Lessons From Ötzi, the Tyrolean Ice Man. Part III

There are two reasons why I chose this time to write about Otzi.  The first is that I've been looking for a good excuse to revisit human evolutionary history, particularly that of Europeans, and what it does and doesn't tell us about the "optimal" human diet.  The second is that Otzi's full genome was sequenced and described in a recent issue of Nature Communications (1).  A "genome" is the full complement of genes an organism carries.  So what that means is that researchers have sequenced almost all of his genes. 

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The Spoils of a "Scorched-Earth Defense" - Merck CEO Got $13.3 Million in 2011

Last week, Bloomberg reminded us of the legal baggage that pharmaceutical giant Merck is carrying. The company had announced yet another settlement of legal actions pertaining to its ill-starred but very profitable sales of now withdrawn Vioxx (rofecoxib) in 2011 (see post here). Now the settlement, including a guilty plea was accepted by a judge.

A unit of Merck & Co. (MRK), the second- largest U.S. drugmaker, pleaded guilty to a criminal misdemeanor charge as part of a $950 million settlement of a U.S. government probe of its illegal marketing of the painkiller Vioxx.

An official of Merck Sharp & Dohme said today that the company agreed to plead guilty to one count of misbranding Vioxx. U.S. District Judge Patti Saris in Boston accepted the plea as part of the drugmaker’s agreement to pay a $321.6 million criminal fine and $628.3 million to resolve civil claims that it sold Vioxx for unapproved uses and improperly touted its safety.

'I’m certainly going to accept this agreement because I think it’s in the public interest,' Saris said from the bench. 'I hope the size of this settlement and the fact that all these cases are being pressed by the federal and state governments -- the 44 states’ attorneys general -- will be a signal that this isn’t acceptable conduct.'

But unacceptable conduct can lead to a great deal of revenue. As Bloomberg noted,

Approved by the Food and Drug Administration in 1999, Vioxx became Merck’s third-largest-selling drug by 2003, generating $2.5 billion in annual sales. The company pulled Vioxx off the market in 2004 after a study found it posed an increased risk of heart attacks and strokes.

It can also lead to a great deal of personal profit for those at the company tasked with defending such "unacceptable conduct," and what has now been found to be criminal behavior. Writing in Slate, Snigdha Prakash, who wrote All the Justice Money Can Buy about the legal aftermath of Vioxx, identified the current Merck CEO and board chairman as the architect of the defense of Vioxx, as

best known for his phenomenal success in defending a sordid chapter in Merck’s recent past—its years-long silence about the safety problems of the popular painkiller Vioxx.

Furthermore, she wrote,

As he showed with the Vioxx litigation, Frazier is adept at mounting a scorched-earth defense that minimizes payouts to potential plaintiffs.

Tens of thousands of former Vioxx users sued Merck after it withdrew the drug, alleging Vioxx had caused them to suffer heart attacks and strokes. Frazier, then the company’s general counsel, declared Merck had done nothing wrong and refused to settle. 'We’ll fight every case,' he declared, and hired top-flight law firms in several East Coast cities, in the South, in Chicago, and Los Angeles, as well as a prominent New York firm to coordinate the overall strategy. It took three years and $2 billion in legal expenses for Frazier’s hard-nosed tactics to pay off. Merck settled in late 2007 for a relative pittance, resolving some 50,000 Vioxx cases for just under $5 billion. It was a far cry from the $25 billion to $50 billion in liability that analysts had predicted when Merck withdrew the drug.

So it appears that Mr Frazier is now reaping his rewards. The Dow Jones News Service reported earlier in April,

Merck & Co.'s (MRK) leader received compensation valued at $13.3 million for 2011, up 41% from the year before, reflecting his ascension to the drug maker's top post and Merck's ability to exceed certain internal performance targets.

Kenneth Frazier, 57, became Merck's chief executive at the beginning of 2011 and chairman of the board in December. He was previously head of Merck's human health business.

In a proxy statement filed Thursday with the U.S. Securities and Exchange Commission, Merck said certain elements of Frazier's compensation reflected growth in Merck's sales and adjusted earnings for 2011.

In addition, Merck's board considered 'his performance, leadership, planning and oversight during a time of continued economic, regulatory and political challenges for the healthcare industry.'

