I am often taught from  Isaiah 53:4 that we can claim bodily healing from cross or Christs death. It is not uncommon, to hear people using Isaiah 53:4 as their basis to ask for bodily healing when they pray. However, since my younger days, I have always been about this claim. I fully respect the godly people who often taught this and I am in no way criticizing fellow brothers or sisters who hold to this view. Nevertheless, I have to humbly say that I disagree with it.
Personally, I find it hard to see any connection between Christs death on the cross and with bodily healing because in the Old Testament sacrificial/atonement system, atonement is always for sin and never for bodily healing. Neither do the New Testament epistles spoke of the effect of Christs death in terms of bodily healing either. However, I would like to encourage us to re-look at the verses that has often been quoted to support this claim and they are 1 Peter 2:24; Isaiah 53:4-5,12; Matthew 8:17. If you do a careful and sound exegesis* of these texts, it is very hard to come to that conclusion. Unless, someone say that there is no need to understand a text in light of the context or meaning at that time. If thats the case, then we can almost make any part of scripture to say what we want. Of course this subject of healing etc will lead to other questions or issues which I will not jump into in this entry, perhaps in the future I may. However, I will leave you with a few paragraphs taken from John Stotts The Cross of Christ which deals with this particular issue of bodily healing and atonement.
*exegesis The use of appropriate tools that would aid in understanding the text as its original readers understood it.

The Christian conviction that Christ has destroyed death (2 Tim. 1:10) has led some believers to deduce that he has also destroyed disease, and that from the cross we should claim healing as well as forgiveness. A popular exposition of this topic is Bodily Healing and the Atonement (1930) by the Canadian author T.J. McCrossan, which has been re-edited and re-published by Kenneth E. Hagin of the pentacostal Rhema Church. McCrossan states his case in these terms: All Christians should expect God to heal their bodies today, because Christ died to atone for our sicknesses as well as for our sins (p.10). He bases his argument on Isaiah 53:4, which he translates surely he hath borne our sicknesses and carried our pains. He particularly emphasizes that the first Hebrew verb (nasa) means to  bear in the sense of suffering the punishment for something. Since it is also used in Isaiah 53:12 (he bore the sin of many), the clear teaching is that Christ bore our sicknesses in the very same way that he bore our sins (p.120).
There are three difficulties in the way of accepting this interpretation, however. First, nasa is used in a variety of Old Testament contexts, including the carrying of the ark and other tabernacle furniture, the carrying of armour, weapons and children. It occurs in Isaiah 52:11 with reference to those who carry the vessels of the LORD. So the verb in itself does not mean to bear the punishment of. We are obliged to translate it thus only when sin is its object. That Christ our sicknesses may (in fact, does) mean something quite different.
Secondly, the concept McCrossan puts forward does not make sense. Bearing the penalty of sin is readily intelligible, since sins penalty is death and Christ died our death in our place. But what is the penalty of sickness? It has none. Sickness may itself be a penaly for sin, but it is not itself a misdemeanour which attracts a penalty. So to speak Christ atoning for our sicknesses is to mix categories; it is not an intelligible notion.
Thirdly, Matthew (who is the evangelist most preoccupied with the fulfilment of Old Testament Scripture) applies Isaiah 53:4 not to the atoning death but to the healing ministry of Jesus. It was in order to fulfil what was spoken through Isaiah, he writes, that Jesus healed all the sick. So we have no liberty to reapply the text to the cross. It is true that Peter quotes the following verse by his wounds we are healed, but the contexts in both Isaiah and Peter make it clear that the they have in mind is salvation from sin.
We should not therefore, affirm that Christ died for our sicknesses as well as for our sins, that there is healing in the atonement, or that health is just readily available to everybody as forgiveness. (John R.W. Stott, The Cross of Christ, pg. 284-285)

I hope this entry will provoke some thoughts about this issue. If you are keen to read more on the subject of sickness, I highly recommend the Anglican bishop J.C. Ryles small booklet entitled Sickness which you can order from TULIP Reformed Book Centre for just $3 (excluding mail charges of course) or alternatively you can read it at http://www.biblebb.com/files/ryle/PRACT15.TXT . The author who wrote it more than 100 years ago offers a very comforting and different view of sickness that will challenge the contemporary church view of sickness.

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Pointing out that the U.S. is the only developed nation that does not guarantee health coverage for all its citizens, the Senate Finance Committee is exploring whether to impose a mandate that would require individual Americans to purchase health insurance, which has proven controversial in states where it has been attempted (Massachusetts, California, etc.). The committee explored the idea in depth in a special policy options paper released recently in advance of a planned private negotiating session last week, where committee members debated options to expand health coverage in the United States.

The committee has since released an additional policy paper on financing health care reform as well. However, I think it is important today to first address the committees proposals for expanding health care to all Americans.

The paper refers to the requirement to buy insurance not as a mandate but as a personal responsibility to own health coverage. In addition, the committee will weigh three options for a public health insurance plan that would allow all Americans to buy coverage through the government for the first time. However, the committee might also reject the public plan all together, and rely instead on a reformed and well regulated private market to expand access to health insurance a move that could help a sweeping health overhaul draw some Republican support.

Thursdays session the second of three includes some of the most hotly debated aspects of health care reform. Those include questions over whether to create a public plan option to compete with private insurers, and whether to allow Americans between ages 55 and 64 to temporarily purchase Medicare coverage while a reform bill is implemented an idea likely to draw opposition by private insurers because it cuts into their market. Now, two Senate committees will work over the next four weeks to move bills to the floor. The Senate Health, Education, Labor and Pensions Committee is expected to release bill language before the Memorial Day recess, and the Finance Committee will follow in the first week of June, according to people familiar with the timeline.

The committee proposed three options for the public plan. One would resemble Medicare, an option favored by liberal lawmakers. The second option calls for third-party administrators to oversee the public plan, a middle-road option that resembles a plan proposed last week by Sen. Chuck Schumer (D-N.Y.).

The third option would allow states to decide whether to create public insurance plans. Under the idea of an insurance mandate, those who do not obtain insurance by a set date would pay an
excise tax, although individuals could seek exemptions. Insurers have pushed vigorously for an individual mandate, arguing that it cannot guarantee coverage for Americans with pre-existing conditions unless the risk is spread around by requiring the young and the old to buy insurance. Tax credits would be available to low-income taxpayers and small businesses to offset the cost of buying insurance, the paper states. In addition, the paper seeks to explore several options for mandating employers to provide health insurance coverage for workers or to pay some form of assessment.

Meanwhile, an alliance is taking shape involving key stakeholders in the health care industry, including such principals as the American Hospital Association, the American Medical Association, Americas Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America, Advanced Medical Technology Association and the Service Employees International Union. In a joint letter this week addressed to the Obama administration, the various groups state a determination to work together to achieve affordable, high-quality and accessible health care for all Americans.

The groups point out that in order to achieve that goal, their unprecedented unified efforts will be directed at offering concrete initiatives to transform the health care delivery system. Primarily, the alliance will be developing consensus proposals to reduce the rate of increase in future health and insurance costs through changes made across the health care sector. Specifically, the letter outlines:
Implementing proposals that focus on administrative simplification such as standardization and
transparency efforts;
Reducing over-use and under-use of health care by aligning quality and efficiency incentive among providers across the continuum of care;
Encouraging coordinated care, both in the public and private sectors, and adherence to evidence-based best practices that reduce hospitalization and manage chronic illnesses more
effectively;
Reducing the cost of doing business by addressing specific cost drivers in each sector through simplified common-sense improvements in delivery models, technology, workforce development and regulatory reform.

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I have frequently thought on many issues that the Democratic Party provides the "wrong answers to the right questions." How can we provide better assistance to the poor? How can we make sure workers are treated fairly? How can we help women with unwanted pregnancies? How can we give everyone access to needed health care...

As the U.S. Conference of Catholic Bishops have told us, everyone deserves medical care, and it is a noble end goal. My own bishop, William Murphy, penned a letter to US Senate Committee on Finance on behalf of the USCCB citing:

"The moral measure of any health-care reform proposal is whether it offers affordable and accessible health care to all, beginning with those most in need"

In noting this, it is still my opinion, and I do not speak for the Magisterium, that the Catholic position should be AGAINST the Presidents Health Care Initiative. There is a grave devil in the details of his plan. The devil is RATIONING.

This concern is so front-and-center, that the Fourth Estate is even shining the spotlight on it. The Wall St. Journal reported from Obamas town hall meeting this week. A concerned citizen brought up a very real-world, tangible family experience she had and asked Obama if the same respect of life would be given under his plan:

"At one point in the town hall, broadcast from the East Room by ABC news, a woman named Jane Sturm told the story of her 105-year-old mother, who, at 100, was told by an arrhythmia specialist that she was too old for a pacemaker. She ended up getting a second option, and the operation, for which Ms. Sturm credits her survival.

"Look, the first thing for all of us to understand that is we actually have some -- some choices to make about how we want to deal with our own end-of-life care," Mr. Obama replied. After discussing ways "we as a culture and as a society [can start] to make better decisions within our own families and for ourselves," he continued that in general "at least we can let doctors know and your mom know that, you know what? Maybe this isn't going to help. Maybe you're better off not having the surgery, but taking the painkiller."

What Mr. Obama is describing is his preferred health-care future. If or when the Administration's speculative cost-cutting measures under universal health care fail to produce savings, government will start explicitly limiting patient access to treatments and services regarded as too expensive. Democrats deny this eventuality, but health planners will have no choice, given that the current entitlement system is already barreling toward insolvency without adding millions of new people to the federal balance sheet."

So basically if someone is 65 years old and is diagnosed with a cancer that has a high mortality rate; here is your Advil according to our President.

With this statement, there is the 800-pound gorilla in the room that no one will mention. They will dance all around it, but not land on it. Obamas health care plan will make a clear distinction between two classes of people. Those who are worthy of health care treatment, and those who are not.

Mike Kinsley, who was the original liberal-defending host of CNNs Crossfire, also sees this reality in The Washington Post:

"But that doesn't mean rationing will be easy to avoid. Statistics on life expectancy or infant mortality are averages. The easiest way to raise your averages -- maybe even the best way, if we're being honest -- is to concentrate on the general level of care and not to squander a lot on long-odds cases. But if the long-odds case is you or a family member, you may well feel differently.

