Tuesday, October 19, 2010

'Mean Girls'? The GOP women's bad rap.

Fair is foul, and foul is fair. There's something witchy in the air.

Perhaps 'tis the season, but womankind is suffering a froth of frivolity.

"I'm not a witch," insists Delaware Senate candidate Christine O'Donnell in an ad that forever will provide the exclamation point on a bewildering political season. Not since Salem have we witnessed such witchification of women who dared stray from the cauldron of the sisterhood.

Now, we hear, female candidates aren't witches after all. Too rhymey with the B-word in these enlightened times. They're "Mean Girls," professional provocateuress Maureen Dowd writes in the New York Times -- "grown-up versions of those teenage tormentors who would steal your boyfriend, spray-paint your locker and, just for good measure, spread rumors that you were pregnant.

"These women -- Jan, Meg, Carly, Sharron, Linda, Michele, Queen Bee Sarah and sweet wannabe Christine -- have co-opted and ratcheted up the disgust. . . . Whether they're mistreating the help or belittling the president's manhood, making snide comments about a rival's hair or ripping an opponent for spending money on a men's fashion show, the Mean Girls have replaced Hope with Spite and Cool with Cold. They are the ideal nihilistic cheerleaders for an angry electorate."

Well. She does have a point, though she misses the bull's-eye.

It was profoundly odd to hear Sarah Palin talk about the president of the United States' "cojones" relative to Arizona Gov. Jan Brewer's posture on illegal immigrants. Ditto when Nevada Senate candidate Sharron Angle instructed 70-year-old Majority Leader Harry Reid to "man up" during their recent debate.

Heaven forbid a man should similarly challenge a woman's physical attributes. Imagine if Reid had responded: "I'm glad you got that off your chest, Madame, such as it is."

As for the other "Mean Girls," the focus on "womanly" habits seems a little off, as well as way off a more important point. First, though California Senate candidate Carly Fiorina did say something about her opponent Barbara Boxer's hair (not realizing her microphone was still on), the remark is hardly the defining entry on Fiorina's résumé, which includes having run Hewlett-Packard.

Dumb comment? You betcha. We're all living and learning to keep our thoughts to ourselves -- to the great detriment of spontaneity and the uncertain future of banter.

As for Meg Whitman, the former chief executive and president of eBay now running for California governor, she is hardly a catty character who puts one in mind of "she's pregnant" gossip.

Do some of the women running on the GOP ticket make us cringe with embarrassment? Let me answer that question with a 2007 quote from O'Donnell:

"American scientific companies are cross-breeding humans and animals and coming up with mice with fully functioning human brains."

Double, double toil and trouble, indeed.

O'Donnell, who made the comment on "The O'Reilly Factor," probably was thinking about a 2005 report about scientists implanting human cells into mice to demonstrate that human brain cells can be created from stem cells.

Alas, it is not the first time a political candidate has become befuddled by facts beyond their ken. To which fact one hastily adds: female and male.

The point missed -- or avoided -- by Dowd is that men and women can be equally dumbfounded and equally "mean," if in sometimes gender-tilted ways. What is gratifying about this season is that we have enough women running that we can criticize them without resorting to the old catfight canard.

Some women, just like some men, are simply unqualified and should be "refudiated" on their merits or the lack thereof. That Queen Bee Sarah has led the hive of busy benefactors, meanwhile, should be cause for a celebration of sorts -- and would be if the brewing brood were Democrats. Why, a swell of liberal women threatening to take over Congress with tough, manhood-withering talk would have the sisterhood in cackles.

Once upon a time, Dowd and I were appearing together on "The Chris Matthews Show" to discuss Dowd's book "Are Men Necessary?" In the green room, I remember telling her: "We have more in common with each other than with them [the men and others who would relish our disagreement]. They obviously want a catfight. Let's deny them."

And so we did.

It is a testament to feminism that we have so many female candidates. That we may dislike or disagree with some -- or find them foolish -- is as the world turns.

Sisterhood means letting women be just as dumb -- and mean -- as men.


YOUR VOTE IS WORTHLESS! These AD buys are not equal! Union Funds vastly different than Crossroads. But most voters to dumb to understand.

Big Election Spenders Revealed

This may be our first comprehensive look at the muscle being put forth by well-funded interest groups after the Supreme Court loosened some campaign fundraising and spending rules.

Public Citizen tracked 120 groups (as of Oct.12) to see how much they've been raising and spending to influence elections this year and here are the new results showing the biggest spenders:

$18.4 million: American Crossroads and Crossroads GPS
$15.5 million: The U.S. Chamber of Commerce
$9.4 million: The AFL-CIO
$7.7 million: American Future Fund
$6.1 million: 60 Plus

Under the law, many of the 120 groups Public Citizen tracked are not required to, and do not, disclose information about their funders. "Of the highest-spending groups, only American Crossroads discloses any information about its funders," says Public Citizen, "its sister organization, Crossroads GPS, is a 501(c)(4) and so does not disclose the identities of its donors."

Another analysis, this one by the Sunlight Foundation, has found that for the first time, outside groups are spending more than political parties: 59 percent of independent expenditures" versus just 18 percent in 2006. That's almost triple.

