In April, the Massachusetts State Senate passed a total ban on all drug company gifts to physicians (see my post here). Spearheaded by Senate President Therese Murray and supported by many others, the ban appeared certain to be approved in some form by the House, and Massachusetts could have bragged about taking the hardest line of any state against this form of legalized bribery.
But in what must go down as one of the greatest ironies in political history, the legislators visited BIO 2008, a massive Biotech conference in San Diego and one of the last of the great dug company swagfests--and now even Senator Murray wonders whether gifts might be necessary for good medicine. According the the State News Service, covered here in the Policy and Medicine Blog, Senator Murray said researchers in San Diego told her the ban would prevent productive interactions between doctors and researchers who are trying to treat the same diseases. “It’s something that we didn’t discuss when we did it, because we were looking purely at gifts to doctors,” Murray said in a telephone interview with the News Service. “But the fact is that some of these companies do bring researchers and doctors together to go over the latest research.”
Wow. Something happened at the convention to hoodwink our finest legislators into believing that doctors can't learn about research without being given free lunches. I didn't attend BIO 2008, but my colleague Harry Tracy did. Dr. Tracy is the writer and publisher of NeuroInvestment, quite possibly the best single source of cutting edge information for those investing in the pharmaceutical industry. Here is his review of BIO 2008, reprinted with his permission from his latest newsletter:
“At the BIO International Convention, 24,000 attendees had the opportunity to watch companies who were limited to fifteen minute sound bites, and much of the fun was to be had in the Exhibits area, where various companies, countries, and municipalities handed out tapas, wine, single-malt scotch, novelty pens, and miniature stuffed koalas, while holding raffles for everything from laptops to trips to London. Indeed, the local paper of record, the San Diego Union-Tribune, devoted a high-profile article to the bounty of "swag" available to attendees. Apparently they overlooked the gift available at the State of New Hampshire booth, which was a plastic band-aid dispenser. While we will treasure ours forever, this stretches the definition of "swag" beyond recognition. But these silly 'Freebies' are just a minor symptom of a larger problem with public relations and perception. San Diego, as it does for other large conventions, literally walled off for an afternoon and evening a five block section of the Gaslamp District, for a BIO-only party. There were three soundstages and seemingly acres of free food laid out for the occasionally semi-intoxicated revelers. Of course, those without a BIO badge were not allowed in, the party was only for "VIP's." As much as NI enjoys VIP treatment, there was something unsettling about seeing the excluded public peering over the barriers at the party-goers. At a time when the pharma industry is widely perceived as concerned with profit rather than with patient care, at a time that the industry is under siege by the Charles Grassley's of the world who believe that the industry deserves to be taken down a notch, this seems unwise. It is probably naive to think that the industry will police its excesses, but if it does not, its losses in the court of public opinion will continue to mount, and few in the audience will protest when the guillotines are brought out.”
I don't mean to imply that Senator Murray, or any other legislators, accepted any of these freebies in San Diego. But there's no question that they allowed their opinions to be influenced in a carnival of swag. Meanwhile, BIO 2008 has announced that Massachusetts Deval Patrick is their "Governor of the Year" on the strength of his support for a $1 billion Life Sciences initiative. I assume they will honor the Massachusetts Legislature with a similar award, depending on the outcome of the vote on S 2660.
Thursday, August 6, 2009
Ghostwriting for Premarin: Steroids on Steroids
Today's New York Times reveals the not particularly astonishing fact that Wyeth Pharmaceuticals engaged a medical writing company to produce 26 articles pushing Premarin as Hormone Replacement Therapy (HRT) in women from 1998-2005. The articles were outlined and written by writers employed by Design Write, and then were sent to top academics in the Ob/Gyn field, who reviewed them, rubber stamped them with occasionally minor edits, and submitted them to journals under their names. In no case was Wyeth's involvement in funding the articles disclosed.
We've heard this sordid tale before. Last year, an article in JAMA revealed that Merck commissioned ghostwriters to produce dozens of articles pushing Vioxx (see the NY Times coverage here--you'd need a subscription to JAMA to read the original paper by Joseph Ross); Eli Lilly paid ghostwriters to push Zyprexa; and Pfizer-funded ghostwriters generated the majority of articles about Zoloft in the late 1990s, according to the British Journal of Psychiatry.
