82 Continuing medical education: a drug-promotion tool - Professors

(1) & (2) Child Pornography - nakedness and its limits
(3) & (4) Ahmadinejad "a Jew and a Freemason"
(5) Netanyahu’s peace is a cynical evasion - (editorial) Financial Times
(6) Australia's suicides: 2500-2700 a year (much higher than the road toll)
(7) 2,500 Australians commit suicide each year
(8) Drug company money 'hurts our credibility'
(9) Continuing medical education: a drug-promotion tool - Professors
(10) Doctors given lucrative education grants - as incentive to increase surgical implants
(11) Cell phones and brain tumors - the latest from ANU
(12) Chilli good for the heart

(1) Child Pornography - nakedness and its limits

From: info@odeion.org Date: 09.09.2009 09:33 PM

You know what, Peter?

We ALL have the right to go naked wherever we please. Militarised, genital-shame-based religions enforce their peculiar customs and twisted morals on us by sticking their guns up our noses but that merely infringes all of our rights and exposes them for the frauds that they are.

(2) Child Pornography - nakedness and its limits

From: dgw <dgwest7@gmail.com> Date: 09.09.2009 07:34 AM

Hello Peter,

I spent five years living in the mountains of Thailand with a Lahu hill tribe.

Their approach to sexuality was very different to the western approach.

Very young children were often naked, but as soon as puberty approached, they covered up.

Nobody was seen in the streets without trousers or a skirt.

However, as breast feeding in public was considered quite normal, women who had given birth were often seen topless.

The unusual thing about their culture was that women's knees were considered sexy, so women NEVER uncovered their lower half, and never showed a knee, although they may be topless. Even in the public shower area, the women somehow managed to bathe with their skirt still in place, though topless.

(3) Ahmadinejad "a Jew and a Freemason"

From: Saleh ME <saleh@pclibya.com>  Cc: s@mazandi.com Date: 09.09.2009 10:46 PM

Hello Peter,

This your friend from Libya. Been a while since last emails.

Still read your new-letters and find them very informative.

I also  see you as wise and one of the real  enlightened guys.

But publishing such filth as this subject is way out of your 

Best regards.
Saleh M. Elkmeshi.
Partner & ICT Consult.
Management Development Services.
http://www.gethelp.se/eng/main.asp
Tripoli - Libya.
Tel +218 (0)92 5094013.
Fax: +218(0)213401109.

(4) Ahmadinejad "a Jew and a Freemason"

From: Shahriar Mazandi <s@mazandi.com> To:  saleh@pclibya.com Date: 10.09.2009 06:07 AM

Dear Saleh,

Greetings to you. Regarding your response to allegations that Mr Ahmadinejad is not a muslim, it is most unfortunate to come to this conclusion but if you were to research his family background and 'follow the money' you cannot come to any other conclusion.

It may seem disappointing for many muslims who see him as an individual who has stood up to Israel and the West but many Iranians such as myself see him as a National embarrassment and do not appreciate his remarks, regardless of how they might be interpreted, or misinterpreted.

Furthermore, many Iranians see the last election as a coup against the mullahs. The mullahs  who are now suddenly advertising themselves as 'liberals'  have many of their own questions to answer, particularly what is happening to virgins who end up in prison and the bodies being returned to families, etc, etc. The Americans and the Israelis don't have a monopoly on kidnappings, tortures or rapes! (sorry to put it that way)

But, as importantly, returning to the elections, despite speculation on all sides, the inside view was that Mr 'Ahmadinejad', or more precisely, Mr Saborjhian, clearly lost the tv debate and had no explanation for the mission $800 billion out of Iran during his first four yours of office. Yet, despite this and the obvious thrashing he received on Iranian tv, he was declared winner in less than two hours after closing of the polls. Again, I politely ask you to please do your own research into this man, his family and his financial backing.

