
Issues: Patient Protection and Affordable Pay Act of 2010 implementation; menu labeling, Food Safety Modernization Act, Federal Trade Commission regulations on food marketing limitations, and other proposals related to nutrition.
E-Verify, restaurant depreciation, international tax reform, comprehensive corporate and individual tax reform proposals. Internet Corporation for assigned names and numbers plan to expand domain names, commercialization of highway rest areas, and food safety proposals (no specific legislation .
Also, debt collection and Securities and Exchange Commission requirements on executive compensation.
3. Cargill Inc. - $360,000
Lobbyists: Anne Murphy, Michael L. Mullins, Anne Knapke, and Bryan Dierlam (Cargill .
Issues: Dodd-Frank implantation as impacting commodity futures, ag competition, GIPSA, Farm Bill policy, bio-based products, biotechnology, the debt limit, general energy policy, biofuels, EPA regulations, cross-state air poluution rules. Food safety, corn sugar policies, sodium, SNAP, school lunch program, child nutrition. Labor, power, waterway issues, foreign trade.
4. Smithfield Foods - $265,000
Lobbyists: L.F. Payne, Louis Finkel, Frank Donatelli, and Mona Mohib (McGuire Woods Consulting
Issues: Opposing the ban on packer ownership of livestock, marketing of livestock and poultry, work on tax issues, trade policies, Farm Bill, biofuels and commodities pricing, ethanol policy, Foreign Sales Corporation and Extraterritorial Income Exclusion, immigration, E-Verify and free trade agreements.
5. Hormel Foods Corporation - $123,076
Lobbyists: Joe Svedberg (Hormel
Issues: Processing, labeling, and safety of food products, FDA and USDA food safety, USDA/FDA Fortification Policy, International Food Assistance Programs, implementation of Mandatory Price Reporting, S 3656, Mandatory Price Reporting Act of 2010, GIPSA Proposed Rule to Implement Livestock Regulations, biofuels policy and animal care.
Also, foreign trade acts, HR 1549 Sub therapeutic antibiotics (entire bill , campaign rules OFCCP Rules, and persuader rules.
6. Starbucks - $120,000
Lobbyists: Lori Otto Punke (Starbucks , Michael Evans, Karishma Page, Patrick Heck, John Godfrey and Daniel Ritter (K&L Gates LLP
Issues: Treatment of foreign income, health care, menu labeling, sodium reduction, foreign trade non-tariff barriers, and Dodd-Frank reform.
7. The Kroger Co. - $90,000
Lobbyists: Brendon Cull (Kroger
Issues: Multi-employer pension laws, on-line sales tax collection, dairy policy and the Farm Bill, menu labeling, SNAP and WIC funding.
8. Safeway - $90,0000
Lobbyists: Robert Jones, Bill Anaya, and Elinor Hiller (Alston & Bird .
Issues: Energy, health care, implementation of food safety legislation, front of package labeling, menu labeling, and FDA funding issues.
Also, tax reform and the U.S. budget.
9. Wegmans Foods - $90,000
Lobbyists: Aubrey Rothrock (Patton Boggs LLP and Lindsay Hooper, Jonathan Talisman, Richard Grafmeyer, joseph Mikrut, William McKenny, Lawrence Willcox, and Christopher Javens (Capitol Tax Partners .
Issues: Legislative and regulatory services related to estate and gift tax reform.
10. Kraft Foods Global Inc. - $50,000
Lobbyists: Randall Russell, Edward Barron, Tyson Redpath and Andrew Harker (The Russell Group.
Issues; Highway reauthorization act, dairy policy reforms in advance of the 2012 Farm Bill, Dairy Policy Act of 2011, implementation of Food, Conservation and Energy Act of 2008, and Healthy and Hunger Free Kids Act of 2010.
Falling just outside the top 10 are tax lobbyists Mathew Schlapp and Frank Sadler, who are contracted through their Cove Stategies to work for Walmart on "e-fairness taxation issues." The pair are the only lobbyists reporting they are doing work for the retail powerhouse at $40,000 per quarter.
Wendy's, Perdue Farms, Pizza Hut and Target are among the food businesses with a $20,000 per quarter contract lobbyist on retainer. National Beef and Taco Bell Franchisees have lobbyists on $10,000 per quarter retainers.
