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Saturday, August 27, 2011
Has Stephen Stahl Gone Off the Deep End? You Decide.
38 comments:
- pacificpsych said...
He seems mildly peeved. Wonder what he's like when he's angry...
I didn't know all these Pharmas are shutting down - and bio-psychiatry is apparently coming to an abrupt end. When did this happen?! I'm crushed.
And because of ME too, for I think I can take some of the credit, as a frequent contributor here. Who knew we had so much power? Flower power! We rock! - August 27, 2011 at 8:08 PM
- Unknown said...
Bizarre. How are you anti-psychiatry when one of your main gigs is to write a (very helpful, thank you) psychopharm newsletter? Maybe the truth of the matter is that the psychotropics are hard to prove worthy in an era of stricter research and closer scrutiny.
- August 27, 2011 at 9:28 PM
- FunPsych said...
As Upton Sinclair once said, "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"
- August 27, 2011 at 10:05 PM
- Nancy Wilson said...
Something's got his dander up.
The disclosure statement posted on the NEI website reflects that "Over the past 12 months (January – December 2008) Dr. Stahl has served as a Consultant to Arena, Azur, Bionevia, BristolMyers Squibb, Eli Lilly, Endo, Forest, Jazz, J & J, Labopharm, Lundbeck, Marinus, Neuronetics, Novartis, Noven, PamLabs, Pfizer, Pierre Fabre, Sanofi, Sepracor, Servier, Shire, SK Corporation, Solvay, Somaxon, Tetragenex and Vanda; he has served on speakers bureaus for Wyeth and Pfizer and has received grant support from Forest, J & J, Novartis, Organon, PamLabs, Pfizer, Sepracor, Shire, Takeda, Vanda and Wyeth."
I wondered if Dr. Stahl had experienced a decline in his consulting/speaking fees and grant support in the past 12 months. - August 27, 2011 at 10:25 PM
- David M. Allen M.D. said...
I've had the feeling that Stahl drank the PhARMA kool-aid for some time now, and his post sounds just like the typical defenses that the paid-off "opinion leaders" use.
Drug companies did not used to be as dishonest as they have been the last few years. I personally am not against pharmaceutical companies spinning their data to emphasize their strenghts and minimize their drawbacks to some degree, nor am I against them sponsoring CME, or even giving out free meals and pens.
What I am against is the blatant and insidiously-disguised dishonesty of their recent marketing strategies, which seem to have become their norm, and which have corrupted academia to an unprecedented degree.
On the other hand, as one who blogs about PhARMA nonsense just like you do, I have indeed had more than my share of comments from the anti-psychiatry types that Stahl describes:
"...the Pharmascolds, scientologists and antimedication crowd who believe either there is no such thing as mental illness, that medication should not be used, or both. Did you know that psychiatric illnesses are pure inventions of Pharma and their experts to treat patients that do not exist with drugs that are dangerous and do not work with the purpose only of profiting themselves? Stop the profits! Make mental illness go away by legislation and committee! Treat human mental suffering with love and peace and all will be well!"
This is a very accurate characterization of the antipsychiatry types.
Of course, since you and I both prescribe psychiatric medications ourselves, we are obviously NOT the people who fit this description. We do, however, sometimes give them a forum in which to speak. But in a free country, that is unavoidable.
Just like the middle ground in American political discourse seems to have evaporated, so has open-minded discussion of psychiatry's problems. - August 27, 2011 at 10:53 PM
Off the deep end for sure. Stahl misses the point completely: psych treatments aren't doomed -- CORRUPTION is doomed (hopefully), and that can only be a good thing. If you connect the dots, saying psych treatments are doomed because (corrupt!) pharmaceutical companies are withdrawing from the market is actually one hell of a revealing statement.
Yes, pharma largely withdrawing from the market may mean a slowing of new drugs from the pipeline, but that also means far less collateral damage to innocent patients (including patients who shouldn't have even been on this stuff in the first place), and more effective treatments for all.
I see pharma's withdrawal as a wonderful opportunity for psychiatry to do some desperately needed soul-searching and get back to what really matters: REAL SCIENCE. It won't be easy, but nothing worthwhile is. - August 27, 2011 at 11:28 PM
Sorry to double-dip, but I want to comment on something David Allen said:
David, I agree wholeheartedly with everything you said EXCEPT that you agree with Stahl's quote about the "antipsychiatry crowd":
"Did you know that psychiatric illnesses are pure inventions of Pharma and their experts to treat patients that do not exist with drugs that are dangerous and do not work with the purpose only of profiting themselves?"
Now, I'm just not sold that EVERY disorder in the DSM is valid. What about the Serafem/Premenstrual Dysphoric Disorder debacle? That seems like an iffy disorder cooked up to extend the patent of a drug (Prozac) to me.
And you yourself quoted Allen Francis on your blog when he said "the drug companies learned a while back that the best way to sell drugs was to sell diagnoses… selling the diagnosis is a way of opening up the new market. New diagnoses are as dangerous as new drugs, at least in psychiatry."
You then went on to criticize this "disease mongering," specifically criticizing bipolar spectrum disorder.
Clearly this is not an anti-psychiatry criticism, right? - August 27, 2011 at 11:45 PM
- David M. Allen M.D. said...
Thanks for your comment. Yes, I agree with what you say. As you must know from reading my blog, I think SOME DSM disorders are a complete crock.
What I was talking about in this last post is "the all-or-none thinking anti-psychiatry crowd." They seem to think that if a drug turns out to be ineffective for some symptoms or in some patients, then ALL psychiatric drugs must be ineffective for ALL psychiatric symptoms in ALL patients. They think that if some diagnoses are bogus, then ALL of them must be, etc., etc.
We in the business call this "black or white thinking" or "splitting," and as I said on another blog, it is a serious logical fallacy (as well a symptom of a certain personality disturbance).
Hope that clarifies. - August 28, 2011 at 12:13 AM
- Nancy Wilson said...
Dr. Stahl reported, "The UK in fact is having a crisis meeting at the Royal Society of Medicine in August, where I am attending with about a dozen others, including the head of the NIMH from the US, the head of the MRC from the UK, and various UK and US academic and industry leaders to discuss what we should do about this...."