Very best wishes,

Shahriar

(5) Netanyahu’s peace is a cynical evasion - (editorial) Financial Times

Netanyahu’s peace is a cynical evasion

FT Editorial

Published: August 25 2009 19:33 | Last updated: August 25 2009 19:33

http://www.ft.com/cms/s/0/7f7b1c42-91a3-11de-879d-00144feabdc0.html

When Barack Obama told Israel that “part of being a good friend is being honest”, the country’s political elites got an inkling that decades of double-talk on the conflict with the Palestinians were over. In his June 4 speech at Cairo University he spelled it out: “Just as Israel’s right to exist cannot be denied, neither can Palestine’s.”

The US president could have been addressing Benjamin Netanyahu, Israel’s prime minister, who refuses to rein in colonisation of Palestinian land or push a two-state solution to the conflict. Yet, however much Mr Obama tries to change the conversation, in and on the Middle East, Mr Netanyahu keeps trying to change the subject.

(6) Australia's suicides: 2500-2700 a year (much higher than the road toll)

http://www.smh.com.au/lifestyle/wellbeing/revealed-australias-suicide-epidemic-20090820-es3p.html

Revealed: Australia's suicide epidemic

RUTH POLLARD INVESTIGATIONS EDITORAugust 21, 2009

AUSTRALIA has dangerously miscalculated its suicide statistics - by as much as 30 per cent in NSW and Queensland - leaving a silent and growing epidemic of mounting deaths.

The figures are in stark contrast to years of backslapping by state and federal governments, congratulating themselves for reducing suicide rates from a peak of 2700 in 1997.

The Herald can reveal the suicide toll is as high now as it was in the 1990s - if not higher - with experts predicting a further rise as the impact of rising unemployment and other economic factors bite.

Ten people each month take their lives either inside a state health facility or within a week of having contact with one.

Discharged too soon from emergency departments, left unobserved in psychiatric wards or denied admission to overcrowded inpatient facilities, their deaths reveal a pattern of repeated systemic failures that demands urgent reform.

The dangerous combination of government under-investment, shutting families out of hospital and police processes, a lack of training and a general community malaise about how to prevent suicide means so many are falling through the cracks.

In the 18 months to June 2008, at least 175 people died from suicide within seven days of contact with the health system, figures from the NSW Clinical Excellence Commission show.

A coroner's inquest into a man who shot himself within hours of being discharged from hospital concluded last week, with police and health departments questioned over their protocols for dealing with people at risk.

In another death, in which a woman set fire to herself after being denied help by a public hospital, the coroner noted: ''This death was preventable and is probably the most tragic example of NSW Health's inability and/or failure to deal with individual cases in an appropriate manner.''

John Mendoza, an adjunct associate professor at the University of Sydney faculty of medicine, said the real rate of suicide was about 2500-2700. ''With this economic downturn we can expect that to increase by around 10 per cent, so we are looking at approximately 3000 people each year,'' he said. ''None of this takes into account suicides by way of single vehicle accidents - these are the only aspect of road accident deaths rising as a percentage of total deaths.''

These figures indicate a major health problem and are much higher than the Bureau of Statistics count of 1800 suicide deaths a year, said Professor Mendoza, who is chairman of the Federal Government's National Advisory Council on Mental Health.

''It is a hidden epidemic and yet the Federal Government only invests $1 per person per year on suicide prevention.''

The director of health and vital statistics at the Australian Bureau of Statistics, Tara Pritchard, confirmed the bureau would release updated figures in March to correct the undercounting.

''What that revision of ABS data will show us is that really we have gone nowhere in terms of overall reductions from the peaks in suicide rates in the early 1990s, and we have certainly gone nowhere among reducing suicide in indigenous populations. They remain four times higher overall,'' Professor Mendoza said.

Governments had done little more than the bare minimum to prevent deaths, said Dawn O'Neil, chief executive officer of Lifeline.

''Once we got confirmation the rates were not coming down … the Government didn't want to know, politically they wanted to believe that the suicide rates were falling.''

(7) 2,500 Australians commit suicide each year

BRAND SHOP SPEARHEADS SUICIDE PREVENTION CAMPAIGN
Oliver Milman

http://www.bandt.com.au/articles/B7/0C063DB7.asp

STW-owned The Brand Shop has spearheaded a major new initiative designed to combat suicide in Australia which was launched this morning by Federal health minster Nicola Roxon.

