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The American Concrete Pavement Association (ACPA) has named the recipients of its 20th annual "Excellence in Concrete Pavement" awards, which recognize quality concrete pavements constructed in the United States and Canada.
The awards program encourages high-quality workmanship in every concrete pavement project and serves as a forum for sharing information about highly successful projects. Projects are evaluated and voted on by judges from across the country and representing various stakeholder groups in the transportation-construction community.
The awards program recognizes contractors, engineers, and project owners who completed outstanding projects. One of the requirements of the program is that projects must be completed in the calendar year prior to judging, which is why projects described herein refer to dates prior to 2009. Recipients are formally recognized each year during a gala awards ceremony held at the ACPA's annual meeting, this year in Orlando, Fla.
The awards fall into 12 discrete categories applicable to construction and rehabilitation of highways, roadways, and airports, and for the first time, industrial pavement facilities. The awards are presented in both gold and silver levels. This year, several projects tied for top honors in various categories.
The award recipients by category are as follows:
(Note: Any commentary that follows is from ACPA.)
Commercial Service & Military Airports
Gold: Main Base Runway Replacement, Edwards Air Force Base, Kern County, Calif.
Contractor/Engineer: CH2M Hill-IHC, a joint venture of CH2M Hill and Interstate Highway Construction, Inc.
Owner: U.S. Army Corps of Engineers (USACE)
The 15,000-ft x 300-ft main runway at Edwards Air Force Base was the long-standing central hub for U.S. Air Force flight testing missions, as well as the west coast landing site for NASA's space shuttles. Built in 1952, the concrete runway was showing significant distress from alkali-silica reactivity, and thus, required reconstruction. This design-build project required innovation, perseverance, and some creative solutions to address some of the unusual challenges.
Prior to decommissioning the existing runway, a temporary 12,000 ft x 200 ft runway had to be built, as the construction project could not compromise flight operations. In effect, the project actually involved the design and construction of two runways in less than two years. This involved moving 44,000 truck loads of rock, sand, and asphalt, as well as more than 800,000 cu. yds. of earthwork.
More than 445,000 sq. yds. of existing concrete had to be demolished in nine weeks, and then, the crews placed a total of 28 miles of concrete pavement, measuring 33 ft to 38 ft wide and in thicknesses of 12 in., 16 in., and 20 in. Other complicating factors included unstable soils; the discovery of 700 waste drums that required disposal of hazardous waste contents; and even an archeological discovery and preservation of accretions of an old town on the site. Were those variables not challenging enough, crews dealt with the harsh environmental conditions of the high Mojave Desert, with daily temperatures sometimes reaching 110 degrees F, with low humidity and wind gusts oft.en exceeding 25 mph.
Silver: Airfield Runway Upgrade, Johnstown, Pa.
Contractor: Hi-Way Paving, Inc.
Owner: U.S. Army Corps of Engineers
Engineer: PBS&J Corporation
To the casual observer, this design-build, best value project seemed straight-forward enough, but some unique circumstances very quickly created some unanticipated delays that not only threatened the schedule, but also could have had a serious impact on the budget.
During the design phase, a stop-work order was issued, delaying the project by 126 days. Work was scheduled to resume in July 2007, but because of the owner's schedule, it was deferred to 2008. This could have impacted costs, but the contractor quickly developed a proposal to expedite the design and submittal process. It took more than a well-written proposal, however, and the contractor also had to hand-carry documents from Ohio to Nebraska, participate in "over-the-shoulder" plan reviews, shorten turn-around times, and do some informal partnering to get the job done.
The project began on August 22, 2007, and by November 22, the contractor had completed 90% of the project. This involved complete removal of an existing 7,003 ft. long main runway, and replacement with a 16-in. concrete pavement.
The airfield required an adjacent cross runway to remain open for a time, and so the project continued into 2008. The reconstruction of the cross-runway, the final element that served as an intersection between two runways, did not begin until May 2008 Although the contractor had only 30 days to complete the intersection and re-open the adjacent runways, the work was actually completed early.