He promised to report back. This will be an interesting story to follow. - August 28, 2011 at 1:07 AM
Great response Dr. Carlat. You asked Dr. Stahl, the most important question about where his evidence is.
Dr Allen, you said, "What I was talking about in this last post is "the all-or-none thinking anti-psychiatry crowd." "
I find your comment ironic as in my opinion, many psychiatrists keep patients on meds come heck or high water. There is nothing else in their toolbox. If that isn't black and white thinking, I don't know what is.
I will bet you many of them have never heard of Emily Deans, who I am a big fan of by the way and who has looked into diet approaches for various conditions of mental illness.
AA - August 28, 2011 at 9:27 AM
Big Pharma marketing is rancid. Big Pharma R&D - not so much.
The one's getting out are getting out because their biological models and assays map to me-too drug development and that's out of gas with CNS, because of pricing pressure and strongly coupled side effects.
When new ideas surface, Big Pharma will get back in.
The paradox is the huge level of effort being applied to neuro-psychiatric diagnostics like fMRI that have produced limited links to drug development. I.e., the wiz-bang machinery can locate and colorize a psycho-pathology, but so what?
BTW, the psychotropic horse has been out of the barn for years. Like it or not, the normative psychiatric practice model is now the psycho-pharm 15 minute "med check". Faustus Psychiatry has been thoroughly seduced by Mephistophilis Big Pharma. There's really nothing left to corrupt.
The Big Pharma psycho-pharm marketing objective is brand switching of me-too drugs. Those expensive dinners merely move the therapeutic food around the plate.
This war is over. All Hail Peter Kramer! - August 28, 2011 at 10:13 AM
My assessment:
Axis I: delusional disorder, paranoid type; rule out mood disorder NOS
Axis II: paranoid and narcissistic features
Axis III: deferred
Axis IV: occupational problems; economic problems; problems related to the social environment
Axis V: current GAF = 40; highest GAF in last year = 80
Treatment plan: Latuda 40 mg qd for antipsychotic and mood-stabilizing effect, also for 5-HT7 activity to preserve cognition; increase to 80 mg qd if paranoia and poor insight persist. - August 28, 2011 at 10:32 AM
- David M. Allen M.D. said...
Once again, you are absolutely right about many psychiatrists and black/white thinking!
It seems I spend half the time I devote to seeing patients trying to get them off inappropriate or no-longer-necessary medications prescribed by previous psychiatrists.
Many patients who have had major depressive episodes, for example, are never even told that they do not usually have to stay on their meds for more than six months. Or that they need to taper them off when they want to stop them to avoid withdrawal(euphemistically, "discontinuation syndrome").
There are quite a few psychiatrists that I would not refer my dog to. - August 28, 2011 at 11:20 AM
- Altostrata said...
Dr. Allen, I know it may be difficult to hear criticisms of psychiatry when you work so hard for your patients' wellbeing.
Those patients whom you save from inappropriate medication have been injured by doctors not practicing so responsibly, and many more patients out there are seeing those very doctors. (As for antidepressants for 6 months max, how many doctors, even psychiatrists, do you think know that?)
As they say in the ad biz, nothing kills a bad product like good advertising. The problem for psychiatry is that psychiatric drugs are prescribed to far too many people and there are a LOT of dissatisfied customers out there who are not keeping quiet.
Unfortunately, psychiatry is doing a very, very poor job of educating other doctors and promoting practice guidelines that protect patients. Instead, it's engaged in a defensive turf war (cf Dr. Stahl).
The "all or nothing thinking" you're talking about is the spread of deep mistrust toward psychiatry. Good doctors as well as bad are being painted with the same brush because -- really, who can a patient trust?
As for Dr. Stahl, he sounds like he's complaining about pharma gravy train drying up for his own pet projects, to h*ll with patient safety.
Strike another blow for the ugly psychiatrist. - August 28, 2011 at 3:23 PM
If you are interested in the CNS challenges from the Discovery end, here's a succinct but telling entry from Medicinal Chemist's Derek Lowe's excellent Pharma blog:
That was published in 2008 before the rash of CNS abandonment by Pharma. But it helps explain why it is happening.
Here's a recent entry of an NIH sponsored public-private CNS initiative:
Again, more front end complexity.
Read the comments of both for a fuller flavor of the debates from the science, not marketing perspective.
BTW, Dr. Stahl would be better served if he paid attention to the people actually working at the tip of the spear rather than the grunts in marketing. - August 28, 2011 at 5:38 PM
- gewisn said...
Has Stephen Stahl Gone Off the Deep End?
When was Stahl at the shallow end?
When was he Not selling the idea that we can "scientifically" target a medicine to a patient based on the receptor affinity profiles? A practice that has never really worked.
He has always oversold the utility of receptor research to push some drugs over others, without proper evidence.
His books have nice cartoons. - August 28, 2011 at 6:04 PM
I, for one, take the opinion that I am in agreement with these two seemingly diametrically opposed viewpoints.
James Woods M.D.
Clinical Assistant Professor of Psychiatry University of Tennessee College of Medicine Department of Psychiatry - August 29, 2011 at 2:29 PM
As a Scientologist (please note the capitalization, guys) and one of those "anti-psychiatry types" whom Dr. Allen believes Stahl characterizes so accurately, I'd just like to say that this whole discussion is wonderfully revealing of the current situation and the broad, diverse culture of the psychiatric profession.
Excellent discussion, good thoughtful people! I will certainly recommend this blog. My guys need to understand your guys better. - August 29, 2011 at 10:29 PM
- DBDouble said...
- August 30, 2011 at 7:43 AM
Dr Allen and Altrostata you both hit the nail right in.
Between our own misbehavior or lack of proper training we are harming patients and also misinforming. I see so many pts chronically on antidepressants now unable to stop it and still believing that withdrawal is depression. What is going on.
Maybe the problem is not pharma alone but ourselves. I have to add non-psychiatrists prescribing also. - August 30, 2011 at 8:07 AM
- SteveBMD said...
I can't help but feel somewhat insulted by Stahl's post.