...Here is a handy-dandy way to determine whether the failure to order some exam or treatment constitutes rationing: If the patient were the president, would he get it? If he'd get it and you wouldn't, it's rationing."

Even super-liberal Mike Kinsley knows what is coming.

Now, back to my Catholic case against the Presidents Health Care Plan. The danger, as mentioned, is setting up two classes of people. Some of the darkest chapters of world history began with this premise and resulted in genocide. This is not hyperbole.

If we, as a society, determine that someone who is possibly treatable does not warrant life-saving or life-extending care because of their demographics or situation- just pain medication - the next logical, expedient, cost-savings and obvious secular step is saying why should this person suffer with absolutely no hope. Its pointless. We should put them out of their misery. Euthanasia is the demonic offspring to the rationed health care that Obama speaks of. This is my grave concern and should be yours.

The immediate front lines of this second class of people, and starting point, will be the handicapped, the elderly, the terminally and chronically ill and less-than-perfect newborns.

This is why His Excellency Bishop Murphy then follows the above statement in his letter to our government with:

"All people need and should have access to comprehensive, quality health care that they can afford, and this should not depend on their stage of life, where or whether they or their parents work, how much they earn, or where they live or where they come from,"

Obamas Health Care Plan is in direct conflict with this second statement and therefore, in my opinion, can not be supported by Catholics. There are other, better solutions out there that do not lead to this culture-of-death end, literally.

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Dear Priests!
 In only about two weeks’ time, on the Solemnity of the Sacred Heart of Jesus, Friday 19th June, we will experience an intense moment of faith, closely united with the Holy Father and amongst ourselves, when we shall begin the Year for Priests by celebrating First Vespers of the Feast in the Basilica of St. Peter at the Vatican.
 Each day we are called to conversion, but we are called to it in a very particular way during this year, in union with all those who have received the gift of priestly ordination. Conversion to what? It is conversion to be ever more authentically that which we already are, conversion to our ecclesial identity of which our ministry is a necessary consequence, so that a renewed and joyous awareness of our “being” will determine our “acting”, or rather will create the space allowing Christ the Good Shepherd to live in us and to act through us (What a wonderful way to see grace working through the priesthood. Note that His Excellency cannot divorce from the internal conversion and holiness gives rise to authentic Christian ministry. It is almost as if a joyous outpouring of service is the unavoidable and necessary consequence of priest authentically being who they are the people God created them to be!)
 Our spirituality must be nothing other than the spirituality of Christ himself (priests are another Christ for us), the one and only Supreme High Priest of the New Testament.
 In this year, which the Holy Father has providentially announced, we will seek together to concentrate on the identity of Christ the Son of God, in communion with the Father and the Holy Spirit, who became man in the virginal womb of Mary, and on his mission to reveal the Father and His wondrous plan of salvation. This mission of Christ carries with it the building up of the Church: behold the Good Shepherd (Cf. Jn. 19:1-21) who gives his life for the Church (Cf. Eph. 5: 25).
 Yes, conversion every day of our lives so that Christ’s manner of life may be the manner of life made ever more manifest in each one of us (The theme of conversion runs throughout the letter).
 We must exist for others (the priesthood looks outwards towards the world it serves), we must undertake to live with the People in a union of holy and divine love (which clearly presupposes the richness of holy celibacy), which obliges us to live in authentic solidarity with those who suffer and who live in a great many types of poverty (Again and again on this blog the value of celibacy is being emphasised by theologians, lay people and priests themselves the voices who call on our priests to abandon their celibate calling seem to come from the misunderstandings of the secular media).
 We must be labourers for the building up of the one Church of Christ, for which we must live purposefully and faithfully the communion of love with the Pope, with the Bishops, with our brother priests and with the Faithful. We must live this communion with the unbroken pilgrimage of the Church within the very sinews of the Mystical Body.
 We should be able to run spiritually in this Year with a “wide open heart” (this is, I believe, a quotation from the prologue of the Rule of St Benedict) so as to inwardly conform to our vocation the better to say, in truth “it is no longer I who live but Christ who lives in me” (Gal. 2:20).
 The holiness of priests redounds to the benefit of the entire ecclesial Body (i.e. a priests personal holiness is not something to selfishly pursue the priest always looks outward to the people he serves). Thus it would be most fitting for all of us, be that the ordained Faithful, seminarians, the male and female religious, and the lay Faithful, to find ourselves all together at the Vatican Basilica for the Vespers presided over by the Holy Father, which will be celebrated after welcoming the Reliquary of the heart of that most outstanding priestly model who is St. John Mary Vianney.
 Those who are unable to be in City of Rome are encouraged to join themselves spiritually to the occasion.

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Call it "Three travelers to go three simple tips will be heavy. The Transport. Also, vendor deliveries will be given the three tips through security checkpoints. Employee leave will be heavy. The Transport.

Also, vendor deliveries will be summarized as IN, OUT, and Security checkpoint is contribute significantly to be restricted,

This website is complete guide on laptop series. We can read reviews, compare prices and check configurations of every model of all popular laptop brands there. This website has is the complete list of external accessories that you must have for your laptop. Read reviews, compare prices and tips to maximize the performance of your laptop.

managers will do everything slow hours and extra attentive effect can avoid security checkpoints may open earlier or close later, depending on the three minutes person.

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* In January, the Company announced that NB-302, the first of four Phase 3 clinical trials of Contrave, met its co-primary and key secondary endpoints, showing a significant reduction in body weight, improvements in markers of cardiovascular risk and reductions in selected food craving measures. In this trial, which included an intensive diet and exercise behavior modification regimen, obese patients treated with Contrave, based on intent-to-treat and completer analyses, lost an average of 20.3 pounds to 25.0 pounds, or 9.3% to 11.5% of their baseline body weight, versus 11.0 pounds to 16.0 pounds, or 5.1% to 7.3% of baseline body weight, for patients treated with placebo. In addition, in the categorical weight reduction analysis, the percentage of patients who lost 10% of their body weight was 41.5% in the Contrave group compared to 20.2% in the placebo group. All of these findings were highly statistically significant (p0.001). Contrave was generally well tolerated by patients, with an overall safety profile that was consistent with its individual components, naltrexone and bupropion. The most frequently observed treatment-emergent adverse events for patients on study drug were nausea, headache, constipation and dizziness. The overall discontinuation rate due to adverse events was 25.9% for patients taking Contrave versus 13.0% for those patients taking placebo. Treatment with Contrave was not associated with increases in symptoms of depression, suicidality or worsening of mean blood pressure.

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Researchers at Stanford University’s School of Medicine received a $5.8 million grant from the California Institute for Regenerative Medicine. Michael Longaker, MD, is the principal investigator on the five-year grant, which is focused on ways to stimulate existing adult stem cells to heal damaged nerves, bone, skin and cardiac muscle.
The grant was made as part of the institute’s Early Translational Research Awards, which are meant to move promising basic stem cell research from the laboratory into the clinic. It was one of 15 grants totaling $67.7 million that were awarded during a meeting of the institute’s 29-member governing board.
“With these Early Translational grants, CIRM has taken the first step in funding translational research that will be critical for the development of future therapies,” said CIRM president Alan Trounson in a prepared statement. “These grants are an important part of CIRM’s strategy to fund the best basic research and then bring the results of that work to patients.”
Longaker, who is the deputy director of Stanford’s Institute for Stem Cell Biology and Regenerative Medicine, and his colleagues plan to continue their ongoing study of a class of protein molecules called Wnts that mediate the natural response of adult stem cells to injury. The grant received the highest score of the 15 applications approved for funding, and reviewers were noted to be “uniformly enthusiastic” about the proposal.
“This approach takes advantage of the solution that nature itself developed for repairing damaged or diseased tissues,” Longaker wrote in the grant application, noting that it also bypasses immunological and ethical hurdles to using transplanted stem cells in human therapy because it would involve stimulating a patient’s own stem cells. “When utilizing this strategy, the goal of reaching clinical trials in human patients within five years becomes realistic.”
This grants from CIRM were a vote of confidence buoyed by California’s recent success in selling public bonds. Board members had been hesitant in the previous two meetings to commit funds to new projects. However, the state sold $6.5 billion in public bonds last month and allocated $275 million to the institute. According to a press release from the institute, additional bond funds earmarked for CIRM were used to repay a prior state loan.
With this grant, CIRM has approved a total of $107 million in grants to Stanford.

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“When we honestly ask ourselves which person in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.” “The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing not healing, not curing that is a friend who cares.” (Fr Nouwen).
Oremus pro invicem.

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Call it "Three travelers to go three simple tips will be heavy. The Transport. Also, vendor deliveries will be given the three tips through security checkpoints. Employee leave will be heavy. The Transport.

Also, vendor deliveries will be summarized as IN, OUT, and Security checkpoint is contribute significantly to be restricted,

This website is complete guide on laptop series. We can read reviews, compare prices and check configurations of every model of all popular laptop brands there. This website has is the complete list of external accessories that you must have for your laptop. Read reviews, compare prices and tips to maximize the performance of your laptop.

managers will do everything slow hours and extra attentive effect can avoid security checkpoints may open earlier or close later, depending on the three minutes person.

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4th - 5th June 2009, BSG Conference Centre, London, UK

"Linking the care that people get to the outcomes they experience is key"

Pharmacoeconomics is an area that is increasing importance every year. Capped health budgets and rising drug costs have led to the high level of interest in the use of economic analysis for decisions about the purchase and subsidisation of new pharmaceutical products. The key point is to establish the relationship between any improved health outcomes with new drugs (compared with established treatments) to the net costs associated with their use.

Health economics is crucial in a world with an ageing population and an ever higher strain on health budgets. Pharmaceutical and biotech companies must be able to measure and prove the value of their products in more sophisticated ways and they must account for many different things. In recent years the burden of proof has fallen squarely on the shoulders of industry and this is unlikely to change. Therefore advancements in pharmacoeconomics and greater understanding of health outcomes and the broader context of health economics is essential.

Visiongain's Health Economics and Outcomes Research 2009 provides the ideal forum for industry decision-makers, pharmacoeconomic analysts and academics alike to keep up with the latest developments in thinking and practice.