The scheme, called R U OK?, has seen the agency team up with 12 sister STW companies to drive awareness ahead of a national action of action on 29 November.

The Brand Shop’s managing director Gavin Larkin launched the drive alongside author Graeme Cowan, who has battled severe depression, and the minister in Canberra. The government is currently in talks with STW over assisting with the scheme’s funding.

Larkin came up with the idea for a national day to tackle suicide after his father took his own life over ten years ago. The Australian Bureau of Statistics estimates that around 2,500 Australians commit suicide each year.

“I’ve wanted to do something for years to honour my father who was a fantastic mentor not only in business but also in life,” Larkin told B&T Today.

“Suicide is such a massive issue, but no-one talks about it. It’s a taboo subject. The irony is that to tackle it, we need to talk about it – that’s the idea of the campaign.

“This isn’t just about those at risk – it’s about the average Aussie asking their mates ‘are you OK?’ We’ve got to drop the macho attitude about this.

“Unlike a lot of these kinds of things, we don’t want people’s money. We just want them to reach out to each other.”

After initially contemplating making a documentary on the issue last year, Larkin instead took the idea of a broader campaign to STW chief executive Mike Connaghan.

Sister STW agencies have since assisted with the drive, with Ikon handling strategy, Alpha Salmon creating a website, which launched today, and Yello undertaking brand design.

A three-year partnership deal with News Ltd has been struck, with an integrated campaign starting in November across the publisher’s print and digital assets. The deal also extends to Foxtel and MCN.

Campaign work, created by STW agencies, will be supplemented by editorial coverage in News Ltd publications. This will culminate on 29 November, with how-to guides on how to support friends and family.

In addition to federal government, News Ltd and STW support, The Brand Shop has partnered with various mental health organisations, including beyondblue, Headspace and the Black Dog Institute.

Larkin said that he visited the organisers of Earth Hour, the environmental awareness project spearheaded by WWF and Leo Burnett, for advice on R U OK?

“Earth Hour have been fantastic,” he said. “I asked them for advice and they were very helpful.

“I’d love to see R U OK? become as big (as Earth Hour) in Australia and also the world. That’s why we went to News Ltd. They said yes to the idea within the first 15 minutes of the meeting.

“In the first year we want to raise awareness, in the second year we want to see action and the third year will hopefully be about advocacy.

“I’d like to see it become a day of reunions between friends. Over time, I can see it maybe working for clients, but people are relatively cynical about that, so I want it to have its own energy at the moment.”

The R U OK? website can be found at www.ruokday.com.au.

(8) Drug company money 'hurts our credibility'

http://www.smh.com.au/national/drug-company-money-hurts-our-credibility-20090906-fctx.html

Sydney Morning Herald
September 07 2009

Mark Metherell Health Correspondent

A LEADING psychiatrist, who has received thousands of dollars from drug companies, has appealed for his colleagues to disclose the payments they routinely receive for industry-sponsored activities.

The medical profession faces a credibility problem because of the money drug companies lavish on influential medical figures, says Philip Mitchell, who heads the school of psychiatry at the University of NSW.

Professor Mitchell has declared he was paid $6500 by three drug companies in 2007-08 for lectures, consultancies and as a company advisory board member, as well as international travel to give an invited lecture.

He told the Herald the vast majority of medical experts drug companies paid for their expertise ''don't just say what the companies want''. But he says doctors now have a credibility problem following the ''outing'' of payments running into millions of dollars by pharmaceutical companies to medical experts who supported their products in the US.

In Australia, ''self-regulation by the medical profession has been largely ineffective'', despite the best intents of groups within the profession.

''This is a problem for both industry and the profession,'' he says in an article in the latest Medical Journal of Australia. ''We now have a major credibility problem with the public; it is an issue of trust.''

The industry group Medicines Australia produces a detailed record of drug company-sponsored promotional events that shows there were 30,000 such events last year. This is required by the Australian Competition and Consumer Commission, but does not extend to disclosing the names of doctors receiving payments for addressing such gatherings.