If, as a psychiatrist, all I did was prescribe drugs, then yes, I agree with him that the downfall of drug company research might lead to "a decade or two ... of no progress and no innovation."
(BTW, isn't he hinting here that all the wonderful things he's written about the mechanisms and efficacy of psych drugs over the years... are really not that wonderful?)
But psychiatrists actually talk to people, too. Maybe we can use this time to study and develop psychosocial treatments, refine our diagnostic categories, and determine better uses for existing drugs. That would be innovation. - August 30, 2011 at 8:54 AM
- Asslete said...
If I were to sum up Dr. Stahl's blog with one of his many copyrighted images, I would choose Green-Face-Man-Looking-Nauseated.
As a recovering Pharma-profiteer, I know how difficult it is to wean off Pharma's-teat. But Dr. S has suckled for so long that even though the milk has soured, he can't stop drinking. He has made millions (yes, millions) off of his schtick...and clever schtick it has been. Promising to move market share, bad-mouthing products from players who wouldn't pony up any coin, and becoming the Stan Lee of psychiatry has created an empire. But it is time for the Emperor to accept that he has no clothes (at least for the next few years)...and not simply fiddle loudly while Psychiatry burns. - August 30, 2011 at 12:43 PM
- David M. Allen M.D. said...
Dr. John,
I agree with everything you said except I would not be so sanguine that the current paradigm in psychiatry is dying. I only wish. In fact, I see it exploding.
And doctors and drug companies aren't the only ones to blame. A lot of patients are demanding the quick fixes that this approach promises.
I haven't checked out the blog on the Child and Adolescent Bipolar Foundation Website lately, but there used to be a whole lot of family members blogging who identified themselves with multiple psychiatric diagnoses as if it were the perfect introduction to who they are. - August 30, 2011 at 1:39 PM
- SteveBMD said...
Dr Allen,
Having recently returned to the academic setting, I can say that the current paradigm in psychiatry is still very much alive and well.
Stahl is revered as a semi-deity and his writings are sacrosanct. Moreover, the entire educational infrastructure-- from textbooks to lectures, and from Boards to PRITE to USMLE to shelf exams-- incorporates this dying (exploding?) model.
It's enough to make me feel schizophrenic-- in the lay sense of the word. - August 30, 2011 at 3:24 PM
- Dr John said...
With all do respect to the good Drs A and SMD, of course the current model is alive and well in academic psychiatry. What else do they have? I would not go to a prayer meeting at my local church looking for an update on the current status and validity of religious belief in my neighborhood.You have to look outside and academic psychiatry certainly is not a proper litmus test for what is going in in the rest of the world.
I don't think Dr Stahl would be in panic mode if things were status quo. The fact that pharmaceutical companies are leaving psychiatric research in droves is far more important than what is being blogged on the Child and Adolescent Bipolar Foundation Website.Those people were not convinced they all had multiple psychiatric Dx over night so it will take a little time for them to move on.
This is just the start of serious cracks in the foundation of the Church of Psychiatry. As the money leaves and the advertising slows down things will change. It will take time, years. When there is no money to pay Drs for dinners or reps to convince Drs to prescribe we will see how long their attention span is for whatever the psychiatric illness du jour is. I am not talking about the cocoon of academic psychiatry but rather what is going on in primary care or more importantly Oprah.
Do you really think primary care Drs are going to be treating Bipolar Disorder like it is some foot fungus 10 years after they have seen their last Seroquel rep?
Sure they will still be trotting out tired descriptions of depleted monoamines for the depressed or excessive dopamine for the psychotic in resident training programs years from now. If they did not they would likely have nothing to say at all.
That's not what I am talking about. I think American society's love affair with bio-psychiatry is coming to a close. The death of pharma and its shills is just the start. 10 years from now I bet more Valium is being passed out by GP's than SSRI's to the American public.If so that will be testimant to the enduring nature of the current paradigm.Time will tell... - August 30, 2011 at 6:03 PM
- David M. Allen M.D. said...
Dr. John,
I hope you're right, but ten years is a long time. When bipolar is used as a synonym for moody in a Katy Perry song, and with the popular acceptance of the bio model I see among high school kids, that tells me that we may have a loooooong way to go.
It is also likely that the drug companies are only getting out temporarily because they've beaten neurotransmitters into the ground and there's nothing new on the horizon (and the new me-too's are not different enough). I guess the glutaminergic drugs didn't work.
If academics discover something truly novel, they will again patent it and license it to the drug companies to distribute. - August 30, 2011 at 7:17 PM
Neuroskeptic has a nice post on this.
http://neuroskeptic.blogspot.com/2011/08/on-antipsychiatry.html - August 31, 2011 at 8:58 AM
- Jeoffry B. said...
I am a family doc with an extensive psychiatric practice. First I want to say I admire Dr. Stephen Stahl immensely. He has personally taught me more about neuropsychopharmacology than any other person. I send all my "incurable" cases to him or psychiatrists he recommends with excellent results.
Having said that, I am almost 70 years old. When I started in practice, research information was relatively primitive, but we docs worked with an "ethical pharmaceutical industry" that had science and patient welfare on the top of their agenda. Over the years they have morphed into corporate marketing machines, whose bottom line is profit. They have used all kinds of covert financial incentives to attract docs to their products, rope in influence leader docs,distorted and ghost written scientific productions, brought less than safe products to market, and grovelled in direct to consumer marketing.Of course, this not all companies and not all products, but who can you trust and when? FDA has levied monstrous fines on especially Pfizer for repeated illegal promotions.
Sure docs and medicine would like more funds for their family and for research in these times of cutbacks. But at what price?
Of course Stahl is right, we need continued CME and research institutes - especially in the remaining frontier of medical neurosciences - but at what price? Big Pharma's usual modus operandi is far from trust worthy. Good riddance. Let's all work with our professional societies and independent governmental agencies to reestablish the the base for needed research. - August 31, 2011 at 11:03 AM
- SteveBMD said...
"...who can you trust and when?"
Interesting that you would ask that question, because I've pondered the same thing, for the same reasons.
Stahl is a perfect example. He's smart and persuasive, and knows far more neuroscience and pharmacology than I could ever dream of knowing. However, I've gotten to the point where, when I read his papers, I'm constantly asking myself, "which product is he promoting here?" (And often, the title, the abstract, and a glance at the disclosures answers this question.)