Earlier this year, Frazier acknowledged that Merck had a tough 2011. The company endured setbacks including negative clinical data for a once-promising heart drug, vorapaxar. Merck's full-year stock price performance lagged behind most of its large-pharmaceutical peers.

But Merck of Whitehouse Station, N.J., continued to cut costs and was able to raise its dividend for the first time in seven years in 2011. Frazier said in January he was optimistic about 2012.

Frazier's total compensation included: $1.5 million in salary, $3.1 million in stock awards, $3 million in option awards, $3.1 million in non-equity incentive plan compensation, and $2.6 million change in pension value and non-qualified deferred compensation earnings.

So somehow a "tough 2011" for Merck's stockholders (Merck's stock price rose a mere 3.9%, from 36.29 to 37.70 through 2011) resulted in a cornucopia of riches for Mr Frazier. So rather than being rewarded for "maximizing shareholder value," (see post here) maybe Mr Frazier was rewarded for, as Ms Prakash put it, "burying monumental corporate failures at Merck."

Here is the latest version of how top health care organizational insiders manage to make even more money no matter what, in this case, no matter what happens to the fortunes of the nominal owners of the company, no matter what happens to the company's once proud reputation, and particularly no matter what happened to the patients unfortunate enough to suffer adverse effects from its drug.

We will not be able to truly reform health care, to really improve outcomes, improve access, and control costs, until we hold the leaders of health care organizations accountable.

Random Thoughts: Obesity, Weight loss, Metabolism, Diet & Exercise

In the interests of saving a bit of time and gathering thoughts, I thought I'd jot down some would-be comment replies in a blog post instead.  First, so we're all (newer readers especially) on the same page, I did no formal exercise during the active weight loss phase and long plateau from sometime summer 2007 through spring 2009.  This was not really by design, but more out of fear as the last time I low carbed I experienced the racing heart mostly when doing rather short periods of pilates and such.  So I kept meaning to up the activity level a bit but never really managed to get around to it.  In 2009 I did start doing concerted cardio -- walking and biking -- and later some more cardio-like exercise DVD's.  As for strength training, the only formal training I have done was that 100 pushups thing that was popular in 2010.  I got to 100 "girlie" pushups and was on my way with the regular ones when I pulled something in my side that made rolling over in bed painful!  So for me personally, regular exercise is a sporadic thing at best ... something I am trying to dedicate myself to just never seems to stick.  That said, I am very active.  Initially this was just doing the "parking far away at work" thing and such, but has progressed to deliberate short bouts of exercise like walking around the yard when I bring the garbage out, always running up stairs, just going up and down stairs for the heck of it, etc.etc.  Additionally, we go through a lot of wood with our fireplace to heat part of our home and I do pretty regular "workouts" transporting/stacking, chainsawing, etc. wood.  

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Perednia: "Starting Over With Healthcare Reform Is, Unfortunately, a Matter of Religion"

Over at "The Road to Hellth" blog, Douglas Perednia MD has written an excellent piece entitled "Starting Over With Healthcare Reform Is, Unfortunately, a Matter of Religion."

The use of the term "religion" is not literal but figurative:

... In deciding what to do [in recent years], political leaders stopped dealing in experience, evidence and compromise, and began dealing in faith-based – almost religious – healthcare decision-making. Of course in this context we’re not talking about “faith-based” in its meaning of handed down from the one true God (or the many true Gods, depending upon your religion), but instead faith-based in the sense of having fixed and immutable beliefs about things like how to run healthcare or, indeed, the whole country.  It doesn’t matter what the available evidence shows or what human experience has been, the political religions of the left and right, Republicans and Democrats, won’t tolerate alternative facts, strategies or explanations.  Doing so would be sacrilege, remediable only by human sacrifice. 

The point of his post is that in the U.S. both political parties have abandoned all pretense of listening to science or reason and making compromises that benefit patients.  They are making all decisions on fervently-held, unshakeable ideological beliefs (and, I add in some cases, for personal gain no matter the consequences to the public).