The latest filings with the Federal Election Commission show that Republicans bested Democrats in direct contributions to candidates in top races in the past three months, but Democrats still have a bit more money left in the bank to spend.
Sharyl Attkisson CBS News

ARE YOU KIDIN' ME? The white hag should be ashamed!! I BELIEVED ANITA HILL. She told other people in 'real time' and other women working EEO also had same comments about BIG BOY Thomas.

Clarence Thomas’s Wife Asks Anita Hill for Apology

WASHINGTON — Nearly 20 years after Anita Hill accused Clarence Thomas of sexual harassment during his contentious Supreme Court confirmation hearings, Justice Thomas’s wife has called Ms. Hill, seeking an apology.

In a voice mail message left at 7:31 a.m. on Oct. 9, a Saturday, Virginia Thomas asked her husband’s former aide-turned-adversary to make amends. Ms. Hill played the recording, from her voice mail at Brandeis University, for The New York Times.

“Good morning Anita Hill, it’s Ginni Thomas,” it said. “I just wanted to reach across the airwaves and the years and ask you to consider something. I would love you to consider an apology sometime and some full explanation of why you did what you did with my husband.”

Ms. Thomas went on: “So give it some thought. And certainly pray about this and hope that one day you will help us understand why you did what you did. O.K., have a good day.”

Ms. Hill, in an interview, said she had kept the message for nearly a week trying to decide whether the caller really was Ms. Thomas or a prankster. Unsure, she said, she decided to turn it over to the Brandeis campus police with a request to convey it the Federal Bureau of Investigation.

“I thought it was certainly inappropriate,” Ms. Hill said. “It came in at 7:30 a.m. on my office phone from somebody I didn’t know, and she is asking for an apology. It was not invited. There was no background for it.”

In a statement conveyed through a publicist, Ms. Thomas confirmed leaving the message, which she portrayed as a peacemaking gesture. She did not explain its timing.

“I did place a call to Ms. Hill at her office extending an olive branch to her after all these years, in hopes that we could ultimately get past what happened so long ago,” she said. “That offer still stands. I would be very happy to meet and talk with her if she would be willing to do the same. Certainly no offense was ever intended.”

In response to Ms. Thomas’s statement, Ms. Hill said that she had testified truthfully about her experiences with the future Justice Thomas and that she had nothing to apologize for.

“I appreciate that no offense was intended, but she can’t ask for an apology without suggesting that I did something wrong, and that is offensive,” Ms. Hill said.

Andrew Gully, senior vice president of the Brandeis communications office, said Ms. Hill turned the message over to the campus police on Monday.

Ms. Thomas, 53, has long been active in conservative circles in Washington. In the past year she has become more prominent as the founder of a new nonprofit activist group, Liberty Central, which is dedicated to opposing what she has characterized as the leftist “tyranny” of the Obama administration and Congressional Democrats. The group has drawn scrutiny in part because of the unusual circumstance of a spouse of a sitting Supreme Court justice drawing a salary from a group financed by anonymous donors.

Ms. Hill, 54, is a professor of social policy, law and women’s studies at Brandeis. In 1991, she was at the center of a confrontation that deeply divided the country and prompted a national debate about sexual behavior in the workplace.

Ms. Hill had been an aide to Mr. Thomas at the Department of Education and the Equal Employment Opportunity Commission. President George Bush nominated Mr. Thomas to fill the Supreme Court seat left vacant by Justice Thurgood Marshall.

In testimony before the Senate Judiciary Committee, Ms. Hill claimed that Mr. Thomas had repeatedly made inappropriate sexual comments to her in the workplace, including descriptions of pornographic films. Mr. Thomas denied the allegations and called them “a high-tech lynching.”

In her 1998 book “Speaking Truth to Power,” Ms. Hill noted that she had been accused of harboring a romantic interest in Justice Thomas by his wife. “Virginia Thomas and I have never met,” Ms. Hill wrote. “And one can imagine that she is guided by her own romantic interest in her husband when she assumes that other women find him attractive as well.”

Justice Thomas weighed in with his own autobiography in 2007, “My Grandfather’s Son, ” referring to Ms. Hill as “my most traitorous adversary” and asserting that liberal advocacy groups stooped to “the age-old blunt instrument of accusing a black man of sexual misconduct” to block his ascent because of his conservative views.

Ms. Hill said she had a previous but indirect interaction with Ms. Thomas. After Justice Thomas’s book was published, she said, Ms. Thomas told an interviewer that Ms. Hill should apologize. In response, Ms. Hill gave an interview reiterating that she had nothing to apologize for.

“I thought that was enough then to end it, but apparently it was not,” Ms. Hill said.

Peter Baker contributed reporting from Washington and Tamar Lewin from New York.

Taliban’s Elite, Aided by NATO, Join Talks for Afghan Peace

KABUL, Afghanistan — Talks to end the war in Afghanistan involve extensive, face-to-face discussions with Taliban commanders from the highest levels of the group’s leadership, who are secretly leaving their sanctuaries in Pakistan with the help of NATO troops, officials here say.