Safety was, of course, a major emphasis, and thanks to training and the focused efforts of more than 1,500 employees, vendors, and subcontractors, and base personnel, there were no lost-time accidents during the more than 400,000 man hours of the project. The successful completion demonstrated resolve, tenacity, and cooperation among all involved. As a result, the project was actually completed ahead of the scheduled deadline.
Concrete Pavement Restoration (CPR)
Gold: 2007-2008 Airfield Concrete Pavement Rehabilitation at Denver International Airport
Contractor: Interstate Highway Construction, Inc.
Owner/Engineer: City and County of Denver – Department of Aviation
Contractors are accustomed to working in some pretty tight places, but when jet aircraft. are taxiing just a few feet from the workzone, there can be no compromising safety, precision, and attention to detail.
This $17.3 million CPR project involved removal and replacement of 83,000 sq. yds. (approximately 2,000 panels) of 17 in. thick pavement on taxiways and runways, as well as more than 450 in-pavement lights. The project also included 500 cu. ft.. of spall repair, replacement of heavy-duty expansion joints, stabilizing (mud-jacking) 34 panels; joint sealing; and 4,000 sq. yds. of surface grinding.
The project was bid in August 2007, but delayed until 2008, which required that all major milestones had to be completed in the 2008 construction season.
The contractor, Denver International Airport officials, and Federal Aviation Administration officials worked closely during the winter months to develop a workable schedule that would accommodate airfield operations, while allowing construction in four discrete areas.
With aircraft. taxiing only a few feet from the workzone, safety measures were followed unfailingly. This included safety training, weekly safety meetings, and constant monitoring. Foreign object debris (FOD) watchers were placed at critical areas to monitor traffic and clean-up FOD immediately to prevent damage to aircraft..
In addition to the special attention to safety, the contractor also had to address some significant change orders. These included replacing 2,000 sq. yds. of concrete around gate areas; correcting profile to address "heaving" concrete on a high-speed taxiway; an additional 54 light-can replacements; reconstructing a manhole vault; and some emergency sewer repairs.
In spite of the challenges of this project, the key milestones were all completed ahead of schedule, and as a result, the runway was opened 17 days earlier than expected.
Silver: Cimarron Turnpike Pavement Rehabilitation
Contractor: TTK Construction Company, Inc.
Owner/Engineer: Oklahoma Turnpike Authority
Restoration of the Cimarron Turnpike could have just been an ordinary project, but when the contractor saw an opportunity to save the Oklahoma Turnpike Authority some money, the project quickly turned from ordinary to extraordinary.
The turnpike was first built to provide a convenient, four-lane highway from Tulsa to northwest Oklahoma. Constructed in early 1970, the pavement lasted for more than 38 years, but D-cracking and base failures necessitated removal and replacement of some of the slabs, and patching in other areas.
The contractor saw an opportunity to submit a value-engineering proposal to make some significant changes to the pavement section. This involved deleting the compacted subgrade; a 4 in. open-graded concrete base; a geotextile separator fabric; and silicone joint sealant. Instead, TTK Construction Company recommended (and the Oklahoma Turnpike Authority approved) a 10 in. cement modified subgrade and hot-pour joint sealant. The result was a greater than $456,000 net savings to the turnpike authority.
All pavement outside the slab replacement areas were dowel-bar retrofitted and diamond ground. Prior to the CPR project, the pavement measured 27.5 in./lane mile using a 0.2 blanking band, but aft.erward, the smoothness was 4.75 in./lane mile. During the construction phase the contractor faced some weather delays, but neither those delays nor the design changes prevented the TTK crews from completing the project on time…and at a significant savings.
County Roads
Gold: William White Blvd. (defense access road), Pueblo County, Colo.
Contractor: Castle Rock Construction Co.
Owner: Pueblo County, Colo.
Engineer: Short Elliot Hendrickson Inc.
Rugged terrain, harsh weather, potential disruptions to local businesses, and the unique needs of a U.S. Department of Defense (DoD) facility might seem the stuff of nightmares, but not for people involved in this unique county road reconstruction project.
