• Pinboard Links

    Flap’s Links and Comments for May 4th on 17:49

    These are my links for May 4th from 17:49 to 18:33:

  • Dentistry,  Oral Bisphosphonates

    Revisiting Bisphosphonates and Femur Fractures

    I have written a number of pieces about the problems associated with bisphosphonates and osteonecrosis of the jaw. Now, there is this piece about some additional problems with these drugs.

    Nearly six years ago in this column, I discussed what was then a little-known problem associated with long-term use of bisphosphonates, the valuable drugs that protect against fractures caused by bone loss. The drugs, among them Fosamax, Actonel and Boniva, can slow bone loss, increase bone density and cut fracture rates in half in women with established osteoporosis.

    Reports had begun to emerge that some women taking bisphosphonates for many years suffered an unusual fracture of the femur, the long bone of the thigh. There was little or no trauma; in most cases the women were simply standing or walking when the femur snapped in half. In some, breaks occurred in both thighs, and many of the fractures were unusually slow to heal.

    Experts think the fractures happened because of the way the drugs work: by slowing the rate of bone remodeling, the normal process by which injured bone heals. As a result, microfractures that occur through normal wear and tear are not repaired. Although bone density may be normal, the bone can become brittle and crack under minor stress.

    In the years since, hundreds of cases of atypical femur fractures have been reported among women and some men taking bisphosphonates for five or more years. A number of studies have tried to assess the risk, and last fall the Food and Drug Administration issued a “safety announcement” and required that the drugs’ labels warn physicians and patients to be alert for this potential complication.

    So, with all of the problems associated with these drugs and the realized benefit, do the risks outweigh the benefits? The latest study was published in JAMA on February 23rd.

    “Compared to the number of fractures prevented,” she said, “the actual risk of a subtrochanteric femur fracture is small” — 1 case in 1,000 in the sixth year of therapy and 2.2 cases in 1,000 the seventh year.

    And, in another report in the The New England Journal of Medicine.

    A report published last year in The New England Journal of Medicine found no increase in atypical femur fractures, but that study did not include enough patients taking bisphosphonates for many years to produce a reliable result. Preliminary data from a much larger study has indicated that the risk of atypical femur fractures increased from 2 cases a year per 100,000 users after two years of bisphosphonate therapy to 78 cases a year per 100,000 after eight years on the drug.

    One more study:

    In a report from a 27-member task force of the American Society for Bone and Mineral Research (published online in September in The Journal of Bone and Mineral Research), the experts noted that the way bisphosphonates work can reduce the “toughness” of bones. “It is highly likely that case reports and case series of atypical femur fractures will continue to accumulate,” the task force wrote, noting that another 47 cases had been reported since their analysis was prepared. Many cases are not reported, and in an unknown number of cases physicians may not recognize the fractures as atypical.

    The task force called for an international registry of cases, including details that could help define who is most at risk.

    So, what should a patient and a dentist do?

    Certainly, be aware of the inherent risks of the bisphosphonates and be sensitive to the need, particularly if you are not at a high fracture risk.

    Initial excitement about bone-protecting drugs led to prescriptions for millions of women who were not necessarily at high fracture risk, and many experts now urge a thorough evaluation before a bisphosphonate is prescribed. In addition to bone density test results, the evaluation should take into account a patient’s smoking and drinking habits, thinness, family history of osteoporosis, previous osteoporotic fractures, drug prescriptions and weight-bearing exercise regimen. An online evaluation tool developed by the World Health Organization is at www.shef.ac.uk/FRAX, though some experts have criticized it as incomplete.

    The task force said a decision to treat should be “based on an assessment of benefits and risks,” and added, “patients who are deemed to be at low risk of osteoporotic-related fractures should not be started on bisphosphonates.”

    Even those with osteoporosis in the spine but little or no problem in their hips, the experts concluded, should consider alternative remedies.

    Osteonecrosis of the jaw is NOT a minor complication and the dentist in consult with the patient and patient’s physician must evaluate the risks, prior to dental surgery.

    The femur of Dr. Jennifer Schneider of Tucson, an internist who after seven years on Fosamax suffered a nontraumatic femur fracture that took two years to heal

    Dr. Schneider invites patients who have had such a fracture to write her at jennifer@jenniferschneider.com

    Previous:

    Oral Bisphosphonates Associated with a SLIGHTLY Elevated Risk of Developing Osteonecrosis of the Jaw?

    New Dentistry Cause for Alarm for Patients Who Use Bisphosphonates – Fosamax, Actonel, Boniva?