Food businesses on Slaughter's mailing list with no federal lobbyist include: A&W Restaurants Inc., Applegate Farms, Au Bon Pain, Bell & Evans, Blimpie, Bojangle's, Bon Appetit Management Co., Carl Jr's, Chick Fil-A, Chipotle Mexican Grill, Coleman Natural Foods Compass Group, Costco,and Dean & Dulca.
Also with no contact lobbyist on retainer are: Dunkin Donuts, Hardee's, In-N-Out Burgers, Jack in the Box, Jennie O Turkey Store, Murray' Chicken, Niman Ranch, Ozark Mountain Port, Panda Express, Panera, Pilgrim's Pride, Popeyes, Restaurant Associates, Roy Rogers, Sonic, Stoneyfield Farm, Stop and shop, Subways, Sweetgreens and Tim Hortons.
Some, like Applebee's, Domino's Pizza and Trader Joe's, once had federal lobbyists, but no longer do.
Many individual companies may not have their own federal lobbyists because of the strength of the food industry's various trade associations. They are known for both strong lobbying shops and their grassroots networks.
Research by Michael E. Mann confirmed the reality of global warming. Little did he know that it would also expose him to a vicious hate campaign
The scientist who has borne the full brunt of attacks by climate change deniers, including death threats and accusations of misappropriating funds, is set to hit back.
Michael E. Mann, creator of the "hockey stick" graph that illustrates recent rapid rises in global temperatures, is to publish a book next month detailing the "disingenuous and cynical" methods used by those who have tried to disprove his findings.
The Hockey Stick and the Climate Wars
is a startling depiction of a scientist persecuted for trying to tell the truth.
Among the tactics used against Mann were the theft and publication, in 2009, of emails he had exchanged with climate scientist Professor Phil Jones of East Anglia University. Selected, distorted versions of these emails were then published on the internet in order to undermine UN climate talks due to begin in Copenhagen a few weeks later. These negotiations ended in failure. The use of those emails to kill off the climate talks was "a crime against humanity, a crime against the planet," says Mann, a scientist at Penn State University.
In his book, Mann warns that "public discourse has been polluted now for decades by corporate-funded disinformation – not just with climate change but with a host of health, environmental and societal threats." The implications for the planet are grim, he adds.
Mann became a target of climate deniers' hate because his research revealed there has been a recent increase of almost 1°C across the globe, a rise that was unprecedented "during at least the last 1,000 years" and which has been linked to rising emissions of carbon dioxide from cars, factories and power plants. Many other studies have since supported this finding although climate change deniers still reject his conclusions.
Mann's research particularly infuriated deniers after it was used prominently by the UN's Intergovernmental Panel on Climate Change (IPCC in one of its assessment reports, making him a target of right-wing denial campaigners. But as the 46-year-old scientist told the
Observer
, he only entered this research field by accident. "I was interested in variations in temperatures of the oceans over the past millennium. But there are no records of these changes so I had to find proxy measures: coral growth, ice cores and tree rings."
By studying these he could trace temperature fluctuations over the past 1,000 years, he realised. The result was a graph that showed small oscillations in temperature over that period until, about 150 years ago, there was a sudden jump, a clear indication that human activities were likely to be involved. A colleague suggested the graph looked like a hockey stick and the name stuck. The results of the study were published in
Nature
in 1998. Mann's life changed for ever.
"The trouble is that the hockey stick graph become an icon and deniers reckoned if they could smash the icon, the whole concept of global warming would be destroyed with it. Bring down Mike Mann and we can bring down the IPCC, they reckoned. It is a classic technique for the deniers' movement, I have discovered, and I don't mean only those who reject the idea of global warming but those who insist that smoking doesn't cause cancer or that industrial pollution isn't linked to acid rain."
A barrage of intimidation was generated by "a Potemkin village" of policy foundations, as Mann puts it. These groups were set up by privately-funded groups that included Koch Industries and Scaife Foundations and bore names such as the Cato Institute, Americans for Prosperity and the Heartland Institute. These groups bombarded Mann with freedom of information requests while the scientist was served with a subpoena by Republican congressman Joe Barton to provide access to his correspondence. The purported aim was to clarify issues. The real aim was to intimidate Mann.
