text:
You can read a summary of the third part of the meeting, including presentations by ME/CFS organizations and the FDA Voice of the Patient Report HERE.
By Erica Verrillo
The final segment of the IOM public meeting held on January 27, 2014 consisted of comments from patients and their representatives.
You can read the meeting agenda HERE.
You can watch the presentations HERE.
You can read information about the committee members HERE.
It is not too late to submit comments to the IOM Committee. Send your comments to: firstname.lastname@example.com
Mindy Kitei (Video) (Transcript)
My name is Mindy Kitei, and I'm a journalist. I've been reporting on myalgic encephalomyelitis for more than twenty years and started my blog, CFS Central, in honor of my friend Nancy Kaiser, who died of the disease in 2008.
Fifty of the finest ME experts believe that the IOM lacks ME expertise and that the government should adopt the Canadian Consensus Criteria definition immediately.
Patients believe that the IOM will devise a name worse than chronic fatigue syndrome, something like "chronic multi-symptom illness," the meaningless moniker the government and IOM use for Gulf War Syndrome. On the IOM website, a curious diagram that accompanies an article by Dr. Daniel Clauw, lists several diseases: Gulf War Syndrome, fibromyalgia and CFS, among them, all covered under the big umbrella of somatoform disorders, psychiatric ailments that just look like physical diseases.
Tell that to Nancy Kaiser, who experienced multiple seizures a day. Tell that to Jerry Crum and Leanne Hyneman, both of whom I interviewed in 1994 and have since died from ME. Jerry was in his fifties; Leanne, in her early forties.
Patients believe that the IOM committee will lump real ME patients with the flawed cohort that CDC studies. Dr. Leonard Jason, the premier expert on ME definitions, published that CDC's cohorts have depression, not ME. Imagine studying HIV—but looking at patients who suffer only from depression, not HIV. It's insanity.
Not only does CDC study the wrong patients, it conducts the wrong studies. Take its new exercise study. The hallmark of ME is post-exertional collapse.
But Dr. Chris Snell published that exercise-capacity deficits in ME aren't really evident until day two of testing. The first day patients resemble deconditioned controls.
So what is CDC doing? A one-day test. Why does CDC want patients to look like couch potatoes? So that the government can write off the ME epidemic of seventeen million souls worldwide, one million in the U.S., the same number with HIV/AIDS.
The best predictor of future behavior is past behavior. In the IOM's book Gulf War and Health, the IOM Gulf War committee writes about CFS—since the symptoms resemble Gulf War—and recommends graded exercise for CFS, which can lead to crashes that last months, even years. Graded exercise is also recommended by CDC and psychiatrists like Simon Wessely—both of whose work the IOM Gulf War committee endorsed.
Given its clear bias, the IOM must recuse itself. And the government should adopt the Canadian Consensus Criteria and spend that $1 million for real research. Thank you.
Jeannette Burmeister (Video) (Transcript)
Hello. I'm Jeannette Burmeister and I'm an attorney. I've heard some people at HHS are confused about patients' deeply-felt opposition to your project. Let me explain in simple terms why:
HHS hijacked the federal CFSAC recommendation and ignored an unprecedented and impassioned request by 50 international M.E. experts to cease and desist.
The majority on your committee are non-experts.
HHS insured bio-medical research will be not be funded or replicated and yet ordered an evidence-based review. You are hurtling down the psychological rabbit hole, repeating the Gulf War Illness anti-science debacle.
HHS hired an institution without experience or authority to develop case definitions.
An excellent case definition, based on science, already exists and the experts endorsed it.
The IOM has a fatal organizational conflict of interest. I have filed a complaint with the Office of the Inspector General. A formal investigation is under way.
HHS has broken federal law as to FOIA compliance. 2.5 weeks ago, I filed a lawsuit against HHS and NIH in U.S. district court.
To circumvent competition rules, HHS moved from seeking a standalone contract to issuing a task order without a clear scope, violating umbrella contract terms.
HHS issued misleading statements about the nature and terms of, and parties to, the contract.
And finally, hundreds of thousands of patients' lives were ruined or ended by a federal consensus definition in 1994. We have long memories. Patients are furious and alienated by what can only be called state-sponsored bullying.
Given your time frame and the meager "budget-dust" sum provided to you, not even a thorough literature review is possible. Do you really expect anyone to consider the definition you produce to be science-based? Everything about this is lose-lose.
You may attempt to serve as oracle of the biased and obstructive NIH/CDC, but your conclusions will be rendered meaningless soon enough. Academic scientists are closing in on the cause of this disease. In due time, your consensus "fairy dust" will be headed for Ripley's "Believe It Or Not"-next to the entries about the earth being flat and the sun revolving around the earth.
My husband, who is an attorney with the world's largest law firm, and I will not hesitate to bring additional lawsuits. We are supported by thousands of patients who are ready to fight you at every step, in federal court and in the court of public opinion.
Mary Dimmock (Video)
I was going to give prepared remarks, but so many people have spoken today that I am going to fill in some potential areas that can be further addressed.
You heard a compelling story of what this disease is like for patients. I especially want to focus on post-exertional malaise and cognitive dysfunction, because those are profound symptoms for patients, and it doesn't take long to know which patients have ME because of those symptoms. Chris Snell has said that with using cardio-pulmonary testing you can actually distinguish between patients with ME and patients with depression, deconditioning and a number of other chronic illnesses. And yet, there is a lot of confusion in the medical community – why is that? The reason is because for 30 years we have used definitions that fail to require these hallmark symptoms – and we are still using these definitions.
We allow patients to have any combination of four out of the eight symptoms of Fukuda. Lenny Jason has shown how we end up with depression, deconditioning, and other medically unexplained fatigue conditions mixed in with ME [using the Fukuda definition]. No wonder doctors are confused. Every patient will tell you stories about going to a doctor, and the doctor tells him he needs talk therapy. My son was recommended to get exercise, because of what is on medical education sites. He crashed. When he went back and told the doctor, she said, "I can't tell you how important it is you continue to exercise."
He woke up this disease on May 19. If he had been told to look out for post-exertional malaise, based on the symptoms he had, he would not have climbed Mt. Washington, and ended up even sicker than he was.
It's important to realize that this doesn't just affect ME patients. 30% of ME patients end up with the diagnosis of chronic fatigue syndrome, before they ever get diagnosed correctly with MS because this is a waste bin diagnosis. If you have fatigue and you go to a doctor, they are going to say you have chronic fatigue syndrome.
The second thing that I want you to keep in mind is exactly what disease you are talking about. Are you studying the ME that every single patient here talked to you about today? Or are you studying the set of all conditions that meet the Fukuda criteria? Remember they are not the same. They are very different.
We heard today about "CFS" being heterogeneous. Of course it's heterogeneous. If you throw all these conditions together you are going to end up with heterogeneity. But it is man-made heterogeneity. It's not real. [Applause] ME is heterogeneous, it's a very complex disease. It depends on how long you've had it, what your trigger was, what your sex is, any number of combinations, but that is not the same as the man-made heterogeneity of CFS.
I'd like you to look for where the proof is that all these biologically unrelated illnesses should be considered one clinical entity, or one spectrum of illnesses. There is no scientific proof that validates that. [CFS] is an invalid clinical entity that needs to go away.
As far as the evidence base goes, because of all these definitions for all these years, the evidence base is so polluted with unrelated cohorts that you need a Ouija Board to read it. It is impossible to make sense of it. I'm going to give you one example, there is a Cochrane study that proved that CBT was an appropriate treatment for CFS. It included studies which required fatigue for six months, for three months, for four months – no other criteria. Because of this and other studies we now consider CBT to be appropriate for these patients. It has nothing to do with us.
Eileen Holderman (Video) (Transcript)
Good afternoon. My name is Eileen Holderman. I'm an advocate. I apologize for not having any formal presentation. I have some notes, so I'm going to "wing it." But I've been living this IOM thing since November 2012 when CFSAC made a recommendation. We'll get to that in a moment. But I'm here today to state my opposition to the IOM HHS contract, and I'm calling for the cancelation of the contract.
The majority of stakeholders oppose the contract for many reasons, and it's evidenced by the letter and call campaigns, twitter campaigns, the congressional calls and meetings, the two petitions, the demonstration, the media interviews, legal actions, Freedom of Information Acts, the advocates' letters signed by 171 advocates, and the ME/CFS expert letter. Fifty ME/CFS experts, researchers and clinicians, got together—they wrote a letter and they sent it and mailed it to Secretary Sebelius , and in that letter they said:
"We, the experts have developed a definition, the Canadian Consensus Criteria, to describe ME/CFS. We're using it, we've been using it, we're committed to refining it. Now we want the government to use it."
