006: Meet M/S No Messing!

A cannabinoid mimics cannabis. Aka synthetic cannabis, tho I personally think this misnomers. However, it seems that workplace usage thereof has entered our community consciousness.

Elsewhere ingredients were at issue. Noted as contaminant the prescription (viz controlled use) drug phenazepam present. Whose presence was what I'd refer to as a likely story( viz excuse).

How come..? What of controls.? Is it one thing to legislate for controlled substances and quite another to expect satisfactory knowledge in commercial profitmakers from such substances? In whom are satisfactory use standards mandated and/or obligatory?

More than interesting is what the New Zealand Drug Foundation director, Ross Bell, had to say on the subject:—

"The trouble with our drug laws is..the onus is on the government to prove a new product is harmful, rather than a manufacturer prove it is safe."

Looks a market-ready recipe for make and sell..what the hell!

Then a surprise when a commenter told of how NZ was the only other country (cf USA) to operate DTC (direct-to-consumer) advertising on non-prescription, or controlled, drugs.

If true, then free market practices have hit upon one major obstacle in the form of uncontrolled and, as the case may be, unacceptable drugs demand.

For myself, a smoking quitter now at least two decades mature, I'd call unacceptable. For reasons related to how consequential costs shall fall upon others in need of health dollars in a very zero sum budgetary scheme of things post-recession and/or recession-strapped.

Okay, so for me there's a case to answer. How does one do this..?

Tell them about the Hearing.. y'know Woodcock—no not Woodstock—I said Doc Woodcock didn't I.. go on..!

Yes, Perjjo, you were rather impressed with her weren't you.. okay..I'll mention it though I can't remember all the points..

She's the point, just remember that—

At the Energy and  Commerce subcommittee Hearing this last week on "Medical Innovation, Jobs and Patients". S/Committee members Dingell and Waxman ready, willing and able to follow through in respect of patient safety.

Backstory to the meeting included in part the heparin crisis of 2008. Briefly:—

The discovery of a contaminant* in batches of heparin throws into stark relief the difficulties, not only for the US Food and Drug Administration, but also for international regulatory agencies, to ensure the safety and quality of active pharmaceutical ingredients.

Riven with political partisanry and polarisations the US in recent years has made little progress on such matters. Added to which Republicans have backed aggressive budget cuts to FDA, whilst requiring it relax scrutiny of new drug approvals and conflicts of interest.

Before them a bill - HR 1483 - the Drug Safety Enhancement Act. Needed was informed evidence on where the FDA was at so as to close gaps. Related, I gather Tom had spotted a p/release and jotted the salient, and to the extent of expanding what the agency would be about in broad global collaborations, I think the proceedings useful. 

On message Rep. Waxman said: “It is in no one’s interest to have a weak FDA.. If Americans lose confidence in the FDA, they will lose confidence in the pharma industry as well. The FDA needs the resources to protect us for(sic) unsafe drugs, and to be sure these drugs work.”

Firm for the FDA, Dr. Janet Woodcock, positively shone:—
".. the agency's job is to keep patients safe, and make sure drugs work.. It is an important piece of the innovation pipeline, not an impediment".

Wow! Whoever would have thought responsible regulation in the food and drug industry was an impediment? No, don't tell me, let me guess ;-)

Far from overcome by the insight several Hearing members argued that a "dry drug pipeline" was the FDA's problem. Woodcock countered immediately, "Safety problems were not the sole province of generic drug makers.. "Heparin was not a generic drug.. This is not a generic drug problem–this is a pervasive drug quality problem".

Hi, Perjjo again: I've gotten the feeling this lady sees the past as a foreign country.. know what I mean? Roll on the future..

She was not done either. Rep Dingell explained to all present how the next session would be rapid fire Q&A—like he was rapid Q and she rapid A..

His first ten getting short solid noes. Because this frames the nature of HR 1483 I'll include five of them as follows...

Do you have —

• ability to control the safety of pharma imports into the US?
• necessary resources to ensure raw materials suppliers do GMP**
• authority to recall drugs you believe to be substandard or unsafe
• power to refuse suspected adulterated imports at the border
• ability to share matters with trusted regulatory partners

Then wry smiles as staccato paused on the humorous note of her two yesses..