I am reproducing the section of his essay on health IT, that illustrates his point well:

A third example is the sacrificial cult of electronic medical records.  [Sadly, that phraseology is all too apt - ed.]  Except for those who work at Departments of Medical Informatics or as physician “champions” for EMR vendors or health systems that are spending billions to implement the darned things, the vast majority of doctors and nurses will tell you that EMRs are a chainsaw to clinical productivity and the amount of time that we actually spend listening to and getting to know our patients and their problems.  Non-vendor, non-government studies that show that these systems save money or actually improve clinical results are scarcer than hen’s teeth, yet not a day goes by without having shamans in the Cult of EMR claim that we will see miraculous increases in efficiency, reductions in cost, improvements in health and a blooming of preventive medicine “any day now”.  

These claims are increasing in intensity and shamelessness.  This is at a time when it is admitted by some of the most respected scientific bodies (e.g., National Research Council, FDA, IOM, NIST) that the technology does not support clinicians' cognitive needs, is in fact disruptive and hard to use, and reports of harm are appearing.  Worse, they report - magnitudes of reported harm are unknown due to impaired information diffusion.  The impairment is both due to lack of regulation and regulatory authorities to report to (which allows opportunism), as well as due to business IT-modeled legal contracts with IP-protection and defects gag clauses.

The cult has grown so powerful that has been able to force clinics and hospitals to sacrifice themselves in the process; goaded by the awards and penalties handed out for the presence or absence of “meaningful use”.  It’s no great revelation that is a new technology is truly useful, beneficial and cost-effective, there is absolutely no reason that a government would need to mandate its use or bribe people to buy it.  Dr. Scot Silverstein at the Health Care Renewal blog has devoted his career to documenting the questionable engineering and lack of clinical awareness that goes into these systems, but you will not identify single iota of doubt in the pronouncements of the Office of the National Coordinator or the politicians who are receiving funds and advice from the “healthcare information technology” (HIT) industry.  Their minds are made up.  Don’t confuse them with the facts.

I wouldn't say I've "devoted my career" to documenting the problems only.  I've been spending considerable time now doing something about it.  This includes, in part, advising attorneys on both sides of the Bar on the problems they need to be aware of.

This knowledge will likely benefit plaintiff's lawyers and injured patients far more than the defense.  There is no defense for cybernetically harming people with poorly designed and implemented, experimental medical devices, used without patient informed consent, or for trying to conceal the malpractice via electronic legerdemain.

It is my belief that a fair share of cavalier health IT experimenters, dyscompetents and "creative medical history editors" responsible for the current shabby state (technically and ethically) of commercial HIT, a situation that could have been avoided via learning from the medical and technological past, will have a very unpleasant and costly time in the courtroom in future years. 

-- SS

#communitysport blog: Jamie Turley

Our latest blog in our Community Sport series comes from Jamie Turley. In his role as a Young Ambassador, 19-year-old Jamie from Ffynongroyw, has been responsible for inspiring, leading and coaching hundreds of young people in his community to get involved in sport.

The Sports Science and Outdoor Activities student freely gives up countless hours of his spare time to motivate othersto take part in a wide range of PE and School Sport activities, working closely with youngsters who wouldn’t normally take part.

Denbighshire Young Ambassador Jamie Turley

I am a Platinum Young Ambassador in Wales. For those of you who don’t know what this is; it’s a voluntary role that involves young people driving sport in their communities. It was launched alongside the Olympic Games bid for London, with each and every Ambassador putting into practice awareness of the Olympic and Paralympic values.

The role is a never ending trail of inspiration, to see the impact you have leading sporting opportunities for the young people around you. It can be anything from leading a sports session in a primary school, to delivering presentations to the Sport Wales Board and working with LOCOG. As Young Ambassadors we all share the passion to drive what’s summarised in the Sport Wales vision of getting ‘every child hooked on sport for life’.

Community sport is at the heart of my passion. It’s where my first opportunities came and where I always refer back to for anything I do. Sport at the centre of a community brings many benefits perhaps unnoticed at times. It not only unites the community young and old, through the social side many sports clubs bring, but it provides a common ground for the development of many life skills and personal achievement.

It teaches you respect for those around you, for your coach, and your team mates. I learn every time I’m involved in community sport and I’m inspired to achieve greater things for the benefit of my community. Seeing the kid’s faces light up with enthusiasm, and for them to be thankful for our efforts, really gives you a feeling of giving back to a cause which gave so much to me.