What to make of all this? The best analysis I've heard yet was provided by Dr. Joseph Ross of Mt. Sinai Hospital in New York, who was quoted in today's paper:
“It’s almost like steroids and baseball,” said Dr. Joseph S. Ross, an assistant professor of geriatrics at Mount Sinai School of Medicine in New York, who has conducted research on ghostwriting. “You don’t know who was using and who wasn’t; you don’t know which articles are tainted and which aren’t.”
In this case, since Premarin is a steroid, Wyeth put its own steroids on steroids. As with baseball players on steroids, when companies pour marketing money into ghostwriting campaigns, they change the rules of the academic game. The playing field is no longer level; the drug company's version of the truth gains the upper hand. Sometimes, their truth really is the truth, but sometimes it's a carefully crafted lie. Sorting it out is difficult even for physicians who specialize in the area being written about. It's essentially impossible for the average generalist physician, to say nothing of patients who did not have the advantage of attending medical school.
As the New York Times article says, some journals now require that all authors detail precisely who wrote what and who was paid by whom before considering manuscripts. It is time for all journals to institute this policy. In addition, several academic medical centers now forbid their faculty from engaging in ghostwriting, a trend that will continue.
As I've said before, it would be nice if those who are caught with their hands in the cookie jar would have the courage to apologize. But nobody involved in this latest scandal is willing to so. Design Write, the company that did Wyeth's dirty work, said that:
[the company ] “has not, and will not, participate in the publication of any material in which it does not have complete confidence in the scientific validity of the content, based upon the best available data.”
Dr. Gloria Bachmann, a professor of Ob/Gyn who rubber stamped an article pushing Premarin for hot flashes and other symptoms, said:
“There was a need for a review article and I said ‘Yes, I will review the draft and make sure it is accurate,’ ” Dr. Bachmann said in an interview Tuesday. “This is my work, this is what I believe, this is reflective of my view.”
And Wyeth's spokesman said that "the articles on hormone therapy were scientifically sound and subjected to rigorous review by outside experts on behalf of the medical journals that published them."
Actually, the proper collective response from all of these participants should have been: "We sincerely apologize for having deceived the medical community by engaging in ghostwriting without disclosure. We have contributed to the erosion of the public's trust in medicine, and we regret it."
We've heard this sordid tale before. Last year, an article in JAMA revealed that Merck commissioned ghostwriters to produce dozens of articles pushing Vioxx (see the NY Times coverage here--you'd need a subscription to JAMA to read the original paper by Joseph Ross); Eli Lilly paid ghostwriters to push Zyprexa; and Pfizer-funded ghostwriters generated the majority of articles about Zoloft in the late 1990s, according to the British Journal of Psychiatry.
What to make of all this? The best analysis I've heard yet was provided by Dr. Joseph Ross of Mt. Sinai Hospital in New York, who was quoted in today's paper:
“It’s almost like steroids and baseball,” said Dr. Joseph S. Ross, an assistant professor of geriatrics at Mount Sinai School of Medicine in New York, who has conducted research on ghostwriting. “You don’t know who was using and who wasn’t; you don’t know which articles are tainted and which aren’t.”
In this case, since Premarin is a steroid, Wyeth put its own steroids on steroids. As with baseball players on steroids, when companies pour marketing money into ghostwriting campaigns, they change the rules of the academic game. The playing field is no longer level; the drug company's version of the truth gains the upper hand. Sometimes, their truth really is the truth, but sometimes it's a carefully crafted lie. Sorting it out is difficult even for physicians who specialize in the area being written about. It's essentially impossible for the average generalist physician, to say nothing of patients who did not have the advantage of attending medical school.
As the New York Times article says, some journals now require that all authors detail precisely who wrote what and who was paid by whom before considering manuscripts. It is time for all journals to institute this policy. In addition, several academic medical centers now forbid their faculty from engaging in ghostwriting, a trend that will continue.