By attending this conference you will:
Apply the latest methodological approaches and tools to optimise your pharmacoeconomic analyses
Move beyond methodology and apply insights from related disciplines that can breathe new life into your analyses
Implement insights from developing pharmacoeconomic models in complicated and rapidly-evolving therapeutic areas defined by their complexity
Address the broader societal context and take insights from case studies of success and failure
Tackle common problems facing all pharmacoeconomics, communicate better with payers and develop analyse that provide win-win solutions

Key Speakers
Professor Wolfgang Meyer-Sabellek, Vice President, Research Development, AstraZeneca
Dr Josephine A. Sollano, Sr. Director, Global Therapeutic, Head Global Health Outcomes, Cardiovascular Metabolics, GlaxoSmithKline
Dr Patrick Mollon, Associate Director, Global Outcomes Research, Pfi zer
Dr Kerstin Uhl-Hochgraeber, Head GHEOR Primary Care, Bayer Schering Pharma
Dr Jorge Mestre-Ferrandiz, Senior Economist, Offi ce of Health Economics
Dr Jacco Keja, VP Global Consulting Services (pricing, reimbursement, HE OR, market services), Quintiles
Dr Jane Speight CPsychol AFBPsS FRSM, Chartered Health Psychologist Director, AHP Research
Professor Michael Calnan, School of Social Policy, Sociology and Social Research, University of Kent
Professor Steven Simoens, Associate Professor, Department of Pharmaceutical Sciences, Leuven Catholic University
Gary Johnson, Managing Director, Inpharmation
Professor Mondher Toumi, Department of decision sciences and health policies, University of Lyon and President, Creativ-Ceutical

Target Audience:
Branded Biotechnology Companies
Pharmaceutical Companies
Branded Generics Firms
Health Economics/Outcomes Service Providers
Regulatory Bodies
Academic Organisations

Who will be there:
VPs, Directors, Heads and Managers of:
Health Economics
Outcomes Research
Pharmacoeconomics
Market Access
Local and international economic strategy
Pricing Reimbursement
Strategy Analysis
Medical Affairs
Medical Information
Evidence Based Medicine
Epidemiology Project Management
Regulatory Affairs and Compliance
Clinical Pharmacology
Sales Marketing

Academic departments and service providers focused on:
Health Economics
Outcomes Research
Pharmacoeconomics
Regulatory Affairs
Evidence based medicine

Day 1
Day 1, Thursday 4th June 2009
09:30 Registration and refreshments
10:00 Opening address from the chair

Dr Jorge Mestre-Ferrandiz
Senior Economist
Office of Health Economics

THE HEALTH ECONOMICS CONTEXT SETTING THE SCENE

10:10 The European health economics context
Setting the scene
Where does HTA sit within pricing, reimbursement and market access?
Examples of HTA processes in Europe
What can the future hold for HTA?

Dr Jorge Mestre-Ferrandiz
Senior Economist
Office of Health Economics

10:50 How value attributes are used in economic valuation
Incorporating the value equation into product development
Identifying Health-Economic methods and tools to demonstrate product value
Key processes for effectively supporting product value from an Health-Economic perspective

Dr Patrick Mollon
Associate Director, Global Outcomes Research
Pfizer

11:30 Morning refreshments

11:50 Pros Cons of IQWIGs cost-benefit assessment
Early discussion with regulatory bodies mandatory for clin development plan (e.g., conditional approval)
Evaluation on retrospective analysis vs realisation of prospective outcome trials ( e.g., current status/recommendation on statins ao)
Critical view on RCT and multinational HTAs (e.g., antihypertensive treatment with RABs)
Limitation in selected population (e.g., pediatric indication)

Professor Wolfgang Meyer-Sabellek
Senior Medical Advisor
AZ Medical Europe

PHARMACOECONOMICS STICKING POINTS

12:30 Overwhelming the three pharmacoeconomic agony aunts: Generalisability, complexity and thresholds
Will pharmacoeconomic studies every really be generalisable across jurisdictions, whiat will it take to make this a reality?
Is more complex necessarily better? How can simplicity and elegance aid transparency and more effective decision-making?
Validity of threshold values for the ICER and how these translate at local levels

Dr Jacco Keja
VP Global Consulting Services (pricing, reimbursement, HE OR, market services)
Quintiles

13:10 Networking Lunch

14:10 Economic criticisms and decision-making by HTAs
What makes HTAs recommend or reject new technologies? (Overview of NICE, SMC, PBAC and CADTH)
The role that submission sequencing has to play - which HTA to submit to first?
Focus on NICE:
- Key concerns raised by ERGs about manufacturer economic submissions, and what to do to avoid them
- The perspective of determination committees in considering manufacturer economic submissions and ERG commentary

Rina Karia
Health Outcomes Analyst
Heron Health

NEW DISCIPLINES NEW ADVANCES

14:50 Sociopharmacoeconomics? Sociological Lessons
The potential contribution of medical sociology to better pharmacoeconomics the overall context
Socioeconomic concepts and exploring social valuation concepts
How understanding the social organisation and production of health and illness can inform health outcomes research

Professor Michael Calnan
School of Social Policy, Sociology and Social Research
University of Kent

15:30 Afternoon Refreshments

PATIENT-REPORTED OUTCOMES

15:50 Patient-reported outcomes: because good questions outrank easy answers
PRO-based labeling claims: More challenges than opportunities?
What value lies beyond the label claim?
How do we know weve asked the good questions?
What are the risks when we take the easy answers?

Dr Jane Speight
Chartered Health Psychologist, Director
AHP Research

16.30 The position of market access decision-makers regarding the use of PRO assessments

Linda Abetz-Webb
Director, Questionnaire Development and Validation
Mapi Values

17:10 Planning value strategy from effectiveness to cost effectiveness
Future value for money process to become a double step assessment
Review of effectiveness including indirect comparison when to start?
Modeling of Public health impact a powerful tool to support decision along development
Cost effectiveness a tool for budgetary impact or a threshold for recommendation?
Planning for health economics or for raising the moral debate?

Professor Mondher Toumi
Department of decision sciences and health policies, University of Lyon and
President, Creativ-Ceutical

17:40 Closing remarks from the chair

17:45 Networking Drinks Reception
Take your discussions further and build new relationships in a relaxed and informal setting

Day 2
Day 2, Friday 5th June 2009
09:30 Registration and refreshments
10:00 Opening address from the chair

10:10 The economics of drug discovery and the ultimate valuation of pharmacotherapies in the marketplace
Is optimality any guarantee of a positive decision comprehending decision-maker unpredictability
Trends in costs of drug discovery and development
Are the investments in R D resulting in more medicines for patients that payors are willing to fund?
Early economic evaluations of pharmacotherapies
Valuing new medicines in a new economy

Dr Josephine A. Sollano
Sr. Director, Global Therapeutic Head Global Health Outcomes, Cardiovascular Metabolics
GlaxoSmithKline

10:50 Predicting which drugs will clear and which drugs will clear and which will fall at the fourth hurdle
Drug and disease characteristics that predict success and failure
How these apply to key bodies like NICE, the Transparency Committee and MCOs
Case studies looking at famous pharma fourth hurdle successes and failures
To what extent could the industry have better predicted what happened?

Gary Johnson
Managing Director
Inpharmation

11:30 Morning Refreshments

11:50 A pharmacoeconomic perspective on the interchangeability of off-patent medicines
The off-patent market: originator/generic medicines and biopharmaceutical/biosimilar medicines
Comparability of generic/biosimilar medicines and originator medicines
Economic evaluation of off-patent medicines
Challenges involved in economic evaluation of biopharmaceutical/biosimilar medicines

Professor Steven Simoens
Associate Professor, Department of Pharmaceutical Sciences
Leuven Catholic University

INNOVATING THE QALY

12:30 The problem with QALYs where are developments needed?
The current state of QALY measurement
Why is this not a static concept and where is the state of the art?
Countering the criticism of QALYs on ethical, conceptual and operational grounds
What is the future of the QALY, are there really plausible alternatives given their pervasiveness as part of the popular CUA

13:10 Networking Lunch

THERAPEUTIC SPOTLIGHT

14:10 Presentation to be announced

Dr Nils Wilking
Director of the Clinical Research Unit
Karolinska Institutet and Stockholm School of Economics Sweden

14:50 Oncology products
The pharmacoeconomic context and the economics of Cancer
The economic Incentives problem examples from cancer screening programs
Mapping the future pharmacoeconomic landscape for advanced oncology products.

Ulf Staginnus
Novartis Oncology Region Europe, Head Pricing, Health Economics Outcome Research Europe
Novartis Farmacéutica S.A.*

15:30 Afternoon Refreshments

CONSIDERATIONS BEYOND MODELLING:

15:50 Product development and marketing based on value
The global pharmaceutical business environment requires a more value oriented approach in product development and marketing
One consistent global economic process detailed along the entire life cycle of a project/ product, starting early in the development phase is needed
Techniques of health economic teams to gain support from R Effective training and communication with sales and marketing to ensure success
Emphasising the benefit of health economic data

Dr Kerstin Uhl-Hochgraeber
Head GHEOR Primary Care
Bayer Schering Pharma

16:30 Better by design
Lessons learned from the setup and structure of pharmacoeconomics departments within pharma companies
Impediments to optimal use of pharmacoeconomic evaluations by companies
Integrating pharmacoeconomic analysis with R D decision making

Dr Gergana Zlateva
Director, Global Outcomes Research
Team Leader, Lyrica
Pfizer*

17:10 Panel Discussion: Addressing the credibility/integrity/bias question? Can this be solved or only ever mitigated?
The nature of bias within pharmacoeconomic analyses
The need to address both the perception and the reality of bias
Given that there is evidence of bias in pharmacoeconomic studies, what can actually be done about it?

17:30 Chairs closing remarks
17:35 End of conference

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Resurrection hope hastens hence
on bud, breeze, and blossom
grieving rynds banished in lilac scents.

Hark, the Easter Hymn rings haste
from its loveliest biding-place.

A lavish breach of winter's curt hard sword
an ardent repudiation of death's dark pall
the out-veining sun of the Christus Lord.

At the refectory of your loving-care
the transfiguration clarion sounds a call
that didicae could ne're convey nor spare.

Thus, Gospel comes ensconced in Word and Deed
and the evidence is your shimmering touch:
Christus Victor, shown in a life's sown seed.