    Dentistry Today: Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate disodium) Associated with Osteonecrosis of Jaw – REDUX

    Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate dis odium) Associated with Osteonecrosis of Jaw

  • Pinboard Links

    Flap’s Links and Comments for May 4th on 14:49

    These are my links for May 4th from 14:49 to 14:55:

    • The Slippery Story of the bin Laden Kill – As for the claim that bin Laden was living in a mansion, as opposed to just a big house, all that's needed to debunk that description is some pictures of the house. A Wall Street Journal reporter went to the scene and gave this eye-witness account, concluding there was nothing mansion-like about it:

      The size and fortress-like nature of the compound stood out in the area, though many of the houses in Abbottabad, built by ex-servicemen and business people, also have high walls. Homes are separated by empty plots where people grow crops like potatoes and wheat.

      The top two floors of bin Laden's three-story house are visible above the high perimeter walls. The house, built in 2005, appears run-down. Grass grows off a ledge below the roof. The outside walls are scarred with damp and mold. A hand-painted advertisement for Jamia Girls College, in Urdu and English, decorates one of the outside walls of the compound.

      One of the awnings on an outdoor window hung down at an angle, perhaps after being damaged during the attack. Otherwise, the house stood intact, with few signs a major firefight only two days earlier.

      There were no visible airconditioning units to keep residents cool through the Pakistan summer. At the back of the house was a small, private triangular garden with a towering fir tree, where bin Laden could have gotten air without being seen by outsiders.

      =====

      Read it all.

      Definitely not a mansion and there has to be a reason why Obama is not releasing bin Laden's death photos.

    • To get bin Laden, Obama relied on policies he decried – Let's cheerfully and ungrudgingly give credit to Barack Obama for approving the military operation that resulted in the death of Osama bin Laden.

      In my Washington Examiner column last Sunday I criticized Obama's foreign policy, which was characterized by one of his advisers in an interview with the New Yorker's Ryan Lizza as "lead from behind." That criticism still stands.

      But in tracking down and nailing bin Laden, Obama led from behind the right way — behind the scenes he made a right but risky decision, without any leaks to the press, to achieve an objective sought by two presidents and thousands in the American government and military since Sept. 11, 2001.

      The decision was risky because the operation could have failed, like Jimmy Carter's Desert One operation to rescue American hostages in Iran failed in April 1980.

      But this time, even though one helicopter was lost, the operation succeeded. There was evidently a lot of redundancy in the plan and a lot of flexibility on the ground. A lot of good people did a lot of good things right.

      ======

      Read it all.

      Yes, he Did

  • Pinboard Links

    Flap’s Links and Comments for May 4th on 12:26

    These are my links for May 4th from 12:26 to 12:38:

    • John Yoo: From Guantanamo to Abbottabad – WSJ.com – John Yoo: From Guantanamo to Abbottabad
    • John Yoo: From Guantanamo to Abbottabad – President George W. Bush, not his successor, constructed the interrogation and warrantless surveillance programs that produced this week's actionable intelligence. For this, congressional Democrats and media pundits pilloried him for allegedly exceeding his presidential powers and violating the Bill of Rights.

      As a candidate in 2008, then-Sen. Obama held Mr. Bush and Sen. John McCain "responsible for the most disastrous set of foreign policy decisions in the recent history of the United States." These decisions, he said, allowed bin Laden and his circle to establish "a safe-haven in northwest Pakistan, where they operate with such freedom of action that they can still put out hate-filled audiotapes to the outside world."

      Upon taking office, Mr. Obama tried to fulfill the dreams of the antiwar left. In January 2009, he signed executive orders to close the prison at Guantanamo Bay and limit the CIA to U.S. military interrogation methods. He made it clear that al Qaeda leaders would be tried in civilian courts. And in August 2009, his attorney general, Eric Holder, launched a criminal investigation into CIA officers who had interrogated al Qaeda leaders.

      Imagine what would have happened if the Obama administration had been running things immediately following 9/11. After their "arrest," we would have read KSM and al-Libi their Miranda rights, provided them legal counsel, sent them to the U.S. for detention, and granted them all the rights provided a U.S. citizen in criminal proceedings.

      =====

      Read it all

  • Death Penalty,  Jerry Brown,  Kamala Harris,  Michael Morales,  Terri Lynn Winchell

    California Says NO Excutions in 2011

    The old San Quentin Prison Gas Chamber

    What a shocker and from anti-death penalty Governor Jerry Brown and Attorney General Kamala Harris, too.

    California corrections officials have put off until at least next year any attempt to resume executions among the 713 condemned inmates on death row, according to court documents.

    The request by the California Department of Corrections and Rehabilitation to delay review of newly revised lethal-injection protocols until January at the earliest follows a decision last week by Gov. Jerry Brown to scrap plans to build a new death row facility at San Quentin State Prison.

    The steps have stirred speculation among death-penalty opponents that California might be drawn into the national trend away from seeking new executions.

    The most recent postponement was due to San Quentin warden Michael Martel’s decision to replace the execution team that had been assembled and trained last year. That team had been ready to carry out executions last September. Corrections officials have declined to say why Martel is assembling a new execution team.