As I've said before, it would be nice if those who are caught with their hands in the cookie jar would have the courage to apologize. But nobody involved in this latest scandal is willing to so. Design Write, the company that did Wyeth's dirty work, said that:
[the company ] “has not, and will not, participate in the publication of any material in which it does not have complete confidence in the scientific validity of the content, based upon the best available data.”
Dr. Gloria Bachmann, a professor of Ob/Gyn who rubber stamped an article pushing Premarin for hot flashes and other symptoms, said:
“There was a need for a review article and I said ‘Yes, I will review the draft and make sure it is accurate,’ ” Dr. Bachmann said in an interview Tuesday. “This is my work, this is what I believe, this is reflective of my view.”
And Wyeth's spokesman said that "the articles on hormone therapy were scientifically sound and subjected to rigorous review by outside experts on behalf of the medical journals that published them."
Actually, the proper collective response from all of these participants should have been: "We sincerely apologize for having deceived the medical community by engaging in ghostwriting without disclosure. We have contributed to the erosion of the public's trust in medicine, and we regret it."
How You Can Help the Louisville Free Public Library Recover from Disaster
I don’t usually blog about libraries here, but the Louisville Free Public Library needs our help – Louisville, KY received about 6″ of rain in 3 hours this week, creating a flash flood situation that filled their Main Library with sewage-contaminated water. Early estimates are that damages are in the $1 million range for the main branch, with approximately 10,000 items (books, audiobooks, and the like) lost. The servers flooded; the bookmobiles flooded; the processing room where the new materials live flooded; 40 new computers for a branch library are gone, as are countless other items. In a time when libraries all over the country are cutting staff, salaries, hours, and purchases because of the economy, I imagine that recovery at LFPL is going to be a long and painful process.
To understand the extent of the damage, you really need to see the photos. The one to the left (click to embiggen for full effect) made me tear up a little yesterday. Here you can see one library staffer’s office – that’s the doorknob just above the water line. This one shocked even the non-librarian spouse. This one, from this morning, reminds us that even when the water starts to subside, there is a whole lot of damage to deal with and materials that are simply unsalvageable.
In the face of all of this bad news for LFPL, the good news is that there are ways for us to help.
To understand the extent of the damage, you really need to see the photos. The one to the left (click to embiggen for full effect) made me tear up a little yesterday. Here you can see one library staffer’s office – that’s the doorknob just above the water line. This one shocked even the non-librarian spouse. This one, from this morning, reminds us that even when the water starts to subside, there is a whole lot of damage to deal with and materials that are simply unsalvageable.
In the face of all of this bad news for LFPL, the good news is that there are ways for us to help.
Thursday, June 25, 2009
Head and Neck Imaging
Product Description:
Mount Sinai Hospital, New York, NY. Encyclopedic and detailed reference with expanded information. Presents more pathology, contains more images, and covers new imaging technologies. Abundant halftone images and extensive references are included. Previous edition: c1996. DNLM: Head--radiography
http://hotfile.com/dl/5211515/c044eb0/Head_and_Neck.rar.html
Mount Sinai Hospital, New York, NY. Encyclopedic and detailed reference with expanded information. Presents more pathology, contains more images, and covers new imaging technologies. Abundant halftone images and extensive references are included. Previous edition: c1996. DNLM: Head--radiography
http://hotfile.com/dl/5211515/c044eb0/Head_and_Neck.rar.html
Tuesday, January 29, 2008
The Handbook of Highway Engineering
Ebook Title: The Handbook of Highway Engineering
Author: T.F. Fwa
Publisher: CRC; 1 edition (September 28, 2005)
Hardcover: 888 pages
Language: English
ISBN-10: 0849319862
ISBN-13: 978-0849319860
Ebook Description
Modern highway engineering reflects an integrated view of a road system's entire lifecycle, including any potential environmental impacts, and seeks to develop a sustainable infrastructure through careful planning and active management. This trend is not limited to developed nations, but is recognized across the globe. Edited by renowned authority T.F. Fwa, The Handbook of Highway Engineering provides a comprehensive, up-to-date treatment of all aspects of highway development and engineering. Its three sections range from consideration of socio-economic and environmental factors to design, construction, maintenance, and management. Beginning with financing, access management, environmental impacts, road safety, and noise, the book explores the expanded responsibilities of the modern highway engineer as well as the increasing trend toward privatization of project development and financing. The next section considers technical issues in highway and pavement engineering, including materials, new mechanistic-empirical design approaches, and new closed-form solutions for backcalculation as well as deflection and stress computation in multi-slab systems. Rounding out the discussion, the final section examines construction, management, performance evaluation including nondestructive testing, and a chapter devoted to highway asset management. Featuring contributions from eminent experts representing eight countries on four continents, The Handbook of Highway Engineering supplies all of the tools needed to manage the entire integrated process of modern highway development and engineering.