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This post was originally posted last June. With the difficulties of unemployment and the stress of financial viability that many fathers are facing in this economy, and considering today is the feast day of St. Joseph, this is an appropriate time to revisit this post. VitC

I often think that marble statues and painted portraits of saints do them such an extreme disservice. The porcelain-doll faces that accompany these works really betray the less-than-perfect, human shortcomings that these saints struggled with daily in theirs lives and had to conquered on the way to their sainthood. For the most part, these works portray these spiritual warriors as immune to all human emotions; somehow having a secret to make their lives easier than ours. There are no hints of tragedy in beautiful oil paintings that have peaceful faces with rose-blushed cheeks. Sculpted marble never conveys fatigue, worry, nor tears.

Specifically to this thought, St. Joseph is always viewed as the quintessential protector and provider in his role to the Holy Family. The fact that this view is widely accepted and requires no reflection does St. Joseph the same disservice.

He holds lilies in his hands to show you how easy it was for him to be pure and a carpenters saw to show you how easy it was for him to provide for his family. We never truly realize the difficulties he undertook to end up with these reverent symbols.

For instance, three times (Nazareth, Bethlehem and Egypt) he had to completely uproot his business and risk the means of his livelihood to move for the protection/benefit of his family. He must have felt exhausted each time and that all of his hard work to build a master artisan's reputation within these towns was completely erased as he lead his family out of each town.
I likewise envision that a stranger coming into a close-knit town was not immediately, nor freely, trusted to the point of being supplied work. In the beginning, he must have taken any job offered, remedial in task or beneath his skill level, to feed the Blessed Mother and his Child (sound familiar dads?). It is hard to envision St. Joseph pleading for any available work, saying that he would do anything for food or payment, or... begging for lodging as well...

How many doors do you think St. Joseph knocked on before he settled on lodging his expecting wife with animals? How many doors do you think you would have knock on before this concession? Thirty... Fifty... One Hundred?

I often wonder that in the quiet moments following Christs birth, when the Blessed Mother was resting from her labor and the child was sleeping in her arms, did St. Joseph, standing vigilant guard, look at his loved ones co-mingled with the dirty beasts and feel as if he had failed to live up to his role as a provider?

These thoughts do not even consider that these difficulties and frustrations must have been amplified many times over considering he knew the importance of whom he was providing for.

But throughout all his struggles and discouragements his Faith never wavered and he knew God had a master plan for his life; that God relied on him meeting his responsibilities.

If one reflects, the master plan of St. Joseph's life was to give all his efforts to serve as protector of the helpless Christ child so that Jesus would be ready to sacrifice himself with great suffering when the time was right. It is really such a chilling irony that his role was to protect his child so that his child could eventually suffer, but take out St. Joseph's protection and the bigger master plan could have be in peril. Herod would have found the child in the "Slaughtering of the Holy Innocents" if not for St. Joseph's action. It was St. Joseph who would act on a dream, saving the Christ child's life so that he could eventually redeem the world.

We can take great insight from understanding this father's master plan. As fathers, our primary goals and efforts in life lie in helping our children achieve God's plans for their lives and help them attain holiness/heaven. Everything else is just a distraction and will not matter a century from now.

So to all you fathers: When the bills are many and the energy is fleeting; when the money is dwindling and the pressures are mounting; when there is a family member who is suffering and you cannot help, pray to the great St. Joseph. Start by heartfully mentioning to him that you are approaching him as one struggling father to another. He, through his experiences, will empathetically feel your hurt and raise your prayers up on your behalf to an Indebted Child that he once protected.

Happy St. Joseph's Day!

Saint Joseph was a just man, a tireless worker, the upright guardian of those entrusted to his care. May he always guard, protect and enlighten families.

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Aids expert who defended the Pope says Harvard University is ending his research project

* 29 Mar 09, 08:14 AM

Dr Edward Green, director of Harvard's HIV Prevention Research Project, who came to the defence of Pope Benedict during last week's international row over condoms in Africa, says Harvard University has ended his research program.

In an extended interview on today's Sunday Sequence, Dr Green told me why he decided to voice his support to Pope Benedict's controversial claim that condom distribution is exacerbating the problem of Aids in Africa. He also challenges the scientific authority of the United Nations Aids organisation, and argues that condoms should be used in Africa as part of a combination strategy to combat Aids. Dr Green says, "I have always been politically incorrect. I have always questioned authority and tried to speak truth to power whatever the consequences." A full transcript of the interview is below the line.


Edward Green: What the Pope said was the distribution and marketing of condoms would not solve the problem of African Aids and that it might even exacerbate the problem. And I think it was that second comment that really set the critics off, really upset a lot of people. I can understand that, because I have worked in Aids prevention for a long time. In fact, I worked as a condom and contraceptive social marketer at the beginning of the pandemic--I was working in family planning. I am part of a group of researchers that have been looking for the behavioural antecedents to HIV prevalence decline in Africa. We now see HIV going down in about 8 or 9 countries in Africa and in every case we see a decrease in the proportion of men and women who report having more than one sex partner in the past year. So when the Pope said that the answer really lies in monogamy and martial faithfulness, that's exactly what we found empirically.

William Crawley: What's the evidence that you are appealing to that condom distribution has made things worse in Africa?

Edward Green: Because we have for a number of years now found the wrong kind of association between condom-availability and levels of condom use.. You see the wrong kind of relationship with HIV prevalence. Instead of seeing this associated with lower HIV infection rates, it's actually associated with higher HIV infection rates. Part of that is because the people using condoms are the people who are having risky sex. It's just like there is more bed nets in use in countries with malaria than in countries without such high levels of malaria.

William Crawley: So it would be a mistake to draw any causal connection between an increase in the use of condoms and an increase in HIV prevalence. That would be a mistake, wouldn't it?

Edward Green: We don't have any proof. The closest thing we have are some prospective studies that follow the same populations. There was one where--Norman Hurst of the University of California was one of the authors, it was published in the journal Aids--where they followed two groups of young people in Uganda, and the group that had the intensive condom promotion--and they were provided condoms after three years--they actually were found to have a greater number of sex partners. So that cancels out the risk reduction that the technology of condoms ought to provide. That's the phenomenon known as risk compensation.

William Crawley: What do you mean by risk compensation?

Edward Green: This is when somebody uses a technology, such as condoms or sun-block, to reduce the risk, but then they compensate for that, or actually lose the risk reduction, by exposure to the sun longer in the case of sun-block or they take greater sexual risks in the case of condoms.

William Crawley: What you have suggested is that the use of condoms in Africa is a complicated story: it relates to abstinence and monogamy programmes as well. In those countries where there has been a reduction in HIV infection, such as Uganda, all three seem to play a part--abstinence, monogamy and the use of condoms. At least according to the United Nations Aids organisation (UNAids), all three play a part. Do you have any evidence at all that condoms are making the problem worse, which is what the Pope suggests?

Edward Green: Well I just mentioned a study that was done in Uganda that suggests that with intensive promotion of condoms you actually have people increasing the number of sexual partners, so in that sense--

William Crawley: But you have already accepted that there can be no causal inference drawn from that study.

Edward Green: Well, except that the phenomenon of risk compensation, or behavioural dis-inhibition, is real, and there have been articles, including published in The Lancet, about this phenomenon. So there could be a causal connection.

William Crawley: The Lancet has described the Pope's comments, which you agree with, as a distortion of scientific evidence.

Edward Green: That's because The Lancet is not thinking about the generalised epidemics of Africa. I hasten to add--and I have tried to do this in all of my interviews, although sometimes only part of my interviews are quoted--I point out that at national levels, we see condoms working in epidemics like those of Thailand and Cambodia. But in the generalised epidemics of Africa--well, there was a UN Aids study done in 2003 by Hearst and Chen, it was actually published in the peer-reviewed journal Studies in Family Planning in 2004, and they conclude that there is not a single country in Africa where HIV prevalence has come down primarily because of condoms.

William Crawley: You accept that condoms do work in other parts of the world, like the Western World, for example?

Edward Green: I do. And they should have a back-up role even in the generalised epidemics of Africa. I believe condoms should be made available to everyone. It should be, and as you say, the ABC strategy: Abstain, Be faithful, use a Condom. Condoms may well have contributed to the prevalence decline in Uganda.

William Crawley: That's a serious ideological difference between yourself and the Pope. He doesn't think that condoms should be used, even in the case of married Catholic couples where one of the partners is HIV-positive.

Edward Green: Yes, well, I don't agree with that. And, I have said that I am not a Catholic, and I am not talking about condoms in any sort of moral-ethical sense. I am talking about what has been found to work and not work. So, yes, the article I mentioned by Hearst and Chen is very clear that condoms work in certain types of situations and certain sub-populations and condoms have had a positive national impact in certain concentrated epidemics. So, yes, I don't agree with the Pope across the board.

William Crawley: Which brings us back to Africa. And to try to explain why there has been a mixed experience in terms of condom distribution in Africa, you are appealing to this possible mechanism of risk compensation. Which is another way of saying, really, that when people feel they are protected by a condom they engage is other risky behaviours. And one could say in response to that, this is not a criticism of condom distribution, it's a criticism of the education programmes that accompany condom distribution, surely?

Edward Green: Yes, we can say that. It's just I am somebody, who, as I mentioned I think, worked in family planning at the beginning--before the Aids pandemic began. And I think we have tried just about everything that can be tried as far as getting people to use condoms consistently and correctly in general populations. You know it's possible in certain sub-populations, such as commercial sex workers and their clients--even in Cambodia and Thailand, it was commercial sex workers in brothels where the 100 per cent condom policy was implemented and was so successful. But once you get outside of brothels are some situations where you have some control, it's again very difficult to get people to use condoms. So, yes, it's the fault of the person and not with the physical device the condom.

William Crawley: You can see why some people perhaps misunderstand your position, Dr Green, because you make a blunt statement like "the Pope is right about this" and "he is right on the science". And it is a much more complicated story once we explore it a little bit. You are encouraging the use of condoms in Africa. You are just saying: in addition to that, we should take seriously abstinence and, particularly, "be faithful" (monogamy) programmes, as well in Africa. That's a very different position to the one that the Pope holds to.