The chief executive of Medicines Australia, Ian Chalmers, disputed the assessment of the profession's relationship with the pharmaceutical industry. ''Market research with doctors in Australia consistently reports broad satisfaction with the relationship.''

(9) Continuing medical education: a drug-promotion tool - Professors

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2231419

Can Fam Physician. 2007 October; 53(10): 1650–1653.

Copyright © the College of Family Physicians of Canada

Is continuing medical education a drug-promotion tool? YES

Michael A. Steinman, MD
Assistant Professor of Medicine in the Division of Geriatrics at the San Francisco VA Medical Center and the University of California, San Francisco

Robert B. Baron, MD MS
Professor of Medicine and Associate Dean of Graduate Medical Education and Continuing Medical Education at the University of California, San Francisco

In recent years, industry sponsorship of continuing medical education (CME) has grown rapidly and now accounts for up to 65% of the total revenue of CME programs in the United States.1,2 In Canada and the United States, national guidelines state that “independent” programs should maintain scientific objectivity and independence of content and receive commercial support only through unrestricted funding mechanisms.3–5 Despite the technically unrestricted nature of such industry-funded programs, however, substantial conflicts of interest and the potential for undue commercial influence persist.6

Chief among these conflicts is the financial incentive for CME organizers to create educational programs that present companies’ products favourably. These conflicts affect medical education and communications companies (MECCs), many of which are for-profit and are funded almost exclusively by drug and device manufacturers. Such MECCs host accredited educational programs and many also service a variety of other industry activities, including hosting company-sponsored advisory boards and advising industry on marketing strategies and tactics.7 This presents a clear conflict, since the survival and success of both the educational and marketing arms of these companies depend on satisfying those who fund them to encourage their support of future programs.

Unfortunately, similar incentives affect academic providers of CME. Some specialty societies and university-based CME providers have assisted in potentially promotional activities, such as organizing industry-supported dinner lecture series and satellite symposia. Even university providers of CME who forego such relationships are not immune to financial conflicts. These universities often receive substantial industry support for their CME activities: in 2005, CME activities originating in US schools of medicine received 60% of their total income from industry, up from 43% 5 years earlier.2 These universities also rely heavily on industry grants for research funding and other educational initiatives.8

These connections create a web of relationships and financial dependency that can have subtle yet strong effects on the objectivity of “independent,” accredited CME. Event organizers can choose to present topics likely to favourably highlight sponsors’ products or discuss emerging clinical areas that sponsors are trying to penetrate. In addition, among a range of qualified experts on a given topic, event organizers can select speakers known to have attitudes favourable to sponsoring companies’ products. The commercial influence that results from these decisions is not necessarily acknowledged or even conscious, but might well reflect the cumulative effect of subtle influences and financial dependency that can affect even the best-intentioned CME providers.
In addition to institutional conflicts, speakers face their own conflicts of interest that arise from receiving educational or research grants from industry, from attendance at company-sponsored events, and from paid service on advisory boards and speakers bureaus.7 Although the great majority of these speakers do not intentionally teach in a biased manner, research suggests that the expectation of reciprocity, personal relationships, and fear of disrupting relationships with companies can dissuade lecturers from speaking ill of companies’ products and thus “biting the hand that feeds them.”9,10

Few published studies have evaluated directly the extent to which industry sponsorship of CME biases program content and in turn affects physicians’ behaviour.11 Corroborating data and a recent US government inquiry suggest, however, that industry uses CME for promotional purposes—with success.12 Several prominent investigations have revealed industry efforts to use educational activities to increase drug sales.7,13 In addition, drug companies track the effectiveness of marketing activities through the purchase of physician-specific prescribing data from pharmacies.14 It is unlikely that industry would contribute substantial resources to CME (approximately $1 billion [US] per year in the United States) if there were little return on that investment. Finally, some providers of CME have advertised their own educational services as having promotional benefits. For example, one MECC declared, “Medical education is a powerful tool that can deliver your message to key audiences and get those audiences to take action that benefits your product.”6