I hate thinking about the leaders in my field this way, but it's what I've been forced to do. - August 31, 2011 at 11:20 AM
Dr. Allen,
RE your passage about "pharmascolds" and scientologists, and legislating away mental problems:
This is ad hominem argument attacking a few stereotyped straw men to avoid addressing psychiatry's serious critics.
Have you read Irving Kirsch's The Emperor's New Drugs? What is your response to this most extensive meta-analysis of SSRI trials, showing the drugs to be no more effective than placebo, except in very severe depression? What do you say to Kirsch's finding that the drug advantage over placebo was only 1.8 on the Ham D, when NICE sets 3 Ham D points as the minimum for clinical significance? How about the JAMA piece out of Duke that substantially corroborated Kirsch's findings?
What do you say to Joanna Moncreiff's The Myth of the Chemical Cure, documenting the evidence that psych drugs don't correct imbalances, but cause a broad range of abnormal brain function in normal and abnormal subjects?
How do you view Nancy Andreassen's report confirming that neuroleptic exposure does decrease brain mass? What of the rationalization that decreased brain volume can be therapeutic (after psychiatry's decades of insistence that volume loss was one indication of schizophrenia's pathological process)?
What of Grace Jackson's Re-Thinking Psychiatric Drugs, or her Drug Induced Dementia. Dr. Jackson is a psychiatrist who put her money where her mouth is about psychiatric drugs and successfully defended her license when psychiatry came after her hammer and tongs. Her books are chock full of detailed factual argument.
Is Grace Jackson a "scold?" I think she is brilliant and courageous - if you think she's a scold, please read her books and rebut her point for point.
Delivering a scolding of your own is not an effective rebuttal against the many serious critics of psychiatric drugs. - September 2, 2011 at 2:32 PM
- David Behar, M.D., E.J.D. said...
pdwyer: You read a few books about marginal side effects of little importance in numbers, damage, or severity.
Have you read that there are 30,000 suicides a year? These suicides are few compared to heart attacks or cancer. However, they happen to young people and possibly take away more productive years than more common causes of death.
Have you read that paranoid schizophrenics kill 2000 people a year, such as the 30 students and professors at Virginia Tech University?
Have you read that 20% of us will endure a disabling mental illness in our lifetimes? And that half of them will go untreated.
Have you read that medications are tools? Have you read that all tools have side effects? For example, you need to get to Ohio. You could use a tool such as a car. However, cars cause 35,000 horrific deaths by butchering the body while alive.
So let's stop the use of all tools until all their side effects have been ended. That is what the anti-drug extremists are saying. Those misleading, biased authors should walk to Ohio. Roads are tools, and not allowed. Shoes are tools, not allowed. Let them get to Ohio walking barefoot through bear country in the winter. Coats and clothing are tools. Not allowed, until all their side effects have been stopped. - September 4, 2011 at 11:27 AM
Dr Stahl,"If you were in the Pharma business, would you work with psychiatry anymore?"
My lover threats dumping me.
Carlo - September 5, 2011 at 5:39 AM
I am from India ,our situation is bit different but ,whatever Dr.Stahl has written is very true.Edison didn't stop trying for new filaments even after many failure.So new drug invention will be there with failures it doesn't mean to stop and control with ridiculous regulation.Within limitation of ethics this can be done but its very obvious to get angry for over-ethics.Its nothing wrong to take freebies from pharma as they are also doing business and we are part of that.If you are getting paid for your expertise nothing wrong as we are not only field in the world like this.
On contrary we should thank Dr stahl for raising voice for this injustice. - September 15, 2011 at 1:57 AM
Dr, Bhat,
Edison didn't stop trying, but he also didn't spend $60 billion annually on PR to sell hundreds of billions worth of light bulbs that didn't work. Additionally, he didn't ruthlessly police the field to prevent anyone else from doing their own experiments. That is not an overstatement: psychiatrists risk their licenses for refusing to prescribe psych drugs; psychologists, social workers and other therapists risk their licenses if they don't refer patients and clients for psychiatric evaluations (which almost always result in prescriptions)). Read The Goose that Laid the Golden Egg, by Douglas Bremner, for an example of what drug companies do to those who cross them.
Your casual dismissal of financial conflicts of interest is exactly what is wrong with Pharma and biopsychiatry. How would you feel if your wife, son, daughter, mother or father's care was compromised by financially driven decisions?
You think there's nothing wrong with psychiatrists accepting drug company promotional perks because you are both in business? Pharma may be a lot of things, but they are not stupid. They spend that money on you because it is very very profitable for them. And that kind of profit is incompatible with honest science and true care for patients. You can rationalize but you can't make it honest or right. - September 15, 2011 at 8:19 AM
- ketaki said...
i agree with dr.tushar bhat and Dr.Stahl..
- September 17, 2011 at 1:12 PM
Dr. Bhat,
Re Edison's failures: he didn't let his failures stop from further experimentation, but he also didn't pretend to the world that his failures were actually successes, and spend $60 billion/year promoting his failures, convincing the public to buy defective or at best mediocre light bulbs. That's closer to what Pharma and biopsychiatry have done.
Re freebies from Pharma being ok because they are doing businees and "we are part of that.": Pharma doesn't hand out freebies to be collegial - they do it because they know the freebies influence how doctors prescribe. They aren't fools - they don't throw billions in promotion around without getting a payoff for their money. Studies show their marketing and freebies do work - and by "work," I don't mean advance science or provide better care to patients. I mean sell more pills and make more money.
Re your claim that there's nothing wrong with the present relationship between Pharma and psychiatrists, because you "aren't the only field in the world like this." Yes, politicians take money from interest groups, investment banks had cozy relationships with sub prime lenders. Is that the standard you want for medicine? I was a prosecutor for 17 years, and I never once saw a defendant successfully justify his/her crimes by "I'm not the only one who does this." I'm sure I don't have to remind you that your profession deals with human misery and human lives. Surely you don't believe "other people do it" is a justification for short changing those you are sworn to serve. - September 17, 2011 at 6:29 PM
Perhaps Dr. Stahl needs to try treating a severly manic or psychotic patient (outside of a hosptial) with nothing but peace and love. 24/7 until the episode comes to an end. Then perhaps we can get a more reasoned argument out of him.