Edward Green: Well, you could phrase it that way. Or you could say: the Pope said that the distribution and marketing of condoms is not the solution or the best solution to African Aids; rather, it is monogamy and faithfulness. And the evidence is so clear about partner reduction. If you promote monogamy and faithfulness what you get is a reduction in the number of partners and concurrent partners. We haven't mentioned concurrency: we are finding that if you have partners, ongoing relationships that overlap, these are particularly effective in transmitting HIV. The evidence is so clear about that, that one of the reasons I stuck my neck out, knowing that I would get into a lot of trouble with my peers and colleagues, is because the Pope didn't repeat the usual condoms-versus-abstinence but instead mentioned fidelity and monogamy.

William Crawley: The United Nations Aids organisation says recent analysis of the Aids epidemic in Uganda confirms, and I am quoting, "that increased condom use in conjunction with delay in age and first sexual intercourse and reduction of sexual partners was an important factor in the decline of HIV prevalence in the 1990s". They say it was all three: ABC. The Pope says it was AB. And you seem to be agreeing with him.

Edward Green: Well, you must understand that UN Aids is not a scientific body. It's an advocacy body. And, in fact, a former director, Peter Piot, in recent years has been saying that what they do is "evidence-informed" rather that "evidence-based". If you stop and think about that distinction, you know, it suggests that UNAids draws upon the evidence that supports what it believes.

William Crawley: We shouldn't trust the UNAids organisation on this?

Edward Green: I would be very careful about trusting the UNAids organisation for anything scientific, anything having to do with, for example, statistics about Aids. They have had to back-pedal and retract a lot of their basic statistics. It may seem pretty shocking for somebody like me to disagree with UNAids, but the fact is that UNAids is changing its thinking on this matter. As a matter of fact, in a very few days, there is going to be joint statement released by our Harvard programme, the Southern Regional Office of UNAids, and the Southern Regional Office of the World Bank, saying that the primary intervention for Aids in Southern Africa should be to discourage multiple and concurrent partners and that condom promotion is a secondary backup strategy.

William Crawley: How can you believe that condom promotion should be a back up strategy and also believe that "condom distribution is making matters worse in Africa"?

Edward Green: Well, I wouldn't keep saying that way, I am--

William Crawley: That's what the pope said, and that's what you say you agree with--

Edward Green: Higher condom use and higher infection rates could be explained in a number of ways: we should be alert to the fact that one of those ways could be dis-inhibition. This has been sort of a taboo word in the field of Aids. We don't want to think that, possibly, we are making the situation worse by giving people a greater sense of security than they ought to have. But, you know, we should think about that possibility.

William Crawley: But condoms are either making the problem worse in Africa, or they are a backup strategy, which is it?

Edward Green: Well, I would say that they should, again, be made available. They should be available as a backup strategy. It's obviously better to not indulge in a risk behaviour ... Lets go back to what we know about condoms: when they are used consistently, when they are used consistently, they provide, under more or less ideal conditions, about 80 to 85 per cent risk reduction, compared to those who don't use them at all. But how many--what percentage of any large national population--uses condoms consistently? Probably nowhere in excess of 5 per cent.

William Crawley: There does seem to be a world of a difference, Dr Green, between what you have just said, and the Pope's simple claim that condoms are aggravating the problem in Africa. Those two positions do not seem to be the same, and yet you say you agree with the Pope.

Edward Green: I told you that I stuck my neck out knowing it would be controversial, because the Pope said that the distribution of condoms was not the solution, that monogamy and fidelity was. It depends on how you look at condoms. Condoms, as a technology, can work in certain circumstances. Yes, they should be a backup if people are not going to avoid the risk altogether. But looking at it from a public health standpoint, we have not seen that condoms have worked at the population or national levels in Africa. So you can interpret that I suppose in different ways.

William Crawley: Let's come to the situation that your programme faces at Harvard University. You have said that you have managed to put yourself in some difficulties with some of your peers. What is the situation you are facing now at Harvard?

Edward Green: Well, before this most recent situation came up with my name being in the news a lot in connection with the Pope, our project was coming to an end, and actually has come to an end. We are running currently on a no-cost extension for another approximately 11 months.

William Crawley: So you regard your position on this as somehow "politically incorrect" over the years in terms of the politics of all of this?

Edward Green: Yes, my position is very politically incorrect. I have always been politically incorrect. I have always questioned authority and tried to speak truth to power whatever the consequences.

William Crawley: Are you are paying an institutional price for that in terms of Harvard?

Edward Green: Well, I don't know. I don't know whether our programme would have ended when it's ending if I had been more politically correct. You would have to ask Harvard.

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Michael Cook | Saturday, 21 March 2009


The mystery of why AIDS has been so devastating in Africa has been solved. And its not lack of condoms.

Red Hill Cemetery in Durban, South Africa / New York TimesBenedict XVIs recent comment on the African AIDS crisis -- "the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem" provoked an international sensation all out of proportion to its half-sentence length.

"Impeach the Pope!" wrote a Catholic columnist in the Washington Post. This Pope is "a disaster", a Vatican official told the London Telegraph. These bouquets came from his friends. His foes were sulphurous. "Grievously wrong!" thundered the New York Times. "There is no evidence that condom use is aggravating the epidemic and considerable evidence that condoms, though no panacea, can be helpful in many circumstances."

No evidence, eh? None at all? Not even just a teensy-weensy bit? Had the Gray Lady and the thousands of other politicians and journalists who rained abuse on the Pope queried any AIDS experts about this? Apparently not. Had they done so, they would have discovered that many African AIDS strategists are having serious misgivings about an obsession with condoms.

In fact, a Harvard expert on AIDS prevention, Dr Edward C. Green, told MercatorNet bluntly: "the Pope is actually correct". Dr Green is no lightweight in the field of AIDS research. He is the author of five books and over 250 peer-reviewed articles -- and, he added, he is an agnostic, not a Catholic.

The not-enough-condoms explanation of the global HIV/AIDS epidemic is driven "not by evidence, but by ideology, stereotypes, and false assumptions," Dr Green wrote last year in the journal First Things. And myths kill: "they result in efforts that are at best ineffective and at worst harmful, while the AIDS epidemic continues to spread and exact a devastating toll in human lives".(1)

Experts with doubts

Dr Green is not a maverick voice. Similar views are being expressed in the worlds leading scientific journals. In an article in The Lancet, for instance, James Shelton, of the US Agency for International Development, stated flatly that one of the ten damaging myths about the fight against AIDS is that condoms are the answer. "Condoms alone have limited impact in generalised epidemics [as in Africa]," Shelton wrote.(2)

As long ago as 2004, an article in the journal Studies in Family Planning conceded that "no clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom promotion". In fact, the prevalence of HIV/AIDS can actually rise with increased distribution of condoms. Take Cameroon, for instance, the country to which the Pope was flying when he made his notorious remarks. Between 1992 and 2001 condom sales there increased from 6 million to 15 million -- while HIV prevalence tripled, from 3 percent to 9 per cent.(3)

Benedicts critics blithely assume that the solution is more condoms because AIDS in Soweto is like AIDS in San Francisco. Its not. In the West, AIDS is confined to high-risk groups, like sex workers, homosexuals, and injecting drug users. Within these groups, studies do show that condoms are effective to some extent. But AIDS in Africa is a generalised, heterosexual epidemic which affects ordinary people.

For years, researchers have desperately sought to understand why AIDS there has been so devastating. Sub-Saharan Africa is most heavily affected region in the world. It accounts for 67 percent of all people living with HIV and for 72 percent of AIDS deaths in 2007.(4) But now the answer is crystal clear. The reason is the widespread practice of "multiple concurrent partnerships".

Multiple partnerships

What does this mean? In Africa, it is not uncommon for an individual to have more than one long-term partner at a time. In the West, we might use the terms "mistress" or "boyfriend". Relationships like these are more than just casual hook-ups; to some extent they are based on intimacy, trust and friendship. In these circumstances, it is very difficult to persuade men to use condoms consistently. Concurrency, as the scholars term it, is a deadly recipe.

This is the theme of a highly-praised 2007 book by the medical journalist Helen Epstein, The Invisible Cure: Africa, the West, and the Fight Against AIDS (warmly reviewed by the New York Times, by the way). For a long time she attributed the epidemic to commercial sex, poverty, discrimination against women and low condom use. But after observing that HIV rates were increasing despite higher condom use, she grasped that concurrency is the key to the problem. She describes these multiple long-term partnerships as the "super highway of infections" with casual sex operating as "on ramps".

"Condoms alone wont stop the virus, because so much transmission is taking place in longer term relationships in which condoms are seldom used," she told an interviewer last year. "Therefore, a collective shift in sexual norms, especially partner reduction, is crucial."(5)

And it turns out that condoms can be worse than just ineffective in a generalised epidemic. Dr Green explained to MercatorNet that they "may even exacerbate HIV infection levels due to a phenomenon called risk compensation, or behavioral disinhibition. People take more sexual risks because they feel safer than is actually justified when using condoms."

Effective solutions

If showering condoms over Africa cant stop the epidemic, what will? According to a recent article in Science by researchers from the University of California at Berkeley, Harvard, the University of California at San Francisco, and the San Francisco Department of Public Health, only two interventions definitely work: male circumcision and reducing multiple partnerships.(6)

Male circumcision significantly reduces the risk of heterosexual HIV infection and has even been called a "surgical vaccine". It may explain why HIV rates in West Africa are relatively low. The UN is promoting it vigorously in southern Africa. But the challenge is huge about 2.5 million circumcisions by the year 2010. Good luck to them!

The other effective strategy, say these experts, is "partner reduction", which -- surprise! surprise! -- sounds remarkably like what the Pope recommends. In Uganda, HIV prevalence reduced dramatically after an intensive "zero grazing" campaign in the 1990s. A recent decline in Kenyas HIV rate seems to be due to partner reduction and marital fidelity. Furthermore, despite scepticism by Westerners, it is possible to change sexual behaviour. A 2006 campaign in Swaziland about the danger of having a "secret lover" resulted in fewer partners.

If the standard HIV-prevention toolbox has "failed utterly to reduce HIV transmission", as Dr Green and other researchers contend in the current issue of Studies in Family Planning (7), how much is being spent on the treatment that works? Very little, complain the authors of the article in Science. The biggest chunk of the US$3.2 billion UNAIDS budget has been allocated to interventions which are "unsupported by rigorous evidence". Only 20 percent goes to generalised epidemics in Africa and elsewhere, even though these account for two-thirds of all HIV infections. Only 5 percent goes towards male circumcision -- and a negligible amount to changing sexual behaviour.