In addition, Mann has been attacked by Ken Cuccinelli, the Republican attorney general of Virginia who has campaigned to have the scientist stripped of academic credentials. Several committees of inquiry have investigated Mann's work. All have exonerated him.
Thousands of emails have been sent to Mann, many deeply unpleasant. "You and your colleagues… ought to be shot, quartered and fed to the pigs along with your whole damn families," said one. "I was hopin [sic] I would see the news and you commited [sic] suicide," ran another.
Yet all that Mann had done was publish to a study suggesting, in cautious terms, that Earth had started to heat up unexpectedly in the past few decades.
"On one occasion, I had to call the FBI after I was sent an envelope with a powder in it," Mann adds. "It turned out to be cornmeal but again the aim was intimidation. I ended up with police security tape all over my office doors and windows. That is the life of a climate scientist today in the US."
Mann insists he will not give up. "I have a six-year-old daughter and she reminds me what we are fighting for." Indeed, Mann is generally optimistic that climate change deniers and their oil and coal industry backers have overstepped the mark and goaded scientists to take action. He points to a recent letter, signed by 250 members of the US National Academy of Science, including 11 Nobel laureates, and published in
Science
. The letter warns about the dangers of the current attacks on climate scientists and calls "for an end to McCarthy-like threats of criminal prosecution against our colleagues based on innuendo and guilt by association, the harassment of scientists by politicians seeking distractions to avoid taking action, and the outright lies being spread about them."
"Words like those give me hope," says Mann.
The Hockey Stick and the Climate Wars will be published by Columbia University Press in April
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JEFFREY BROWN: And we turn to a big change for one of the tech industry's giants in the debate over online privacy.
In recent weeks, Google has been alerting its more than one billion users around the world that, beginning today, the company is consolidating some 60 privacy policies of its different services into one and more closely coordinating those services into one large database.
Here's part of how the company explains it.
WOMAN: So, instead of over 60 policies for different Google products and features, we're introducing just one, with fewer words, simpler explanations and less legal goop to wade through. That means that when you use Google, from Gmail and search, to YouTube and calendar, you can count on one simplified policy that explains our privacy commitment to you.
JEFFREY BROWN: Google says the move will also allow it to better serve customers by pulling together personalized information across a variety of different sites.
But not everyone agrees; 32 state attorneys general recently wrote a letter to Google CEO Larry Page, calling the new policy an invasion of privacy. And some regulatory agencies in the European Union warned that the new policy might be a violation of the E.U.'s data protection rules.
And we debate the merits of the policy and the broader issue now with Markham Erickson. He's the executive director of the Open Internet Coalition, representing more than 50 of the largest Internet companies in the country, including Google. But he doesn't speak or represent Google in this specific policy. And Lori Andrews is professor at the Illinois Institute of Technology Chicago-Kent College of Law and author of the new book "I Know Who You Are and I Saw What You Did: Social Networks and the Death of Privacy."
For the record, we invited Google to join us, but the company declined.
Lori Andrews, as the title of your book suggests, you're one of those who has raised concerns about privacy online. What concerns do you have about what Google is now doing?
LORI ANDREWS, Illinois Institute of Technology Chicago-Kent College of Law: Well, Google at heart is an advertising platform. It makes 96 percent of its money, or $36 billion a year, by targeting ads.
So this new policy allows them to target ads across platforms. So, if I send an email over Gmail to a divorce lawyer and then I do a Google search for depression, if I then am watching a YouTube video with my -- a young son, ads will pop up related to divorce and mental health, which might trouble him. This private information of mine will become visible.
And Google has erred in the past. In 2010, when young people went on Google chat rooms to say I'm thinking of committing suicide with X-chemical, a Google ad would pop up immediately, saying dial 1-800-blah-blah-blah, two for one, get that chemical. So the algorithms invade privacy and may push us toward harmful behaviors.
JEFFREY BROWN: Well, Markham Erickson, of course, Google would say that this is a transparent system and a service to its customers. What's the best argument for what they're trying to do?
MARKHAM ERICKSON, Open Internet Coalition: Well, frankly, the criticisms you just heard I think are way overblown and they're more akin to fear-mongering about, not Google, but an attack on the commercial Internet itself.
And for over 20 years, America has led the way in creating new products and innovative services, many of which, if not most of which, are free for consumers, things like mapping services and email services, video services. And those services are provided for free to consumers because the products -- the companies that provide those services are able to collect information about your browsing habits.