About The Author
T.F. Fwa is the Recipient of the ASCE 2005 Frank M. Masters Transportation Engineering Award For his innovative research on highway and airport pavements and excellence in teaching and professional activities to enhance transportation engineering. --Transportation and Development Institute of ASCE, 2005
http://rapidshare.com/files/24734615/Fwa__The_Handbook_of_Highway_Engineering___CRC_2005_.rar
pass: gigapedia
Author: T.F. Fwa
Publisher: CRC; 1 edition (September 28, 2005)
Hardcover: 888 pages
Language: English
ISBN-10: 0849319862
ISBN-13: 978-0849319860
Ebook Description
Modern highway engineering reflects an integrated view of a road system's entire lifecycle, including any potential environmental impacts, and seeks to develop a sustainable infrastructure through careful planning and active management. This trend is not limited to developed nations, but is recognized across the globe. Edited by renowned authority T.F. Fwa, The Handbook of Highway Engineering provides a comprehensive, up-to-date treatment of all aspects of highway development and engineering. Its three sections range from consideration of socio-economic and environmental factors to design, construction, maintenance, and management. Beginning with financing, access management, environmental impacts, road safety, and noise, the book explores the expanded responsibilities of the modern highway engineer as well as the increasing trend toward privatization of project development and financing. The next section considers technical issues in highway and pavement engineering, including materials, new mechanistic-empirical design approaches, and new closed-form solutions for backcalculation as well as deflection and stress computation in multi-slab systems. Rounding out the discussion, the final section examines construction, management, performance evaluation including nondestructive testing, and a chapter devoted to highway asset management. Featuring contributions from eminent experts representing eight countries on four continents, The Handbook of Highway Engineering supplies all of the tools needed to manage the entire integrated process of modern highway development and engineering.
About The Author
T.F. Fwa is the Recipient of the ASCE 2005 Frank M. Masters Transportation Engineering Award For his innovative research on highway and airport pavements and excellence in teaching and professional activities to enhance transportation engineering. --Transportation and Development Institute of ASCE, 2005
http://rapidshare.com/files/24734615/Fwa__The_Handbook_of_Highway_Engineering___CRC_2005_.rar
pass: gigapedia
Standard Handbook for Civil Engineers
Ebook Title: Standard Handbook for Civil Engineers
Author: Jonathan T. Ricketts, M. Kent Loftin, Frederick S. Merritt
Publisher: McGraw-Hill Professional; 5 edition (December 29, 2003)
Hardcover: 1600 pages
Language: English
ISBN-10: 0071364730
ISBN-13: 978-0071364737
Ebook Description
A revision of the classic reference covering all important principles and techniques needed by practicing civil engineers. The 5th Edition incorporates changes in design and construction practices, especially in design specifications for construction materials, buildings and bridges, safety and health concerns, and the most current codes changes including ACI, AISC, ASTM, NDS for wood structures, etc. Standard Handbook for Civil Engineers, covers systems design, community and regional planning, the latest design methods for buildings, airports, highways, tunnels and bridges. It includes sections on construction equipment, construction management, materials, specifications, structural theory, geotechnical engineering, wood, concrete, steel design and construction.