An editorial in the Seattle Times derided Pope Benedict for living in an "alternate universe".(8) But it isnt the Pope who has take up residence there. Its his critics. As Dr Green wrote last year, "Christian churches -- indeed, most faith communities -- have a comparative advantage in promoting the needed types of behavior change, since these behaviors conform to their moral, ethical, and scriptural teachings. What the churches are inclined to do anyway turns out to be what works best in AIDS prevention." (9)

Michael Cook is editor of MercatorNet.

Notes

(1) Edward C. Green and Allison Herling Ruark. "AIDS and the Churches: Getting the Story Right". First Things. April 2008.

(2) James D. Shelton. "Ten myths and one truth about generalised HIV epidemics." The Lancet. December 1, 2007. pp 1809-1811.

(3) Norman Hearts and Sanny Chen. "Condom promotion for AIDS prevention in the developing world: is it working?" Studies in Family Planning. March 2004. pp 39-47.

(4) "2008 Report on the global AIDS epidemic". UNAIDS. July 2008.

(5) "AIDS Journalist Helen Epstein on The Invisible Cure". Philanthropy Action. May 20, 2008.

(6) Malcolm Potts et al. "Reassessing HIV Prevention". Science, May 9, 2008. pp 749-750.

(7) Edward C. Green et al. "A Framework of Sexual Partnerships: Risks and Implications for HIV Prevention in Africa." Studies in Family Planning. March 2009, pp 63-70.

(8) "Pope Benedict's alternate universe". Seattle Times. March 19, 2009.

(9) Edward C. Green and Allison Herling Ruark. "AIDS and the Churches: Getting the Story Right". First Things. April 2008.

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VATICAN CITY, 12 MAR 2009 (VIS) - Made public today was the Letter of His Holiness Pope Benedict XVI to the bishops of the Catholic Church concerning the remission of the excommunication of the four bishops consecrated by Archbishop Lefebvre.

The Letter is dated 10 March and has been published in English, French, Spanish, Italian, German and Portuguese. The complete text of the English-language version is given below:

"Dear brothers in the episcopal ministry.

"The remission of the excommunication of the four Bishops consecrated in 1988 by Archbishop Lefebvre without a mandate of the Holy See has for many reasons caused, both within and beyond the Catholic Church, a discussion more heated than any we have seen for a long time. Many bishops felt perplexed by an event which came about unexpectedly and was difficult to view positively in the light of the issues and tasks facing the Church today. Even though many bishops and members of the faithful were disposed in principle to take a positive view of the Pope's concern for reconciliation, the question remained whether such a gesture was fitting in view of the genuinely urgent demands of the life of faith in our time. Some groups, on the other hand, openly accused the Pope of wanting to turn back the clock to before the Council: as a result, an avalanche of protests was unleashed, whose bitterness laid bare wounds deeper than those of the present moment. I therefore feel obliged to offer you, dear brothers, a word of clarification, which ought to help you understand the concerns which led me and the competent offices of the Holy See to take this step. In this way I hope to contribute to peace in the Church.

"An unforeseen mishap for me was the fact that the Williamson case came on top of the remission of the excommunication. The discreet gesture of mercy towards four bishops ordained validly but not legitimately suddenly appeared as something completely different: as the repudiation of reconciliation between Christians and Jews, and thus as the reversal of what the Council had laid down in this regard to guide the Church's path. A gesture of reconciliation with an ecclesial group engaged in a process of separation thus turned into its very antithesis: an apparent step backwards with regard to all the steps of reconciliation between Christians and Jews taken since the Council - steps which my own work as a theologian had sought from the beginning to take part in and support. That this overlapping of two opposed processes took place and momentarily upset peace between Christians and Jews, as well as peace within the Church, is something which I can only deeply deplore. I have been told that consulting the information available on the internet would have made it possible to perceive the problem early on. I have learned the lesson that in the future in the Holy See we will have to pay greater attention to that source of news. I was saddened by the fact that even Catholics who, after all, might have had a better knowledge of the situation, thought they had to attack me with open hostility. Precisely for this reason I thank all the more our Jewish friends, who quickly helped to clear up the misunderstanding and to restore the atmosphere of friendship and trust which - as in the days of Pope John Paul II - has also existed throughout my pontificate and, thank God, continues to exist.

"Another mistake, which I deeply regret, is the fact that the extent and limits of the provision of 21 January 2009 were not clearly and adequately explained at the moment of its publication. The excommunication affects individuals, not institutions. An episcopal ordination lacking a pontifical mandate raises the danger of a schism, since it jeopardises the unity of the College of Bishops with the Pope. Consequently the Church must react by employing her most severe punishment - excommunication - with the aim of calling those thus punished to repent and to return to unity. Twenty years after the ordinations, this goal has sadly not yet been attained. The remission of the excommunication has the same aim as that of the punishment: namely, to invite the four bishops once more to return. This gesture was possible once the interested parties had expressed their recognition in principle of the Pope and his authority as Pastor, albeit with some reservations in the area of obedience to his doctrinal authority and to the authority of the Council. Here I return to the distinction between individuals and institutions. The remission of the excommunication was a measure taken in the field of ecclesiastical discipline: the individuals were freed from the burden of conscience constituted by the most serious of ecclesiastical penalties. This disciplinary level needs to be distinguished from the doctrinal level. The fact that the Society of Saint Pius X does not possess a canonical status in the Church is not, in the end, based on disciplinary but on doctrinal reasons. As long as the society does not have a canonical status in the Church, its ministers do not exercise legitimate ministries in the Church. There needs to be a distinction, then, between the disciplinary level, which deals with individuals as such, and the doctrinal level, at which ministry and institution are involved. In order to make this clear once again: until the doctrinal questions are clarified, the society has no canonical status in the Church, and its ministers - even though they have been freed of the ecclesiastical penalty - do not legitimately exercise any ministry in the Church.

"In light of this situation, it is my intention henceforth to join the Pontifical Commission 'Ecclesia Dei' - the body which has been competent since 1988 for those communities and persons who, coming from the Society of Saint Pius X or from similar groups, wish to return to full communion with the Pope - to the Congregation for the Doctrine of the Faith. This will make it clear that the problems now to be addressed are essentially doctrinal in nature and concern primarily the acceptance of the Vatican Council II and the post-conciliar Magisterium of the Popes. The collegial bodies with which the congregation studies questions which arise (especially the ordinary Wednesday meeting of cardinals and the annual or biennial plenary session) ensure the involvement of the prefects of the different Roman congregations and representatives from the world's bishops in the process of decision-making. The Church's teaching authority cannot be frozen in the year 1962 - this must be quite clear to the Society. But some of those who put themselves forward as great defenders of the Council also need to be reminded that Vatican II embraces the entire doctrinal history of the Church. Anyone who wishes to be obedient to the Council has to accept the faith professed over the centuries, and cannot sever the roots from which the tree draws its life.

"I hope, dear brothers, that this serves to clarify the positive significance and also the limits of the provision of 21 January 2009. But the question still remains: Was this measure needed? Was it really a priority? Aren't other things perhaps more important? Of course there are more important and urgent matters. I believe that I set forth clearly the priorities of my pontificate in the addresses which I gave at its beginning. Everything that I said then continues unchanged as my plan of action. The first priority for the Successor of Peter was laid down by the Lord in the Upper Room in the clearest of terms: 'You ... strengthen your brothers'. Peter himself formulated this priority anew in his first Letter: 'Always be prepared to make a defence to anyone who calls you to account for the hope that is in you'. In our days, when in vast areas of the world the faith is in danger of dying out like a flame which no longer has fuel, the overriding priority is to make God present in this world and to show men and women the way to God. Not just any god, but the God Who spoke on Sinai; to that God Whose face we recognise in a love which presses 'to the end' - in Jesus Christ, crucified and risen. The real problem at this moment of our history is that God is disappearing from the human horizon, and, with the dimming of the light which comes from God, humanity is losing its bearings, with increasingly evident destructive effects.

"Leading men and women to God, to the God Who speaks in the Bible: this is the supreme and fundamental priority of the Church and of the Successor of Peter at the present time. A logical consequence of this is that we must have at heart the unity of all believers. Their disunity, their disagreement among themselves, calls into question the credibility of their talk of God. Hence the effort to promote a common witness by Christians to their faith - ecumenism - is part of the supreme priority. Added to this is the need for all those who believe in God to join in seeking peace, to attempt to draw closer to one another, and to journey together, even with their differing images of God, towards the source of Light - this is inter-religious dialogue. Whoever proclaims that God is Love 'to the end' has to bear witness to love: in loving devotion to the suffering, in the rejection of hatred and enmity - this is the social dimension of the Christian faith, of which I spoke in the Encyclical 'Deus caritas est'.

"So if the arduous task of working for faith, hope and love in the world is presently (and, in various ways, always) the Church's real priority, then part of this is also made up of acts of reconciliation, small and not so small. That the quiet gesture of extending a hand gave rise to a huge uproar, and thus became exactly the opposite of a gesture of reconciliation, is a fact which we must accept. But I ask now: Was it, and is it, truly wrong in this case to meet half-way the brother who 'has something against you' and to seek reconciliation? Should not civil society also try to forestall forms of extremism and to incorporate their eventual adherents - to the extent possible - in the great currents shaping social life, and thus avoid their being segregated, with all its consequences? Can it be completely mistaken to work to break down obstinacy and narrowness, and to make space for what is positive and retrievable for the whole? I myself saw, in the years after 1988, how the return of communities which had been separated from Rome changed their interior attitudes; I saw how returning to the bigger and broader Church enabled them to move beyond one-sided positions and broke down rigidity so that positive energies could emerge for the whole. Can we be totally indifferent about a community which has 491 priests, 215 seminarians, 6 seminaries, 88 schools, 2 university-level institutes, 117 religious brothers, 164 religious sisters and thousands of lay faithful? Should we casually let them drift farther from the Church? I think for example of the 491 priests. We cannot know how mixed their motives may be. All the same, I do not think that they would have chosen the priesthood if, alongside various distorted and unhealthy elements, they did not have a love for Christ and a desire to proclaim Him and, with Him, the living God. Can we simply exclude them, as representatives of a radical fringe, from our pursuit of reconciliation and unity? What would then become of them?