- September 29, 2011 at 5:17 PM
- Unknown said...
Dr. Stahl's research is phenomenal and he has persevered for many years. I think if you follow (read) the breadth of his life's work you will understand the source of his frustration.
- November 3, 2011 at 5:18 PM


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Deployment Experience: Use Cases
Use Cases are the descriptions of smart grid applications that define the important actors, systems and technologies, and their requirements that are part of the smart grid applications. The Smart Grid Information Clearinghouse (SGIC) provides links and synopses to available smart grid-related Use Cases from trusted sources, such as EPRI Intelligrid and Southern California Edison (SCE). Use the tool below to browse available Use Cases by smart grid domain and year. The search results are sorted alphabetically by information source and title. The link from each Use Case title provides a brief description and the ability to download the full document.
Please note that all Use Cases available in the Clearinghouse are subject to Terms and Conditions set forth by the original repository owners, i.e. EPRI and SCE.


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About Crochetville
The Crochetville forum was founded in 2004 as an online place for crocheters to gather and encourage each other. Everyone is welcome, from the self-taught beginner to the experienced crocheter. Members can get help with a crochet question, join in on a crochet-along , show-and-tell projects, and more. Crochetville is woman-owned by two lifelong crocheters.
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Can two companies in the same industry have very different valuations? In short, the answer is a resounding, yes. Let's take an example of two companies that both have an EBITDA of $6 million but with two very different values. In fact, Business One is valued at five times EBITDA, which prices it at $30 million whereas Business Two is valued at seven times EBITDA, meaning it has a value of $42 million.
Value Difference Checklist
- Revenue Size
- Profitability
- The Market
- Growth Rate
- Regional/Global Distribution
- Management & Employees
- Capital Equipment Requirements
- Systems/Controls
- Uniqueness/Proprietary
- Intangibles (Intellectual property/patents/brand, etc.)
There are quite a few variables on the above checklist that stand out, with the top one being that of growth rate. Growth rate is a major value driver when buyers are considering value.
Business Two, for example, with its seven times EBITDA has a growth rate of 50%, whereas Business One, with its five times EBITDA has a growth rate of just 12%.
Discovering the real growth rate story means answering some pretty important questions.
- Are the company's projections achievable and believable?
- Where is the company's growth coming from?
- Are there long-term contracts currently in place?
- Where is the growth originating? In other words, what services or products are driving growth? Will those services or products continue to drive growth in the future?
- How is the business obtaining its customers for the projected growth?
- How reliable are the contracts/orders?
Ultimately, finding the difference in value between two businesses, that otherwise appear similar, usually resides in growth rate. This is a factor that should not be overlooked. It is essential to know a company's growth rate as well as the key questions to ask regarding its growth. If you are going to obtain an accurate valuation as well as understanding the valuation between different companies, this part of the process cannot be overlooked.


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Monday, September 27, 2010
Employee of the Year
Monday, September 27, 2010
38 comments | Post a Comment
- Bakingdom said...
SO close.
- September 27, 2010 at 9:30 AM
- J. R. W. said...
The flotsam is NOT helping this thing.
- September 27, 2010 at 9:31 AM
- Scott said...
The question mark may be in regards to the retirement rather than the name.
Like, "Please tell us the rumors of your retirent are true. You ARE leaving us, right? We don't have to put up with you here anymore, right?" - September 27, 2010 at 9:33 AM
- Jules AF said...
Maybe they thought they'd make one of those cute curly exclamation points?
- September 27, 2010 at 9:37 AM
why are there jelly beans and cashews in the gravel pit?
- September 27, 2010 at 9:55 AM
- Miranda Jacobs said...
Yak now, up until the beach fell on the road and the huge tractor in front landed there, that cake wasn't looking too awful.
- September 27, 2010 at 9:55 AM
WV - handig
Retiring from driving the front loader meant Mike would have to handig that errant oasis off the road. Is he sure he really wants to retire just now?
~Becky - September 27, 2010 at 9:56 AM
Too bad, because it was a nearly cute cake otherwise. (The mystery patch with the smarties was a bit odd).
- September 27, 2010 at 9:57 AM
- Rebecca said...
Um ... that thing in the middle. Does it look eerily like maggots in a piece of hardtack, or is it just me?
- September 27, 2010 at 10:03 AM
- caferacers66 said...
I am horrible with names but I think I would of found a better way than that... sure is a LOT going on on that cake...
- September 27, 2010 at 10:07 AM
Perhaps Mike will enjoy his retirement playing with all the toys on top of the cake. He does get to keep those. Right?
Is the second table there to have a place to put all the flotsam so they can actually eat the cake? Perhaps putting them on a larger cake board AROUND the cake would have been a better idea. - September 27, 2010 at 10:12 AM
- Shylah said...
Why does it look like there are body parts (particularly a severed head) in that excavated area??
- September 27, 2010 at 10:21 AM
- Jan said...
Awww, that's cute. But they might have expressed disbelief at his retirement with that "?" Either way, it's inadvertently funny.
- September 27, 2010 at 10:28 AM
Best part of the whole cake is the STOP sign. If only the wreckerator had heeded the warning and learned to self edit before plopping two thirds of those items on the cake, or writing the inscription before calling the client and resolving the question mark issue.
I think STOP would be a great theme for a cakewrecks post. Thoughts?
~~Swan - September 27, 2010 at 10:45 AM
- Amanda Mac said...
Guess they were afraid he'd pull a Brett Favre.
- September 27, 2010 at 10:53 AM
Those pesky pterosaur nests, always popping up in the middle of desert road construction! Besides that and an extra tractor or two, it's a pretty cute cake. I hope Mike? liked it!
- September 27, 2010 at 10:54 AM
- Jeff said...
Don't be too hard on them... clearly the cake is under construction.
- September 27, 2010 at 11:09 AM
- Gary said...
I have no ruddy idea what's going on in that scene, but I hope Mike? or whatever his name is has a happy retirement.