So.. let me see, saith Rep. Dingell — it's a nine year frequency for visiting foreign drug manufacturing facilities.. and a one year frequency for dog food making facilities.?

Yes.

Do you(FDA) need these additional authorities and would HR 1483 have afforded you need to deal with the heparin problem?

Absolutely, yes.

Do it America, and collaborate internationally without getting too hung up over drug "counterfeiting" etc. This needn't mean a return to the  - lucky you! - trade protection regime that so very fortunately avoided much thalidomide tragedy - but needed is to re-enable capability for demanding responsible and obligations-led pharmaceutical and biopharmaceutical global business.

*  The heparin was made in China, which like the melamine contamination of milk had prior 'approval' because ** good manufacturing practices were not or had not been observed and a critical number of casualties in the market took time to build up and get noticed.

005: III - Trilogy

Also upholding the Michigan Court’s decision was a major surprise in the form of Circuit Judge Sutton.

President G. W. Bush’s appointee in 2003. [ Recall if you will this was the same year the President signed $400 bn for pensioners pharmaceuticals package into Medicare so as to secure his second term from their otherwise sizeable democratic constituency. ] Firmly conservative, strong on states rights and legislation, he also came with worthies backing an astute mind ( having time served in SC Justice Scalia’s office ) for future Supremes nomination.

As if speaking directly to Judge Graham’s powers of federal force he argued:—

In most respects, a mandate to purchase health insurance does not parallel these other settings or markets... Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life. Not every intrusive law is an unconstitutionally intrusive law.

So.. in the order of things person-2-patient acceptable rule would be: find, treat(remedy), set upon upon recovery and process payment for service rendered

This compassionate conservative then appeared join Judge Martin on the economic component with — "Call this mandate what you will -- an affront to individual autonomy or an imperative of national health care -- it meets the requirement of regulating activities that substantially affect interstate commerce”.

Enough said. For a majority 2-1 decision at anyrate.

But Judge Graham had flashed a beacon to followers. Most of whom were stunned by a majority going against them. Appalled, as they saw things, that one of their own should back the President. Politics, politics, their wherewithal, when law and its relevance was at issue.

Spotting the light from among them, however, the libertarian Cato’s constitutional studies fellow, Ilya Shapiro blogged: “... it is shocking that an avowed constitutionalist like Judge Sutton requires Congress to show only a rational basis behind what it does.. to survive constitutional scrutiny. Under such logic, Congress can do anything it wants so far as it is essential to a larger regulatory scheme. That cannot be the law.”

Which of course overstates Judge Graham’s point. Besides, who would seriously abide “cannot”s pertinent the law in this case. And with these people.

Elsewhere though highly relevant—never mind the law—those Republican legislators went yesterday, there’s a debt problem and regardless Americans polled willingness to take cuts or afford more(premia or taxes) so as to sustain Medicare, we say cut $600bn from that government expense! What Congress gives(2003 qv) Congress can take away!

High-handed Big GovT ( from hypocritical republicans ) wouldn’t you say.?

As for Shapiro et al I think the unmentionable is due.

Larsson is a fine Swedish writer and knows well enough the libertarian mind. Yes, even the American libertarian mind. As readers of The Girl Who Played With Fire realise. Heroine Salander has been severely abused by her father and a second male state-appointed lawyer guardian, Bjurman. Knowing this her first-appointed guardian(stroke-sufferer recovering with her able assistance) discusses with his doctor her decision to ‘go after’ the two men still scourging her existence. The doctor declares himself surprised at Palmgren’s “libertarian aspect” insofar as his endorsement of her depravity, not to mention that she could kill herself in the endeavor. The lawyer then admits: “Yes, so am I.”

The only conclusion a reader can draw for his support is that emotion is/was the driver. Libertarians thus, and most certainly between themselves, are no less irrational than the remainder of human beings when push comes to shove.

Shapiro’s “rational” accusation upon Judge Jackson’s logic is both mistaken. And misplaced.

To wrap, Law Prof. Jost(Washington & Lee) said the Appeal Court had undertaken “a much more sophisticated opinion than we’ve seen before; a more thorough examination of the precedents”.

