FBI agents investigating government watchdog Scott Bloch have subpoenaed any records that would reveal whether concerns about the 2004 elections prompted him to clear Secretary of State Condoleezza Rice of ethics violations.

Bloch, the U.S. special counsel who investigates federal employee whistleblower complaints, found no merit to allegations that Rice, then President Bush’s national security adviser, timed some of her trips to boost Bush’s 2004 reelection campaign.

If this truly is the right way to do things, they should have taken steps so as to insure it did not look improper. If it looks like a duck, walks like a duck, and quacks like a duck; you probably got a duck. Fiore has the traits of a duck. Quack!

You don’t have shit for a duck Bmaz. Nothing is quacking and I’m surprised with your legal experience you couldn’t site and didn’t read the recommendations of the committee. They didn’t favor Chantix so how the fuck does anything quack like a duck or make a sound? You don’t like being called on something do you–at least tonight you don’t! I’m sorry but I have the medical experience here. There was nothing in the recs that favored any drug. Geez Louise there are only seven on the fucking market. 5 Nicotine analogs, 25 year old buproprion that we’ve had forever. And this nicotinic agonist. And I drilled into all the adverse reactions.

The psych warning is standard in every single antidepressant and psychotropic drug and nicotinic agonist on the American market.

Have you perhaps had a bad medical experience that has you chronically pissed off and colored your rush to judgement before actually reading the guidelines as I just did? A doc was not a good expert witness for you in a case? I mean there is nothing favorable in that 250 page epistle for Pfizer whatsoever!!!!!!

A few bottom lines for you Bmaz. I don’t know how long you’ve practiced medicine.

1) Nothing in the recs favored any drug. There are only seven on the US market as I drove home. You implied that the guy was a jackleg because it did. Show me Exhibit “A” where it did. I spent time reading it. Nothing there.

2) I gave you considerable years of clinical perspective and you’ve pissed on it like you were insulted.

The feds and this committee wrote a pretty meaningless standard set of recs as they do hundreds of times a year. Welcome to the USA. I’ve been seeing them for years. But Fiore and no one else on that 24 member committee or anyone else in that agency recommended any one drug (of the 7 and 5 are nicotine derivatives and only 2 are on the market that aren’t for Chrissake). I can’t agree to disagree. The medical facts are what they are. There isn’t anything subjective open to other interpretations here.

I know that MSNBC had a nitwit with no medical experience write an article and so did WSJ.

WSJ’s approach to the entire Libby trial was not one single article on it, not even when the fucker was convicted. They did however give us two stupid editorials. One was from Dorothy Rabinowitz and one was from Victoria Toensig and they were imbecilic. Welcome to the USA, and welcome to the WSJ.

For medical info try Larry Altman, M.D. who writes for the New York Times.

I’m not going to distort info when I give it to you–sorry. Have a good one.

I read the pack insert and a good deal of the the research info on this drug.

Do you mind rephrasing this sentence so that I can understand it with all respect due? I’ve read the PDR on Chantix and Pfizer’s ancillary information gleaned in their NDAs on this nicotinic receptor agonist. I’ve posted the entire pack insert from the PDR here and the significant points that it isn’t even metabolized in any passes in the liver and even in patients on hemodyalsis there have been no adverse effects reported during years of testing at multiple medical centers.

When the kind md looks in the pdr, consider multiorgan impairments as a background on which to introduce it. PharmaceuticalRegimens of various sorts, some routine and some ‘atypical’ have been a longtime baliwick of both regular prisins and intell, and is a zone included in the list of exemptions in congress’ permissive mca, if I recall

.

The most common adverse reactions include nausea, sleep disturbance, constipation, flatulence, and vomiting. Nausea occurred in 30% of patients; 3% discontinued due to nausea.

Observe patients for serious neuropsychiatric symptoms including changes in behavior, agitation, depressed mood, suicidal thoughts or behavior. These symptoms as well as worsening of pre-existing psychiatric illness have been reported in patients attempting to quit smoking with CHANTIX.

In the first place after years and years of following hundreds if not a couple thousand drugs in the literature and in patients, a legal allegation that something may have caused HRS doesn’t count for much. If we take the pack insert (they btw have to pay to get their drugs in the PDR so thousands of generics aren’t in the PDR

I can take a random bunch of pages out of the PDR and in every single drug I can find rare instances case reported of some of the worst side effects or diseases. That’s always going to be the case. Sometimes there are post marketing sequellae that didn’t show up in years of testing during NDAs pre-market.

The on point question though is what are the incidences of documented side effects/adverse reactions/significant serious clinical results in carefully controlled statistical couble blinded studies done by experienced, reputable people?