- September 27, 2010 at 11:27 AM
- Melinda said...
Jeff gets my vote for best comment of the thread. Ha!
The lettering on the cake is actually pretty nice, but the rest of the decorations are just too much. At least they mostly go together, although I'm not sure what a dinosaur nest has to do with road construction. - September 27, 2010 at 11:34 AM
I know some guys who'd love this.. and since there's a "?" after Mike... they could ALL have it!!
Seriously, though, what's with the candies in the dirt pit? Couldn't figure out how to make rocks? *snort*
Maybe I'm getting too used to Wrecks, as this doesn't seem to qualify other than for the ambiguous punctuation!
'Pull a Favre'...'clearly under construction'... *massive giggles*
wv - uperatic -- a most uperatic scenario -- we only need to add the fat lady, or does the grade-all sing? - September 27, 2010 at 11:39 AM
- mare said...
and, apparently, when "mike"? retires he's going to...do some heavy construction in florida?
- September 27, 2010 at 11:42 AM
So many things to figure out...
What are cashews doing on a cake, and what are they supposed to represent?
What is the 'oasis' made of (please tell me it's not real dirt) and how the wreck did the crew manage to pave -- and stripe -- *under* it? Speaking of pavement, please tell me that is also flotsam -- it looks a tad too real to be safely edible.
What does the flag represent? It's not white, so it's probably not surrender. It has some kind of symbol on it and text underneath, but zooming to the resolution limit offers no clues.
Why wasn't anyone sure who retired or if they retired? Shouldn't that be the first issue resolved when ordering a retirement cake?
Nice attempt at perspective with the different-size construction vehicles, though. At least different-scale flotsam pieces aren't randomly grouped, as they have been on other wrecks. - September 27, 2010 at 12:14 PM
- Stoich91 said...
Mike Matt Mark! :D SO FUNNY! ;)
- September 27, 2010 at 1:20 PM
- Danger Boy said...
This was very funny?
- September 27, 2010 at 1:23 PM
What I wonder is, does Melani's last name really start with an X, or is that there as a substitute?
- September 27, 2010 at 2:07 PM
Love decorating cakes? Win one of Kerry's favorite decorative tools!
Join Fantourage by signing up here - http://fantourage.com/fz/13179/kerry_vincent - September 27, 2010 at 2:15 PM
- Unknown said...
This is the first 'construction' cake I've seen on this site that actually looks all right. If the little traffic cones and such are edible, then even more points.
But I do wonder...is Mike a workaholic and they're just not sure he's going to retire...or has he been in the basement so long that they're not sure of his name anymore a la 'Red Stapler' guy from Office Space?
Confusion with a side of cake. It could be worse, I suppose. - September 27, 2010 at 2:46 PM
- Stephanie McGee said...
No retirement home is complete without paved roads, front-loaders, and bulldozers for entertainment around the watering hole.
- September 27, 2010 at 3:05 PM
- Classic Steve said...
Either they're asking how his retirement's going so far, or they're implying that he needs to show up to work more often.
- September 27, 2010 at 4:08 PM
- Mrs. Q. said...
What the hell did Mike? dig up for a living? Dinosaur eggs? Arms and legs? Giant cashews?
- September 27, 2010 at 4:38 PM
Makes me think of my uncle Carmon's retirement - he was County Road Supervisor (actually, the whole dept., all by himself) for something like 50 years, and all the equipment migrated to his farm/barn, because it was easier. At his retirement party, the bosses asked, "Ummm, you ARE returning all the equipment to the county garage, right?" He replied they were welcome to send guys to get the gear, but he wasn't going to hand-deliver it for 'em, 'cause the walk back would be too tiring at his age (about 72, I think). Eventually, they did collect the grader, the dozer, the trucks, the plows, the schoolbus, and the rest - took weeks!
WV: acinsh - this cake would've been ascinsh to please Uncle Carmon!
Merry at Annie's Book Stop - September 27, 2010 at 4:52 PM
Is that a giant octopus rising from the pit?
Maybe the question mark isn't so much "Will Mike retire?" as it is "Will we all be devoured by the ancient evil we accidentally unearthed?" - September 27, 2010 at 8:02 PM
- Stef said...
that was AWESOME! My brothers are named Matt and Mike, and my dad's name is Mark, so we mess up their names all the time! Haven't messed it up on a birthday cake though... :)
- September 27, 2010 at 10:58 PM
I had a good long laugh at this... because my mother (long-suffering matriarch of seven children) used to utter those very words: "Matt-Mark-Mike-oh whatever your name... clean up this mess!"
- September 27, 2010 at 11:15 PM
The fact they added a question mark to the end makes me wonder what indeed happened to this person?
- September 28, 2010 at 12:20 AM
- Caroline B said...
Mike's the guy who stands on the road with his stop/go sign for the traffic...no-one's sure if he's even employed there, one day he just stopped showing up.....
- September 28, 2010 at 2:20 AM
Maybe Scott is right, and the interrogatory refers to the retirement rather than the name. Mike may have done several Brett-Favre-esque retirement fake-outs.
- September 28, 2010 at 11:16 AM
Maybe he's TRYING to retire and he's finally going to? There are a lot of 'retired' guys where I work. They are retired, but they get called back in because the good engineers are all busy and the incompetent engineers are useless, so they bring in the retired folks to get the job done right. One guy is on his 4th 'retirement' I think.... Good luck to Mike!
- October 15, 2010 at 2:25 PM
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Monocycle is a fast paced arcade game where you have to balance not on a regular bike but on a monocycle. Once the game starts you can only influence if the monocycle shall lean forward or backward. If you lean too much to one side you will inevitable fall and you will break the monocycle. Now you might think it would be a good idea to drive very slowly with almost no slant but this is very, very wrong. You need every little bit of momentum to get past the hills. Otherwise you will come to a halt or even go back. Play Monocycle now for free and show your skills!