The discussions, some of which have taken place in Kabul, are unfolding between the inner circle of President Hamid Karzai and members of the Quetta shura, the leadership group that oversees the Taliban war effort inside Afghanistan. Afghan leaders have also held discussions with leaders of the Haqqani network, considered to be one of the most hard-line guerrilla factions fighting here; and members of the Peshawar shura, whose fighters are based in eastern Afghanistan.

The Taliban leaders coming into Afghanistan for talks have left their havens in Pakistan on the explicit assurance that they will not be attacked or arrested by NATO forces, Afghans familiar with the talks say. Many top Taliban leaders reside in Pakistan, where they are believed to enjoy at least some official protection.

In at least one case, Taliban leaders crossed the border and boarded a NATO aircraft bound for Kabul, according to an Afghan with knowledge of the talks. In other cases, NATO troops have secured roads to allow Taliban officials to reach Afghan- and NATO-controlled areas so they can take part in discussions. Most of the discussions have taken place outside of Kabul, according to the Afghan official.

American officials said last week that talks between Afghan and Taliban leaders were under way. But the ranks of the insurgents, the fact that they represent multiple factions, and the extent of NATO efforts to provide transportation and security to adversaries they otherwise try to kill or capture have not been previously disclosed.

At least four Taliban leaders, three of them members of the Quetta shura and one of them a member of the Haqqani family, have taken part in discussions, according to the Afghan official and a former diplomat in the region.

The identities of the Taliban leaders are being withheld by The New York Times at the request of the White House and an Afghan who has taken part in the discussions. The Afghan official said that identifying the men could result in their deaths or detention at the hands of rival Taliban commanders or the Pakistani intelligence agents who support them.

The discussions are still described as preliminary, partly because Afghan and American officials are trying to determine how much influence the Taliban leaders who have participated in the talks have within their own organizations.

Even so, the talks have been held on several different occasions and appear to represent the most substantive effort to date to negotiate an end to the nine-year-old war, which began with an American-led campaign to overthrow the Taliban after the 9/11 attacks. “These are face-to-face discussions,” said an Afghan with knowledge of the talks. “This is not about making the Americans happy or making Karzai happy. It’s about what is in the best interests of the Afghan people.”

“These talks are based on personal relationships,” the official said. “When the Taliban see that they can travel in the country without being attacked by the Americans, they see that the government is sovereign, that they can trust us.”

The discussions appear to be unfolding without the approval of Pakistan’s leaders, who are believed to exercise a wide degree of control over the Taliban’s leadership. The Afghan government seems to be trying to seek a reconciliation agreement that does not directly involve Pakistan, which Mr. Karzai’s government fears will exercise too much influence over Afghanistan after NATO forces withdraw.

But that strategy could backfire by provoking the Pakistanis, who could undermine any agreement.

Mullah Muhammad Omar, the overall leader of the Taliban, is explicitly being cut out of the negotiations, in part because of his closeness to the Pakistani security services, officials said.

Afghans who have tried to take part in, or even facilitate, past negotiations have been killed by their Taliban comrades, sometimes with the assistance of Pakistan’s intelligence agency, Inter-Services Intelligence, or ISI.

“The ISI will try to prevent these negotiations from happening,” the Afghan official said. “The ISI will just eliminate them,” he said, referring to the people who take part.

Earlier this year, the ISI detained as many as 23 Taliban leaders residing in Pakistan after the intelligence service discovered that the Taliban leaders were talking secretly with representatives of the Afghan government.

Cutting Mullah Omar out of the negotiations appears to represent an attempt by Afghan leaders to drive a wedge into the upper ranks of the Taliban leadership. Though there is some disagreement among Afghan officials, many regard Mullah Omar as essentially a prisoner of the Pakistani security establishment who would be unable to exercise any independence.

Some American and Afghan officials believe that the Taliban is vulnerable to being split, with potentially large chunks of the movement defecting to the Afghan government.

The Haqqani group is the namesake of Jalalhuddin Haqqani, a former minister in the Taliban government in the 1990s who presides over a Mafia-like organization based in North Waziristan, in the tribal areas of Pakistan. The Haqqani network has sheltered several members of Al Qaeda and maintains close links to Pakistan’s security services.

The group is believed to be responsible for many suicide attacks inside Kabul that have killed hundreds of civilians. Earlier this year, Gen. David H. Petraeus, the commander of NATO forces here, asked the Obama administration to declare the Haqqani network a terrorist organization. That has not happened.

Indeed, the endorsement of such talks presents the Americans with a paradox. Many if not most of the leaders of the Taliban and the Haqqani group are targets for death or capture. Many of the same individuals are also on the United Nations “black list,” which obliges governments to freeze their assets and prevent them from traveling.

Waheed Omar, a spokesman for President Karzai, acknowledged that the government was in contact with a range of Taliban leaders, but he declined to discuss any details. “I cannot confirm that there have been discussions with the Quetta shura,” he said.