Simple as that. Why waste a million dollars on a contract, especially when this disease gets only five million, and as Dr. Klimas said eloquently, less than male pattern baldness. And that's a fact. That money could go toward biomedical research. Why waste 18 months to do a study when we already have a good consensus criteria, and then years more to roll that out and "mis-educate" doctors and healthcare professionals with what may be a worse definition than Fukuda, and a worse name than "Chronic Fatigue Syndrome"? And it's no reflection of the people on this panel because I do have tremendous respect for all of you as individuals, but when HHS sets up a poor study design, you guys can do only so good as what they dictate. And I know that CDC does this all the time by inviting experts to participate on their website, on the CME courses, but then when they dictate the terms of it and say that you can only teach doctors by using the Fukuda definition, which is 20 years old, outdated, erroneous—doesn't have the hallmark symptom of PEM—and is used for research only, then you're really not educating doctors; you're mis-educating them.
So what is so upsetting to the patient community is that in November 2012, CFSAC—and I'm a member of that committee—we made a recommendation, and I helped craft the language of that recommendation. We wanted to convene a workshop with only ME/CFS experts, meaning researchers, clinicians and patients, to reach a consensus on a research and clinical case definition, starting with the Canadian Consensus Criteria. We basically wanted to just endorse that criteria. And what happened after that was outrageous because in our subcommittees, there was contention at the highest level.
I chair one of the subcommittees, and I don't want to get into the ugly realities of what was going on behind the scenes; but it was so ugly that anyone who spoke out, and I was one of them, got calls from the government. We were intimidated, and we were threatened with eviction from the committee, and there is an ongoing investigation about it. It directly relates to the case definition recommendation we made. We are the experts making the recommendation, and the government is not taking our recommendation. They're hijacking it, making it their own, and not using all experts like we asked, drawing it out. They're going to do the same thing that VA-IOM did to Gulf War veterans by redefining—by giving them a new name, "Chronic Multisymptom Illness," by saying the best clinical practices for that disease are CBT, GET and antidepressants. The [IOM] study that came out in January was very alarming because it had a section on ME/CFS, and in that section it said the same clinical practices, GET, CBT and antidepressants, would be used for ME/CFS. So we don't know how this new panel could possibly contradict the earlier findings of the IOM study. I simply don't know how that would work.
It also troubles me that CDC and NIH will be participating in this, and there is a contradiction because on one hand, IOM says once the sponsor finishes, they'll have no contact. On the other hand, HHS says there will be continual meetings with NIH and CDC to give them information. I've been very vocal about the flaws in both of those studies. I'm not going to get into them today, other than to say that for 30 years we waited for biomedical research for this brutal neuroimmune disease with an infectious component; and instead, we are getting now three initiatives at the same time – talk about redundant and waste of money – to come up with case definitions. We've already got one. It's the Canadian Consensus Criteria. Our 50 ME/CFS experts have said "We've got it. Let's use it." Let's use the money instead for biomedical research, education and treatment for the over one million Americans and 17 million worldwide suffering from this serious neuroimmune disease, Myalgic Encephalomyelitis.
So, I'm part of the patient advocacy movement that is going to continue to push the envelope and ask for the cancelation of the contract, and let's get on with the serious business of studying and treating this disease. Thanks.
Ellen Wright Clayton: I do want to clarify one point: there will be no contact between the committee members and HHS at any point from now on until the end of the study. The contact between the staff is only to show that they're doing work so that is…um…you know…just to give progress reports, but it will in no way go to the substance of what the committee is talking about. There will be no contact between the committee and HHS till the end of the study. I just want to be very, very clear about that.
Anne Keith (Video) (Transcript)
[Anne placed four containers of water, a fifth empty container, and three different food coloring dyes on table. A small vase with flowers was left in the back of the room since she couldn't carry it all up front.]
I'm an ex-school teacher so I brought some visual aids.
The basis of medicine is "primum non nocere": "First, do no harm." It is the underlying principle of all medicine. It is drilled into medical students for a very good reason. Medicine, beyond any other field, has the greatest potential to do good and harm.
Harm is not necessarily determined by intent, effort, or education. "Primum non nocere" is a reminder that it is important to evaluate and mitigate both potential obvious and hidden harms. It takes insight and courage to speak up and say that something is should be done differently or not done at all.
This simple demonstration will show you why HHS's request to consider using multiple definitions to come up with a new definition puts you in the position of needing to have that insight and courage.
A perfect definition is like water. It's clear and it's unadulterated by anything. [Anne held up a container of pure water.]
No definition of ME, CFS, or ME/CFS is perfect but there is a distinct progression of clarity.
CFSAC requested the refined definition be based on CCC for a very good reason. You have been asked, in your statement of work, to "consider the various existing definitions," which is to say to combine these definitions, and the results of research based on them, to create a superior definition.
While that sounds laudable and even-handed, it is actually a political answer to a scientific question. No matter how great your skill and motivation is, it is simply impossible to merge divergent definitions, each with their own issues, into one superior one.
A definition may be clouded by many things. It is difficult to describe a disease that as complex as ME/CFS and so even the CCC has its faults. [Anne added a drop of dye to a second container of water.]
Fukuda has the same faults and so does Oxford or other definitions you use. [Anne added dye to third and fourth containers.]
Fukuda (I just looked at the main definitions) is general in its description of the symptoms. They are vague. It describes PEM but it does not make it a mandatory item. [Anne added a few drops of a different dye to container 3.]
Oxford really describes a depressive situation, as much as anything. Yes, it applies to CFS but it is also describing depression. It does not describe the distinct patterns that are often found by our researchers in this disease and it does not even mention PEM. [Anne added a lot of the second dye to container 4.]
It is the definition that might as well just have everything in it. [Anne added a lot of third dye to container 4.]
What HHS has asked you to do is to combine these definitions to come up with a different one. There's no way that you can take this definition [Anne poured some of the now dark water of the "Fukuda" container into empty container] and this definition [Anne poured some of the now black water of the "Oxford" container to same new container] and come up with pure water [Anne held container of original container of clear water next to "mixed" container].
You can't do it. You need to look at what is the actual disease.
Our various experts do know this and we are ignoring them. That was what the CCC was. That is why our experts signed that letter suggesting that that was appropriate.
The imperfections in these definitions cloud all the research that comes out of it. This morning I put some daisies into this dye [Anne indicated "Fukuda" and "Oxford" containers] and you can see that my white daisies [Anne pointed to the flowers] have turned green and orange in a matter of an hour or two.
It is the same way with research. These imperfections absolutely permeate the research that their based on.
So if you have research based on the Oxford definition, it is going to have those flaws inherent in it. They may be corrected for but you need, as a committee, to recognize that what you are reading, though it may sound reasonable, has flaws that you need to understand.
Combining these will not get a better definition, it will not clarify research. Research will only improve by starting with the best definition, using just the best research, and filtering the problems out. It is clear that the CCC is superior to other definitions and that it should be the basis of further refinement.
By serving on this committee, you have tacitly agreed to live by "do no harm." A muddled definition will harm millions of patients for decades.
I ask you to choose to "do no harm" by refusing HHS's long-standing patter of imprecise definitions. I ask you to report back to the HHS that they should immediately adopt CCC until such time as an expert-only committee can properly update it.
Joseph Landson (Video)
I've had ME/CFS for nine years. I believe the most important issue for the committee to consider is the unintended consequence of diagnostic criteria based on symptoms alone. To that point I would like to recommend a book. It's called Brain on Fire by Suzannah Cahalan. (I don't receive any profits from the sale of the book.) Miss Cahalan did not write about ME/CFS. She has nothing to do with our illness, at least not directly. Rather, she describes in the book how she went completely insane, and then completely recovered.
She recovered because she had a treatable autoimmune disease that looked exactly like mental illness. Most of her doctors concluded that she was just plain crazy. Only one doctor believed that Suzannah's normal personality was still inside her twitching, emaciated body. But all the doctors were right. All of them were right, because if she hadn't been diagnosed, and treated for her autoimmune disease, her insanity would likely have become permanent. There is a narrow treatment window, a point of no return.
She would have spent the rest of her existence drooling in a locked psych ward, or possibly have died. In other words, the doctors' objective, symptoms-based diagnosis, would have become, instead, a self-fulfilling prophecy.
It's not like her medical team didn't try to find a reason for her sudden onset paranoia, violence, delusions, and seizures. Dozens of laboratory tests showed absolutely nothing. A spinal tap showed that her white blood cell count was elevated, so the doctors looked for an infection but they couldn't find one.
They looked for some external stressor that had driven her insane, but they couldn't find one. Instead, her immune system was inflaming receptors in her brain in a manner so subtle that it took a brain biopsy to change her doctors' minds.
If you've read or listened to this carefully then you know why I am telling this story at a conference about ME/CFS. However, I'll spell it out anyway.
For decades, we too have had symptoms that seem psychiatric. For decades we too have taken tests that showed nothing. For decades researchers pursued psychogenic models of our disease, but failed to explain its precipitance, severity or persistence. Also for decades, researcher pursued dozens of infectious agents, or other external insults. All they found were immune disruptions that don't seem to correlate to anything.
I believe they do correlate to something; we need only to find what it is.
I wish the committee best of luck in its work. I know you will be objective and fair. But then, so were Suzannah's doctors. Please take care what you prophesy.