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text: Work consists of 39 dinner place settings of porcelain flatware (fork, knife and spoon), porcelain chalice, and decorated porcelain plate. Each setting is laid out on a separate embroidered textile runner. Thirteen place settings are on each side (48 feet long) of a triangular table draped with a white felt cloth, with a triangular millennium runner at each of three corners. Each of the settings represents one of thirty-nine historically significant women. The table sits on a floor of 2304 porcelain triangular tiles (in 129 units) inscribed with the names of 999 significant women. The work is introduced by 6 hanging banners woven in the traditional French Aubusson tapestry technique. These banners and the work itself "express the belief and hope that once reverence for the feminine is reestablished on Earth, a balance will be restored to human existence and 'Everywhere will be Eden once again'." Adjacent to the work in the Brooklyn Museum installation hang 7 photographic reproductions of the original Heritage Panels. The accompanying 3 Acknowledgement Panels are reproduced on the Museum's website. All the elements necessary for the installation of the floor and table including 36 ceramic table leg sleeves were designed and fabricated for the work. The lighting and guard rail that came with the work are in the domain of the Design Department and have been replaced for reinstallation in a permanent space.


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Soft Silk Ikkat SK-4-23-018
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Dixie County Bankruptcy Court
Bankruptcy cases from Dixie County are handled in the Northern District of Florida, United States Bankruptcy Court. The Northern District of Florida is a federal bankruptcy court which handles cases from the following Counties in Florida: Alachua County, Bay County, Calhoun County, Dixie County, Escambia County, Franklin County, Gadsden County, Gilchrist County, Gulf County, Holmes County, Jackson County, Jefferson County, Lafayette County, Leon County, Levy County, Liberty County, Madison County, Okaloosa County, Santa Rosa County, Taylor County, Wakulla County, Walton County, Washington County. The federal courts have 90 different judicial district across the states and U.S. territories (some states have more than one district court).Each district court has a matching bankruptcy court which handles all the bankruptcy cases arising from that jurisdiction.
Can I file my Dixie County bankruptcy case in Northern District of Florida Bankruptcy Court?
If your residence is in Dixie County or the principal place of your business is in Dixie County, you can file your case in Northern District of Florida Bankruptcy Court. Additionally, Northern District of Florida handles cases from all of the following Counties: Alachua County, Bay County, Calhoun County, Dixie County, Escambia County, Franklin County, Gadsden County, Gilchrist County, Gulf County, Holmes County, Jackson County, Jefferson County, Lafayette County, Leon County, Levy County, Liberty County, Madison County, Okaloosa County, Santa Rosa County, Taylor County, Wakulla County, Walton County, Washington County. This is referred to as the court's jurisdiction. Because Northern District of Florida is a federal bankruptcy court, it has a limited jurisdiction of bankruptcy cases arising out of the above Counties. A regular case for breach of contract or tort action needs to be filed in the appropriate Florida State Court (or Northern District of Florida Court).
What is the difference between Chapter 7 and Chapter 13 bankruptcy?
In Chapter 7 bankruptcy, the non-exempt assets of the debtor are liquidated and the proceeds are distributed to the debtor's unsecured creditors. Chapter 7 is the most simple and quickest form of bankruptcy. In 2005 amendments were made to the bankruptcy law to require a "means test" that a debtor must meet in order to be eligible to file for Chapter 7 bankruptcy. If the "means test" is failed, the case will either be dismissed or converted to a Chapter 13 bankruptcy.Chapter 13 bankruptcy allows an individual to keep all of their possessions or assets, but they must devote a portion of their future income to repay their creditors. The debtor must have a regular source of income in order to develop a plan to repay all or part of their debts. In Chapter 13 bankruptcy the payback period is between 3-5 years depending upon the amount of income the individual has.The biggest difference is that the debtor is able to keep all their possessions in a Chapter 13 filing, but must pay back their debt over a 3-5 year period.
Dixie County Bankruptcy Court Clerk
Each bankruptcy court has its own court clerk. The court clerk's office is where documents are filed for the bankruptcy court. The clerk's office (or at least a part where filings are taken) is generally located in the same courthouse as the court.A court clerk can provide legal information, but not legal advice.
What is an automatic stay?
An important part of all bankruptcy filings is what is referred to as an automatic stay. By filing for bankruptcy, an automatic stay is imposed and immediately stops most lawsuits, reposessions, foreclosures, evictions, garnishments, attachments, utility shut-offs, and any debt collection.
What is a bankruptcy discharge?
A discharge in bankruptcy removes the debtor from liability for certain debts (ie. the debtor no longer has any legal obligation to pay the debts that were discharged). The discharge is permanent and prevents the creditor from further pursuing repayment of the debt or contacting the debtor. Put another way, the Debtor is no longer obligated to pay any debts that are discharged.The bankruptcy discharge is a permanent order.Once granted, the Creditor is prohibited from taking any form of collection action on a discharged debt including written communications or telephone calls with the Debtor.The discharge removes the Debtor from personal liability, but any valid lien that was not avoided in the bankruptcy case still remains.Under Chapter 7, a bankruptcy discharge may occur as soon as four months after the bankruptcy petition is filed with the clerk's office.Under Chapter 12 or 13, the discharge occurs only after all payments under the plan which may be about four years after the bankruptcy petition is initially filed.
What is the "means test" for filing Chapter 7 bankruptcy?
If the debtor's income is more than the state median income, they must satisfy the "means test" (If their income is less than the state median income, then they may file for Chapter 7 bankruptcy).The means test takes the the debtor's aggregate current monthly income over 5 years, net of certain statutorily allowed expenses, is more than (i) $11,725, or (ii) 25% of the debtor's nonpriority unsecured debt, as long as that amount is at least $7,025.The debtor may rebut a presumption of abuse only by a showing of special circumstances that justify additional expenses or adjustments of current monthly income.Unless the debtor overcomes the presumption of abuse, the case will generally be converted to chapter 13 (with the debtor's consent) or will be dismissed. 11 U.S.C. § 707(b)(1).
Will I be required to appear in court?
A typical Chapter 7 Debtor will usually not be required to appear in court.The Chapter 7 Debtor will only have to appear in court if an objection is filed.A Chapter 13 Debtor will usually only have to appear before the bankruptcy judge at a plan confirmation hearing. A debtor usually only has to appear at a 341 meeting.A 341 meeting is a usually held at the office of the U.S. Trustee.The meeting is required under Section 341 of the U.S. Bankruptcy Code and requires a Debtor to attend the meeting so the Creditors can ask the Debtor questions about debts and property.