    The internal corrections department revisions were disclosed during a meeting of the department’s lawyers last week with U.S. District Judge Jeremy Fogel. The San Jose judge overseeing a federal case that has halted executions for the last five years expressed frustration with the protracted process and concern that the public doesn’t understand why it has taken so long to correct flaws in the execution procedures.

    UC Santa Cruz professor Craig Haney, who opposes capital punishment and has tracked public attitudes on the death penalty for 30 years, said Brown’s decision to scuttle new death row construction to save taxpayers hundreds of millions of dollars, and the corrections department’s slowing down of its efforts to resume executions are “examples of the increasing signs that the death penalty’s days are numbered in the United States.”

    I think it is time for California voters to ask why there has been such a protracted delay in enforcing the law. If there are problems with the lethal injection method, even after spending close to a $ million on a new execution chamber, then why not resume use of the gas chamber. Photo below:

    The newly renovated San Quentin Prison Death Chamber

    AP Photo

    If the California legislature needs to change the capital punishment law to facilitate a return to the gas chamber or hanging, so be it. My best guess is that Jerry brown would veto such legislation. The only recourse would be an initiative campaign by the voters of California – which of course, will take years or an election cycle.

    So, don’t count on any executions to be held in California any time within the next few years – at least while Jerry Brown is governor.

    .
    No justice yet for Terri Lynn Winchell.

    An attorney for death row inmate Michael A. Morales, whose February 2006 execution was called off by Fogel over concerns that the former procedures could inflict unconstitutional pain, said the latest delays reflect a more cautious approach in the exercise of capital punishment by Brown’s administration.

    “It appears that the state is attempting to be diligent in their obligations under the law, which would be in stark departure from what was the case with Governor [Arnold] Schwarzenegger,” said David Senior, one of Morales’ attorneys.

    Terri Lynn Winchell

  • Pinboard Links

    Flap’s Links and Comments for May 4th on 08:43

    These are my links for May 4th from 08:43 to 08:46:

    • President 2012: Where is Mitch Daniels’s ‘A’ team? – First, the lineup is exceptionally light on presidential campaign experience. Mark Lubbers was on a 1996 Dick Lugar presidential campaign (honest, the senior Indiana senator really did run once). Kim Alfano is the closest to a seasoned national campaign adviser, and her experience consists primarily of a brief stint as a consultant the ill-fated Fred Thompson campaign. GOP advisers with whom I spoke praise Alfano’s abilities, but are generally not impressed with the quality and level of the campaign team’s experience. Indeed, if you compare the list to the all-star lineups put together by Mitt Romney and Tim Pawlenty you wonder whether Daniels understands the rigors of a national campaign.

      Second, as one adviser put it, “You’d think for a guy with strong Bush ties that you’d see some of the Bush operatives lining up to help Daniels get prepared. So far that doesn’t seem to be the case.” This is especially true, if, as has been reported, Daniels has spoken to former president George W. Bush about a run. Two GOP communications gurus point to the presence of the former head of the National Economic Council, Al Hubbard. He’s certainly a respected economist and able fundraiser, but not the sort who would run a campaign or serve as a top strategist. Others suggest that once Daniels comes on board many Bush administration veterans will climb on board.

      In short, it doesn’t appear there as of now is an “A” team of top-notch advisers on whom Daniels would rely. That is perhaps to be expected at this stage given former White House staffers’ observations that Daniels is someone who keeps his own counsel. That, in a presidential race, however, has considerable downsides and leaves a candidate unused to the national spotlight without critical sounding boards. (In private, Daniels has suggested he really can do without a lot of consultants.) If Daniels does throw his hat into the ring, he most likely will need to bolster his home-state team with some seasoned pols.

      ======

      Jennifer Rubin at the Washington Post has a "hard-on" for Mitch Daniels i.e. she criticizes him at every turn.

      One wonders who then will be Jennifer's pick will be for the race for 2012?

      Jennifer is a good conservative pundit but when you get on her bad side, I guess you better be able to take the heat.

    • President 2012: Mitch Daniels’ political inner circle – The Mitch Daniels Inner Circle (listed alphabetically)

      *Kim Alfano: Alfano served as Daniels’ media consultant in his 2004 and 2008 gubernatorial campaigns. While Daniels’ lore holds that he writes his own television ads, Alfano was also intimately involved in helping craft the populist persona that proved so successful for Daniels in Indiana. Alfano has also done work in the past for former Tennessee senator Fred Thompson’s presidential campaign and made the ads for Iowa Gov. Terry Branstad during the 2010 election.

      * Debbie Hohlt: Hohlt runs Daniels’ D.C. office and is the main point of contact for the governor in the nation’s capital. She’s been in GOP politics for years including serving a stint at the Republican National Committee as deputy communications director during the 1988 election. Her husband, Rick, is a major GOP fundraiser — and a native Hoosier.