Subscribe to the World's Most Popular Newsletter (it's free!)
Thank you for your kind attention.
Susan Kreutzer (Video)
I felt an obligation to speak on behalf of Anne LeConti, because she wanted to have a voice here today.
MECFSForums is an internet forum for people who suffer with Myalgic Encephalomyeitis (M.E.), which is also sometimes called as you know "Chronic Fatigue Syndrome" or "CFS" and friends of ME sufferers. This forum began in June 2010 and now has over 6850 members. MECFSForums was not invited to present information to the IOM at this meeting.
Perhaps MECFSForums was not invited to present because a forum administrator, Patricia Carter, created a Petition to Stop the HHS-IOM contract and accept the [CCC] definition of ME on October 7, 2013. This petition now has more than 5000 signatures. [Applause]
The Petition to Stop the HHS-IOM Contract and Accept the CCC Definition of ME is solid evidence of the position of thousands of ME/CFS stakeholders on the contract HHS has made with the Institute of Medicine has entered into to define ME/CFS–and there are thousands of patients and friends oppose this contract.
A poll of the forum membership was taken asking forum members' positions as to the IOM contract. The result was that 100% of members who voted agree with this statement: "I oppose the contract and I support the experts' letter urging HHS to adopt the CCC now."
This Statement from MECFSForums represents the views of thousands of M.E. patients, families, caregivers and friends in opposition to this IOM contract. Millions of people worldwide suffer from Myalgic Encephalomyelitis (ME).
For decades, sufferers have been left with no real biomedical research and no effective treatments. Now the HHS is attempting to prolong this by contracting with the Institute of Medicine (IOM) to redefine the illness. This is unnecessary because experts in the illness, researchers and clinicians alike, have reached a consensus that the Canadian Consensus Criteria (CCC) we believe that should be used for both research and clinical purposes. They have sent an Open Letter to Secretary Sebelius expressing their support for the CCC.
We believe the HHS contract with IOM is simply a waste of precious resources.
This is the text of the petition which now bears more than 3700 signatures: "We, the undersigned people suffering from Myalgic Encephalomyelitis, along with our families, caregivers and friends hereby ask Secretary Kathleen Sebelius to cancel the contract HHS signed with the Institute of Medicine (IOM) to develop "clinical diagnostic criteria" for ME/CFS. We further urge Secretary Sebelius to respect the consensus reached by a group of experts and adopt the Canadian Consensus Criteria (CCC) as the research and clinical case definition for ME/CFS."
Denise Lopez Majano (Video) (Additional comments)
Many thanks to all advocates for their presentations and comments. I especially want to thank Mary Schweitzer and Charmian Proskauer for highlighting concerns about young people.
I want to address two hallmark symptoms of this illness, and then highlight five points about the process you will use.
Number 1: Post-exertional collapse, unfortunately also known as post-exertional malaise. Post-exertional collapse can result from minimal physical or cognitive exertion, is unpredictable and lasts for days or weeks. The pervasiveness of post-exertional collapse often has no correlation with the minimal exertion of the triggering event.
Number 2: Impairment of executive function. Impairment of executive function is evident in areas such as processing speed, reaction time, working memory, and concentration. These impairments have been recorded as a significant concern, both in research and in reports such as FDA's "The Voice of the Patient."
As of today, you have just 371 days until your deadline for the clinical and diagnostic criteria for this illness. These are five important things I think you should think about:
One: This illness may require different diagnostic criteria, such as pediatric and adult, depending on the age at presentation.
Two: The definitions used to select patients for studies greatly impacts the study results. Therefore, assessment of literature about this illness must include careful evaluation of the definitions used and the symptoms covered. The clinical and diagnostic criteria that you have agreed to develop will have far-reaching effects on diagnosis, health insurance and treatment, and will likely have very important effects on school accommodations for young people with this illness.
Three: Clinical and diagnostic criteria should include detailed assessment of symptom severity and frequency and should reliably assess post-exertional collapse and cognitive impairment.
Four: The clinical and diagnostic criteria must include clearly defined criteria and appropriate assessment tools. It must be as accurate as possible at this point in time. As you develop the diagnostic criteria, think about how this criteria will best serve patients and practitioners. The outreach strategy you develop to operationalize and disseminate this criteria must provide for widespread information about this illness, so that patients are appropriately diagnosed, including all those who are currently undiagnosed, or misdiagnosed.
Five: This afternoon is very limited time to spend with those who know this illness best. FDA spent months poring over input to develop "The Voice of the Patient." Your work will be most successful if you enlist experts and patients throughout the process.
Thank you. [Lopez Majano's comments continue.]
And now, on behalf of my son [Matthew]. For those who don't know, my two sons are patients. I am the caregiver.
Good afternoon. My life changed dramatically nine years ago when I got sick with this blasted illness. I went from being an active adolescent to being housebound. In one sense, I am one of the "lucky" ones. I was diagnosed within six months of onset. This is not usually the case, as research has shown that all too often patients are undiagnosed or misdiagnosed. That brings me to the question of the most important thing you should consider throughout the course of this study: Criteria you develop must be accurate. You must carefully consider, as separate criteria are needed for onset and different ages. The criteria need to include assessment of frequency and severity of symptoms, assessment of cognitive impairment must also be included, because physical and cognitive exertion can result in post-exertional collapse, it too must be included in the criteria and must be accurately assessed.
Keep in mind that post-exertional collapse with this illness is different than in other illnesses, and our physiological response to exertion is different from that from other people with other illnesses and healthy people.
I said earlier that in a sense, I am one of the "lucky" ones. In another sense I'm not. Despite now being a patient of one of the best specialists, despite doing everything I can to try to get better, I haven't been able to. No treatment that I have tried has been successful. That there are no successful treatments is likely due to heterogeneity of the patient population as the result of overly broad definitions. Replacing this heterogeneity with accurately diagnosed patients will help us move forward to identify successful treatments.
Accurate clinical diagnostic criteria will benefit me as well as all those who are undiagnosed or misdiagnosed. Precise clinical diagnostic criteria will reduce that heterogeneity and improve the suitability of study cohorts, because those diagnosed with this illness will know if they qualify for research studies. Studies will have more appropriate subjects, and resulting study signals will be clearer, enabling assessment of treatment safety, and efficacy.
Until there are successful treatments, I, like many others, am stuck. I guarantee you we want to be healthy again. I leave you with this quote from Dr. Leonard Jason.
"In order to progress the search for biological markers and effective treatments, essential features of this illness need to be empirically identified to increase the probability that individuals included in samples have the same underlying illness."
Dr. Enlander's comments to the IOM committee delivered by Jay Spero (Video) (Transcript)
I was honored and pleased to have been asked to sign what has become known as the 'Experts' Letter,' where several dozen colleagues have expressed opposition to possibly altering or redefining the criteria of M.E. & C.F.S. by virtue of the pending IOM contract. If it was the case that there was opposition to the existing Canadian Consensus Criteria, then open discussion about these criteria would be more useful than closed door redefinition by a panel where the majority are not known to be familiar with the disease, Myalgic Encephalomyelitis.
At present, the Canadian Consensus Criteria are used by a majority of experts who diagnose and treat this disease; they adhere to the concepts defined by Dr. Melvin Ramsay, who helped pioneer research in this disease, in contemporary clinical settings. Were discussion and debate even necessary, one million dollars could still have been saved – a not insignificant percentage of NIH research funding dollars in this area. Given the paucity of funds allowed for research and study of what we know as Chronic Fatigue Syndrome, it seems, with all due respect, to be a shameful waste of money.
Open discussion on the IOM method of approach has not been made available; we can only hold out hope that the result is closer to one of the more strictly defined criteria. However, given all we have seen recently, marvelously chronicled by several patient-bloggers (notably, Jeannette Burmeister, Jen Spotila, and Erica Verrillo), it seems inevitable that any preference given to the "Evidence Base," may produce a set of loose criteria. In this area, where the 'evidence' has long been grossly distorted, and to date has produced a flawed, inaccurate model of this very serious physical disease, such criteria may well describe other conditions or disease models that are, simply put, not the disease described by Ramsay.
A group of us are forming the "Academy of M.E. & C.F.S. Physicians," composed of experienced clinicians and researchers familiar with the disease, M.E., and related conditions. The Academy will be an independent resource for government, corporate and private groups to derive information relating to the latest research, diagnostic methods and treatment approaches. Training of young physicians in this area will be of prime importance.
Dictatorial direction will continue to do a grave disservice to a long-suffering patient community. My patients deserve better, as does anyone suffering from this horrible disease, and I must register my protest at this sadly unnecessary contract.
Maryann Spurgin, comments read by Charlotte Von Salis (Video)
There are people in this country who spend decades of their lives in silent, darkened rooms, crippled and in excruciating pain. They have orthostatic intolerance of variegated causes (such as low blood volume, cardiac diastolic dysfunction, and haemotological and RBC pathologies) — they are unable to sit up or to stand. They suffer hyperacusus — they cannot tolerate any light or sound without becoming severely more ill and without suffering additional pain that does not subside, nor can they summon the strength to speak.