Not putting words into mouths, but lifting their game is where it is at for Affordable Care Act opponents

Already heard, two further appeals awaited. Will they result in a Supreme Court decider.? Who knows. Yet politics, politics, so messy, might not money + mouthiness meet more minds.!

If so, then sadly, the wrong expense.

005: II — Trilogy

Given the intervention later yesterday it was clear that a break was called for. No politics, the contention. Difficult to avoid, I argued, since material to follow arose directly from the minds and majority decision of former US presidential appointees to the judiciary, that third bastion of US democracy. Whereupon silence, our group constituting this no ordinary meaning and specialist politics, as it were, trumping the vulgaré

So, today we continue in the second part regarding the Appeals Court decision which weighed into the constitutionality of health care overhaul by the AFFORDABLE CARE ACT.

The Act, aiming to provide medical coverage for more than 30 million UNINSURED Americans, holds major impact for the health sector — health insurers, pharmaceuticals manufacturers, devices and hospitals

Given that Republicans have attacked it as a form of intrusive government power, it is likely to be a major issue through presidential and congressional elections in 2012.

Heard in the 6th Circuit's Cincinnati court, a 3 judge panel ruling separate opinions. Hence interest in unanimous or majority decisions and, given the particular nature of this panel, how much weight might go to the outcome.

The Appeal arising from a case brought by Thomas More Law Center in Michigan on the day the President signed it into law. Arguing that Congress could not regulate how Americans pay for healthcare services and insurance. A federal judge in Michigan upheld the law as legal and the Center appealed.

So..  upholding the Michigan court ruling President Carter's 1979 appointee, Judge Martin. Said by his opponents to be a liberal and anticipating Congress being able to order anything. In the event, this Judge wrote: "The activity of [forgoing] health insurance and attempting to cover the cost of health care needs by self-insurance is no less economic than the activity of purchasing an insurance plan."

Affirming the Michigan ruling.

Importantly, IMO, is how this provision aka the individual mandate brings the Affordable Care Act front and center America's concern. Person-2-patient responsibility presumed existent in respect of costs, as required, and  authorised by Congress.

At first I thought dissenting Judge Graham was addressing this very point of inaction or inactivity, with its overrun costs aspect. A President Reagan appointee(1986) and strong views about "runaway healthcare costs being a national problem" I'll admit to being disappointed when he switched to [ runaway costs ] "does not mean that Congress can try and solve them in any fashion it pleases".

Wants debt reduction or doesn't he!—mebbe he doesn't want President Obama's means to this end.?

Clearer: "If the exercise of power is allowed and the mandate upheld, it is difficult to see what the limits on Congress's Commerce Clause authority would be. What aspect of human activity would escape federal power?"**

Ah, that's it then, Conservative obsesses over powers, more makes for Big Govt. But what of the unconscious life-threatened guy in the middle of the road? Treat or don't treat?

Economic view, yes; macro no, surely? Be that as it may my double asterisk note above reveals in the next part Judge Graham as the wouldbe beacon for opponents.

Score: 1-1

Reuters - has coverage fyi tho not the great unmentioned(qv later)

Part 3: Surprises galore! Including the great unmentioned by those oh so objectivized opponents..

005: Today, Tomorrow & the Next Day - a trilogy

Upon good advices received from Just Muppo(qv) today's blog relates a procedure which in this theater's vernacular is termed scraping bones. You will understand, and accept I hope, my metaphor insofar as footing the soil above those bones has already taken place.

So.. what do we have here.? ( o/c: sayeth medz muse: Along the way to a thoroughgoing differential one ought to discern the parts..)

Ah yes, immediately I see several parts and shall take them in order.

Concerning the first we have a news item by Pollack upon the Medicare decision to continue fund treatment to existing patients a chemotherapeutic which the Federal Food and Drug Administration (FDA) recently declared non-approved for breast cancer.

At a single stroke the FDA thus took Avastin 'off-label' - (non-approved removes this indication from the drug's labelling) - yet in no wise eliminated off-label use. Which physician-administered course is both privately practised and Medicare funded.

Personally and unlike this decision's strenuous and overly sharp critics, who to a man (strangely most government-opposed!) declare the FDA did it because of the money!—meaning that Genentech's price at ~USD88,000 p.a. is too much to pay—I see the wisdom of prudent arms-length twixt government agency and manufacturer in operation.