"Certainly, for some time now, and once again on this specific occasion, we have heard from some representatives of that community many unpleasant things - arrogance and presumptuousness, an obsession with one-sided positions, etc. Yet to tell the truth, I must add that I have also received a number of touching testimonials of gratitude which clearly showed an openness of heart. But should not the great Church also allow herself to be generous in the knowledge of her great breadth, in the knowledge of the promise made to her? Should not we, as good educators, also be capable of overlooking various faults and making every effort to open up broader vistas? And should we not admit that some unpleasant things have also emerged in Church circles? At times one gets the impression that our society needs to have at least one group to which no tolerance may be shown; which one can easily attack and hate. And should someone dare to approach them - in this case the Pope - he too loses any right to tolerance; he too can be treated hatefully, without misgiving or restraint.

"Dear Brothers, during the days when I first had the idea of writing this letter, by chance, during a visit to the Roman Seminary, I had to interpret and comment on Galatians 5:13-15. I was surprised at the directness with which that passage speaks to us about the present moment: 'Do not use your freedom as an opportunity for the flesh, but through love be servants of one another. For the whole law is fulfilled in one word: You shall love your neighbour as yourself. But if you bite and devour one another, take heed that you are not consumed by one another'. I am always tempted to see these words as another of the rhetorical excesses which we occasionally find in St. Paul . To some extent that may also be the case. But sad to say, this 'biting and devouring' also exists in the Church today, as expression of a poorly understood freedom. Should we be surprised that we too are no better than the Galatians? That at the very least we are threatened by the same temptations? That we must always learn anew the proper use of freedom? And that we must always learn anew the supreme priority, which is love? The day I spoke about this at the Major Seminary, the feast of Our Lady of Trust was being celebrated in Rome . And so it is: Mary teaches us trust. She leads us to her Son, in Whom all of us can put our trust. He will be our guide - even in turbulent times. And so I would like to offer heartfelt thanks to all the many bishops who have lately offered me touching tokens of trust and affection, and above all assured me of their prayers. My thanks also go to all the faithful who in these days have given me testimony of their constant fidelity to the Successor of St. Peter. May the Lord protect all of us and guide our steps along the way of peace. This is the prayer that rises up instinctively from my heart at the beginning of this Lent, a liturgical season particularly suited to interior purification, one which invites all of us to look with renewed hope to the light which awaits us at Easter

"With a special Apostolic Blessing, I remain Yours in the Lord".

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Compulsory licensing of copyrighted works seems like a great middle ground between allowing authors to receive compensation for use of their works and granting the maximum amount of access to copyrighted works. In Chapter 6 of his book, Netanel outlines one proposal for compulsory licensing, including a scheme to reach a fair competitive price for licenses, while still accounting for the risk that studios and other authors take when investing time and money into creating a work. Though compulsory licensing is often touted as a more efficient and fairer alternative to private negotiation, it is unclear if such a system would really be either more efficient or fairer.


Efficiency


As Sarah points out in her post, there are several questions surrounding Netanels proposed compulsory licensing scheme. Before reaching questions of administrability or practicability, however, it is worth considering the more baseline question of whether compulsory licensing will be a more efficient or cheaper alternative to individual private negotiations.


Without compulsory licensing, as Netanel points out, people who want to use a copyrighted work have to negotiate individuals with the copyright holder. In some cases, multiple parties might hold copyrights to various parts of the work, making this process arduous, time-consuming, and potentially costly. A system that allowed for parties to avoid this process could be helpful it was faster and cheaper.


The alternative proposal Netanel mentions in his book, however, would require people interested in a license to litigate their claim in order to obtain the compulsory license. Litigation, as we know, is rarely fast or cheap. Dans anecdote from his professor illustrates this point well. Even with modifications to the copyright system, it is likely that any copyright litigation would involve months of fact-finding, expert debate and wrangling over profits and market power. Sarahs post explains some of the specific problems that might arise in a typical case litigated under Netanels proposal. Is market power measured with respect to a parent company and all its subsidiaries? Are profits measured with respect to a parent company and all its subsidiaries? What about determining risk? Even if standards for these questions were developed through litigation over time, the questions would be at issue in each and every case because copyright cases are so fact-specific. While the ultimate judicial determination might be easy to abide by, getting to that determination is likely to be extremely costly and time-intensive.


Moreover, even if litigation was just as fast as individual negotiation, it is likely that some parties might attempt to privately negotiate at first anyway. Litigation is often uncertain, and parties seeking the use of copyrighted works might decide that it makes sense to attempt a private negotiation before resorting to a judicial remedy. Then, if private negotiation fails, the party might turn to the courts for a mandated license. It is not clear that litigation would result in an affordable price for the licensee (or a price that was acceptable to the licensor), however. If the goal of compulsory licenses is to allow greater use of copyrighted works, but a judge decides the fair or competitive price is at a level that is still too high for the potential licensee to meet, then the compulsory license system is not much better than the private negotiation system. Of course, we might think that having a judge decide the competitive price is , and that therefore potential licensees will feel better about not being able to obtain a license, but this does not decide the compulsory license question.


Further, it is questionable as to whether a judge-mandated price for a license would be more efficient than a price negotiated by the parties. Individual parties to a negotiation will probably know the market for their works better than a judge will. Judges can hear testimony on industry operations, but will not be able to understand them as well as the parties can. Additionally, in cases like that of Jon Else versus Fox, Fox obviously will have the money advantage during litigation. This money advantage may translate into one-sided litigation, in which judgments will not be any different than outcomes in private negotiation.


Another related problem is the precedential effect of judicial decisions. Would a decision in one case influence other cases involving repeat players or similar players? How often would judges deviate from previous decisions? Prices and markets change as time goes on, so if judges stuck to previously decided license fees, it could result in problems. Would judges take into account the license seekers type of work? That is, once a judge decides that the competitive price for Else using The Simpsons in his documentary is X, would the same price be applied to a director wanting to use a portion of The Simpsons in a more commercial movie or a television show or a book or a song? These markets are very different, but it is possible that through a compulsory license system, the price would be set the same for each market, though it would not have been through private negotiation. Moreover, the fact that the first case might have important precedential value means studios or other conglomerates defending against a license seeker would have incentives to throw as much money at that case as possible in order to obtain a favorable judgment. This could deter smaller license seekers, who would rather wait for someone else to try the case and see the results instead of litigating themselves.


Fairness


One of the benefits of a compulsory license system that is often touted is that it will be fairer. That is, because a judge sets the license price, parties can be confident that the copyright holder is not exploiting market power to censor speech. As discussed above, though, there are questions as to whether the license price decided by a judge would be accurate. Indeed, as Sarah mentions, it is hard to know what a fair price is for licensing The Simpsons. Most would agree that $10,000 is probably too high for Elses proposed use, but that does not mean it is clear what a fair price is. A lower price, such as $1000 might seem fairer, but that does not necessarily mean Else could afford it or would pay it.


Another consideration that often gets dismissed in these discussions is fairness to the copyright holders. Although we usually dismiss moral rights concernsbecause, after all, if the author is compensated for the use of his work, then it must be fairNetanel lists a few examples in his book of artists that refuse to license their work for any amount of money. John Densmore refused a $15 million offer to license one of his songs for a commercial. (p. 48). Most would agree that $15 million is probably much more than a competitive price for one song, but clearly, for some authors, compulsory licensing will never be able to compensate them for their work. Perhaps this is not a large concern because we do not think that authors should ever be able to prevent certain speech by refusing to license. But, certainly there are some situations in which would not think it is fair to force an author to license his or her productpoliticians wanting to use a musicians song as a campaign theme song, for example. Netanel mentions that people probably would not take this to mean that the musician is endorsing the politician, particularly if we had extensive compulsory licensing, but I am not so sure. The larger point here is that maybe the musician should be able to make sure that his or her work is not used to support people or causes he or she disagrees with. The compulsory license system might seem fairer because it involves third parties making pricing decisions, but the machinations of such a system are like to result in decisions that are not fair to the copyright holders or the license seekers.

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I recently spoke with the CHRISTUS Muguerza Academy class of 2008 about what leadership must do or change in challenging times. Although they were meeting in Monterrey, Mexico, I joined them via video conference to conserve resources and continue our commitment to good stewardship.

I began by encouraging this Academy class to continue seeking out opportunities to learn and grow and embrace a commitment to continuous, lifelong learning. Health care is always changingnew diseases are discovered, some existing diseases are cured and technology is constantly developing. Leadership always requires a strong foundation and ensuring that you are prepared for the times unfolding before you.

Today, we know that the entire word is traveling through trying times. We are experiencing an economic crisis, continued volatility of the stock market and worldwide investments and even weather disasters like the hurricanes that affected CHRISTUS facilities last year. Many people believed that health care was a market, but we all know now that this is not necessarily the case.

These times have proven to us that, indeed, the world is Because the U.S. is so linked to the economics of other countries (for example, through trade in China and service centers in India), our countrys market volatility quickly spread to the world. CHRISTUS Health provides international services, recognizing that because of this global outlook, our international services continue to become ever more important.

This also means that trying times call for even greater and more focused leaders. They must see challenging times as providing new opportunities for change and improvement. Great leaders take difficult times to address opportunities which they havent been able to address before.

It is true that significant change comes in hard times, and even personal character is really built this way, as well. I believe that I am who I am more because of the hardships I have endured than the successes I have achieved. It seems that, many times, we learn more from hardships than successes.

So although these times are challenging, leaders have great opportunities, as well. I believe that in times of change, great leaders must do the following:

1. Accept change as the new reality. Great leaders do not resist change, but find ways to harness and create it. As a physician in the Emergency Department, one of the most invigorating experiences for me was seeing a patient with multiple injuries and complications. Some people may have given up, but I said, s save this person. I think I probably performed better than I would have on an elective surgery like a gallbladder procedure because I was focused and knew that the patients outcome rested solely in our hands.

2. Find ways to maintain an optimistic outlook. Leaders must be able to motivate people to follow them, and therefore must be worth following. Be sure to talk about the positives and always look positive and optimistic. You will certainly need to spend time quietly behind closed doors, but when you are in front of people, you must see the glass as half full. Many times I treated patients and told them that I was going to save their lives. If the patient died, they did so in spite of what my team did, not for our lack of effort or because we gave up.