They don't sell that personally -- that personal information, any personal information to third parties. It's internal. But, because of that, they're able to sell advertisements to their users that target the interests that their users have when they browse the Internet.
So, therefore -- so that kind of tradeoff has been part of the commercial Internet since the very beginning.
JEFFREY BROWN: But you're saying, so, consumers should know that that's the economic model, and therefore in exchange for the free service, they are giving away some of their personal data for use by advertisers?
MARKHAM ERICKSON: Well, they're not giving their personal data to advertisers.
JEFFREY BROWN: I'm sorry, Lori. First, let Markham Erickson answer that.
MARKHAM ERICKSON: Yeah, they're not giving personal data to advertisers, not at all.
They collect data that is non-personally identifiable, and they're able to allow advertisers to target ads that are of interest to users without disclosing any personal information. And, frankly, users would rather see ads that more represent what they're interested in than seeing ads that aren't relevant to them. So that kind of tradeoff has made the Internet work for over 20 years.
JEFFREY BROWN: Okay.
Lori Andrews, you wanted to jump in.
LORI ANDREWS: Sure.
It's not fear-mongering when people are losing their jobs or losing benefits as a result of this. Google's collecting this information, including things that people say they don't want. All the surveys of consumers suggest they'd rather not be tracked over the Internet.
And things happen, such as, if you do a Google search about a health condition -- and you might be doing it for your mother or someone else -- then if you go to a health insurance site or a life insurance site, that's thought to represent you. They don't need my name to have my data and use it against me.
Plus, Google announced this policy saying one benefit is that we're going to track you, and so if your Google calendar says you're supposed to be at an appointment, and you're -- we can tell from your GPS that you're far away, we will send you a Google Map to get you there faster.
Well, the problem is Google does nothing to prevent third parties from using that information. In fact, 93 percent of the time, when the government asks for information, your private searches, GPS data, it turns it over.
Employers now are asking for your private passwords. So the employer might use that same information that Google is touting as a benefit to say oh, your GPS location shows that you were at a competitor or at your lover's house.
We're already seeing people losing jobs. One-third of employers say that they won't hire someone if on their social network page there's a picture of them with wine in their hands; 75 percent of employers now have a policy.
JEFFREY BROWN: Well, let me ask. . .
LORI ANDREWS: If Google really does care about the consumer, they'd be working to prevent third parties from requiring access.
JEFFREY BROWN: All right, respond to that, Mr. Erickson. And why not have a system -- or I guess one question asked is where consumers would have to opt in, rather than being allowed to opt out in some cases.
MARKHAM ERICKSON: Consumers actually do have to opt in order for Google to track a user's activities across the various Google products and services.
Again, these criticisms aren't particular to Google. They're criticisms of the commercial Internet itself, of social networks and of search engines and of free Internet products and services. And those free products and services aren't going to be free anymore if we don't allow the companies to offer those kinds of services, and, again, with full knowledge from the consumers of the tradeoff that they're making.
The reason Google has spent five weeks educating consumers about what's happening is because they're not trying to do anything in secret. In fact, Google and most of the large Internet companies that I work with support baseline federal privacy legislation to deal with some of the problems that have been raised.
JEFFREY BROWN: Well, are you -- just very briefly, Mr. Erickson, are you worried about stronger regulation? You hear it from the A.G.s. You hear it from the European Union.
MARKHAM ERICKSON: Well, I think the criticisms you have heard here tonight are not in the mainstream of what serious policy-makers are considering.
We support what the White House called for last week, which was baseline privacy legislation. And we think that a light-touch legislative structure, statutory structure, with enforcement by the Federal Trade Commission to go after bad actors that are abusing the system, that are selling information without users' permission, those actors should be gone after. But that's not what's happening here.
JEFFREY BROWN: Well, briefly, Lori Andrews, you would like to see it stronger?
JEFFREY BROWN: Very briefly, please.
LORI ANDREWS: Sure.
And, so, he said serious policy-makers, but we have a variety of people in Congress, Congressman Markey, Senator Al Franken, very concerned about this. It doesn't reflect what the public wants. You're asking people to give up a very important right. We wouldn't say -- allow companies to say, oh, the only way you will get your service is if you give up your right to vote or your right to have children.