William White Road connects State Highway 47 with the Pueblo County Airport, which is a DoD installation surrounded by a number of defense contractors. The existing asphalt was badly distressed and so, the decision was made to both reconstruct and build new sections with concrete. The 2.6-mile long project consisted of 98,700 sq. yds. of 10 in. doweled and grooved concrete pavement; 5,000 sq. yds. of concrete driveway; and 15,000 ft. of integral curb and gutter. The concrete pavement was 65 ft. wide in the reconstruction area and 60 ft. wide in the new construction area. The entire reconstruction area required excavation to a depth of 3 ft., with no disruption to utilities, which included fiber optics, water, phone, and sewer.
To avoid disruption to area business access, the pavement was reconstructed in half-width sections, leaving gaps at businesses for access during peak hours. The reconstruction sections had to be completed within 120 days, which required some paving in the winter months.
The terrain also was a factor, because the site is in the high-plain desert region, which has several arroyos (dry stream beds that tend to fill with water quickly and unexpectedly aft.er heavy rains). As such, reinforced concrete pavements or box culverts had to be installed before fill and subgrade preparations were made. Crossing the inlets was a challenge for the paver, so the side form was modified and special blocking was added to prevent the paver from falling into the inlets.
There also was a bridge that had to be resurfaced to account for the raise in profile elevation. The bridge also presented a challenge because it was 6 ft. narrower than the concrete pavement, so a significant amount of the work was done by hand. In spite of the challenges, the crews completed the project on time, within the budget, and with as little impact as possible to the traveling public, areas businesses, and the airport.
Silver: Polk Township 270th Street
Contractor: Loch Sand & Construction Co.
Owner: Polk Township, Missouri
The good news is this farm-to-market road seemed like a convenient way to bypass traffic associated with nearby business and industry, as well as a convenient way to get to two routes north and south of nearby Maryville, Mo.The bad news was that driving on the gravel and rough asphalt pavement sections probably added more adventure and a few more jolts than motorists desired.
The 270th Street project in Polk Township was the last road to be paved among a network of roadways reconstructed in the area recently. Along with the other Polk Township projects, this was a design/build project, and because it connected to existing Missouri DOT right-of-way roads, had to be designed carefully to meet the agency's specifications.
The project used the existing road profile, with some minor adjustments to improve the site distance and entry points off the main arteries. The new road required some excavation, including realigning a ditch for adequate draining, as well as removal of the existing roadway and re-grading and re-compacting the existing subgrade. With that work completed, a new 7 in. concrete pavement with 15 ft. joint spacing was placed.
Transitioning to concrete pavement from the previous asphalt and gravel sections would just naturally be an improvement, but the contractor's use of an optimized concrete mixture, global positioning satellite technology, and attention to detail made a good concrete pavement even better. Thanks to the quality design and construction, road users now have a reliable road they can use to connect to the two separate routes north and south of the area.
Divided Highways – Rural
Gold: Interstate-25, Cheyenne to the Colorado State Line
Contractor: Interstate Highway Construction, Inc.
Owner/Engineer: Wyoming Department of Transportation
Even a quick glance at the schedule for this project would have led most people to sum it up with a single word—impossible.That word is evidently not in the vocabulary of the contractor and agency involved in the reconstruction of Interstate-25, from Cheyenne to the Colorado state line.
The 4th of July holiday period, very quickly followed by the Cheyenne Frontier Days for 10 days in late July gave plenty of reasons to celebrate in Wyoming, but for the people involved in this project, the events added to the complexity of a 212-day project window to place 7.64 lane miles of 10-in. concrete. Were that not challenging enough, deep, soft. subgrade and extremely high and damaging winds added to the drama of finishing this project on time.
Interstate Highway Construction had to remove and replace an almost 50-year-old plain concrete pavement on the northbound lanes of the interstate and replace the sections with jointed, doweled concrete pavement and concrete shoulders.
The project also included rehabilitation of four bridges, and overlay of the port-of-entry (while replacing static and weigh-in-motion scales); installation of median cable guardrail; new right-of-way fencing; a roadway management system; interchange lighting; and a winter road-closure station. More than 2,500 heavy trucks, along with passenger cars traveling the route also presented traffic control challenges. The project required close coordination of construction with train schedules because of bridges that crossed over railroad tracks.