Meaning truly good news for Big Pharma as it sustains the manufacturer's freedom to target their drug's market - thus upholding marketshare and revenues - via pricing. They have, as it were, retained the freedom(thus right) of decision. Herein with its greater value of sustainability. Surely?

Put simply: the higher the price the fewer the patients; the fewer the patients the less likely abuse and/or overuse. Thus, rather obviously, the longer its life.

To those oh so price-conscious critics one sees the squeal of $88 grand 'off-label' hitting purse and pocket as Recession bites upon perhaps their constituency's costly choices. Cries for help has never been their thing, whereas contention that taxes ought claw back costs reigns uppermost.  Yea, regardless taxpayers in general.

Ho.. whoa.! Don't go there, don't talk about general taxpayers, that's political. See! And political in these times is a way out of.. of taking ownership.  Responsibility..? Yes, mostly individual responsibility.
...

When I started out folks, a trilogy blog was no way envisaged. Now I don't see myself avoiding it. I thus encourage you stay the course, for its space and time holds value for all who do.

...

Tomorrow, the second part—AFFORDABILITY..

004: Necessary Insertion

Last time I finished up saying: "Next time: Eminentia and Trade, else WTO and rules.."

Truth is, however, that to do so immediately would put me ahead of myself and clear exposition in relation to that topic.

I have Perjjo to thank for this realisation. For during the week he called to "wonder" whether my last blog (003) had reached into the souls of US pharmaceutical industry and/or marketing to an extent of 'eminence lacking!'. Today.

To explain this he had been reading an article which revealed Pfizer buying into Boston academia's "eminence". That is to say buying basic research collaborations. To my mind and knowing pharma's potential for such matters it had hitherto been not so much pharma executive requirement as investors' ace-holding directive. On consideration - checking dates and a few other relevant things - I decided no, any soul change was down to others. Still, within a week of that particular publication kind of says I was both close to the mindset and in need of this insertion.

So.. further to 003.. was a genuine lack of pharma R&D evident? If so, where lay a sustainable future for its players.?

If the first then surely Ledford@Nature would have an indicative answer.

If the second then credence is given another finding to hand. In the matter of innovation which framed my question on the topic, the Federal Drug Administration(FDA) approvals of Big Pharma drugs between 1997 and 2008. Importantly, two thirds [ 2/3 ] of those were classified as "follow-ons". Quite possibly approval-seeking to shelve patent or patent-ready stock for sustaining future marketshares. Cashflows. A case of old wine, new bottles...

At best then, only one third [1/3] truly new chemicals or molecules or like processes. To perhaps truly earn eminence by innovation. Likewise per its long tradition that innovation justifies this industry's patented price premia.

So what gives now—if a net third innovative then a larger market leverage shall be applied.? for whom? How? Waitta minute..!

Costs..?

Why yes, we cannot overlook this since the Financial Times in London has made pretty clear recently all the M&A has really been about cost cutting. Rationalizations..chopping jobs and old manufacturing plant including labs(Sandwich, Kent, anyone! NY out, Groton in!) Yet even FT say term's up for cost cutting. Show us the growth!

Enter Heidi Ledford(above) who opens — "The agreement is the latest sign of a growing trend in the pharmaceutical industry, which is trying to cut costs and improve efficiency by outsourcing the earliest phases of drug discovery."

Which in its way says it all. For her cited parties.

And Perjjo tells me how the later phases will run cheap (and mebbe nasty) among multitudes in third world clinics. Where ethics are somewhat slacker. BAU. Besides, some will always rely on homo sapiens being all-for-one, with one for all ;-)

The leverage.. see?

Yet I now wonder about this. From here I'd say there was a firm investors' sense of which costs Big Pharma must keep. And despite Merck's(qv) talk of its own previous collaborations.

For investors the innovation tag is pretty vital. Corporates legitimizing premia prices. With overall profitability tumbling even lowered pricing would give them no show against lower-priced and already major long-term generics competition.

But of course with but one third [1/3] of FDA approval drugs novel what ratio of these are In-house? Or owned? Could it be that already the external and/or independent twosomes and threesomes in molecular and nano science and biopharmaceuticals, along with novel agents in such processes have tipped the balance away from Big Pharma control over patent holders' monopoly pricing.?