On the pharm issue one of the gitmoite prisiners had mentioned something like chantix in a complaint recently which described what may be hepatorenal syndrome

Considering local attorneys are filing suits against the government for wiretapping them at Gitmo according to the NYT yesterday, and from reports I’ve heard Gitmo runs a pretty minimalist opersation I’d be astounded that Gitmo hasChantix or anything for smoke ending other than abstenance on their formulary and they probably encourage smoking as a way to calm their prisoners down.

Gitmo doesn’t give a flying fuck about the health of their prisoners, and I can tell you DOJ/BOP stateside doesn’t and the medical personnel they deploy are among the dumbest/most incompetent on the planet.

I find it hard to believe that Chantrix ever found its way into a Gitmo prisoner’s mouth.

Documenting that a single drug caused hepatorenal syndrome when it hasn’t got a clinical history of doing so is a difficult proposition.

Paradoxically, in the brief update we get mailed once a month, there are dosages of Chantrix for patients with “severe renal impairment” and even for patients on dyalysis!!!!

Prescribing Info Chantix

There is no hepatic impairment mentioned in this document. In fact, “Due to the absense of significant hepatic metabolism (relatively rare for most drugs, verinicline pharmokinetics should be unaffected in patients with hepatic insufficiency.”

In patients on hemodialysis 3 times a week, renal clearance was comparable to normal subjects.

The most common adverse reactions include nausea, sleep disturbance, constipation, flatulence, and vomiting. Nausea occurred in 30% of patients; 3% discontinued due to nausea.

Observe patients for serious neuropsychiatric symptoms including changes in behavior, agitation, depressed mood, suicidal thoughts or behavior. These symptoms as well as worsening of pre-existing psychiatric illness have been reported in patients attempting to quit smoking with CHANTIX.

Nothing is very surprising or atyical here. The worstening of psychiatric side effects comment is standard for virtually every single psychotropic medication including all anti-depressants and anti-psychotic meds on the American market.

And Chantix is a nicotinic receptor agonist so of course it has the side effect profile that Bmaz made such a fanfare of. So does every other psychotropic and nicotinic receptor agonist known to man. You wouldn’t know it from the erratic superficial articles at MSNBC or in the WSJ though. How surprising that is. Superficial ignorant articles in the print media that are medically naive with no pharmacologic background whatsoever. Heavens to Besty! How shocking!

The new guidelines mention the psychiatric risks but also say the popular Pfizer Inc. drug is the most effective at helping people get off cigarettes.

So says the WSJ. But in fact the guidelines don’t say anything remotely like this. They simply list the drugs.

HHSGuideline Links Smoking Cessation

2008 HHS Guidelines Update

1) Number on the Committee: 24 mostly MD’s with MPHs, a couple of PhDs, a nurse, and one pharmacist. That’s par for the course.

2) Six liasons from medical entities.

3)Seven staff members (several are PhD level).

4) Typical federal government method of killing tress and wasting a considerable amount of time. About 250 pages of junk my 10 month old puppie already knows as far as clinical efficacy goes.

With the exception of listing a lot of studies for the sake of listing them, there is next to no clinical help at all. For an MD in practice for years, this yields zilch/zilch/zip/nadda over not diddly squat of useful clinical information. It doesn’t enhance or change most people’s practice one scintilla nor help a patient one scintilla.

And one of the reasons is that when you get down to it, we havent’ had any corner turning break through smoke ending efficacious drug in 30 years. I still put Catapres head and shoulders above these, and it’s not even on the list because that’s an off label indication drug that works beautifully to aid in smoke ending.

I’m wondering except for conventional custom why this was really written. The studies listed may be useful since some of them are in one place for research purposes, or completeness’ sake, but other than that I fail to see anything helpful here.

That said:

I don’t find one sentence in this whole thing that recommends Chantrix whatsoever.

So where in the world is the beef over the hue and cry that someone who used to do studies with Pfizer is one of 24 members of this committee when the committee didn’t recommend any of the seven “modalities” on the market as particularly effective over the other? And ironically in years of practice, I and hundreds of other people haven’t seen six of them work worth diddly squat.

All but two are generic modalities; but two, Bupropion SR (Wellbutrin) and, notably, Varenicline (yep, that would be Chantix) are patented single maker drugs.

Bmaz lol yeah, except that:

There aren’t any other approved medications in the US for smoke ending.

So where is the reason for your concern that this guy was pushing or the feds were pushing Chantrix when there are literally only those drugs available–5 are Nicotine in some form of delivery–the other is Wellbrutin that we’ve had around sinnce the 1970’s and has been packaged as Zyban for smoke ending (doesn’t work worth a damn. Where did they say Yo “Chantrix is head and shoulders more efficacious”?

So then what has Fiore or anyone else on that several member committee done to promote Pfizer’s drug? They just named all of ‘em on the market!