Value engineering proposals to crush the concrete on grade, and to substitute geotextile for the lime-stabilized subgrade, not only saved money for the agency, but also allowed the project to be completed quickly. The project was the first in Wyoming to feature a longitudinally tined texture. Innovation, hard work, and attention to detail allowed the contractor to finish the project early … and to earn 100-percent of available incentives for thickness and 63% for smoothness.
Silver: Interstate-70 Reconstruction, Saline County, Kansas
Contractor: Koss Construction Co.
Owner: Kansas Department of Transportation
Many people talk about partnering, but this contractor and agency once again demonstrated how mutual trust, respect, and communications can produce high quality, smooth pavement that will serve the citizens of Kansas for many years to come.
Reconstructing 26 lane miles of a divided, four-lane highway can be a daunting task to complete in any circumstances, but when the project involves new technologies and several surface textures, the challenges can be almost incalculable.
Not so for Koss Construction, which partnered with the Kansas DOT to build 4 miles of the eastbound roadway using a two-lift. concrete paving process with seven different surface types Although two-lift. paving process is common in Europe, it has had extremely limited applications in the United States. If this were not challenging enough, there were seven different surface types.
Innovation was a key emphasis, not only because of the two-lift. construction and different surfaces, but also because the top lift. used two different mix designs. The contractor also used rhyollite admixtures with a special interground performance enhanced pozzolan made from Class F fly ash to mitigate alkali-silica reactivity on the top lift.'s mix design. Other innovations included an exposed aggregate section, in addition to the traditional surfaced and ground sections. Another innovation was a knife mounted under the paver pan to create a center line joint that did not require sawing or sealing.
In support of this project, Koss provided 19 experienced supervisors to manage a workforce of 165, underscoring the company's serious commitment to quality and workmanship. Koss used its own quality control laboratory and highly qualified personnel to administer the QC plan that was approved by the owner. As a result of this teamwork, backed by experience, expertise, hard work, and extra effort, the citizens of Kansas now have an innovative, high quality, smooth pavement they can be proud of for many years.
Divided Highways – Urban
Gold: Interstate-75, Birch Run Creek to Bridgeport Interchange, Saginaw Country, Mich.
Contractor: Interstate Highway Construction, Inc.
Owner: Michigan Department of Transportation
Engineer: Rowe Professional Services Co.
Removing and replacing an urban pavement is challenging, but when the project also involves bridges, storm sewer pipes, and other elements, the project becomes even more complex. None of the challenges was a match for the innovation, experience, and skill of the people involved in this difficult project.
The $50 million Michigan DOT project involved reconstruction of 6.5 miles from Birch Run Creek to the Bridgeport Interchange. The contractor removed and replaced three lanes of existing concrete pavement, but the project also involved widening to the median, adding a fourth lane, valley gutter, and a permanent barrier wall; and reconstruction of a park-and-ride facility. Adding to the complexity was the removal, replacement, and widening of four bridges.
Storm water pipes up to 25 ft. deep added to the complexity of the project, as each required substantial deep sheeting and dewatering to accommodate the traffic while the storm sewer was placed in phases. To help mitigate public impacts, a moveable barrier wall was used to provide three lanes of traffic in the high flow direction — northbound for heavy recreational traffic on the weekend, and southbound for traffic returning to the Detroit area.
A new barrier gate system, the first of its type in Michigan, was installed in the median barrier wall to allow authorized vehicles entry with a key code. This provided critical access to the opposite roadway without going to the nearest interchange, while also allowing fast action in emergency situations.
The project also required a five-year material and workmanship warranty on the concrete pavement, and in response, the contractor used an internal quality control (QC) program that involved a detailed, job-specific QC plan and the requisite documentation to meet the DOT requirement.
The project had no major accidents and no lost-time. With a sharp eye on quality, the contractor earned 85 percent of the available incentive for strength, and 100 percent for the smoothness on the mainline paving. Equally important, road users now have an excellent section of Interstate that will provide years of quality service.
Silver: Interstate-355 South Extension (I-05-7709), Will County, Ill.
Contractor: K-Five Construction Corp.