Some are too weak to feed themselves, others paralyzed. Many cannot even focus on a thought.
A significant group of such patients have died of complications of this disease — some at a young age, others some 20 years earlier than their peers of similar backgrounds and socioeconomic status, according to a paper by Dr. Leonard Jason.
Known as Myalgic Encephalomyelitis, this disease has a long history. It was recognized by the World Health Organization as a neurological disease in 1969.
These severely ill people, and others with the same or similar yet milder symptoms, have been tossed into a pot with a group of other individuals whose symptoms look strikingly different — persons with depression, some with something so mild as unspecified fatigue, others with pain syndromes like fibromyalgia. These are not the same diseases as Myalgic Encephalomyelitis. This pot is what the government calls "Chronic Fatigue Syndrome" — a name that was the government's 1988 response to an outbreak of M.E in Lake Tahoe in the early 1980?s, the Holmes criteria.
Unfortunately, the Holmes criteria was broadened in 1992 with the Fukuda criteria, and even further with the Reeves criteria. Some youths with M.E. have died or become worse due to inappropriate treatments (Cognitive Behavioral Therapy and Graded Exercise Therapy) based on these "fatigue" definitions.
M.E was never recognized by the U.S government, but it is not new or fatigue based.
It is scientifically unsound to take people who are sick with M.E. and throw them into a pot with people whose illnesses look very different, and then to conclude that M.E. has no universal biomarkers. There are more than 500 papers in the medical literature that show measurable physiological abnormalities in the melting pot of "CFS." These papers show a pathophysiology for all three of the essential components of the M.E. criteria that Dr. Melvin Ramsey described: circulatory, immune, and muscle impairment. Articles describing all of these pathophysiologies in M.E patients, although published under the name "CFS," are available on my website.
Although the cause or causes of M.E. are unknown, the pathophysiology of M.E is not "medically unexplained." It is available to anyone willing to read the research. Patients who show these abnormalities should be separated from the "CFS" pot and studied separately as M.E patients.
The Canadian Consensus Criteria (CCC) is a description of these M.E. patients and requires all three of the components that Dr. Ramsey originally described to meet the definition of M.E. It appropriately identifies milder M.E. patients and those who are homebound and/or bedridden.
"CFS" does not name a specific disease. The study of "fatigue" and the term "CFS" should be abandoned.
We urge that the IOM cease its re-definition effort and recommend that the government adopt the CCC as a clinical and research definition of M.E. until more research can be completed. Further, unrelated diseases such as fibromyalgia, depression, or unspecified fatigue should not be lumped or studied with M.E.
We further urge that M.E be called by its long-recognized name by the World Health Organization, "Myalgic Encephalomyelitis."
Joan Grobstein, MD (Video) (Transcript)
Hello. I'm Joan Grobstein, M.D.
This committee has been asked to develop evidence-based clinical diagnostic criteria for ME/CFS. This could be a very easy task because the Canadian Consensus definition has already been developed by experts in the field, has been recommended by the primary professional society for this disease, and was recently endorsed again by experts. Clearly, experts think the evidence supports the Canadian definition. It isn't perfect, but it doesn't have to be. Few medical definitions are perfect, since knowledge changes over time. The Canadian is adequate and should be used. Thus your primary task has essentially already been done. If you choose to endorse it, you can spend the million dollars allocated to this report to identify the many gaps in our knowledge of ME/CFS and put together a sorely needed research plan with adequate funding.
Unfortunately, the evidence base for ME/CFS has been adversely affected by two factors: lack of research funding and a multitude of definitions of the disease. ME/CFS receives approximately 6 million dollars per year in most years. Compare this to the billion dollars per year that has allowed AIDS patients to lead essentially normal lives. Because of poor funding, none of the definitions are particularly well-supported by research and many aspects of the disease – multiple infections, immune and mitochondrial dysfunction, and orthostasis – have not been adequately studied. Large, well-powered studies are rare. And, because there are overly broad definitions of "CFS" that include many patients who don't have ME, there are studies in the literature that do not apply to ME patients at all.
The CDC study will not clarify the definition. The design is flawed–most of the data is self-reported symptoms. The patient community has begged the CDC to collect data on promising objective measures such as 2 day CPET, viral loads and natural killer cell function. The CDC has refused.
Please note that treatment of infections, hypotension, and immune and mitochondrial dysfunction have helped patients in small studies. Looking at evidence of successful treatment, published and unpublished, helps to define the disease's essential features.
Post-exertional malaise, orthostatic intolerance, cognitive dysfunction, and viral symptoms are the most disabling aspects of ME/CFS. The Canadian includes these and other important aspects; Fukuda and other even broader definitions do not require them. Broad definitions make it impossible to identify abnormalities in bona fide ME patients.
Since the definition issue can be easily solved by endorsing the Canadian, I urge you to address the issue that has made it difficult to characterize the disease and make progress: poor funding. Be bold. Good science costs money. DHHS has asked the wrong questions, but you can still give them the right answers: use the Canadian and increase funding. The medical community has treated this group of patients poorly.
You, as medical leaders, have the opportunity to begin to change that reality.
Charlotte von Salis, J.D. (Video)
Dear Panelists:
You've heard a lot today.
You've heard from three government health agencies, you've heard from IOM-selected stakeholders, you've heard that there is a huge groundswell against this study, and you've heard why that is so.
What can you do?
You can assess this situation as scientists and physicians.
Dr. Nancy Lee is on record stating that Secretary Sebelius told her a case definition is a clinical decision that has to come from the clinical community, not the Federal government.
Yet you have just heard from three representatives of the Federal government. And you have been told to coordinate and work with this study's sponsor, the NIH, through its Pathways to Prevention program.
This is in direct violation of IOM's study process and presents a blatant conflict of interest.
How is this an independent and objective process? How is this about science and medicine?
If you think your task order isn't politically motivated, consider that the CDC has been well-aware of the scientifically sound and expert-driven Canadian Consensus Criteria for over a decade – yet refuses to take down its own diagnostic and treatment guidelines, the harmful and misleading CFS Toolkit.
Your task, to develop clinical diagnostic criteria for ME and CFS, has already been accomplished.
Two primers, specifically aimed at clinicians unfamiliar with the diseases, are already available.
Both are based on criteria developed by disease experts and published in peer-reviewed medical journals. Both are available as easy -to-distribute pamphlets.
I am referring to the Overview of the Canadian Consensus Criteria and the ME-ICC Primer for Medical Practitioners. The latter is an update of the former to reflect scientific developments through 2011.
That's right. It's based on science, not politics.
And the combined knowledge of experts who collectively have diagnosed and/or treated more than 50,000 patients with M.E., have more than 500 years of clinical experience, have approximately 500 years of teaching experience, and have authored hundreds of peer-reviewed publications.
You cannot do better. Some of you are new to this disease.
How would you feel if non-experts decided to diagnose heart failure? Or lymphoma? Or Lupus?
If you truly want to fulfill your task, all you need to do is read, share, and distribute these pamphlets. Both are available from the UK charity, Invest in M.E., and can be downloaded from a number of websites.
Both can and should be distributed. Each one of you is a unique position to do just that. Order these guidelines, print them out, or at least share the websites URLs with your networks. Use your positions to get these documents out to primary care physicians.
Tomorrow, tell the IOM to stop this needless study. Defer to the collective judgment of your eminently qualified colleagues and do your part to get the CCC officially adopted.
Resign from this panel.
To do otherwise is to harm patient care and impede research.


text:
[Intro: Joey Badass]
Overseas chicken, please I over see these chickens
As I squeeze swishers... as I switch positions
[Verse 1: Joey Badass]
Heard you trying to get worked tonight, but you got work tonight
That same excuse won't work tonight
Shit is on you I ain't tripping
You know where I be hidden at, the tipton still tipping
Rippin these bongs, shit is written in these songs
I'm dripping sweet charm, sweetheart, just know it
Won't be no restart when I depart these parts, so dont blow it
Plus how you talk the talk and won't show it, (FRUNCHIN!!)