And ironically although I haven’t tried Chantix and don’t see much reason to, the one that isn’t formally indicated but terribly safe that I’ve had a lot of success with isn’t on that list because it’s not approved formally for that indication. It happens to work extremely well. The others aren’t worth didly in my opinion, and in the opinion of several people I know. But Bmaz that committee didn’t in any way I see single out and showcase Chantrix in any way at all. And just for the hell of it this week later when I have time, I’ll “run Chantrix” meaning I’ll dig into it if you like and give you my straight up opinion. And often you’ll find that an alarmist lay article like the MSNBC little blurb that breathlessly reports suicide doesn’t clinically hold water in the legitimate medical literature, where double blind studies have been done at good tertiary centers like the med schools you have in Arizona and statistical results are actually reported. You’re entitled to that level of literature–not an MSNBC article designed to get web site hits.

Again where in that list is use of any one of those recommended? And look at the list–5 of them are all nicotine delivered by various means. I wouldn’t touch nicotine to help someone stop smoking. It’s a pathetic failure. Catapres works terifically well, but again they have to exert the same will power you need to exert when you’re trying to quit anything cold turkey. I view it as a helpful and inexpensive and safe adjunct. Buproprion not worth a damn for smoke ending. So that only leaves Chantrix which those guys and girls haven’t singled out preferentially and right now I don’t have any sense of how good or bad, safe or efficacious Chantrix is. But I’ll take a stab finding out sometime in the next week–possibly.

One thing is important to realize. Of the “modalities” listed–those are all of the approved ones. I take pride in the fact I’ve never used any of the nicotine replacement therapies and by the time anyone has ever asked me for help, they’ve always tried them. They fail consistently and remarkably. That leaves two on the list–Zyban (Buproprion) which has been available to us for over 20 years as buproprion or Wellbrutin for depression and in my opinion and many of my collegues totally pathetic as to efficacy for smoke ending–it gets touted cyclically for weight loss, ADHD, and many other potential indications, and I’ve been profoundly underwhelmed that it offers much help for anything except for depression in a small subset of patients.

So the committee of which the guy was one member simply listed every single drug that’s on the market right now. I’m holding in my hand the book we get mailed every month that lists all current medications, all new meds released this quarter, and all meds in the pipeline for the next six months. I’m looking at the list of what can be used for smoke ending and it coincides with the list you just posted.

There are no other drugs “approved” They just listed the ones availabe and left out the one I believe works much better than all of them.

I haven’t had any particular interest in Chantrix to date until I saw you mention it. So to call me obsessed was out in left field.

Here’s how this went. I like you. You spend a lot of time with good reasearch and good legal insights mixed with a healthy dose of common sense, and I was happy to use the tools I have and an objective look–I had to go back to see what drug the fuss was about–because I thought it would help you.

This is in the same vein that you mentioned wondering about Ted Turner’s opinion of dropping out of AOL/Time Warner day before yesterday or so, and I happend to have a long interview in a local paper of Ted who lives in the same town I do and I made a mental note to email you a copy when I got the time.

I’m trying to give you a straight up representation after many years of every day practice. I mean we see these conflict situations all the time–they are written about rather extensively in most of our journals, and Marcia Angel who is a brilliant internist was the editor of the New England Journal of Medicine which is a very prestegious job and she was terrifically experienced and well suited for that job. Marcia resigned her job over an article that she perceived to be a conflict of interest in 2000 after doing a superlative job running the NEJM editorialwise and medicine wise for 20 years–I’d have to look up the details but they are coming back to me.

Marcia wrote a recent book researching conflicts between doctors doing research and their relationships with Big Pharm–and because I know Marcia’s work–it has to be one of the best out there.

In my experience there has not been one med including all current ones that works near as well to stop smoking and it’s not a panacea but damn effective as Catapres TID and you can titrate up a bit with no significant side effects, dizziness, dry mouth or hypotensive worries. When I saw that sentence in the MSNBC article that

The new guidelines mention the psychiatric risks but also say the popular Pfizer Inc. drug is the most effective at helping people get off cigarettes.

It didn’t mean much to me. The guideline might impact some PPO/HMOs lists, but not all that much. They do nothing for me. I’ve had a terrific success rate with Catapres–and when people ask me to help them stop smoking, they’ve already tried every form of nicotine gum, patch, etc. and it hasn’t done squat for them. I never use those products because in my experience over years they are a waste of time and money. The people have also tried quitting “cold turkey” by the time they ask for something, and they’ve failed with “cold turkey”.

The WSJ article didn’t do much for me because none of the claims was backed up by a scintilla of any studies in the lit.

I prefer Catapres pills to the patches and so do most patients for a variety of reasons.