The Taliban leadership and those in their immediate circle appear to be in the dark as well. A Pakistani cleric close to the Quetta shura and the Haqqani leadership said in an interview that he was unaware of any face-to-face discussions with Afghan leaders. But he said the Afghan government had recently sent out feelers to several Taliban commanders, with the proviso that Mullah Omar be left out.

“The problem is, they want to exclude Mullah Omar,” the cleric said. “If you exclude him, then there cannot be any talks at all.”

The Pakistani cleric said that some discussions among members of the Quetta shura may have taken place recently in Saudi Arabia, where many of the group’s leaders had traveled during the holy month of Ramadan.

One Pakistani security official said he was aware of talks involving a member of the Quetta shura. But he said those discussions would likely come to nothing, because the Taliban leader did not any have official endorsement.

“He’s useless,” the Pakistani security officer said of the Taliban leader. “This guy is not in a position to make a deal.”

For their part, American officials say they are wary of investing too much hope in the discussions. In the past, talks — or, more accurately, talks about talks — have foundered over preconditions that each side has set: for the Taliban, that the Americans must first withdraw; for the Afghan government, that the Taliban must first disarm.

Perhaps the biggest complication lies on the battlefield. As long as the Taliban believe they are winning, they do not seem likely to want to make a deal. In recent months, as the additional troops and resources ordered up by President Obama have poured in, the American military has stepped up operations against Taliban strongholds.

So far, the insurgents have shown few public signs of wanting to give up. That much was acknowledged Tuesday by the C.I.A. director, Leon E. Panetta.

“If there are elements that wish to reconcile and get reintegrated, that ought to be obviously explored,” he said in Washington. “But I still have not seen anything that indicates that at this point a serious effort is being made to reconcile.”

Sangar Rahimi contributed reporting from Kabul, and Mark Mazzetti from Washington. A Pakistani employee of The New York Times also contributed reporting.

Docs on Pharma Payroll Have Blemished Records (some of YOU always know this to be true)

The Ohio medical board concluded [1] that pain physician William D. Leak had performed “unnecessary” nerve tests on 20 patients and subjected some to “an excessive number of invasive procedures,” including injections of agents that destroy nerve tissue.

Yet the finding, posted on the board’s public website, didn’t prevent Eli Lilly and Co. from using him as a promotional speaker and adviser. The company has paid him $85,450 since 2009.

In 2001, the U.S. Food and Drug Administration ordered [2] Pennsylvania doctor James I. McMillen to stop “false or misleading” promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.

Still, three other leading drug makers paid the rheumatologist $224,163 over 18 months to deliver talks to other physicians about their drugs.

And in Georgia, a state appeals court in 2004 upheld [3] a hospital’s decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why. He’d also been accused of exposing women’s breasts during medical procedures. When confronted by a hospital official, Taylor said, “Maybe I am a pervert, I honestly don’t know,” according to the appellate court ruling.

Last year, Taylor was Cephalon's third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.

Leak, McMillen and Taylor are part of the pharmaceutical industry’s white-coat sales force, doctors paid to promote brand-name drugs to their peers — and if they’re convincing enough, get more physicians to prescribe them.

Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs.

But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.

This story is the first of several planned by ProPublica examining the high-stakes pursuit of the nation’s physicians and their prescription pads. The implications are great for patients, who in the past have been exposed to such heavily marketed drugs as the painkiller Bextra and the diabetes drug Avandia — billion-dollar blockbusters until dangerous side effects emerged.

"Without question the public should care," said Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has written about the industry’s influence on physicians. "You would never want your kid learning from a bad teacher. Why would you want your doctor learning from a bad doctor, someone who hasn’t displayed good judgment in the past?"

To vet the industry’s handpicked speakers, ProPublica created a comprehensive database [4] that represents the most accessible accounting yet of payments to doctors. Compiled from disclosures by seven companies, the database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties. In addition to Lilly and Cephalon, the companies include AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer.

Although these companies have posted payments on their websites — some as a result of legal settlements — they make it difficult to spot trends or even learn who has earned the most. ProPublica combined the data and identified the highest-paid doctors, then checked their credentials and disciplinary records.

That is something not all companies do.

A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.

More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don’t post these actions on their web sites.

In interviews and written statements, five of the seven companies acknowledged that they don’t routinely check state board websites for discipline against doctors. Instead, they rely on self-reporting and checks of federal databases. Only Johnson & Johnson and Cephalon said they review the state sites.

ProPublica found 88 Lilly speakers who have been sanctioned and four more who had received FDA warnings. Reporters asked Lilly about several of those, including Leak and McMillen. A spokesman said the company was unaware of the cases and is now investigating them.

“They are representatives of the company,” said Dr. Jack Harris, vice president of Lilly’s U.S. medical division. “It would be very concerning that one of our speakers was someone who had these other things going on.”

Leak, the pain doctor, and his attorney did not respond to multiple messages. The Ohio medical board voted to revoke Leak’s license in 2008. It remains active as he appeals in court, arguing that the evidence against him was old, the witnesses unreliable and the sentence too harsh.

In an interview, McMillen denied nearly all of the allegations in the FDA letter and blamed his troubles on a rival firm whose drug he had criticized in his presentations.