Do I need an attorney?
Corporations, Partnerships, or any other association are required to have an attorney.Individuals can file bankruptcy without an attorney and go "pro per" or "pro se."But, it is very difficult to do as the rules of bankruptcy are very complex. Parties are required to follow the rules and procedures of bankruptcy court whether or not they are represented by an attorney.
What rules govern bankruptcy?
Article I, Section 8 of the United States Constitution authorizes Congress to enact laws related to bankruptcy. The rules and procedures for Bankruptcy proceedings in the United States are written in Title 11 of the United States Code. These rules are called the Federal Rules of Bankruptcy. Under the rules, the bankruptcy judge has jurisdiction to make all the decisions surrounding the bankruptcy case including eligibility and whether a debtor is entitled to a discharge. A large majority of the bankruptcy process is administrative. In certain cases (filed under Chapters 7, 12, and 13), a trustee carries out many of the administrative functions.
What are the different types of bankruptcy?
Six basic types of bankruptcy are allowed under the U.S. Bankruptcy Code.
What is a Chapter 7 Bankruptcy?
Chapter 7, sometimes called Liquidation, allows for an orderly court-supervised procedure where a trustee takes over the assets of the Debtor, reduces them to cash, and distributes the funds to Creditors.This distribution to Creditors is subject to certain exemptions that the Debtor is entitled to.Generally in Chapter 7, there is little to no assets which are nonexempt.This means generally the Creditors will not receive anything under this Chapter.These are called "no-asset cases."A Creditor will only receive a distribution from the Debtor's estate if the case is an asset case and the Creditor has filed proof of the claim with the bankruptcy court. Usually, in Chapter 7 cases, the Debtor is an individual and will receive a discharge that releases the Debtor from personal liability for the debts. This discharge is usually received a few months after bankruptcy is initially filed.In order for a Debtor to qualify for relief under Chapter 7, the Debtor must qualify under a "means test."If the income exceeds a certain amount under the "means test," the Debtor is not eligible for relief under Chapter 7.
What is a Chapter 13 Bankruptcy Case?
Chapter 13 is designed for a Debtor who has a regular source of income. Chapter 13 is preferred by most Debtors over Chapter 7 because it allows a Debtor to keep a certain asset (usually a house), and allows the Debtor to set up a "plan" to repay Creditors over a period of time (usually three to five years).Chapter 13 is also used by individual Debtors who do not qualify for Chapter 7 under the "means test."The confirmation hearing is where the court either approves or rejects the Debtor's repayment plan.In making its decision, the court looks to the requirements for determination under the U.S. Bankruptcy Code.Chapter 13 is different from Chapter 7 because the Debtor usually remains in possession of the property (usually the house), and makes payments to the Creditors for the duration of the payment plan.Also a difference from Chapter 7, is that the Chapter 13 Debtor does not receive a discharge until all the payments required under the plan are made.One other advantage is that the discharge under Chapter 13 is broader than under Chapter 7 (ie. more debts are eliminated).
What is a Chapter 11 Bankruptcy Case?
Chapter 11 is normally used by commercial enterprises that wish to keep operating a business and repay Creditors through a debt repayment plan approved by the bankruptcy court.During the first 120 days, the Debtor has the exclusive right to file a plan of reorganization and provide Creditors with a disclosure statement that provides the Creditors with enough information to evaluate the plan. The bankruptcy court makes the ultimate decision to approve or reject the reorganization plan.Under the plan for reorganization, the Debtor can reduce its debts by discharging some or repaying only a portion of its obligation under the original debt.Under this Chapter, the Debtor undergoes a period of consolidation and leaves with a reduced debt load and reorganized business.
What is a Chapter 12 Bankruptcy Case?
Chapter 12 is written specifically for farmers of fisherman. The procedures under Chapter 12 are very similar to those under Chapter 13. Under Chapter 12, the Debtor agrees to pay a portion of the Debtor's debts under repayment plan (between three and five years).Like Chapter 13, under Chapter 12, there is also a trustee appointed to to disperse payments to Creditors.Under Chapter 12, a fisherman or farmer is able to continue operating a business while the repayment plan is carried out.
What is a Chapter 9 Bankruptcy Case?
A Chapter 9 bankruptcy allows for a municipality (city, town, county, school district or other public entity), to undergo a reorganization that is very similar to that available to commercial enterprises under Chapter 11. This Chapter is only available to municipalities.
What is a Chapter 15 Bankruptcy Case?
Chapter 15 deals with corporate entities where a Debtor or a Debtor's property is subject to the laws of the United States and one or more foreign states.
What is bankruptcy?
Bankruptcy is a process where Debtors are given a fresh start from burdensome debts. It does this through a bankruptcy discharge which releases a Debtor from personal liability of certain debts and prevents Creditors from ever taking action against the Debtor to collect those debts.
What rules apply to bankruptcies in Northern District of Florida Bankruptcy Court?
The procedures of bankruptcy are defined in the Federal Rules of Bankruptcy Court and the local rules.
Dixie County Bankruptcy Court Location
- Tallahassee
Address: 110 E. Park Ave., Ste. 100, Tallahassee, FL 32301
Phone: (850) 521-5001, (866) 639-4615
Email: firstname.lastname@example.com
Hours: 9:00am – 4:00pm


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LC/UPC- LC/UPC, OM3, 2.0mm Multimode Duplex Fiber Patch Cable PVC 5 Meter Aqua - Import
LC/UPC- LC/UPC, OM3, 2.0mm Multimode Duplex Fiber Patch Cable PVC 5 Meter Aqua - Import
Attribute | Specification |
Product Weight | ~0.12 lbs. |
Product Volume | ~12 in3 |
Length | 5.0 meters |
Product Type | Fiber Optic Cable |
This below list may not be a complete list of the applicable countries for this product. Contact us if you are inquiring about a specific country.
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IMP-LCLC-OM3-DX-05M-P.pdf | |
RoHS/REACH Declaration | |
Conflict Minerals Statement |
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A remarkable film; flawed, but deeply captivating.
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