Owner: Illinois State Toll Highway Authority
Engineer: Harry O. Heft.er Associates, Inc.
Placing a quarter million square yards of concrete pavement and appurtences in 15 months is a daunting task in even the ideal conditions, but when four months of that schedule are lost to harsh winter weather, it's easy to see why this project was especially challenging.
K-Five Construction placed about 4.3 miles of new pavement on the northbound and southbound lanes of I-355 in suburban Chicago, along with median and outside bituminous shoulders in each direction and cast in place median concrete barrier wall as the divider. The contract was one of several awarded by the tollway authority and one of four projects constructed by the contractor. All told, K-Five constructed more than 400,000 sq. yds. of concrete pavement on the four projects, and this particular project, at 250,000 sq. yds. of concrete, represented the longest project with the most concrete paving of all those awarded.
K-Five had to coordinate other projects that interfaced with this project, including construction of four cross-road bridges, a toll plaza facility, and fiber optic cable installation.
Temporary bridges and creek crossings were constructed around the two bridges being built on the mainline portion of the highway.
Subcontract activities had to be coordinated carefully because of the limited capacity of the creek crossings, as well as in consideration of environmental factors. The mainline bridge construction also had to be coordinated and staged to ensure the paving equipment could cross the completed bridge decks and to ensure the schedule was maintained.
If the 11-month window for paving did not present enough challenges, near record rainfall in the fall of 2006 and the summer of 2007 further delayed progress, and in fact, so much so, that the tollway authority ordered acceleration to maintain the original completion date.
Among the innovations on this project were 10 experimental test sections implemented under the aegis of NCHRP 10-67 Experimental Surface Texture Study. Of those, two were test sections added at the request of the ACPA Noise and Surface Characteristics Task Force. This project presently serves as one the concrete pavement industry's test sites for its "Next Generation Concrete Surface."
Another innovation was the use of a compact dowel bar inserter directly on the slipform paver, thereby eliminating placement of dowel baskets.
This was the first such use of this equipment in the state of Illinois. Innovation, attention to detail, and excellent quality are all hallmarks of this project, which will serve motorists in one of the nation's busiest metropolitan areas for years to come.
Silver: Interstate-235, IM-NHIY-0235-1 (092) 003, in Oklahoma County
Contractor: Duit Construction Co., Inc.
Owner: Oklahoma DOT
Engineer: The Benham Companies, LLC
It seemed only logical that Oklahoma's largest single project in terms of its more than $29 million value, should have a 500-day schedule to complete all the work. Aft.er all, the project included the removal of sections of 4-lane, divided highway near downtown Oklahoma City, placement of a 6-lane divided highway with an extra high-occupancy vehicle lane and ramp lanes. It also included replacing two bridges and the addition of $5 million in decorative retaining walls and sound walls in the area.
Although 500 days were allotted, Duit Construction bid only 439 calendar days, then went on to complete the project in only 396 calendar days. A+B specifications were used to help ensure timely completion. The project also had penalties on lane rentals and some internal milestones, including a $135,000 per lane per 24-hour period whenever the lanes were shut down due to construction. Given the contractor's exceptional performance in constructing under traffic and ahead of schedule, Duit achieved 45% of the time incentive, or $645,000. In addition to the durable, reliable highway sections, motorists, area residents, and other citizens will also enjoy the aesthetics of buffalo and scissortail flycatcher birds, which adorn the newly-constructed retaining and sound walls.
Industrial Pavements
Gold: Oklahoma Welcome Centers' parking areas, STPY-136E (127) EH in Kay County/STPY-105 (138) EH in Beckham County, Oklahoma
Contractor: Duit Construction Co., Inc.
Owner: Oklahoma Department of Transportation
Engineer: Tetra Tech FHC
There is a lot to be said about first impressions, and for the drivers of more than 42,000 cars, trucks, and recreational vehicles (RV's) crossing into the Sooner State from Texas or Kansas, the Welcome Centers on Interstate 40 and Interstate-35 stand to make a very good impression, thanks in part to concrete pavement.
The facilities include parking areas, restrooms, pet areas, watering fountains, and RV facilities, and feature displays of native American culture that is so closely tied to the state's heritage.