This book provides code changes from the ACI, ASTM, & AISC, the most up-to-date specifications for wood construction, & recent EPA & OSHA regulations. Presents new methods for nondestructive testing of piles & applications of geosynthetics. Systems requirements: PC with 486 or higher processor, Microsoft Windows 3.1, Windows 95, or NT 3.51 or later, & 16 MB of RAM. CD-ROM. --This text refers to an out of print or unavailable edition of this title.
This new, completely updated, and expanded Fifth Edition features:
- The most recent code changes, including AIC, AISC, ASTM, NDS for Wood Structures, and more
- Current EPA and OSHA regulations
- Additional information on design build delivery systems
- Increased coverage of stormwater runoff
- Over 700 tables, formulas, and drawings to make every explanation and procedure crystal clear
- Sections on construction management; materials specifications; structural theory; wood and concrete, steel design and construction; and much more
- The latest design methods for buildings, airports, highways, tunnels, and bridges
Turn to this one-stop review of the field for simplified solutions to the hundreds of practical problems you face in your day-to-day civil engineering practice.
Ebook Review
Sci-Tech Book News : The fifth edition of this reference in civil engineering features coverage of recent code changes, including AIC, ASTM, and NDS for Wood Structures, and current EPA and OSHA regulations, plus expanded information on design build delivery systems and increased coverage of stormwater runoff. There is also new information on three-dimensional modeling of pile groups, cracking in high strength steel beams, intelligent transportation, and various types of wharf designs. Coverage encompasses fundamentals of civil engineering and the latest changes in design, construction, materials, and equipment in 23 different disciplines including systems design, geotechnical engineering, and community and regional planning. Ricketts is a consulting engineer.
Choice : ...contains much useful information and many equations, tables, and facts needed in many aspects of civil engineering...well written...easy to read...Highly recommended.
From the Back Cover : IF CIVIL ENGINEERS COULD HAVE ONLY ONE REFERENCE BOOK – THIS WOULD BE IT
About the Author
Jonathan T. Ricketts is a Consulting Engineer in Palm Beach Gardens, Florida, a registered engineer in several states, and the editor of McGraw-Hill's Building Design and Construction Handbook.
http://rapidshare.com/files/38254021/Standard.Handbook.for.Civil.Engineers-0071364730.zip
Author: Jonathan T. Ricketts, M. Kent Loftin, Frederick S. Merritt
Publisher: McGraw-Hill Professional; 5 edition (December 29, 2003)
Hardcover: 1600 pages
Language: English
ISBN-10: 0071364730
ISBN-13: 978-0071364737
Ebook Description
A revision of the classic reference covering all important principles and techniques needed by practicing civil engineers. The 5th Edition incorporates changes in design and construction practices, especially in design specifications for construction materials, buildings and bridges, safety and health concerns, and the most current codes changes including ACI, AISC, ASTM, NDS for wood structures, etc. Standard Handbook for Civil Engineers, covers systems design, community and regional planning, the latest design methods for buildings, airports, highways, tunnels and bridges. It includes sections on construction equipment, construction management, materials, specifications, structural theory, geotechnical engineering, wood, concrete, steel design and construction.
This book provides code changes from the ACI, ASTM, & AISC, the most up-to-date specifications for wood construction, & recent EPA & OSHA regulations. Presents new methods for nondestructive testing of piles & applications of geosynthetics. Systems requirements: PC with 486 or higher processor, Microsoft Windows 3.1, Windows 95, or NT 3.51 or later, & 16 MB of RAM. CD-ROM. --This text refers to an out of print or unavailable edition of this title.
This new, completely updated, and expanded Fifth Edition features:
- The most recent code changes, including AIC, AISC, ASTM, NDS for Wood Structures, and more
- Current EPA and OSHA regulations
- Additional information on design build delivery systems
- Increased coverage of stormwater runoff
- Over 700 tables, formulas, and drawings to make every explanation and procedure crystal clear
- Sections on construction management; materials specifications; structural theory; wood and concrete, steel design and construction; and much more
- The latest design methods for buildings, airports, highways, tunnels, and bridges
Turn to this one-stop review of the field for simplified solutions to the hundreds of practical problems you face in your day-to-day civil engineering practice.