Solutions

These problems require both short- and long-term solutions. In the long-term, commercial influence on CME could be minimized by eliminating industry sponsorship of educational programs or by funding CME programs from a general pool of industry support within each academic medical centre.15 In the absence of such sweeping changes, however, CME providers and doctors can take other steps to mitigate potential bias. Providers of CME can go beyond minimum accreditation requirements to institute quality-control mechanisms, such as declining to host events sponsored by a single company, using risk assessment tools to prospectively identify activities at higher risk of bias, and assessing potential bias through attendee questionnaires and direct observation of higher-risk courses.16 Individual doctors can minimize their exposure to potentially biased information by avoiding programs that are heavily subsidized by one company. These programs can often be identified by low or no registration fees. Physicians can also be mindful of other risk factors for bias, such as the presence of course faculty who are representatives of or closely allied with industry, including members of companies’ speakers bureaus.

Continuing medical education is critical for disseminating new advances in medicine and improving the quality of care that physicians provide to their patients. Commercial intrusion into CME threatens the reality and perception of scientific objectivity and best practice. Substantial changes in the structure and regulation of CME activities are needed to correct these problems. In the meantime, individual physicians need to be aware of and to minimize commercial intrusion into their CME.
 
Acknowledgment ...
 
Notes
CLOSING ARGUMENTS

    * Medical education is an important part of drug companies’ promotional strategy to increase sales of their products.
    * Many continuing medical education (CME) programs are funded wholly or in part by drug and device manufacturers.
    * Despite various mechanisms to protect against commercial influence, financial conflicts of interest faced by CME providers and speakers can affect course content in favour of sponsors’ products.
    * To minimize commercial bias, physicians should seek CME programs with less industry sponsorship and with rigorous mechanisms to mitigate conflicts of interest.

Footnotes
Competing interests
Dr Steinman served as an unpaid expert witness in United States of America ex rel. David Franklin v. Pfizer, Inc, and Parke-Davis, Division of Warner-Lambert Company, litigation that in part alleged that Parke-Davis used educational activities to promote gabapentin (Neurontin). Dr Steinman also participated in the creation and development of an online, searchable archive of documents from the gabapentin litigation (http://dida.library.ucsf.edu). Seed funding for this archive was provided by a gift from Thomas Greene, lawyer for the whistle-blower plaintiff in this litigation, to the University of California Board of Regents. Drs Steinman and Baron are coinvestigators on an educational grant administered through the Attorney General of Oregon that was funded through a settlement fund from the aforementioned litigation. Dr Baron is Associate Dean of Graduate Medical Education and Continuing Medical Education at the University of California in San Francisco and in this role has participated in the organization of CME courses that have received educational grants from industry.

References ...

(10) Doctors given lucrative education grants - as incentive to increase surgical implants
Grants a sales tool for implants

Date: September 07 2009

Nick McKenzie and Gerard Ryle

http://www.smh.com.au/national/grants-a-sales-tool-for-implants-20090906-fctv.html

THE aggressive marketing approach used by some companies to push their products can be found in numerous confidential documents drawn up by the giant US firm Medtronic and obtained by the Herald.

In 2007, Medtronic devised a secret marketing strategy to increase the use of its implants in Australian patients by giving doctors lucrative education grants.

A six-page Medtronic Australia marketing presentation states that the aim of its Global Fellowship Program - which pays doctors to further their education - is to secure ''new business revenue streams'' and to ''nurture and support potential customers''.

The ''potential customers'' are the doctors who are given the education grants and who implant devices into patients.

The documents reveal that one of the ways the doctors given the scholarships will be encouraged to favour Medtronic's products is by undertaking their education placements at ''Medtronic-friendly sites,'' a reference to hospitals in which Medtronic products are used.

The documents state that if the company spends $1.5 million on fellowship grants, it can expect a ''potential 200 per cent return on investment''.

A graph compares the expense of putting 18 doctors through the program with the potential revenue the doctors will return to the company.

In a separate 2009 letter seen by the Herald, a surgeon who was given a Medtronic education grant states that he intends to use Medtronic's products because the company gave him a scholarship.