It's cool, I shouldn't even be gettin myself into you
I should get myself in the mood for these interviews (cancel that)
Well, it's whatever doe hit the jack
Worst scenario hit the Twitter I'm following back
And in a matter of facts, perhaps she came back cause I'm runnin these tracks
She like you sayin if you wasn't the Usain of rap
Than I wouldn't put the key into my ac' that fast
I'm like, I ain't even act that fast, put my hands where them titties is
You didn't even act fastidious, no serious
Niggas dont know about this phat sidity shit
Let me tell you what it really is
[CJ Fly]
Naw, lemme tell you what is really was, it was like uh
30 sumchins in a hotel overseas, ya know, fly shit
[Verse 2: CJ Fly]
I'm a stand up guy, could you tell by my stance
Still down to earth, like a meteorite crash
Was never really into luck so this might just be my chance
I might die this time if we let this pass
I just can't one glance we get close, I see more than the pans
Curve every player trying to hit what I pitch her in a flash
Hold it, beauty is what you possess, when you hitting em poses
You be gettin me focused, won't give you props than it ain't reel
Ain't have it we wanted power so we made millls
Hard work, tell me how selling cane fields
This my shot, thats why I'm glad you stayed still
Was just tryna be down, but still living it up
Being super supercilious, how silly of us
Tell em don't mind us, cause her butt made a plush
And I told her she could be blunt, while I get in her guts
Got me like O damn, let me let you know what I was hoping
Other niggas mad cause they just hopeless
Me and you could smoke up on some potent
To get you open, would you promote in
And you and I could listen to some slow jams
Not a little boy, I'm a grown man
Hope you know that your were really chosen
I'm living golden
[Outro: Joey Badass]×2
Overseas chicken, please I over see these chickens
As I squeeze swishers, (Beastcoast) as I switch positions (Flatbush)
Joey Bada$$ & my man CJ Fly go hard in track 11 on "Peep: The Aprocalypse" called "Overseas". This beat got a tribe flow like most of the album, cool as fuck. The message they give is saying how the women they with don't matter much because of the mindgames that are imminently displayed by the bitches. These members of Pro Era finna keep adding their word play into their spray, the beat is smooth as hell too.

subset: commoncrawl


text: Video description : You are now watching porn video from amateur sex channel. Free amateur sexy girls toying and masturbating vid-07 sex movie was added 1 hour ago together with more porno videos. Find more amateur, sexy, girls, toying, masturbating, vid-07, dildo, teen, pussy, tits, boobs, blonde, ass, brunette, amateur, fingering, redhead, closeup, vibrator, toys, masturbate, insertion, fist, porn on our biggest collection of free xxx porn videos. Well organized porno movies are updated daily for you.


text:
Malky Mackay: Will not be Crystal Palace's new manager
Iain Moody has resigned from his role as sporting director of Crystal Palace with immediate effect as the Football Association continue their investigation into allegations made by Cardiff City
The Football Association is looking into allegations made by Cardiff against former manager Malky Mackay and Moody, who worked at Cardiff before moving to Crystal Palace..
Mackay's name was dramatically pulled from the race to take over from Tony Pulis as Crystal Palace manager on Wednesday just before the existence of the dossier became public knowledge.
A statement from Palace read: "In light of the events of yesterday, sporting director Iain Moody has tendered his resignation and it has been accepted with immediate effect. There will be no further comment from the club on this matter."
Sky Sports understands the dossier was sent to the FA more than a week ago and the governing body has now confirmed it is investigating the matter.
Cardiff have sent a dossier to the FA detailing allegations about Malky Mackay and Iain Moody's time at the club.
It reportedly includes allegations against Mackay and Moody from their time together in Cardiff.
The allegations refer to work-related text messages sent between Mackay and Moody that bring the game into disrepute. Those messages are believed to be homophobic, racist and allegedly sexist.
An FA spokesman said: "The FA can confirm it is currently investigating this matter."
League Managers' Association chief executive Richard Bevan confirmed to Sky Sports the body's lawyers are going through the allegations and will respond in due course.
Cardiff owner Vincent Tan sacked Mackay in December 2013, just six months after he had ended the club's' 51-year wait for top-flight football.
Two months earlier Moody had been placed on gardening leave by Tan before being subsequently dismissed.
Mackay launched a £7.5m legal claim against Tan for compensation and wrongful dismissal after his sacking but dropped the claim in May and issued an apology to the Malaysian businessman.
With Mackay apparently out of the race, former Tottenham manager Tim Sherwood is now the favourite to take over from Pulis at Selhurst Park.


text:
When choosing a tire for your Mustang, you're probably considering a number of different factors, like durability, performance, and how it makes your Mustang look. With the tires from Sumitomo, you're getting some of the most technologically advanced tires on the market that look great, are designed to last for years, while giving your Mustang increased stability, traction and overall performance. With these benefits, don't wait – order your new Sumitomo tires from CJ Pony Parts today.
Sort by
2 Results
Results per page
From: $130.99
From: $119.99
Sort by
2 Results
Results per page
SumitomoAs a company, Sumitomo was founded in the early 17th century, when the company's namesake opened a book and medicine shop in Kyoto, Japan. After years in business, Sumitomo documented his business principles, which became the foundation for the company that blossomed out of those humble beginnings. After that original store, Sumitomo diversified into copper mining, finance, insurance, iron and steel, real estate and trade, all over a period of more than 350 years. Today, Sumitomo is one of the leading business groups in Japan, though a sizable chunk of the company's business has migrated to the United States. However, Sumitomo might be best known in the United States of America for their tire business, which is sold under the Sumitomo name and caters to a wide variety of automobiles, including cars, light trucks and heavy trucks.
Many of the products from Sumitomo are available for the Ford Mustang. Their tires are known to feature innovative engineering, quality and cutting edge technology. Through CJ Pony Parts, many quality Sumitomo products are available, including the HTR-Z and HTR-Z III tires. Both Sumitomo tires offer high performance, including V-shaped directional treads, which disperses water and offers better wet grip and dry traction. Their tires are also engineered to offer greater stability in performance situations, while continuing to offer the ride comfort that you'd expect from a high quality tire.
With Sumitomo tires from CJ Pony Parts, you can get the tires individually, or you can combine your tire purchase with new wheels. When you do this, you get free mounting and balancing for your kit, basically giving you new wheels and Sumitomo tires that are ready to bolt on. Plus, with free same day shipping, you aren't going to wait around to get them. Order yours today.


text:
The Making of Knowledge in Composition: Portrait of an Emerging Field
Boynton/Cook Publishers, 1987 - Education - 403 pages
In a style that combines scholarly care with remarkable readability, North examines the development of the field of composition in a way it has not been examined before. Rather than focusing on what people claim to know about teaching writing, he concerns himself primarily with how they claim to know it. Eight groups of knowledge-makers are treated in separate chapters: Practitioners, Historians, Philosophers, Critics, Experimentalists, Clinicians, Formalists, and Ethnographers. Each of these chapters orients the reader by tracing the mode's first uses in the field and listing its best known and most important adherents; then goes on to explain how the mode of inquiry works, illustrating key points with painstaking analysis of well-known studies. In his final three chapters, North turns from these individual modes to consider the field as a whole: How have these different ways of making knowledge come together? What is Composition now, and what is it likely to become?
What people are saying - Write a review
composition Becomes Composition
The Practitioners
5 other sections not shown


text:
Linear barcode Encode SDK/ASP Control v2.0 by AIPSIS Software Laboratory
Linear 1D barcdes carry information in one direction,they are capable of storing a maximum of approximately 20 digits. the SDK provides developers with complete control over every aspect of encoding and writing linear 1D barcodes such as Matrix 2 of 5,industrial 2 of 5,interleaved 2 of 5,iata 2 of 5,logic 2 of 5,Deutshe Post Leitcode,Deutsche Post Identcode,UPCA,UPCE,EANX, EAN128, CODE39, pharmazentral, CODE39, CODABAR, CODE93, CODE11, MSI_PLESSEY, MSI_10, MSI_10_10, MSI_11, MSI_11_10, Telepen ASCII, Telepen Numeric, Pharmacode One Track, Plessey Code, ITF14, Korean Post Authority Code, flattermarken, Facing Identification Mark, POSTNET, PLANET, RM4SCC, AUSPOST, AUSREPLY, PHARMA_TWO, ONECODE, ISBNX, CODE39_43, EXCODE39_43,Intelligent Mail (aka USPS OneCode). Features Create Linear 1D barcode symbols from alpha/numerical text Output barcode image with the formats such as BMP, GIF, JPEG, PNG Render barcode images on any devices, and create device resolution dependent images Full controls of the bar code image styles, such as background color, bar color, image quality, rotation angle, x-dimension, captions, etc. Automatically computes checksum or check digits for all Symbologies Automatically validates the value to encode Program is easy,several lines of code can get barcode image generated.
Price: USD $179.00
Tags: Code, Codabar, Of, Standard, Industrial, Iata, Interleaved, Data, Logic, ITF-14


text:
- SpecsConvert Specs to MetricCapacity53.15 "
- About Company
ETL Laser (Shanghai) Technology Co., Ltd., is a hi-tech enterprise specializing in R&D and manufacture of laser equipments for laser engraving, marking and cutting. Our main products include Laser Engraving Machine series, Laser Cutting Machine series, Laser Marking Machine series, CNC Engraving Machine series, Yag Laser Cutting Series, Cutting Plotter etc. These products are widely used for industries such as aerostatic, automotive, machinery, plastic, printing & package, electronics, tobacco, glass, costume, bamboo and wood ware, portraits engraving, craftwork gifts etc. Our laser equipments have acquired CE and FDA certificates, and been exported to over 20 states and areas such as USA, Italy, France and Middle East etc., and our products have gained good reputation in the market for its high quality, competitive price and good services after sales. Furthermore, our company also have professional laser processing lines for different grade application and satisfy with the processing requirements of different customers. We believe: endless innovation of products, keep the technical in the highest flight, offer the satisfying service to customer all the time, cost reducing, energy saving and environment-friendly, to improve our competition in the market.