“I’m more cautious now than I ever was,” said McMillen, who said he also does research. “That’s why I think a lot of the companies use me. I’m not taking any risks.”

Taylor said that the allegations against him were “old news” from the 1990s and that regulators had not sanctioned him. “It had nothing to do with my skills as a physician,” said Taylor, noting that he speaks every other week around the country and sometimes abroad. “Even my biggest detractors in that situation lauded my skills as a physician. That’s what’s most important.”

Disclosures are just the start

Payments to doctors for promotional work are not illegal and can be beneficial. Strong relationships between pharmaceutical companies and physicians are critical to developing new and better treatments.

There is much debate, however, about whether paying doctors to market drugs can inappropriately influence what they prescribe. Studies have shown that even small gifts and payments affect physician attitudes. Such issues have become flashpoints in recent years both in courtrooms and in Congress.

All told, 384 of the approximately 17,700 individuals in ProPublica’s database earned more than $100,000 for their promotional and consulting work on behalf of one or more of the seven companies in 2009 and 2010. Nearly all were physicians, but a handful of pharmacists, nurse practitioners and dietitians also made the list. Forty-three physicians made more than $200,000 — including two who topped $300,000.

Physicians also received money from some of the 70-plus drug companies that have not disclosed their payments. Some of those interviewed could not recall all the companies that paid them, and certainly not how much they made. By 2013, the health care reform law requires [5] all drug companies to report this information to the federal government, which will post it on the Web.

The busiest — and best compensated — doctors gave dozens of speeches a year, according to the data and interviews. The work can mean a significant salary boost — enough for the kids’ college tuition, a nicer home, a better vacation.

Among the top-paid speakers, some had impressive resumes, clearly demonstrating their expertise as researchers or specialists. But others did not –contrary to the standards the companies say they follow.

Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies.

Experts say the fact that some companies are disclosing their payments is merely a start. The disclosures do not fully explain what the doctors do for the money — and what the companies get in return.

In a raft of federal whistleblower lawsuits [6], former employees and the government contend that the firms have used fees as rewards for high-prescribing physicians. The companies have each paid hundreds of millions or more to settle the suits.

The disclosures also leave unanswered what impact these payments have on patients or the health care system as a whole. Are dinner talks prompting doctors to prescribe risky drugs when there are safer alternatives? Or are effective generics overlooked in favor of pricey brand-name drugs?

"The pressure is enormous. The investment in these drugs is massive,” said Dr. David A. Kessler, who formerly served as both FDA commissioner and dean of the University of California, San Francisco School of Medicine. “Are any of us surprised they’re trying to maximize their markets in almost any way they can?”

From drug reps to doc reps

For years, drug companies bombarded doctors with pens, rulers, sticky notes, even stuffed animals emblazoned with the names of the latest remedies for acid reflux, hypertension or erectile dysfunction. They wooed physicians with fancy dinners, resort vacations and personalized stethoscopes.

Concerns that this pharma-funded bounty amounted to bribery led the industry to ban most gifts voluntarily [7]. Some hospitals and physicians also banned the gift-givers: the legions of drug sales reps who once freely roamed their halls.

So the industry has relied more heavily on the people trusted most by doctors — their peers. Today, tens of thousands of U.S. physicians are paid to spread the word about pharma’s favored pills and to advise the companies about research and marketing.

Recruited and trained by the drug companies, the physicians — accompanied by drug reps — give talks to doctors over small dinners, lecture during hospital teaching sessions and chat over the Internet. They typically must adhere to company slides and talking points.

These presentations fill an educational gap, especially for geographically isolated primary care doctors charged with treating everything from lung conditions to migraines. For these doctors, poring over a stack of journal articles on the latest treatments may be unrealistic. A pharma-sponsored dinner may be their only exposure to new drugs that are safer and more effective.

Oklahoma pulmonologist James Seebass, for example, earned $218,800 from Glaxo in 2009 and 2010 for lecturing about respiratory diseases “in the boonies,” he said. On a recent trip, he said, he drove to “a little bar 40 miles from Odessa,” Texas, where physicians and nurse practitioners had come 50 to 60 miles to hear him.

Seebass, the former chair of internal medicine at Oklahoma State University College of Osteopathic Medicine, said such talks are “a calling,” and he is booking them for 2011.

The fees paid to speakers are fair compensation for their time away from their practices, and for travel and preparation as well as lecturing, the companies say.

Dr. Samuel Dagogo-Jack has a resume that would burnish any company’s sales force: He is chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center. Dagogo-Jack conducts research funded by the National Institutes of Health, has edited medical journals and continues to see patients.

While most people are going home to dinner with their families, he said, he is leaving to hop on a plane to bring news of fresh diabetes treatments to non-specialist physicians “in the trenches” who see the vast majority of cases.

Since 2009, Dagogo-Jack has been paid at least $257,000 by Glaxo, Lilly and Merck.

“If you actually prorate that by the hours put in, it is barely more than minimum wage,” he said. (A person earning the federal minimum wage of $7.25 would have to work 24 hours a day, seven days a week for more than four years to earn Dagogo-Jack’s fees.)