In response to questions about the documents, Medtronic's chief executive, Jamie Stanistreet, told the Herald: ''Medtronic Australasia senior management became aware of this program in mid 2007. The staff member involved was informed that the program was inappropriate and should immediately cease as it is not consistent with Medtronic Australasia Business Conduct Standards or the regulations governing the medical device industry.''

Other confidential files reveal that Medtronic gave $100,000 to an Australian medical research centre to fund the yearly salary of the centre's assistant.

The files show Medtronic pays other Australian surgeons between $2000 and $3000 a day to work as company consultants - work that is undertaken both here and abroad. One contract states that among the services the consultant doctor will provide Medtronic are ''rendering assistance in satisfying TGA concerning Medtronic products''.

Mr Stanistreet declined requests to be interviewed but responded to a list of written questions, including why his company spent $7625 on food last November at an educational event for 61 doctors at the exclusive Melbourne restaurant Jacques Reymond. He said the dinner was held so a Monash University professor, Ian Meredith, could present the results of a global study in which he was the lead investigator.

Dr Meredith, a cardiovascular expert, told the dinner audience that he was a paid consultant of Medtronic.

Mr Stanistreet defended his company's decision several years ago to pay for a helicopter to fly another of its consultant surgeons from the Monash Medical Centre to the airport to avoid peak-hour traffic, but he would not say how much the trip cost.

''This [the helicopter flight] was the only viable option to ensure timely attendance at an international conference without compromising patient safety,'' Mr Stanistreet said.

He also declined to reveal how many Australian doctors it pays as consultants. He said such arrangements had ''been instrumental to the development of new therapies and the improvement of existing products'' and that they complied with the Australian code of conduct, which bans kickbacks to doctors and stipulates that all fees must be for genuine services.

Mr Stanistreet also said that all existing Medtronic education scholarships were not given to doctors, but to ''teaching institutions who exercise control over the funds''.

Contact the reporter: gryle@smh.com.au

(11) Cell phones and brain tumors - the latest from ANU

Cell phones and brain tumors: a review including the long-term epidemiologic data

18 Aug 2009

http://omega.twoday.net/stories/5884085/

Surg Neurol. 2009 Sep;72(3):205-14; discussion 214-5. Epub 2009 Mar 27.

Khurana VG, Teo C, Kundi M, Hardell L, Carlberg M.

Australian National University, Australia. vgkhurana@gmail.com

BACKGROUND: The debate regarding the health effects of low-intensity electromagnetic radiation from sources such as power lines, base stations, and cell phones has recently been reignited. In the present review, the authors attempt to address the following question: is there epidemiologic evidence for an association between long-term cell phone usage and the risk of developing a brain tumor? Included with this meta-analysis of the long-term epidemiologic data are a brief overview of cell phone technology and discussion of laboratory data, biological mechanisms, and brain tumor incidence.

METHODS: In order to be included in the present meta-analysis, studies were required to have met all of the following criteria: (i) publication in a peer-reviewed journal; (ii) inclusion of participants using cell phones for > or = 10 years (ie, minimum 10-year "latency"); and (iii) incorporation of a "laterality" analysis of long-term users (ie, analysis of the side of the brain tumor relative to the side of the head preferred for cell phone usage). This is a meta-analysis incorporating all 11 long-term epidemiologic studies in this field.

RESULTS: The results indicate that using a cell phone for > or = 10 years approximately doubles the risk of being diagnosed with a brain tumor on the same ("ipsilateral") side of the head as that preferred for cell phone use. The data achieve statistical significance for glioma and acoustic neuroma but not for meningioma.

CONCLUSION: The authors conclude that there is adequate epidemiologic evidence to suggest a link between prolonged cell phone usage and the development of an ipsilateral brain tumor.

PMID: 19328536 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/19328536

Informant: Iris Atzmon

(12) Chilli good for the heart

From: Mary Ardley <ard@aapt.net.au Date: 04.09.2009 06:49 AM

Chilli is good for the heart in another way too....it has the same effect as nitroglycerine in undoing heart attack...a pinch of it on the tongue just then saves lives. People suffering from angina can vouch for its effects.