text:
Subscribe To Lovelace Updates
Subscribe To Lovelace Updates
Lovelace (2013)
Lovelace Synopsis
Lovelace Release Date
In Theaters August 9, 2013
Lovelace Credits
Starring: Amanda Seyfried, Peter Sarsgaard, Hank Azaria, Wes Bentley, Adam Brody, Bobby Cannavale, James Franco, Chris Noth, Robert Patrick, Eric Roberts, Chloë Sevigny, Sharon Stone, and Juno Temple
Written By: Andy Bellin
Directed By: Jeffrey Friedman and Rob Epstein
Produced By: Heidi Jo Markel, Laura Rister, Jason Weinberg, and Jim Young
MPAA Rating: [ R ]
Distributor: Radius-TWC
Running Time: 92 min.
Trailer 1
Latest Lovelace News
This Week In Home Entertainment: More From Twilight And The Hobbit, Plus White House Down
Channing Tatum and Jamie Foxx should have opened up one of this summer's biggest movies. Both actors are big names in the business, and they had The Amazing Spider-Man's James Vanderbilt and big budget guru Roland Emmerich to put together the film, as well. While the movie didn't manage to dominate the box office, it's still a fun but frilly movie that's short on surprises but long on fun.
Jessica Rawden Nov 05, 2013
This Week In Home Entertainment: More From Twilight And The Hobbit, Plus White House Down
Lovelace Will Head To Blu-ray And DVD In November
Lovelace tells the tale of the 1972 making of the famed porn film Deep Throat, which has lived on through history via the Watergate scandal. Although Deep Throat serves as a focal point in the film, it's mostly about the life of Linda Lovelace, how she rose from humble beginnings, changed her name, and became a focal point for the feminist movement in the seventies.
Jessica Rawden Sep 11, 2013
Lovelace Will Head To Blu-ray And DVD In November
Amanda Seyfried's Lovelace Hit With Lawsuit From Deep Throat Porn Producers
Based on what they put in this brief, they've got a fair case to make. Arrow claims that they have allowed other productions to license Deep Throat in the past, but seem to take special exception with Lovelace, which shows how Linda was threatened by her husband Chuck Traynor (played by Peter Sarsgaard) during the film's production, and later came to regret making the film at all
Katey Rich Aug 07, 2013
Amanda Seyfried's Lovelace Hit With Lawsuit From Deep Throat Porn Producers
Sarah Jessica Parker Edited Out Of Lovelace
The biopic that was intended to cover the highs and lows of Deep Throat star Linda Lovelace's life was in need of an older actress to play feminist icon Gloria Steinem, and Parker proved a saving grace to the feature's helmers Rob Epstein and Jeffrey Friedman by stepping in on such short notice. But as the film preps for its premiere at the Sundance Film Festival, the directing duo confesses Parker's contribution to the picture has been cut completely.
Kristy Puchko Jan 16, 2013
Sarah Jessica Parker Edited Out Of Lovelace
Amanda Seyfried Gets Ready For The Money Shot In Lovelace Image
Lovelace is directing duo Rob Epstein and Jeffrey Friedman's follow-up to their offbeat docudrama Howl, which centered on the obscenity trial Allen Ginsberg faced over his provocative poem. The film set in the 1970s will not only capture Lovelace's rise to fame, but also her subsequent shaming and claims that she'd been forced into porn
Kristy Puchko Jan 15, 2013
Amanda Seyfried Gets Ready For The Money Shot In Lovelace Image
Amanda Seyfried Poses In Lace For The New Lovelace Poster
Since production began on the Rob Epstein and Jeffrey Friedman directed Linda Lovelace biobic, we've gotten a few glimpses at the film, including a look at James Franco as Hugh Hefner an official still of stars Amanda Seyfried and Peter Sarsgaard as Linda Boreman (a.k.a. Linda Lovelace) and Chuck Traynor respectively, and even a vintage poster of Seyfried as Deep Throat's Linda Lovelace.
Kelly West May 02, 2012
Amanda Seyfried Poses In Lace For The New Lovelace Poster
Sarah Jessica Parker To Take Over Demi Moore's Role In Lovelace - Updated
One notable film star is set to replace another in the upcoming Rob Epstein and Jeffrey Friedman directed Lovelace. Following word that Demi Moore was dropping out of the Linda Lovelace biopic due to personal issues, the big question was, who would replace her? We have our answer today and it's a name that's just as recognizable as Moore's.
Kelly West Jan 27, 2012
Sarah Jessica Parker To Take Over Demi Moore's Role In Lovelace - Updated
Chloe Sevigny Joins Lovelace As A Feminist Journo
There's been little word on how the film will approach Lovelace's much-debated life story. However, this bit of casting news may provide some crucial insight. Will Sevigny's journalist prove to be the device/character that allows audiences to see Lovelace's perspective on her own rise to celebrity and infamy? Or perhaps Sevigny's role may serve as a mirror of the modern audience member trying to make sense of Lovelace's life from the various and conflicting accounts.
Kristy Puchko Jan 25, 2012
Chloe Sevigny Joins Lovelace As A Feminist Journo
Adam Brody Scores Lead in Some Girls And Welcome To The Jungle
Adam Brody will soon be stepping up from character actor and kooky sidekick to leading man as The O.C co-star has just landed the lead in not one but two upcoming features. It's a hard-won evolution for Brody, who has previously performed supporting roles in everything from moody dramas (The Romantics) to stoner comedies (Smiley Face), and slasher-horror (Scream 4).
Kristy Puchko Jan 16, 2012
Adam Brody Scores Lead in Some Girls And Welcome To The Jungle
Debi Mazar And Cory Hardrict Join Linda Lovelace Biopic
If you're still wondering why the life of a porn star has proven so fascinating to so much of Hollywood, it's due in no small part to the effect the release of Deep Throat had on American pop culture and the sexual revolution of the 1970s. Linda and her jaw-dropping sexual skills made her a poster child for a new and unashamed sexual freedom...
Kristy Puchko Jan 12, 2012
Debi Mazar And Cory Hardrict Join Linda Lovelace Biopic
Lovelace Producer On Amanda Seyfriend And Nudity In The Film
With its focus on the adult film industry, nudity in the upcoming film Lovelace seemed like a likelihood, however, the words "lots of" has been used to emphasize the amount of nakedness viewers might be able to expect from the upcoming adult film star biopic, which stars Amanda Seyfried.
Kelly West Jan 10, 2012
Lovelace Producer On Amanda Seyfriend And Nudity In The Film
Lovelace First Look Photo Shows Amanda Seyfried And Peter Sarsgaard Looking Happy
Slowly but steadily, the cast of the upcoming pornstar biopic Lovelace has grown to include some very notable names, including Demi Moore, Sharon Stone, Hank Azaria and Bobby Cannavale, not to mention stars Amanda Seyfried and Peter Sarsgaard. While the film has yet to receive a release date, production has begun and we now have our first look at Seyfried as Linda Boreman, posed happily with her husband Chuck Traynor (Sarsgaard).
Kelly West Jan 06, 2012
Lovelace First Look Photo Shows Amanda Seyfried And Peter Sarsgaard Looking Happy
Demi Moore To Play Gloria Steinem In Lovelace
Gloria Steinem really hates porn (I've always wanted to open a news story with that sentence). She has spent a large portion of her career rallying people against the porn industry, saying things like, "Whatever the gender of the participants, all pornography is an imitation of the male-female, conqueror-victim paradigm," and ""Erotica is as different from pornography as love is from rape."
Eric Eisenberg Jan 02, 2012
Demi Moore To Play Gloria Steinem In Lovelace
James Franco In Talks To Play Hugh Hefner In Lovelace
Can you picture James Franco playing the role of Hugh Hefner circa the early '70's? That may become a reality as the star is in talks to appear in the upcoming drama Lovelace. This news follows word that four more actors were recently cast in the movie, which is set to begin filming next week.
Kelly West Dec 20, 2011
James Franco In Talks To Play Hugh Hefner In Lovelace
Hank Azaria, Bobby Cannavale And Two More Join Lovelace
The cast of the upcoming film Lovelace already shows promise, with Amanda Seyfried and Peter Sarsgaard set to star. And now, a week from when the movie is set to begin filming in Los Angeles, a few more have boarded the project, among which is Hank Azaria.
Kelly West Dec 20, 2011
Hank Azaria, Bobby Cannavale And Two More Join Lovelace
Juno Temple And Wes Bentley Join Amanda Seyfried In Lovelace
Considering how long this project spent in development hell, it's coming along quite nicely. Epstein and Friedman have gathered an exceptional cast and they are scheduled to start production at the end of the month in Los Angeles. Now we'll just have to wait and see if the competing biopic starring Olivia Wilde comes together quickly and makes 2013 the year of Linda Lovelace.