For the pharmaceutical companies, one effective speaker may not only teach dozens of physicians how to better recognize a condition, but sell them on a drug to treat it. The success of one drug can mean hundreds of millions in profits, or more. Last year, prescription drugs sales in the United States topped $300 billion, according to IMS Health, a healthcare information and consulting company.

Glaxo’s drug to treat enlarged prostates, Avodart — locked in a battle with a more popular competitor — is the topic of more lectures than any of the firm’s other drugs, a company spokeswoman said. Glaxo’s promotional push has helped quadruple Avodart’s revenue to $559 million in five years and double its market share, according to IMS.

Favored speakers like St. Louis pain doctor Anthony Guarino earn $1,500 to $2,000 for a local dinner talk to a group of physicians.

Guarino, who made $243,457 from Cephalon, Lilly and Johnson & Johnson since 2009, considers himself a valued communicator. A big part of his job, he said, is educating the generalists, family practitioners and internists about diseases like fibromyalgia, which causes chronic, widespread pain — and to let them know that Lilly has a drug to treat it.

“Somebody like myself may be able to give a better understanding of how to recognize it,” Guarino said. Then, he offers them a solution: “And by the way, there is a product that has an on-label indication for treating it.’’

Guarino said he is worth the fees pharma pays him on top of his salary as director of a pain clinic affiliated with Washington University. Guarino likened his standing in the pharma industry to that of St. Louis Cardinals first baseman Albert Pujols, named baseball player of the decade last year by Sports Illustrated. Both earn what the market will bear, he said: “I know I get paid really well.”

Is anyone checking out there?

Simple searches of government websites turned up disciplinary actions against many pharma speakers in ProPublica’s database.

The Medical Board of California filed a public accusation against psychiatrist Karin Hastik in 2008 and placed her [8] on five years’ probation in May for gross negligence in her care of a patient. A monitor must observe her practice.

Kentucky’s medical board placed Dr. Van Breeding on probation [9] from 2005 to 2008. In a stipulation filed with the board, Breeding admits unethical and unprofessional conduct. Reviewing 23 patient records, a consultant found Breeding often that gave addictive pain killers without clear justification. He also voluntarily relinquished his Florida license.

New York’s medical board put Dr. Tulio Ortega on two years’ probation [10] in 2008 after he pleaded no contest to falsifying records to show he had treated four patients when he had not. Louisiana’s medical board, acting on the New York discipline, also put him on probation [11] this year.

Yet during 2009 and 2010, Hastik made $168,658 from Lilly, Glaxo and AstraZeneca. Ortega was paid $110,928 from Lilly and AstraZeneca. Breeding took in $37,497 from four of the firms. Hastik declined to comment, and Breeding and Ortega did not respond to messages.

Their disciplinary records raise questions about the companies’ vigilance.

“Did they not do background checks on these people? Why did they pick them?” said Lisa Bero, a pharmacy professor at University of California, San Francisco who has extensively studied conflicts of interest in medicine and research.

Disciplinary actions, Bero said, reflect on a physician’s credibility and willingness to cross ethical boundaries.

"If they did things in their background that are questionable, what about the information they’re giving me now?” she said.

ProPublica found sanctions ranging from relatively minor misdeeds such as failing to complete medical education courses to the negligent treatment of multiple patients. Some happened long ago; some are ongoing. The sanctioned doctors were paid anywhere from $100 to more than $140,000.

Several doctors were disciplined for misconduct involving drugs made by the companies that paid them to speak. In 2009, Michigan regulators accused one rheumatologist of forging a colleague’s name to get prescriptions for Viagra and Cialis. Last year, the doctor was paid $17,721 as a speaker for Pfizer, Viagra’s maker.

A California doctor who was paid $950 this year to speak for AstraZeneca was placed on five years’ probation by regulators in 2009 after having a breakdown, threatening suicide and spending time in a psychiatric hospital after police used a Taser on him. He said he’d been self-treating with samples of AstraZeneca’s anti-psychotic drug Seroquel, medical board records show.

Other paid speakers had been disciplined by their employers or warned by the federal government. At least 15 doctors lost staff privileges at various hospitals, including one New Jersey doctor who had been suspended twice for patient care lapses and inappropriate behavior. Other doctors received FDA warning letters for research misconduct such as failing to get informed consent from patients.

Pharma companies say they rely primarily on a federal database listing those whose behavior in some way disqualifies them from participating in Medicare. This database, however, is notoriously incomplete.

The industry’s primary trade group says its voluntary code of conduct is silent about what, if any, behavior should disqualify physician speakers.

“We look at it from the affirmative — things that would qualify physicians,” said Diane Bieri, general counsel and executive vice president of the Pharmaceutical Research and Manufacturers of America.

Some physicians with disciplinary records say their past misdeeds do not reflect on their ability to educate their peers.

Family medicine physician Jeffrey Unger was put on probation [12] by California’s medical board in 1999 after he misdiagnosed a woman’s breast cancer for 2½ years. She received treatment too late to save her life. In 2000, the Nevada medical board revoked Unger’s license for not disclosing California’s action.