Privacy is a fundamental right. The surveys of what consumers want is much different. And we're seeing pushback, a lot of class actions that consumers have won. NebuAd, a company in California, actually put hardware on Internet service providers and collected for 400,000 people in California every email, every Skype call, every Google search.
JEFFREY BROWN: Okay.
LORI ANDREWS: That information is being traded on. And you don't have a choice.
Google's saying, if you want to use our services, this is the way it is; take your business elsewhere if you don't agree with it.
JEFFREY BROWN: All right, I'm -- I'm afraid we do have to leave it there.
Lori Andrews and Markham Erickson, we will return to the subject. Thanks very much.
One of the nation's largest providers of hospice care has agreed to pay $25 million to settle a Medicare fraud case initiated after a former company nurse in Milwaukee filed a whistle-blower suit.
It was the second such settlement in six years for Odyssey Healthcare Inc., which paid the federal government $12.5 million in 2006 after another Wisconsin-based employee sued.
"The real heroes of these cases are the medical professionals who stood up against the alleged fraud," said Nola Hitchcock Cross, their Milwaukee attorney. "The real winners in this fraud-fight story are the taxpayers."
The whistle blowers don't do too badly, either. Under the False Claims Act, they are entitled to a cut of the recovery and will share about $4.6 million.
Odyssey, which operates in 26 states, is now part of Atlanta-based Gentiva Health Services, which runs hospice offices in West Allis and Burlington. Gentiva officials declined to comment, but referred to an announcement it posted on its investor relations website last month.
"Gentiva cooperated fully with this investigation, which covered a period prior to our acquisition of Odyssey, and the settlement is consistent with our efforts to instill Gentiva's culture of compliance throughout the company," said John Camperlengo, general counsel and chief compliance officer.
The statement said the firm is proud of the care its thousands of hospice clinicians provide, and of Gentiva's efforts to ensure strict compliance with all regulatory requirements.
Medicare provides a benefit meant to cover hospice care for the terminally ill. It covers 24-hour in-home nursing service only during limited crisis periods. But from 2006 to 2009, Odyssey practiced a pattern of enrolling and recertifying non-terminal patients, and billing for continuous care that wasn't necessary or reasonable, according to the False Claims Act suit filed in 2008 but just unsealed Thursday.
Suits are sealed
Under the act, citizens with evidence of fraud against government contracts can sue on behalf of the government to recover the stolen funds in the form of triple damages, and are entitled to a portion of any award. The suits are filed under seal for 60 days to allow government prosecutors time to consider joining the cases. If they do, the cases remain secret even longer.
U.S. Attorney James Santelle said the case shows the government's continued commitment to battling health care fraud, and its support for whistle blowers' roles in that effort.
Jane Tuchalski, a registered nurse, was fired by Odyssey after raising concerns about company operations, and she filed the federal suit. Other Odyssey employees, from Virginia and Texas, later filed their own False Claims Act suits. One was folded into the Milwaukee case and one was dismissed.
In addition to sharing in the recovery, Tuchalski reached a separate private settlement with Odyssey over her claim of retaliatory termination.
Employees benefit
She said other former employees also may have recovered money from Odyssey for retaliatory firing, even if their False Claims actions were dismissed and they did not collect part of the settlement. Under the act, employees fired for revealing fraud are entitled to double back pay and benefits and special damages.
Because the actions are filed under seal, many times there are multiple claims by different employees or others with inside knowledge who don't know that other claims have been filed. The first person to file generally gets the greatest share of any recovery.
"You can work on cases for years and then find out you weren't first to file, and get a bag of beans," Cross said. "You have to be motivated by cleaning up fraud, potential fraud and potential harm to patients."
The federal government says it recovered $4.1 billion in fraudulent health care payments in 2011, and charged 1,430 people with crimes related to that fraud.
No one has been charged in connection to the Odyssey hospice fraud.