Eric Eisenberg Dec 06, 2011
Juno Temple And Wes Bentley Join Amanda Seyfried In Lovelace
Sharon Stone To Play Amanda Seyfried's Mom In Lovelace
Rob Epstein and Jeffrey Friedman recently made huge steps towards actually getting their Linda Lovelace biopic off the ground. Earlier this month it was reported that Amanda Seyfried and Peter Sarsgaard were both in talks for the film, with the actress playing the former starlet and the actor signed up to play her abusive husband/pimp, Chuck Traynor. Now a third piece of the puzzle has been added.
Eric Eisenberg Nov 17, 2011
Sharon Stone To Play Amanda Seyfried's Mom In Lovelace
Amanda Seyfried And Peter Sarsgaard In Talks For Linda Lovelace Biopic
Over the years there have been many projects about Linda Lovelace in development, but in the last year it has gotten fairly crazy, largely because just about every actress in Hollywood has been rumored to play the former porn star turned anti-porn activist. It began with Lindsay Lohan being attached to the movie titled Inferno, and got a bit nuttier when Lohan was replaced by Malin Akerman.
Eric Eisenberg Nov 01, 2011
Amanda Seyfried And Peter Sarsgaard In Talks For Linda Lovelace Biopic
Olivia Wilde Might Play Linda Lovelace In Biopic
Olivia Wilde's contemplating playing porn icon Linda Lovelace in a planned biopic of the Deep Throat actress. E! Online says Wilde informed them that playing Lovelace on screen would be "a tremendous honor," and she gushed about the actress's unconventional career. But Wilde stopped well short of verbally committing to the role.
Sean O'Connell Jul 29, 2011
Olivia Wilde Might Play Linda Lovelace In Biopic
James Franco In Talks To Pimp Out Kate Hudson For Lovelace Biopic
There's never a dull moment in the career of James Franco. There's a good chance he'll get an Oscar nomination in just a few hours for his work in 127 Hours, and while that's going on
Josh Tyler Jan 24, 2011
James Franco In Talks To Pimp Out Kate Hudson For Lovelace Biopic
Hot Topics
New Reviews


text:
Richard Littlemore | May 5, 2012
By Richard Littlemore • Saturday, May 5, 2012 - 12:28
Microsoft is finally taking a clearer position denouncing the Heartland Institute's irresponsible position on climate science, but the computer megacorp still won't shut the door on providing Heartland with free software in the future.
In the wake of Heartland's highly offensive advertising campaign, in which Heartland said, flatly, "the most prominent advocates of global warming aren't scientists; they are murderers, tyrants and madmen," Microsoft''s Director of Corporate Citizenship Steve Lippman distanced his company from the Heartland position:
"The Heartland Institute does not speak for Microsoft on climate change. In fact, the Heartland Institute's position on climate change is diametrically opposed to Microsoft's position. And we completely disagree with the group's inflammatory and distasteful advertising campaign."
But he went on with this unconvincing dodge:
"Heartland did participate in our global software donation program in 2010, as did thousands of other nonprofit organizations. It's important to point out that hundreds of environmental and conservation groups also took advantage of the same program, and received over $13 million in free software to pursue their missions."
And Lippman concludes with:
"Again, our software donation program does not support or endorse any particular nonprofit or any particular policy views - it supports giving all nonprofits in the world access to free software."
So, by that comment, Microsoft intends to take no responsibility for its past support and to promise no judgment whatever in extending future in-kind funding or gifts. Microsoft's only standard in offering support is that applicants NOT make a profit. (Al Qaeda might want to get their free software request in with the next batch.)
What's called for here is a simple statement saying that Microsoft will not give Heartland free goods, services or cash in the future. Anything less suggests that the company has no real issue with Heartland's "inflammatory and distasteful advertising campaign" - or any of the other irresponsible and disingenuous programs for which Heartland has become famous.
Well at least Microsoft came
Well at least Microsoft came out with that statement in plain english saying they oppose the climate change stance of Heartland.
And as far as them donating software to Heartland. I suspect that is more about what is good for Microsoft than anything else. They want to remain the dominant operating system and if they have to throw in some free OEM's to maintain that dominance, they will.
"(Al Qaeda might want to get their free software request in with the next batch.)
Source: Desmogblog (http://s.tt/1aXTp)"
You are probabaly right. I don't think they care too much where it goes, as long as people are using it.
David B. Benson replied on Permalink
another reason not to buy anything from that company.
If another reason was actually required.
PeterMizla replied on Permalink
destroy Bill Gates
how can we destroy Micrsoft? Bill Gates is just another Plutocrat piece of crap.
climate criminal replied on Permalink
Don't buy Micro$oft, choose Linux
Don't buy anything from Micro$oft, choose Linux.
Android phones use Linux.
"Don't buy anything from
"Don't buy anything from Micro$oft, choose Linux."
I'm sure we have all had that fantasy, but it's a little easier said than done. Microsoft has almost 90% of the market share. Linux doesn't even have 2%.
For friends who use a little initiative and don't mind spending a few mins looking things up, if it means free, Ive put them onto Ubuntu, open office, wine. I have it at home for the whole family, as well as a mac for my wife and a pc.
It's pointless teaching my kids only Mac, or only Linux, when they use PC at school. They know the basics on all three now.
Don't just slime Bill Gates...
… remember who suckered Koch into funding the Berkley Earth Surface Temperature Project?
Bill is in fact active in fighting climate change in his own selfish capitalist way.
(So of course.. the right wing is attacking him if you read through the comments on that ted talk.)
Its not hard to imagine why Bill Gates is confronting climate change since all the money he's dumping into the third world will amount to nothing if we let climate change run rampant. Also note that Bill has field workers galore in the third world. So he has an inkling of what the apparent damage is so far (probably not much so far).
His old chief of technology has worked on geo engineering solutions to climate change. He's also funded a Calgary professor (now at Harvard) to solve climate change.
I don't think we can label Bill Gates\Microsoft as some sort of enemy.
Fern Mackenzie replied on Permalink
I agree
Bill Gates is a complicated person, and all the time I am cursing Word for trying to tell me how to write, I am remembering that he has also chosen to give back. The Koch brothers should take a page from his book.
They kinda did... FUD
FUD Fear Uncertainty and Doubt
That is how Microsoft fought Linux. And you have to admit that it is how the Koch's fight climate change.
The Heartland Institute is the product of the Koch Brothers
The Heartland Institute is the product of the Koch Brothers, Barry Seid, & other self-serving libertarian billionaires.
Foundation funders
Media Transparency lists Heartland as having received grants from a range of foundations between 1986 and 2009. Of these foundations, by far the largest donor has been the foundation of Chicago industrialist Barre Seid[41], maker of Tripp Lite surge protectors.
- Barbara and Barre Seid Foundation $1,037,977
- Lynde and Harry Bradley Foundation $648,000
- Exxon Mobil $531,500
- Walton Family Foundation $400,000
- Sarah Scaife Foundation $325,000
- Charlotte and Walter Kohler Charitable Trust $190,500
- Jaquelin Hume Foundation $166,000
- Rodney Fund $135,000
- JM Foundation $82,000
- Castle Rock Foundation $70,000
- Roe Foundation $41,500
- John M. Olin Foundation $40,000
- Claude R. Lambe Charitable Foundation $40,000
- Charles G. Koch Charitable Foundation $37,578
- Armstrong Foundation $30,000
- Hickory Foundation $13,000
- Carthage Foundation $10,000
Exxon funding
Greenpeace's ExxonSecrets website lists Heartland as having received $676,500 (unadjusted for inflation) from ExxonMobil between 1998 and 2006.[42] (As mentioned above, Heartland insist that Exxon has not contributed to the group since 2006.)[43]
Exxon contributions include:
- $30,000 in 1998;
- $115,000 in 2000;
- $90,000 in 2001;
- $15,000 in 2002;
- $85,000 for General Operating Support and $7,500 for their 19th Anniversary Benefit Dinner in 2003;
- $85,000 for General Operating Support and $15,000 for Climate Change Efforts in 2004; and
- $119,000 in 2005; and
- $115,000 in 2006.
Martin Vermeer replied on Permalink
While I don't have any warm
While I don't have any warm feelings for the Borg (I've been using Linux exclusively for over a decade, and contributed significantly to free software replacing Microsoft offerings), I must say that I understand their viewpoint on this. Currently they provide their software free of charge to all organizations that the IRS considers charities. Simple. Should they really be setting up their own parallel database of deserving vs. undeserving charities? And by what rules? Figuring this all out is hardly their core business.
No, it's the IRS that should get their act together, and throw out charities that obviously aren't. Keeping fingers crossed.
GingerLadySlipper replied on Permalink
I agree
It isn't up to MSFT to decide what is a non-profit charity and what is a lobbying organization.
It's the IRS.
Heartland should pay taxes and those who donate to it should pay taxes if it obviously lobbies.