Example for the small independents lies well in IT app-builder business opportunities. A several year software development and web/net beta testing can see very significant buyouts by deeper pockets dependent on 'viral' growth and product streams. Goose, gander stuff, I mean to say.

Then not beyond the bounds of reason are that these deals or research buyouts amount to pharma-wrap of such knowledge and future-makers in secrecy. Serving only insiders. Hey there's a lot at stake.!

Bottom line: Contention has a mind of its own. And its very own people. Conditioning chronic convergence. Hence the need of vigilance and watching this space..

003: Bigger Pictures

At lunchtime today I learned from Radio New Zealand's Midday Report segment WorldWatch that IBM - International Business Machines - was 100 years old.

Occasion to remind me of several visits to what the 1980s termed IBM House in a cityside property along Oxford Terrace, Christchurch. I was to learn there how IBM had arisen from "business mergers" and earned its 'big blue' reputation.. and .. wasn't there a computer that could beat any brain anywhere at chess!

Sandwiched between a tree-lined and pretty River Avon at its front and commercial warehousing construction at the rear. Inside, several offices per floor with then fashionable large single rooms divided by multi-partitions whose workstations revealed the firm to have shifted from typewriters, cash registers and office machinery to computers. For them desktop times had arrived.

But, it should be said, IBM was then already behind the times. Technology, and IT, times. Thenceforth they would not catch up, and so far as I know from the radio commentary's conclusion of a present "reinvention" arrived at in ruthless cutting-off-the-past style, this will be insufficient to regain the BAU lead. Kindly put, a phrase to aptly characterize them would be slow followers.

In saying this I'd like to reiterate a term I'd come up with back then yet whose currency in the relevance of a bigger pictures take on the pharmaceutical industry(PI) today in relation to westernized medicine, is a good match.

That term: EMINENTIA.

And taken to mean not what Gould's might give to an anatomical protuberance in the inner ear or a ridge of heart chamber tissue, but a condition arising from eminence. A condition arising despite the best and/or worst efforts of all PI players in westernized medicine, whose 'golden years' were said by a wiki topic as being in the 1990s. A condition which unless recognised  - IMO 1980s - and robustly dealt to as it arises would set forth a rigidity from which so very few would escape. Until too late.

That eminentia is well-and-truly set today for let's say the U.S. pharmaceutical industry is discernible in the context of a Standard & Poors Valuation and Risk Strategies research group report recently made. The PI - and yes largely US-led in this respect - has been embarked on very substantial merger and acquisition programs as it sought also to restate itself in the Health Care business..

Latest data shows how for all business some 828 M&A deals @ ~$93B have taken place. Compared to 2007 - 905 deals @ ~$172B - decline is apparent. Yes, the global Recession in part responsible.

Again all business, when it comes to choice we find Europe taking 45% in 2011(cf 50% 2010); whereas M&A  shot up 85% in target deals around Africa and the Middle East. Whilst for Latin America and the Caribbean the figures were somewhat less.

So much for context. Now for the sectors. Real and vital pointers. For Health Care:

Year-on-year(yoy) @ 2011 Health Care M&A dived. Minus 28%.

We could say how Pfizer's Wyeth 2009 buyout - reportedly the "biggest ever" at $68B - was writing on the wall. Surely?

Perhaps more significant, however, was the nature of that acquisition — cash, shares, loans essential to make the stake. What else might remain in circulation for such activity..? And besides, vigorous take-up in M&A terms does not plenteous opportunity make. But, OTOH, serious - unbuyable - contenders.

Contenders and contention then. Replacing competition..? If yes, eminentia rules. If no, no one rules. Another possibility is the PI remainder stuck and waiting for  upturn in M&A and the industry's so-called leaders pitching their immediate futures in biopharmaceuticals.

Which brings me back to a like theme of the intro. News of a BBC production about 20 vaccines for the future of.. patients or megalo-eminentia?

Next time: Eminentia and Trade, else WTO and rules..

Beginnings: 002

Post-WW1 they had resumed schooling together. She was early teens, he late. Attracted he was for sure. Nothing more fluid in form, style and balance existed in school athletics. Entered in the 150 yards dash, as their peers called it back then, she’d start out of the blocks in front and stay there all the way to the tape. The one to watch. Every audience’s hero in a race, his alone just everywhere else.