Duit Construction Co., Inc. was the prime contractor/site work contractor on both projects and worked closely with the general contractor, Atlas General Contractors, which constructed the buildings on a separate contractor. As site-work contractor, Duit constructed a water system, including a stand pipe and sewage system lagoons; demolished original facilities; and prepared the building pad for Atlas.
The pavements were constructed in 8 in., 9 in., 10 in., and 11 in. thicknesses and from two different concrete mixes.
Duit had to address complex patterns in the joint design and construction, and used guidance from ACPA to ensure proper types of tied- and doweled-joints were used. Some 34 different radii made the joint layout challenging, and so, numerous tapers were included to ensure against premature failure.
Completion of both projects was timed to meet scheduled grand openings, which in turn, coincided with the 100th year celebration of Oklahoma's statehood. The new welcome centers, featuring bright and aesthetically pleasing concrete pavements and ramps to and from the highways, will stand as a gleaming beacon to motorists for many years to come.
Silver: Williston Point Road Improvements, Fort Riley, Kans.
Contractor: Smoky Hill, LLC
Owner/Engineer: U.S. Army Corps of Engineers
Tight curves and steep grade can present challenges to any construction project, but when those condition exist on a busy thoroughfare, the challenges are even greater.
Williston Point Road is one of the busiest routes on the U.S. Army's Fort Riley military installation.
The existing asphalt pavement had quickly deteriorated, so it was removed and used as surfacing on the shoulders. The new pavement section was a 24 ft.. wide, 9 in. doweled, jointed concrete pavement with a 6 ft.. aggregate shoulder. The project also included six reinforced concrete boxes, two of which were triple 12- by 12-ft.. boxes, required temporary detours to move traffic safely around the construction areas.
The terrain also presented some challenges during construction. Some of the rock cuts exceeded 25 ft.., and fills were required to eliminate both a hairpin curve and some of the steepest grades. Even with these improvements, the project had superelevations and 6-percent grade.
In fact, a 200 ft.. diameter roundabout was built on a 4.85-percent grade. The project also had a mandatory construction window of 6 months aft.er the initial road closure. The work also included major tree clearing, rock excavation, blasting, and earthwork, all of which required close coordination to keep earthwork, bridge work, and paving on schedule.
Municipal Streets & Intersections (Greater than 30,000 Sq. Yds.)
Gold: State Highway 59: Donkey Creek to Interstate 90, Gillette, Wyo.
Contractor: Concrete Works of Colorado, Inc.
Owner: City of Gillette, Wyo.
Engineer: WWC Engineering
What do you get when you combine harsh weather, a tight schedule, and some complex construction details with the busiest traffic corridor in the state of Wyoming? The answer for those involved in this construction project was a well-orchestrated project completed ahead of schedule.
Concrete Works of Colorado, Inc. planned to complete in one season the reconstruction of Highway 59 from Donkey Creek (to the south) to the Interstate-90 interchange (to the north). The project involved removal of severely distressed asphalt pavement, and then, replacement with more than 81,000 sq. yds. of 9 in. concrete pavement, as well as widening Highway 59 though the City of Gillette. The widening resulted in the equivalent of 10 lanes (three through lanes in each direction, as well as double left.-turn lanes at all intersections and shoulders).
In addition to the paving, the project also involved 10,000 feet of curb and gutter; a raised, colored median and median skirt; a sidewalk/bike path; precast box culverts; and a range of other items that would have proved daunting for even the most experienced road builders.
Making matters even more interesting, the subgrade preparation for the project included excavation of some 50,000 cu. yds. of unclassified material and muck, with as much as 8 ft. of unsuitable materials being removed and replaced in some areas. Twelve inches of crushed rock subbase and 4 in. of crushed rock base course were placed on a geo-grid of geotextile fabric.
The project was constructed in numerous phases and sub-phases, which required more than 25 individual bulkheads in both the northbound and southbound directions. Of course, very harsh weather conditions also threatened to slow the project, but the weather was no match for the tenacity, dedication, and hard work of all involved. The contractor earned significant smoothness incentives and earned a $1 million early completion bonus.