I'm outraged that the shoddy lies it fosters are considered "good works".
"nefarious lies" & "evil deeds"
come more to our mind.
Corporate Responsibility is Foremost
re: "Should they really be setting up their own parallel database of deserving vs. undeserving charities? And by what rules? Figuring this all out is hardly their core business."
Yes, like any responsible corporate entity, Microsoft & its management have the foremost social responsibility to determine who & what so-called "non-profits" they donate money or resources to. Last we heard, Al Qaida was still a non-profit.
And, no, its not that difficult to determine that the Heartland Institute is a PR firm hired to lie & deceive the public for the benefit of the tobacco & fossil fuel industries at the health & welfare expense of the general public.
Contrary to John Bircher libertarian propaganda, it is the business of all corporations to be responsible corporate citizens.
And it is the responsibility of the Board of Directors & CEO's of all public corporations to ensure that the actions of the corporation – including the funding of for-profits & non-profits – are for the public good, not for the public harm.
Bailing a bad brand.
Corporate funders are bailing the Heartland name-brand like rats a sinking ship, including AT&T, GM, Microsoft, Diageo, ABIR & XL Group, & now State Farm.
We can all can put a fire under the rest by writing letters to their CEO's that we are switching to their competitors because of their support for Heartland's anti-science antics, & sharing our sentiment with citizens at the checkout stand & customer service.
Many of these bad actors are especially vulnerable to consumer action – Anheuser-Busch, Comcast, PepsiCo, & Time-Warner. We all make choices that affect our lives & our children's future.
Martin Vermeer replied on Permalink
> Last we heard, Al Qaida was
> Last we heard, Al Qaida was still a non-profit
Surely you have a link to their latest Form 990?
One such company is Laga Handbags,they must buy from stores that exclusively sell quality wholesale handbags like Huafu. Attribution,you rolex replica and miu miu the list is endless when it comes to designer handbags. Technology has provided the option of online shopping to women rolex replica of regarding company's submission deal truth be told there work up to many of these motion which can potentially care fewer in case you give them a call back chanel bags intended to be able to find the one which hands as much as your measures associated with the original Hermes handbag. hermes birkin want a designer handbag, then you need to shell out a good sum of money. Though they are durable and good looking, they can definitely get expensive.Finally, the rolex replica uk popular styles of designer handbags has to be the shoulder handbag. Hundreds of designers like Dior, Louis Vuitton and Coach are popular hermes birkin ags, you may must surf all-around to choose an net based retail outlet which will have replica handbags of every last one of esse hermes birkin I saw that her look was extremely comfortable for her, but that she wore heels that would compliment her feminine side, as well as her sexy Rolex replica! It's hard to replica chanel must be concerned about display racks, storage expense, or shelf pricing when going via a wholesale dealer. The top quality will rolex replica But High-End replica luxury watches just below $300.00 usd ,What will be your choose? Swiss watches is so expensive,but swiss replica watches is so cheap and high-end replica watches They may know swiss rolex replica true value and share with you. No matter which model you are going to choose, it won't disappoint you. not shed a dent in your pocketbook. replica watches brands on earth. The replica hermes handbags are usually well-reviewed through Celebrities and other superstars every one replica watches uk their shopping on the day of the actual holiday, I am going to assume that you haven't even thought about Valentine's day. You probably forgot, didn't you? Well check chanel bags


text:
Latest News
Happy Earth Day! Take a stand with your money
Late last week, the U.S. Environmental Protection Agency issued a news release listing the 50 organizations that use the most electricity from green sources.
On Earth Day 2013, it's appropriate to know who these companies are, and to ask: Why aren't any Kentucky-based companies and universities on the list?
According to the EPA, here are the 10 companies that use the most annual kilowatt hours of green energy to power their operations:
1. Intel Corp.2. Microsoft Corp.3. Kohl's Department Stores4. Whole Foods Market5. Wal-Mart Stores Inc.6. U.S. Department of Energy7. Staples8. Starbucks company-owned stores9. Lockheed Martin Corp.10. Apple Inc.
"We applaud the leadership demonstrated by organizations that are helping reduce carbon pollution and spur the growth of clean, American-made energy sources by increasing their use of renewable energy," EPA Acting Administrator Bob Perciasepe said in the news release. "As President Obama has made clear, clean energy is critical to our health, our economy, our security, and our ability to effectively address climate change."
FYI: EPA defines green power as electricity produced from solar, wind, geothermal, biogas, eligible biomass, and low-impact small hydroelectric sources.
Granted, the top 10 are all major corporations, or government agencies, with significant resources. Intel uses green power to cover 100 percent of its electricity load, according to the news release. Apple, which is new to the top 50, now has 85 percent of its electricity used in the U.S. coming from green power.
But universities are scattered throughout the top 50. The University of Pennsylvania ranks 25th, and the University of Oklahoma is 34th.
On the list of top 20 universities, in addition to these two schools, fellow SEC member Tennessee ranks 10th.
To see all of the companies, universities and other rankings, go to
And then, use your buying power to tell companies, organizations and schools that green power matters to you.
– Linda J. Johnson, editor GreenSpot


text:
Catalonia calls early elections in bid for greater independence
Economically developed but heavily indebted Catalonia plans to conduct elections two years ahead of schedule on November 25.
Unemployment, financial instability and austerity measures imposed by the central government in Madrid have made 46.4% Catalans support independence, according to a recent survey. It is twice as many as four years ago before the financial crisis began.
Catalan separatism has been around for more than a hundred years, but since the 2008 crisis the process has been gaining popularity.
On September 11 over a million people from all over the region rallied on the streets of the Catalan capital Barcelona in support of independence from Madrid.
But despite mass protest in Catalonia Spain's Prime Minister Mariano Rajoy last week rejected province's demand for special fiscal powers.
In calling the election Catalonia's President Arthur Mas said 'The moment has come when the village of Catalonia exercises it's right to self-determination, so that the people can decide what sort of future they want as a nation."
Catalonia has an economy greater than neighboring Portugal wants to change things.
The region is trying to get more control over the tax revenues it gathers because now it is the central government in Madrid that distributes finances within the country.
Catalonia currently runs a debt of about 40 billion euro, and that has forced the regional authorities to introduce cuts in health care and education.
A meeting of Catalonia's President Arthur Mas and Spain's Prime Minister Mariano Rajoy brought no tangible results on financial concessions to the region so Catalonia has called the elections.
Catalonia cannot conduct a referendum on independence because the Spanish constitution adopted in 1978 which does not allow referendums on the matter in the country's provinces.
Prime Minister Mariano Rajoy puts blame on the situation on the "most de-centralized in the history of our country" constitution.
"It is a new crisis being added to the crisis," he said.
On Tuesday around 6,000 protesters rallied outside the Spanish Parliament in Madrid. Over 1,000 riot police prevented them from getting near the building. Police used batons while demonstrators threw bottles and stones. Spanish TV reported 22 protesters detained and 28 people injured in the clashes.
The protesters called for members of Parliament members to be sacked for misleading the voters with austerity measures which were introduced despite promising otherwise before the elections last November.
The unemployment level in Spain is the highest in the EU with up to 25 per cent of working-age adults out of work.
Though PM Rajoy has promised not to cut pensions there is a risk the retirement age might be raised to 70. The new austerity measures might be announced on Thursday as government is expected to present a draft budget for 2013.
Madrid is making great efforts to assure its European partners and creditors that the austerity measures it is taking are going to be effective in decreasing country's debt.


text:
The Santa Cruz County Interscholastic Disc Golf League had it's fourth match of the season last Sunday with 19 students attending. Teams were present from Soquel, San Lorenzo Valley, Scotts Valley and Santa Cruz High Schools.
San Lorenzo had the lowest team scores with several new players adding to their improved performance. Santa Cruz high was second followed by Soquel and Scotts Valley.
Individual player scores had Scott Edwards of Scotts Valley High shooting the hot round of a one under 53 with Robin Johnston, who has had the best scores of the season so far in second with a one over 55. Soquel's Thomas Tomaselli and Robert Biagiotto from SLV tied for third with two over par 56s. Erica Tinetti from Santa Cruz high shot a stellar 10 over 64 to put her team in second for the day.
The Black Mouse course in Felton is known for it's many trees and dogleg fairways which challenge the students throwing ability and disc selection.
The League will resume after the Easter break on April 14th at Aptos High School's disc golf course for match 5 out of eight. The League finals will be at Shaffer Park disc golf course on Sunday, May 5th.
— From Mark Karlskind, league director


text:
I have an image with width 4096 and height 2896. I would like to scale the image to below 4000 pixels wide - and as close to 4000 as possible. I would also like to keep the dimensions whole numbers.
Is there an equation to do this?
More Details
Clarification: I do not care if I divide by a rational number.
Reason: I am doing this due to a software limitation. The software that we make the image with can not have a width or height 4000px or more. But the size I want is 4096. To try and make the final image as crisp as possible, I reasoned that you should not have any rounding.