Aged 18 her symptoms started.. double vision.. fatigue.. Gotta see the eye man, was early advice. He hardly listened — hadn’t he seen it all before — here, try these prism glasses..  you’ll be fine.. opthalmologist-speak. Fatigue.. why wasn’t that all the running, training. Besides, you are a growing woman and shouldn’t be doing that stuff.. y’know what men do.

Things were beyond argument when her limbs went weak. Found a neurologist, her father soon declared, eminent isn’t the word for him. He has agreed to see you. Only one condition, that you are honest and tell him truly..

Which she did, right after his physical examination. Not hysterical, she told herself and reiterated: “My symptoms, that’s what I’m worried about.” Shown the door for her trouble she vowed henceforth avoid the patronizing patina of perfect fools. Wherever possible.

Worse, and worsening (euphemisms like ‘disease progression’ not allowed), even to the point of being unable turn over in bed, eat properly, likewise for speech. It was her fiancé, now a medical student who came home with a possible diagnosis. Myasthenia gravis.

He knew how this rendered her vulnerable. To a so-called wisdom of the times: No known treatment thus many things to try. - (Disabilities and How to Live With Them(1952). London: Lancet).

Gold injections, thyroid and suprarenal extracts, lecithin, glycine, ephedrine — among a you-name-it brigade — later, and so discharging his extended learning as much as her frustration at false hopes, there came a day she would never forget in 1935.

Living alone save her nurse companion she declared herself indifferent to another injection. A new substance her fiancé enthused. In minutes this changed to a strange feeling. As she was to put it, “ When I lifted my arms, exerting the effort to which I had become accustomed, they shot into the air ... every movement I attempted was grotesquely magnified until I learnt to make less effort... strange, wonderful, and at first very frightening ... we danced twice round the carpet. That was my first meeting with neostigmine, and we have never since been separated.”

Neostigmine is an anticholinesterase drug. Its use is also diagnostic for myasthenia gravis, dramatic relief of weakness and fatigue confirming this disease.

Implicit to its use is knowledge of the biochemical balancing act a body performs by way of the central nervous system(CNS)—motot neuronal—muscle set ups. Body release of acetylcholine makes it the primary driver of nerve ending/muscle action.

This is not of permanent duration in and of itself, being reduced - hence controlled - by cholinestrase. Too much cholinesterase makes for too little muscle action via acetylcholine. The weakness, fatigue and loss of muscular function MG’s attendant and consequential symptoms.

So.. rebalance cholinesterase with anticholinesterase administration and.. and retrain muscles for more normal movement.. and voila!

I smiled, thought: the bigger bolt..  to eliminate slack in those rehaped lopper blade holes.. well not quite but pretty darn good.

He was looking away from me, out the window into the rear garden darkness. Can’t say why yet I sensed his mind upon a small plaque set beneath a tree there. After a long pause he spoke.

“The doctor was her locknut. Drug titrations, watching, always watchful. I mean complementary atropine to keep a check on her CNS’s buddy the autonomic.. and then those too much (cholinergic crisis) times including ats knocking up the rebalancer..”

“You were her doctor,” I said slowly, quizzically.

“No, no, I did surgery. But you know that. Her doctor was.. is a friend of ours.. I mean mine.. Look, if you’ve time tomorrow we could mebbe go over there.. drop in.”

He eyed me kindly, his look saying the subject was over, and the tone of his voice tellingly so. “You er.. you don’t happen to play chess do you.. like to help me with an opening I screwed up!”

Next time - 003 - bigger pictures.. contexts.. for trade, industry, jobs, government...

Beginnings: 001

Tom's critical "surmise" was a surprise. Stinging. Yet also, and I am pretty sure he had no idea what he had set in train, taking me back to the safety of constructive effect. In experience.

Which I will now relate. In the interests of telling exactly where I am coming from. And how.

I'd been to a conference, given a talk, and next day promised myself a visit to a former surgeon who had retired in the vicinity.

On arrival I found him sitting on a wooden step beside the cottage's sunny front garden. Beside him a couple of hand tools, a stripped down pair of hedge loppers and a very worn, very dark greasy bolt and nut.