As a result, Unger said, he decided to slow down and start listening to his patients. Since then, he said, he has written more than 130 peer-reviewed articles and book chapters on diabetes, mental illness and pain management.

“I think I’ve more than accomplished what I’ve needed to make this all right,” he said. During 2009 and the first quarter of 2010, Lilly paid Unger $87,830. He said he also is a paid speaker for Novo Nordisk and Roche, two companies that have not disclosed payments.

The drug firms, Unger said, “apparently looked beyond the record.”

Companies make their own experts

Last summer, as drug giant Glaxo battled efforts to yank its blockbuster diabetes drug Avandia from the market, Nashville cardiologist Hal Roseman worked the front lines.

At an FDA hearing, he borrowed David Letterman’s shtick [13] to deliver a “Top Five” list of reasons to keep the drug on the market despite evidence it caused heart problems. He faced off [14] against a renowned Yale cardiologist and Avandia critic on the PBS NewsHour, arguing that the drug’s risks had been overblown.

“I still feel very convinced in the drug,” Roseman said with relaxed confidence. The FDA severely restricted access to the drug last month citing its risks.

Roseman is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center or in a leadership role among his colleagues.

Roseman’s public profile comes from his work as one of Glaxo’s highest-paid speakers. In 2009 and 2010, he earned $223,250 from the firm — in addition to payouts from other companies.

Pharma companies often say their physician salesmen are chosen for their expertise. Glaxo, for example, said it selects “highly qualified experts in their field, well-respected by their peers and, in the case of speakers, good presenters.”

ProPublica found that some top speakers are experts mainly because the companies have deemed them such. Several acknowledge that they are regularly called upon because they are willing to speak when, where and how the companies need them to.

“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.

“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”

To check the qualifications of top-paid doctors, reporters searched for medical research, academic appointments and professional society involvement. They also interviewed national leaders in the physicians’ specialties.

In numerous cases, little information turned up.

Las Vegas endocrinologist Firhaad Ismail, for example, is the top earner in the database, making $303,558, yet only his schooling and mostly 20-year-old research articles could be found. An online brochure [15] for a presentation he gave earlier this month listed him as chief of endocrinology at a local hospital, but an official there said he hasn’t held that title since 2008.

And several leading pain experts said they’d never heard of Santa Monica pain doctor Gerald Sacks, who was paid $249,822 since 2009.

Neither physician returned multiple calls and letters.

A recently unsealed whistleblower lawsuit against Novartis [16], the nation’s sixth-largest drug maker by sales, alleges that many speakers were chosen “on their prescription potential rather than their true credentials.”

Speakers were used and paid as long as they kept their prescription levels up, even though “several speakers had difficulty with English,” according to the amended complaint filed this year in federal court in Philadelphia.

Some physicians were paid for speaking to one another, the lawsuit alleged. Several family practice doctors in Peoria, Ill., “had two programs every week at the same restaurant with the same group of physicians as the audience attendees.”

In September, Novartis agreed to pay [17] the government $422.5 million to resolve civil and criminal allegations in this case and others. The company has said it fixed its practices and now complies with government rules.

Roseman, who has been a pharma speaker for about a decade, acknowledged that his expertise comes by way of the training provided by the companies that pay him. But he says that makes him the best prepared to speak about their products, which he prescribes for his own patients. Asked about Roseman’s credentials, a Glaxo spokeswoman said he is an “appropriate” speaker.

Getting paid to speak “doesn’t mean that your views have necessarily been tainted,” he said.

Plus pharma needs talent, Roseman said. Top-tier universities such as Harvard [18] have begun banning their staffs from accepting pharma money for speaking, he said. “It irritates me that the debate over bias comes down to a litmus test of money,” Roseman said. “The amount of knowledge that I have is in some regards to be valued.”

ProPublica Director of Research Lisa Schwartz and researcher Nicholas Kusnetz contributed to this report.

DAMMN is she STUPID! No brain strikes again!

Palin Swipes Maureen Dowd

Apparently The New York Times opinion page doesn’t make Sarah Palin’s regular reading list, though we guess Katie Couric could have told us that. In an interview with Fox News, Palin responded to a scathing column from Maureen Dowd, saying “That’s so funny because I don’t think I’ve ever met that gal, Maureen Dowd—O’Dowd—whatever the heck her name is,” GOP 12 reported Tuesday. Dowd’s October 16th column attacked a group of female Tea Party candidates and their “Queen Bee Sarah.” Palin went on to dismiss Dowd, encouraging “liberty-loving Americans to just keep smiling.” The mainstream media, she said, was just getting “all wee-weed up” about her “mama grizzlies.”


O'Donnell questions separation of church, state

WILMINGTON, Del. -- Republican Senate nominee Christine O'Donnell of Delaware on Tuesday questioned whether the U.S. Constitution calls for a separation of church and state, appearing to disagree or not know that the First Amendment bars the government from establishing religion.

The exchange came in a debate before an audience of legal scholars and law students at Widener University Law School, as O'Donnell criticized Democratic nominee Chris Coons' position that teaching creationism in public school would violate the First Amendment by promoting religious doctrine.