Silver: Havana and 40th – Stapleton Filing 7, Denver, Colo.
Contractor: Castle Rock Construction Co.
Owner: Forest City | Stapleton, Colo.
Engineer: J.F. Sato
Just a few of the challenges of this roadway reconstruction project were to pave in the dead of winter; while also meeting sustainability requirements, including environmental concerns and aesthetic considerations.
The project involved reconstruction of Havana Street from Interstate-70 to Smith Road, as well as new construction on 40th Ave. in Denver.
Castle Rock Construction Co. completed the project, which consisted of 38,700 sq. yds. of 10.5 in. doweled and grooved concrete pavement; 900 sq. yds. of 8 in. concrete pavement; 15,000 ft. of curb and gutter; media cover; and sidewalk. The project was aimed at widening Havana St., while also providing better access into the Stapleton Redevelopment area, as well as surrounding area.
Also, because the project encompassed two railroad crossings, special agreements had to be reached between the owner and the railroad. The agreements were not in place at the time construction began, so the paving sequence had to be changed to meet the schedule.
As a result, the contractor had to pave in December and January, which required a plan for snow removal, ground-frost prevention, and cold weather paving. To prevent ground frost, the contractor used ground heaters and cover, and when the falling temperatures required additional measures, the contractor used heated water to product concrete in a wet batch plant.
The contractor used a special cement containing fly ash to meet environmental programs established by Forest City, the City of Denver, and Colorado Bill Governor (D). The design of 40th Ave. also was changed from solid concrete from curb-to-curb to landscaped median islands, which made the project more aesthetically pleasing.
Municipal Streets & Intersections (Less than 30,000 Sq. Yds.)
Gold: South Main Street Design/Build Project, 1st St. to Halsey St., Maryville, Mo.
Contractor: Loch Sand & Construction Co.
Owner: City of Maryville, Mo.
Engineer: Snyder & Associates
After the winter months ending in March 2008, Maryville, Mo., city officials realized there was a serious problem with a 2,400 lineal ft. section of South Main St.
The existing roadway, which was comprised largely of asphalt overlays, had deteriorated to the point the city was dumping and grading rock on the roadway as a daily maintenance routine. With Main Street as the primary artery for the city, and with a population of about 20,000 college students, officials determined something had to be done quickly.
Although taxpayers in April 2008 approved a capital improvement program tax, the problem was discovered a few months prior, so the city advertised it as a design/build project.
The contractor proposed removing the deteriorated roadway a full 32 feet in width, and then, placing concrete pavement, as well as curb and gutter. To manage the project, while allowing access for all affected, the contractor built the project in two phases. The first was a section of two city blocks, where most businesses are located, then phase two would include the rest of the project. As part of the phase two work, Loch quickly found some unsuitable subgrade, which had to be addressed. In all, the project consisted of 8,117 sq. yd. of base; 6,297 sq. yd. of mainline paving; 2,790 ft. of curb and gutter; and 2,198 sq. yds. of sidewalks and driveways.
Weather also was a factor, but not enough to slow down the project. Although the contractor had 5-1/2 months to complete the project, the work was finished a month ahead of schedule.
Silver: Intersection of Douglas & Oliver St. Improvements
Contractor: Pavers Inc.
Owner: City of Wichita, Kans.
Engineer: K.E. Miller Engineering
Reconstructing this busy intersection was important because the four narrow lanes, with no controlled left. turns had become the scene of numerous automobile accidents. At the same time, the needs of area businesses also had to be considered.
The city's plan called for widening the intersection to five lanes, with dedicated turn lanes, new traffic signals, and brick crosswalks.
With 40 businesses adjacent to the roadway, the city promised business owners that all work would be complete by October 31, 2008, assuring them construction would not spill into the prime holiday shopping season.
To assure on-time completion, the city had a specified daily damage rate of $5,000 per calendar day for each day past the deadline, as well as a like incentive per calendar day, up to 20 days or $100,000 for if the work was complete and the road open to unrestricted traffic.