About half the 2011 recoveries were attributed to civil actions begun under the False Claims Act.
defeated in a 51 to 48 vote that broke largely along party lines. Democrat Senators Ben Nelson of Nebraska, Bob Casey of Pennsylvania and Joe Manchin of West Virginia crossed party lines to vote with the Republicans, while Republican Senator Olympia Snowe voted with the Democrats. Senators Casey and Manchin are up for re-election this year. Democrats said the language of the Blunt amendment, known as the "Respect for Rights of Conscience Act,” was far too broad, and could be used by some employers to deny benefits beyond contraception. "It would allow any employer or insurer to deny coverage for virtually any treatment for virtually any reason," said Senate Majority Leader Harry Reid (D-NV , who called the bill "an extreme, ideological amendment." Although the legislation was never expected to pass, Senator Reid said he had allowed it to come to a vote because Republicans would not let the transportation bill advance without a vote on the Blunt amendment. In a
statement issued after the vote, Senator Blunt vowed that the fight was not over, and said he would continue working with lawmakers on both sides of the aisle. “I am truly disappointed by the partisanship that has been injected into this debate on religious freedoms,” he said. “For the first time in our history, the Obama Administration’s health care mandate is an egregious violation of our First Amendment rights.” “Unfortunately, this is only a glimpse of what Americans can expect as a result of President Obama’s government health care takeover – which is why we need to repeal and replace this bill with common-sense bipartisan solutions,” he said. Senate Democrats, who characterized the legislation as something that would deny women access to contraception, took to the microphones immediately following the vote, calling the bill’s defeat a victory for women. "This was an important step today and an important the message to the women - and to the men - in this country that we and the Democratic caucus will stand up to fight for their rights," Senator Patty Murray (D-WA told reporters. Attorneys general from seven states -- Nebraska, Florida, Michigan, Ohio, Oklahoma, South Carolina and Texas – filed a lawsuit against the Obama administration last week to block the contraceptive mandate. The full text of the bill can be viewed at
http://thomas.loc.gov/cgi-bin/query/z?c112:S.1467:
Category: Health News
Created: 2/29/2012 2:05:00 PM
Last Editorial Review: 3/1/2012
Doctors can still get free samples of medicines, though not football tickets or lunch for their spouses, under a revised code of conduct drafted by a global drug industry trade group.
The new rules clarify the differences between gifts, promotional aids and items such as anatomical models that can be used in medical practice, the
International Federation of Pharmaceutical Manufacturers & Associations said today in a statement. The federation’s member companies will be required to adopt the new guidelines and provide related training to their 1.3 million employees, the group said.
The code may help curb legal expenses related to marketing, particularly in the U.S., where
GlaxoSmithKline Plc (GSK last year agreed to pay $3 billion to resolve criminal and civil investigations and other matters.
Pfizer Inc. (PFE and
Eli Lilly & Co. (LLY each paid more than $1 billion to settle marketing allegations in 2009.
Novartis AG (NOVN and
AstraZeneca Plc (AZN are among drugmakers that in the past year have disclosed U.S. subpoenas seeking information on the selling of certain products.
“The new code provides a framework for the industry to act with integrity and build trust,” AstraZeneca Chief Executive Officer David Brennan, the federation’s president, said in the statement. “This is not about doing the easy thing, but the right thing.”
Free Samples
Free samples of medicines may be given to doctors who are authorized to prescribe them to patients, the federation said in the code. Companies should avoid extravagant venues for meetings, be transparent in promotional materials, and shouldn’t offer items for the personal benefit of a doctor or nurse, such as gift certificates or concert tickets, according to the guidelines.
“As a general rule, the hospitality provided must not exceed what participants would normally be prepared to pay for themselves,” the federation said in the code. “Companies should not pay any costs associated with individuals accompanying invited health-care professionals.”
The rules don’t address direct-to-consumer advertising, pricing or other trade terms for supplying wholesalers and other commercial customers, or promotion of medical devices, the federation said. Drugmakers that fund patient advocacy groups shouldn’t insist on being the sole sponsor of such an organization, and should outline in writing the nature of the financial support, according to the code.
To contact the reporter on this story: Kristen Hallam in London at
khallam@bloomberg.net
To contact the editor responsible for this story: Phil Serafino at
pserafino@bloomberg.net
Category: Health News
Created: 2/29/2012 4:06:00 PM
Last Editorial Review: 3/1/2012
Category: Health News
Created: 3/1/2012 11:00:00 AM
Last Editorial Review: 3/1/2012
Category: Health News
Created: 2/29/2012 6:06:00 PM
Last Editorial Review: 3/1/2012
Category: Health News
Created: 3/1/2012 11:01:00 AM
Last Editorial Review: 3/1/2012
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