"No, no, you finish up," I said when he stood to wipe his hands and grasp mine in welcome. "Besides, I'm curious to know how you do this. Worn out surely—you are fixing them?"

"Sure thing," said he fossicking among glass jars in a wooden box. "Ream or rasp them out .. those holes.. then a bigger bolt with good thread and two nuts and—"

"Two nuts?" I smiled, shaking my head in misgivings at the rudeness.

Evenly he said, "You'll see, go on indoors, make us a cuppa.."

Fifteen minutes later, coffees on a tray, and I saw. He had cleaned out the lopper blades' holes and filed them larger, rounder, with a metal rasp. Then fitted a larger bolt with a washer and nut to hold those blades together, operating via the tool's meter length tube handles.

"Now this," he explained as he fitted another nut, spinning it into place with his index finger, "nut two. When one won't do you make it two. One was why this tool  wore out and I never knew. So.. number one tightens the blades for open-and-shut cutting, number two locks it down. Lock-nut. Least for me, here and now, that's the theory. Here, give 'em a try for me.. put theory to work.."

Worked, showered, dined and conversation after a wonderful dinner in the quiet enclosure of late evening there I was to ask him where the fix it idea came from.

"Wherever did I get it from? The lock-nut idea? Hey, that will take me back. Lemme see now..."

I waited. I'd known about such things from hobby DIY mechanics days , but that was then, now was planned obsolescence, replace the whole tool and keep a workforce in jobs.

Still seeking a firmer line with which to answer he began, "Actually, and thanks again for helping with the hedge, that other pair I was using was new at the weekend. Looked the same, newer but.. same kind of mechanism and.. well, I figured it would probably be a shorter time to the same stuffed lopping as the old pair.. yeah, I can tell from your nod you agree tools aren't made to last.."

"Well you've changed that all right," I said, "a sharpen here and there and the oldies are forever." With a learner's gratitude adding, "At least two of everything makes for twice as long."

My reward was hearty laughter. Throwing his head back to show a muscular tanned neck and firm torso. Reveal how fitness and figure had made his retirement good.

Yet in no wise hinting at anything else about him. Like what followed.. and served to graduate me in what I became skilled at..

Tomorrow: a heartenening story .. untreatable chronic disease and the medical student..

Blind-Siding the Big Trade Blockage

Put a search out for WTO or Global Trade and likely you'll soon discover how little coverage actual activities or any real sense of progress there is. These days.

Nations — the signatories, usually via government cabinet ministers, to WTO or the World Trade Organisation — squabble over important differences and wording/s to legislative documents designed to hold all parties to them and agreements reached. I'd like to say amicably, which was largely how it was in the early stages of WTO's life. But doing so today would misrepresent and mistate realities.

And very clear to observers is that the WTO executive, officers and advisors, along with business and sovereign expertise know this to be a fact.

So much so that an ostensible Trade meeting in Montana, USA, has government ministers airing their opinions on whether WTO's Doha Round break up, and either give up altogether or align interested nations into "something" else as the Honourable Ron Kirk @ USDT put it recently.

And it is that something else — I believe already underway — which is nudging renewed trade impetus onward.

Not that folks in general would know this; nor for that matter the nature of it. Or its drivers!

And this state of affairs has arisen out of distrust and infighting in the other WTO process. Which is to say that constructive commentary and examination needs to know the new ropes.

As I said earlier - first post (looksee) - Tom - does not know those ropes. He makes a solid plausible, albeit bold, case. But it is not based in exactly where and how things are at.

My task here then is to address both the real situation and provision deficiencies arising. With any luck at all our readers can arrive at a doable conclusion from this.

Because it does need a wider audience's correction.

Looksee-3

This one publishes.. the text font being well-propped with good 'x' and spacing.. easily seen, lifted off the bg and hence solid readability.. goes with the copper-plate look of that backlight.. least ways to me..

I started this blog because a guy I know - he was a partner once - has gotten himself suckered by the very people he has always been opposed to.. not so much the people I mean to say as what they are about.. which is undermining honest and decent people in their everyday tasks.. I guess it's the idea of folks who once respected this ex-buddy for his forthright views now laughing at him behind his back.. that it, BAU for them..

Anyway, let's see how it goes..