Coons said private and parochial schools are free to teach creationism but that "religious doctrine doesn't belong in our public schools."

"Where in the Constitution is the separation of church and state?" O'Donnell asked him.

When Coons responded that the First Amendment bars Congress from making laws respecting the establishment of religion, O'Donnell asked: "You're telling me that's in the First Amendment?"

Her comments, in a debate aired on radio station WDEL, generated a buzz in the audience.

"You actually audibly heard the crowd gasp," Widener University political scientist Wesley Leckrone said after the debate, adding that it raised questions about O'Donnell's grasp of the Constitution.

Erin Daly, a Widener professor who specializes in constitutional law, said that while there are questions about what counts as government promotion of religion, there is little debate over whether the First Amendment prohibits the federal government from making laws establishing religion.

"She seemed genuinely surprised that the principle of separation of church and state derives from the First Amendment, and I think to many of us in the law school that was a surprise," Daly said. "It's one thing to not know the 17th Amendment or some of the others, but most Americans do know the basics of the First Amendment."

O'Donnell didn't respond to reporters who asked her to clarify her views after the debate. Her campaign manager, Matt Moran, later issued a statement saying that O'Donnell wasn't questioning the concept of separation of church and state.

"She simply made the point that the phrase appears nowhere in the Constitution," Moran said.

During the exchange, she said Coons' views on creationism showed that he believes in big-government mandates.

"Talk about imposing your beliefs on the local schools," she said. "You've just proved how little you know not just about constitutional law but about the theory of evolution."

Coons said her comments show a "fundamental misunderstanding" of the Constitution.

The debate, their third in the past week, was more testy than earlier ones.

O'Donnell began by defending herself for not being able to name a recent Supreme Court decision with which she disagrees at a debate last week. She said she was stumped because she largely agrees with the court's recent decisions under conservative chief justices John Roberts and William Rehnquist.

"I would say this court is on the right track," she said.

The two candidates repeatedly talked over each other, with O'Donnell accusing Coons of caving at one point when he asked the moderator to move on to a new question after a lengthy argument.

"I guess he can't handle it," she said.

O'Donnell, a tea party favorite who stunned the state by winning the GOP primary last month in her third Senate bid in five years, called Coons a liberal "addicted to a culture of waste, fraud and abuse."

Coons, who has held a double-digit lead in recent polls, urged voters to support him as the candidate of substance, with a track record over six years as executive of the state's most populous county. He said O'Donnell's only experience is in "sharpening the partisan divide but not at bridging it."


Ted Forstmann "Extortion"?

A lawsuit is accusing the billionaire dealmaker of racism, escort use, and gambling against his client, Tiger Woods. Lies, Forstmann tells The Daily Beast's Charlie Gasparino exclusively, from a "shakedown artist." Forstmann has made many brilliant bets—his stance against junk bonds in the 1980s, Gulfstream Aerospace in the 1990s, calling the credit crisis in 2008—and like any Wall Street veteran, more than a few clunkers. One of his worst calls, he says, involves a friendship with a man named James Agate. That decision is now costing him dearly—Agate's leveling salacious allegations against him, and now Forstmann is speaking out for the first time about the feud.

New York's Insane Political Circus

The state's candidates for governor, "debating" Monday night, threaten to wreck America's ability to export democracy around the globe. Pity the poor people of New York: Can there ever have been a state so rich, so abundantly endowed with talent and enterprise, to have had a political choice so abject, so meager, so embarrassing? The Daily Beast's Tunku Varadarajan reports on a showing that ensured Cuomo's win.

How the Media Blew the Midterms

Even top journalists were blindsided by Christine O'Donnell, don't get the Tea Party, and feel Obama's getting short shrift. The media narrative has solidified: Voters are mad as hell and they're not going to take it anymore. But if you read between the lines, there's a hint that the likely outcome is somehow unjust. The Daily Beast's Howard Kurtz explains what the mainstream press got wrong.

Banks Restart Foreclosures

Bank of America and GMAC are restarting foreclosures after problems with paperwork caused the banks to halt the process in 23 states. Bank of America reopened 100,000 home-seizure files after saying it found no major problems in its paperwork procedures. GMAC didn't say how many foreclosures it would restart work on. Lenders are pushing back against a growing political backlash over allegations that their employees signed hundreds of foreclosure documents a day without bothering to read them. A Bank of America spokesman said the move was a "first step" in efforts to debunk "speculation" that the mortgage market has big problems. The company will begin selling seized homes in November.

Read it at The Wall Street Journal

Judge Rejects Don't Ask, Don't Tell Stay

A federal judge rejected the government's request to stay her decision overturning Don't Ask, Don't Tell while the ruling is appealed, saying the feds had failed to prove that stopping the anti-gay policy would cause "irreparable harm" to the armed forces. The government said halting the policy would endanger national security and undermine the Defense Department's study to figure out the best policy for dealing with open gays. U.S. District Judge Virginia Phillips dismissed that argument, saying her decision only required the military to stop kicking out gays, not to end its quest for a new way of dealing with them. The government offered no evidence that gays would hurt unit cohesion or readiness.

Read it at Los Angeles Times