Ebook Review
Sci-Tech Book News : The fifth edition of this reference in civil engineering features coverage of recent code changes, including AIC, ASTM, and NDS for Wood Structures, and current EPA and OSHA regulations, plus expanded information on design build delivery systems and increased coverage of stormwater runoff. There is also new information on three-dimensional modeling of pile groups, cracking in high strength steel beams, intelligent transportation, and various types of wharf designs. Coverage encompasses fundamentals of civil engineering and the latest changes in design, construction, materials, and equipment in 23 different disciplines including systems design, geotechnical engineering, and community and regional planning. Ricketts is a consulting engineer.
Choice : ...contains much useful information and many equations, tables, and facts needed in many aspects of civil engineering...well written...easy to read...Highly recommended.
From the Back Cover : IF CIVIL ENGINEERS COULD HAVE ONLY ONE REFERENCE BOOK – THIS WOULD BE IT
About the Author
Jonathan T. Ricketts is a Consulting Engineer in Palm Beach Gardens, Florida, a registered engineer in several states, and the editor of McGraw-Hill's Building Design and Construction Handbook.
http://rapidshare.com/files/38254021/Standard.Handbook.for.Civil.Engineers-0071364730.zip
Nonlinear Mechanics of Reinforced Concrete
Ebook Title: Nonlinear Mechanics of Reinforced Concrete
Author: K. Maekawa
Publisher: Taylor & Francis; 1 edition (May 16, 2003)
Hardcover: 700 pages
Language: English
ISBN-10: 0415271266
ISBN-13: 978-0415271264
Ebook Description
Nonlinear Mechanics of Reinforced Concrete, this book describes the application of nonlinear static and dynamic analysis for the design, maintenance and seismic strengthening of reinforced concrete structures. The latest structural and RC constitutive modeling techniques are described in detail, with particular attention given to multi-dimensional cracking and damage assessment, and their practical applications for performance-based design. Other subjects covered include 2D/3D analysis techniques, bond and tension stiffness, shear transfer, compression and confinement. Nonlinear Mechanics of Reinforced Concrete presents a practical methodology for structural engineers, graduate students and researchers concerned with the design and maintenance of concrete structures
Ebook Info
Text describes the nonlinear mechanics and constitutive models of two- and three-dimensional reinforced concrete. Illustrates the use of these finite element models in the design, performance assessment, maintenance and seismic strengthening of reinforced concrete structures. DLC: Reinforced concrete construction.
Ebook Review
This monograph presents an updated practical methodology for structural engineers, graduate students, and researchers involved with the design and maintenance of concrete structures. - MCEER News
http://www.4shared.com/file/19773068/edd9abca/NonLinearMechanics.html
pass: AlhandasaNetSameerCo
Author: K. Maekawa
Publisher: Taylor & Francis; 1 edition (May 16, 2003)
Hardcover: 700 pages
Language: English
ISBN-10: 0415271266
ISBN-13: 978-0415271264
Ebook Description
Nonlinear Mechanics of Reinforced Concrete, this book describes the application of nonlinear static and dynamic analysis for the design, maintenance and seismic strengthening of reinforced concrete structures. The latest structural and RC constitutive modeling techniques are described in detail, with particular attention given to multi-dimensional cracking and damage assessment, and their practical applications for performance-based design. Other subjects covered include 2D/3D analysis techniques, bond and tension stiffness, shear transfer, compression and confinement. Nonlinear Mechanics of Reinforced Concrete presents a practical methodology for structural engineers, graduate students and researchers concerned with the design and maintenance of concrete structures
Ebook Info
Text describes the nonlinear mechanics and constitutive models of two- and three-dimensional reinforced concrete. Illustrates the use of these finite element models in the design, performance assessment, maintenance and seismic strengthening of reinforced concrete structures. DLC: Reinforced concrete construction.
Ebook Review
This monograph presents an updated practical methodology for structural engineers, graduate students, and researchers involved with the design and maintenance of concrete structures. - MCEER News
http://www.4shared.com/file/19773068/edd9abca/NonLinearMechanics.html
pass: AlhandasaNetSameerCo
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