Community sport needs to be embraced firstly by the participants, if the children are motivated to take part then the sequence becomes like a snowball effect of inspiration. The coaches and volunteers inspire the children, the children inspire the coaches. Each community has its heroes and it’s about utilising and supporting everyone involved. I personally feel there needs to be more recognition for unsung heroes, coaches, volunteers, who - without fail - week in week out go out and deliver sessions with passion.

Facilities, finance, transport, kit; there are so many barriers sometimes to overcome, but one thing always comes out on top and that’s the passion that the people involved have in all they do.

Sport plays a huge role in bringing a community together. No matter what level if anyone’s ever played for a sports team or club, they’ll have friends from that club to last a lifetime. The common ground concept flourishes not only in a sense of like for like, members friends with members, but coaches, members, secretaries, treasurers, orange preparers, and supporters, the network it forms throughout a community - particularly the smaller ones - develops continually. This I believe cannot be summarized in writing but has to be witnessed as it’s personal to each and every community.

I have been lucky enough to have been selected as an Olympic torchbearer on May 29th in Towyn. This represents not only a great personal achievement but I feel I’m representing each and every coach, participant, and volunteer I’ve ever worked with. It’s a moment to shine, close enough to home for my community to be around and be involved with the celebration. Whilst at my new university home of Bangor I have also been asked to assume a role of volunteer co-ordinator at the Olympic flame evening celebration a day before my torch bearing.

Whatever happens I know having seen firsthand, the impact of the torch relay will be hugely influential and will create a long lasting legacy across my home region of North Wales. It will inspire the community as a whole, more participants into clubs, as well as leaders and volunteers to continue what they’re already doing for a very long time to come. But above and beyond that, it’s a once in a lifetime opportunity, inspiring members of the community to be the best they can be. 

As for the Young Ambassadors and the opportunities that brings; the program I feel will continue to grow and develop the next generation of leaders in sport.

This blog was written in conjunction with the launch of a strategy for Community Sport in Wales.  If you’d like your say, get involved in the debate on twitter – using the hashtag #communitysport and you can mention us @sport_wales

#communitysport blog: Ainsley Richards

Our latest blog in our Community Sport series comes from Ainsley Richards. In her role as a Young Ambassador, the teenager from Swansea has been responsible for inspiring, leading and coaching hundreds of young people in her community to get involved in sport.

A London 2012 Young Ambassador for the City and County of Swansea, she has been a busy volunteer with her school, the feeder primary schools and in her community as a coach.

Ainsley with Olympic and world Champion cyclist Geraint thomas

My parents have inspired to me take part in sport. They both train regularly. My dad has represented Wales in Karate and my mother has recently won two Welsh titles in the Welsh Masters Badminton Nationals, and represents Wales at Masters level. Both my younger brother and sister participate in different sports. This season, all three of us  ran in the County Cross Country team. It’s not unusual to see the whole family out running!

I realise the importance of sport from an obvious health factor, but individuals play a huge part in encouraging and motivating young people in sport. Certain individuals  that have been a great inspiration to me include people like Andrea Whitcombe in running, Lloyd Cole in Surfing, Huw John in Badminton and Wendy Bleddyn in Netball. They are so passionate about their sport, their enthusiasm is contagious and has  inspired me to develop and compete.

School has been really important. I attend YG Gwyr, where the PE department is excellent. Bethan Davies, Head of PE, has supported me in every area of sport, in torrential rain in cross country events and even sometimes travelling as far as Devon for a weekend to enable the school to compete in a British surfing competition, where I secured third place!

I wouldn’t have reached the level of badminton I have attained if it wasn’t for Mr Dai Long and his commitment to the school badminton club! Mrs. Katherine Davies, head teacher has also been really supportive of all my sporting activities.

Outside school, I belong to a number of different sporting clubs, including Glamorgan Badminton club, Mumbles Treforus netball and Swansea Harriers. It’s great having so many different friends outside school, and obviously it has improved my performance in these different sports.

I sometimes wish I had started to compete at an earlier age and had more opportunities to try different sports at primary school. My school had no resources on-site, so we had to be transported to venues. I used to envy children who have playing fields in the school grounds!

I was recently asked to help in a survey promoting ‘Rounders’ in England. I would love to see the development of Rounders as a sport in Wales.

I think that the advantages of taking part have to be promoted to young people at an early age. The Young Ambassador scheme is developing throughout Wales rapidly. I believe it is important for younger children to have role models to aspire to. Some young people are not aware of the activities available to them, perhaps sporting organisations could be a little more pro-active in visiting schools and offering taster sessions.