3. Review and recommit to your mission, vision and values. You cannot forgo or walk away from these or the Journey to Excellence. You must pause and recommit.

4. Clearly define the challenges. Many times, we face multiple challenges at once, and becoming overwhelmed by them renders us ineffective. Facing the unknown is terrible. Facing known challenges is difficult, but they are easier to address. When treating a trauma patient, if we know their injuries, we can address them one-by -one and ensure we treat the most drastic problems first.

5. Be more focused on detailed action plans. One of the things we did in this troubled economy was refinance our bonds to the lowest interest rates possible. This year, we were required to meet face-to-face with our investors, just like for-profits. They asked many questions. Which of your regions are not doing well? What are you doing to turn them around? Where will these regions be in three months? Where will you grow? Where will you shrink? When the region turns around, how profitable will it be? As a leader of CHRISTUS, I had to know the answers to those questions and be very familiar with our financial situation.

6. Be extremely clear in success metrics. Our balanced score card reports things like our patient satisfaction in the Emergency Department, our days in cash, etc. We need to know these measurements because its important to know where we are, where we have been and where we are going. Leaders who are not great have a lot of hope that things will get better. Unfortunately, though, hope is not enough. Improvement requires measurement so actions with clearly-defined results can be put into place.

7. Elevate your commitment to team efforts. Big challenges require big teams, and these teams must be stronger than in good times. When I was a practicing surgeon, I could remove a diseased gallbladder with only an anesthetist and a scrub nurse. However, if I was operating on a serious trauma case, I could remove a spleen and ruptured liver, but we would also need a hematologist to monitor blood clots and a cardiologist to repair a ruptured valve. The team must constantly ask, Are we doing the right things? They must also praise people when things go well and learn to ask, How can I help you make things better? In the end, the question is not how I did, but how we did.

8. Celebrate the incremental victories. Celebrating small steps gives you the energy to conquer the next steps. Significant challenges will not be solved overnight, but will require short-and long-term solutions. We must celebrate the short-term victories to have enough energy to reach the top of the mountain in our long-term quest.

9. Review and refocus your strategies. Strategies for good times may not be the same as strategies for challenging times; in fact, we may need to cancel, delay, or change some of our existing plans. We know that construction on many hospitals in the U.S. has halted, and openings of new hospitals have been delayed by other systems. We know that elective procedures such as hip and knee replacements and bariatric and plastic surgery will see a lower demand in challenging times, and we may need to alter our strategies accordingly. Also, if we were planning on building a hospital or a clinic, we might decide to build it smaller or in a different location. It is possible to delay some investments, but we must know why this choice is being made. Most importantly, dont get hung up on last years plans, especially if this years environment is significantly different.

10. Communicate constantly. In challenging times, it is even more important to tell our story. During times like these, people become distracted by all the challenges, so we must tell our story over and over and over again. Truth calms, but rumors are destructive. If we do not repeat the truths over again and fill the communication bucket, it will get filled with rumors. Keep the rumor mill to a minimum by filling those communication channels with truth.

In challenging times, it is easier to say it isnt worth it because it is harder to motivate people. However, the rewards of leadership are never greater than when we can look back at the end and say we have been successful in taking CHRISTUS through challenging times, and it has emerged better than before.

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Upcoming auction to decide Wadleys fate; potential buyer looks to the future By: Ashley Gardner - Texarkana Gazette - Published: 02/07/2009 While ultimate ownership of Wadley Health System will be determined at a Feb. 19 auction, Brim Healthcare of Texas LLC, officials are excited about the possibilities the future may hold. Our real intent is to have a viable hospital, said Dave Woodland, Brim Board of Directors vice-president and former company CEO. The health care company has a binding agreement to purchase Wadley if it isnt outbid in the upcoming auction. The auction is court requirement since Wadley filled for reorganization of debt under Chapter 11 bankruptcy in early January in the Eastern District of Texas. Brim Healthcare of Texas LLC was formed by Brim, a hospital management company out of Brentwood, Tenn., and Collom Carney Clinic of Texarkana. The purchase would allow local physicians to become part owners of the hospital. The investment opportunity would be open to any interested physicians in the community, Woodland said. The way its presently constituted, Brim would retain 80 percent and physicians 20 percent but that number can change, Woodland said. The physician component can go up. Were not opposed to that. Physician interest in the project will most likely gain strength if legislation limiting physician ownership of hospitals fails to pass. s what everybody was waiting on, said Tom Simmons, Collom Carney CEO. Simmons is excited about the future. This is a way to keep Wadley open. Were very supportive of it. We want someone with significant hospital experience to continue to operate the hospital. Collom Carney Clinic has been in Texarkana more than 60 years and we plan to be here for the foreseeable future. Our interest is in whats best for the community. As far as the Brim partnership, their goals align with our goals, Simmons said. Physician involvement isnt about making money, Woodland said. The intentions are right. People may misconstrue, but this isnt about money. This is about being an active participant in the governance of a hospital, Woodland said. There are advantages to physicians being part owners in a hospital. s not one patient or one dollar generated without physicians being involved. Its that basic. They want a place friendly to them ... that focuses more on physicians than administrators ... To have them as partners is tremendous for us, Woodland said. Rather than being a part of the problem, they are part of the solution. Woodland said hes seen many instances where hospital administrators and physicians have squared off against each other in disagreements over what services to offer or what equipment to buy. Having physicians involved, youd never buy an expensive piece of equipment thats not going to be used. Theyre asked their opinion and thats what makes it a powerful partnership, Woodland said. Until the purchase is final, there are no set-in-stone future plans for changes at Wadley. We dont have any preconceived ideas about whats going to happen at Wadley ... That needs to be done with physician partners, said Woodland, who added they have no plans to cut services and are looking more toward expanding existing services. We know the emergency department is the portal to the hospital. Thats how most patients get into a hospital. Our intent is to make the emergency department as attractive a place as it can be, Woodland said. Fourteen to 16 percent of patients who use the emergency room are admitted ... so the more emergency department visits we get, the more patients we get. Its the single biggest attractor of inpatients. Another area Brim is interested in is neonatal care. We see a big gap in the need. There is a big need for a neonatal intensive care unit. High-risk infants arent taken care of in the community. With the physician community, wed like to explore that, said Woodland. Brim was originally contacted by Collom Carney about partnering in building a new hospital in Texarkana. Back in 2007, we were approached by a consultant and representatives from Collom Carney about their interest in developing a new hospital for the Texarkana community. Part of their concern was that Wadley wouldnt survive financially and they wanted a choice. A competitive market is better for the community, Woodland said. As we got into early 2008 and we were actually looking at property and visiting parcels in town ... about mid-year we were contacted by someone from the Wadley side about eventually doing business with Wadley, said Woodland. In October, we put in a proposal to assist with keeping Wadley afloat but our proposal was turned down so we basically went back to the drawing board ... and said lets develop a new hospital. Brims offer was turned down in favor of an offer from CHRISTUS St. Michael Health System in October. That deal fell through after CHRISTUS submitted a different letter of intent and Brim got back into the mix. We met with our physician partners and said lets forget about the new hospital for now. Lets build services at Wadley... Lets expand services where necessary to attract physicians. Lets give some competitiveness to the healthcare sector and were pretty excited about that, Woodland said.

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Howdy, fans! I haven't posted much in a very, very LOOONNNGGG time -- for the same reason that Brian doesn't comment as much: I've been extremely busy with the shop, which is now up and running quite nicely. My organ subbing also fills my time. I find that I'm much busier now as a substitute organist than I ever was as a full time music person (but without the staff meeting on monday morning!). Also, I actually get to meet my colleagues from other churches with whom I had formerly only spoken over the phone, or, regarding my friends working at Protestant churches, whom I had never met at all. A few months ago, I played my first Presbyterian service. Somehow in 26 years, I had never played for the Presbyterians, if you can believe it. Good folks. When I'm not subbing, I am one of 9 basses in the choir at Ascension Episcopal. I must say, it's great singing in a choir with such strong men's sections. There are about just as many tenors as there are basses -- and of course a goodly supply of female voices too (don't want to slight the ladies!). On tap currently: the Tallis "If Ye Love Me" (SATB edition), the Vaughan Williams "O Taste and See", the Mueller "Create in Me", the Mozart "Ave Verum", a wealth of good newly composed anthems, and my personal favorite in preparation now: the Lacrymosa from the Mozart Requiem. Around Christmas, we sang a Mozart Gloria for Christmas Eve as well as the Glory to God from Messiah. The congregation at Ascension are good singers too -- and without a cantor singing over them. I remember way back when I taught the Apostles' Creed to high schoolers, having quoted a concept stated by St. Augustine that evil exists so that God can make his own glory shine forth more brilliantly. This past year has proven that again and again. The old saying goes that "when a window is shut, a door is opened". In this case, when a porthole was shut, a gate was opened. I bear witness to the fact that the working of the Holy Spirit is truly amazing. I also owe much to the powerful intercessions of Our Lady of Perpetual Help, who has never failed to support me with her prayers. As an act of thanksgiving for her assistance, I hung her icon in my shop as a perpetual reminder of her goodness and faithfulness.

Although I'm rather out of the loop with some of the Roman church politics, I do hear about the major points from the customary news outlets but either have had no interest to comment on them or simply little time to sit down to compose an essay regarding them. Obviously, given the bumper crop of my commentaries lately, I've commented more on ecclesial goings-on, in conversations with friends and in real life public fora than online, so don't think that certain topics don't go unseen or uncommented. I'ved just not written them out here. I came very close to pointing out the irony of Benedict's "wound to humanity" comment from his statements around Christmas time, but just sighed then giggled to myself. The best comment would be a cartoon with the caption "sine verbis".

I recently found an antique altar card from the Latin Rite at a flea market. Bought it for a nickel! A nickel! Vintage 1950's. It wasn't in a complete set, just the central frame with the lesson prayers and bits of the Roman Canon. Pretty cool item. We moved the print of Oak Alley Plantation from over the toilet tank in the bathroom and hung the altar card in its place. Wonderful conversation piece when guests come over. It gets far more attention and reading there than it has in over 40 years! Pretty neat to have the first thing you read each morning be the Munda cor meum! Evangelization takes place everywhere, folks!

Have a great week.

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