      * Eric Holcomb: Holcomb is the first among equals in Daniels’ political world, having managed the governor’s 2008 re-election campaign. He is now the chairman of the Indiana Republican party, replacing Murray Clark, another Daniels’ ally, who stepped down at the end last year.

      * Al Hubbard: Hubbard is an Indiana native who has spent considerable time in previous Republican Administrations, serving as head of the National Economic Council during George W. Bush’s second term. Hubbard was also a major fundraiser for Bush during the presiden’st two terms in office.

      * Mark Lubbers: Lubbers is a longtime friend of Daniels who served as his top political adviser for a time in the governor’s office. He also managed Indiana Sen. Dick Lugar’s 1996 bid for president and helped organize the reality television show Daniels created during his gubernatorial campaigns. Lubbers is married to Teresa Lubbers, a former state senator and now the Commissioner of Higher Education in Indiana.

      * Christine Matthews: Matthews is the low-profile pollster who handled survey research for Daniels during his 2004 and 2008 runs for governor. She is the president and founder of Bellwether Research.

      * Brian McGrath: McGrath is the executive director of Aiming Higher, a Daniels-aligned political action committee in the state.(The group sponsored ads slamming state House Democrats for leaving town earlier this year.) McGrath has a hand in the fundraising and policy-making worlds of Daniels, according to those in the know.

  • Donald Trump,  Jon Huntsman,  Mike Huckabee,  Mitch Daniels,  Mitt Romney,  Polling,  President 2012,  Sarah Palin,  Tim Pawlenty

    President 2012 GOP Poll Watch: Mitt Romney and Mike Huckabee Lead – Palin and Trump = Not So Much

    According to the latest Quinnipiac National Poll.

    By healthy margins, American voters say they would consider or be enthusiastic about backing former governors Mitt Romney and Mike Huckabee for president, but 58 percent would never support Sarah Palin or Donald Trump, according to a Quinnipiac University poll released today.

    No surprise here.

    Sarah Palin and Donald Trump will NOT be candidates, in any case.

    The race will either be Huckabee Vs. Romney Vs. Daniels or Huckabee Vs. Romney Vs. Pawlenty. And, Jon Huntsman will be in the mix somewhere.

  • American Economy,  Food Stamps,  Welfare

    About 1 in 7 Americans Receive Food Stamps



    California is a little less than 1 in 10, but come on now.

    Growth in the food stamp program appeared to reach a plateau in February — with 14.3% of the population relying on the safety net program.

    The number of food stamp recipients was essentially flat in February, the most recent month available, with 44.2 million Americans receiving benefits, according a new report from the U.S. Department of Agriculture. (See a sortable breakdown of the data here.)

    The food stamp program ballooned during the recession as workers lost their jobs or saw their hours and income reduced. The rise in recipients has begun to flatten in recent months, which may mean that as the economy is improving fewer Americans are seeking to join the program. Enrollment in the program is still high though, with 11.6% more people tapping benefits in February than the same month a year earlier.

    Food stamp numbers aren’t seasonally adjusted though, meaning a variety of factors could influence the monthly tallies and the program could grow again in coming months.

    Mississippi and Oregon were among the states with the largest share of the population utilizing food stamps in February: At least one in five residents in each state were receiving benefits.

    Wyoming had the lowest rate of recipients with just 6.6% of the state’s residents using food stamps.

    The economy is poor, the federal budget is running massive deficits requiring massive debt, and there is high unemployment.

    And, Americans cannot feed themselves or their children without help from the government?

    What is wrong here?

    I would recommend the Congress and the President get busy in paring back regulations, reducing taxes, providing business incentives and helping American companies get a foothold, so they can hire Americans for their jobs, instead of offshoring or relying on illegal immigrants. America needs to manufacture things here again.

    This is ridiculous.

  • Barack Obama,  Polling,  President 2012

    President 2012 Poll Watch: Still NO Bounce in Polls for Obama Since Bin Laden Killed?



    It appears so in the latest Rasmussen Poll.

    The Rasmussen Reports daily Presidential Tracking Poll for Wednesday shows that 24% of the nation’s voters Strongly Approve of the way that Barack Obama is performing his role as president. Thirty-seven percent (37%) Strongly Disapprove, giving Obama a Presidential Approval Index rating of -13.

    Daily updates are based upon nightly telephone interviews and reported on a three-day rolling average basis. As a result, one-third of the interviews for today’s update were conducted before news was released about the death of Osama bin Laden. Tomorrow (Thursday) will be the first update based entirely upon interviews conducted after that event. Results from the two nights of data collected following bin Laden’s death show a modest increase in the number who Strongly Approve of the president’s performance.

    Since this poll is a three day average, stay tuned until tomorrow. But, looking at the Gallup polling, any bounce may be modest.