I have been fortunate to have been selected to volunteer at the Olympics. I’m hoping that the London 2012 Olympics/Paralympics will be a great vehicle to get more young people participating in sport.

This blog was written in conjunction with the launch of a strategy for Community Sport in Wales.  If you’d like your say, get involved in the debate on twitter – using the hashtag #communitysport and you can mention us @sport_wales

Karya-Karya sang Legendaris, Iwan Fals !

Unik Informatika - Sepanjang hidupnya Iwan Fals, sangat banyak mengabdi kepada bangsa Indonesia salah satunya adalah menciptakan seni di Indonesia menjadi salah satu yang terbaik di dunia. Seni musik yang sudah ditekuninya sejak kecil menghasilkan banyak karya seni, baik itu dalam dunia film atau musik itu sendiri, dalam dunia film Iwan Fals berhasil bermain di 3 film anak bangsa yaitu Damai Kami Sepanjang Hari, Kantata Takwa dan Kekasih masing-masing pada tahun 1985, 1990 dan 2008.

Sedangkan dalam dunia musik karya putera bangsa satu ini memang layak mendapat 10 jempol menurut saya karena musik yang ia ciptakan sangatlah khas, dan tak jarang ia harus berhadapan dengan aparat keamanan negeri ini, karena memang lagunya yang sangat kontroversial kerena memang ia dilahirkan mempunyai jiwa yang peka terhadap hidup bersosial dan dekat dengan rakyak kecil dan bahkan kecilnya ia memang seorang pengamen, sungguh semangat yang luar biasa dan patut dicontoh.

Karya nya antara lain adalah Album dan Single musik, yang akan saya coba untuk merangkumnya dibawah ini karena memang postingan saya kali ini akan membahas tentang karya-karya Iwan Fals dalam dunia Film dan Musik, baiklah saya juga akan mencoba menupload sebanyak mungkin album dari Iwan Fals, nah jika anda melihat akan adanya link dalam tulisan saya dibawah ini maka Album tersebut sudah bisa anda Download, baiklah tanpa basa-basi lagi saya akan coba uraikan Album Iwan Fals dari masa ke masa dulu ya ! cekidot :

Album-album Iwan Fals :

1. Canda Dalam Tawa (1979)

2. Canda Dalam Ronda (1979)

3. Perjalanan (1979)

4. 3 Bulan (1980)

5. Sarjana Muda (1981)

6. Opini (1983)

7. Sumbang (1983)

8. Barang Antik (1984)

9. Sugali (1984)

10. Kelompok Penyanyi Jalanan atau KPJ (1985)

11. Sore Tugu Pancoran (1985)

12. Aku Sayang Kamu (1986)

13. Ethiopia (1986)

14. Lancar (1987)

15. Wakil Rakyat (1988)

16. 1910 (1988)

17. Mata Dewa (1989)

18. Antara Aku, Kau dan Bekas Pacarmu (1989)

19. Swami I (1989)

20. Kantata Takwa (1990)

21. Cikal (1991)

22. Swami II (1991)

23. Belum Ada Judul (1992)

24. Hijau (1992)

25. Dalbo (1993)

26. Anak Wayang (1994)

27. Orang Gila (1994)

28. Lagu Pemanjat (1996) bersama Trahlor

29. Kantata Samsara (1998)

30. Best of The Best (2000)

31. Suara Hati (2002)

32. In Collaboration with (2003)

33. Manusia Setengah Dewa (2004)

34. Iwan Fals in Love (2005)

35. 50 : 50 (2007)

36. Untukmu Terkasih (2009)

37. Keseimbangan - Iwan Fals (2010)

38. Tergila-gila (2011)

Single-single Iwan Fals :

1. Serenade (bersama Ritta Rubby) (1984)

2. Kemesraan (bersama artis Musica) (1988)

3. Percayalah Kasih (bersama Jockie Surjoprajogo dan Vina Panduwinata)

4. Terminal (bersama Franky S.) (1994)

5. Mata Hati (bersama Ian Antono) (1995)

6. Orang Pinggiran (bersama Franky S.) (1995)

7. Katakan Kita Rasakan (bersama artis Musica)

8. Di Bawah Tiang Bendera (bersama artis Musica) (1996)

9. Haruskah Pergi (bersama Indra Lesmana dan Import Musik) (2006)

10. Selancar (bersama Indra Lesmana dan Import Musik) (2006)

11. Tanam Tanam Siram Siram (Kampanye Indonesia Menanam) (2006)

12. Marilah Kemari (Tribute to Titiek Puspa) (2006)

13. Aku Milikmu (Original Soundtrack Lovers / Kekasih) (2008)

Single Hits Ciptaan Iwan Fals yang dinyanyikan oleh Penyanyi lain :

1. Maaf (dibawakan oleh Ritta Rubby) (1986)

2. Belailah (dibawakan oleh Ritta Rubby) (1986)

3. Trauma (dibawakan oleh God Bless) (1988)

4. Damai Yang Hilang (dibawakan oleh God Bless) (1988)

5. Orang Dalam Kaca (dibawakan oleh God Bless) (1988)

6. Pak Tua (dibawakan oleh grup band Elpamas) (1991)

7. Oh (dibawakan oleh Fajar Budiman) (1994)

8. Nyanyian laut ( dibawakan Nicky Astria )

9. Menangis (dibawakan oleh Franky S.)

10. Bunga Kehidupan (dibawakan oleh artis Musica)

Album Kompilasi Iwan Fals :

1. Tragedi

2. Banjo & Harmonika

3. Celoteh-celoteh

4. Celoteh-celoteh 2

5. Country

6. Tembang Cinta (1990)

7. Akustik

8. Akustik Ke-2 (1997)

9. Salam Reformasi (1998)

10. Salam Reformasi 2 (1999)

11. Prihatin (2000)

Baiklah sobat, Mungkin hanya sekian dulu ulasan saya tentang penyanyi yang juga menjadi penyanyi favorit saya, saya akan curhat sedikit mengapa saya suka Iwan Fals !

Karena ada seorang guru saya di SMA Unggul Sigli, yang menjelaskan detail tentang penyanyi ini, dari semua apa yang terjadi pada dia dan apa yang dia perbuat dan segala karya-karya dia, salutnya saya kepada guru saya dia adalah fans sejati Iwan Fals, segala Album dan Aksesoris Iwan ada pada beliau...

Dia adalah salah satu guru favorit saya, dan sangat berterima kasih kepada beliau karena telah mengenali saya dengan sosok hebat, Iwan Fals !

Thanks to Pak Agus !

Does a "calorie not in" equal a "calorie out"?

Apparently not!

According to this study, how one creates a caloric deficient can make a difference.

The Impact of Exercise Training Compared to Caloric Restriction on Hepatic and Peripheral Insulin Resistance in Obesity

Context: It has been difficult to distinguish the independent effects of caloric restriction versus exercise training on insulin resistance.

Objective: Utilizing metabolic feeding and supervised exercise training, we examined the influence of caloric restriction vs. exercise training with and without weight loss on hepatic and peripheral insulin resistance.

Design, Participants, and Intervention: Thirty-four obese, older subjects were randomized to: caloric restriction with weight loss (CR), exercise training with weight loss (EWL), exercise training without weight loss (EX), or controls. Based on an equivalent caloric deficit in EWL and CR, we induced matched weight loss. Subjects in the EX group received caloric compensation. Combined with [6,62H2]glucose, an octreotide, glucagon, multistage insulin infusion was performed to determine suppression of glucose production (SGP) and insulin-stimulated glucose disposal (ISGD). Computed tomography scans were performed to assess changes in fat distribution.

Results: Body weight decreased similarly in EWL and CR, and did not change in EX and controls. The reduction in visceral fat was significantly greater in EWL (−71 ± 15 cm2) compared to CR and EX. The increase in SGP was also almost 3-fold greater (27 ± 2%) in EWL. EWL and CR promoted similar improvements in ISGD [+2.5 ± 0.4 and 2.4 ± 0.9 mg · kg fat-free mass (FFM)−1 · min−1], respectively.

Conclusions: EWL promoted the most significant reduction in visceral fat and the greatest improvement in SGP. Equivalent increases in ISGD were noted in EWL and CR, whereas EX provided a modest improvement. Based on our results, EWL promoted the optimal intervention-based changes in body fat distribution and systemic insulin resistance.

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