Prior to the start of construction, the contractor and city officials met with business owners to lay out the plan. A number of business owners expressed opposition, fearing they would not have access to their property. The contractor not only assured access, but also offered to assist with deliveries, including unloading trucks in the direction of traffic, as well as carrying items to the door. The contractor also worked closely with the phone company, energy company, and gas utility to ensure major utility relocation, as well as to safeguard against service disruption. The contractor even developed a separate traffic control plan to install new waterline system and services along with the majority of the sewer system. Although the utility work and relocation took three hours longer to complete, the contractor and city developed a plan to reduce the phasing from four to three phases.
The final result was the contractor opened the road to unrestricted traffic 21 days ahead of the October 31, thereby earning the $100,000 bonus.
Silver: University of Michigan-Flint, Kearsley Street Reconnect
Contractor: Angelo Iafrate Construction Co.
Owner: University of Michigan
Engineer: Rowe Professional Services Co.
The idea of reconnecting two University of Michigan-Flint (UM-Flint) campus facilities with the downtown area was part of the City of Flint's traffic-pattern master plan. The plan called for re-establishing the connection between the cultural center located on the east side of Interstate-475 with the main campus and downtown areas, located on the west side of the same highway.
The project called for the removal of the existing asphalt, concrete curb, and aggregate base, and construction of a 4 in. aggregate base and 9 in. concrete pavement.
The intersection of Kearsley St. and Wallenberg St. was determined to be the gateway point, and as such, most of the aesthetic features were designed for this area. Three logos were applied in the area, with two in the sidewalk crossings and the third in the intersection.
The intersection logo consisted of three colors of concrete and two separate stamp patterns. The concrete crosswalks were a red blend with an old brick herringbone pattern. The intersection concrete was an integral colored concrete (caramel bluff) and was stamped with a Roman slate texture. The UM-Flint logos were applied on the colored concrete using a water-based pigment. A custom template was laser-cut from steel , and then bush hammers were used to remove about ¼ in. of concrete. Next, a water-based pigment was applied to complete the logo. The result is greater access and mobility, as well as a durable and aesthetically pleasing pavement that will last for many years.
Gold: Interstate-77 Reconstruction Design-Build project, Yadkin County, N.C.
Contractor: The Lane Construction Corp.
Owner: North Carolina DOT
Engineer:HDR Engineering, Inc. of the Carolinas
The use of overlay technology, and more specifically, an unbonded concrete overlay on the existing concrete roadway, helped the contractor address the challenges presented by a very tight schedule and some stringent traffic control requirements. The project was a total of 26.1 lane miles and used 11 in. thick concrete for mainline sections, 13 in. in full depth reconstruction areas, and 9 in. on ramps and loops.The overlay was placed on existing continuously reinforced concrete with 1.5 in. of surface course bond breaker, while the FDR areas used 6 in. of stone and 4 in. of asphalt base course.
The concrete pavement portion of this design-build project was scheduled to begin in mid-September 2007 and was scheduled for completion in May 2009. The contractor completed the project in November 2008, almost six months ahead of schedule.
Because of holiday and seasonal restrictions, Lane had very short time windows to complete the work on various sections before they needed to be re-opened to traffic. To address the challenge, the projects were separated into multiple sections that allowed completion of each section over a span of two to three months.
Traffic had to be in a two-lane pattern, and the contractor could not close or narrow a lane during holidays, summer weekends, or during NASCAR sporting events taking place in nearby Charlotte, N.C. The design-build team solved the challenge by placing a detour the entire length of the project, allowing for a two-lane crossover pattern in the median. The challenge also was met by completing the concrete paving in phases. Because the ramps, loops, and bridge tie-ins could only be closed for 11 days, the construction team worked around the clock to complete the work during these closures.
One innovation used on the project was the use of wireless maturity testing. The process, which involved a wireless, hand-held device that collected data from microprobes in the concrete, helped estimate the time at which the new concrete obtained sufficient strength to allow construction equipment onto the slabs to continue the next phase of construction.
Gold: Project NHY-033N (012), Sequoyah County, Okla.
Contractor: Duit Construction Co.Inc.
Owner/Engineer:Oklahoma DOT
U.S. 59 passes through some very scenic views in Sequoyah County. Motorists travel along steep, 7-percent grades past Wildhorse Mountain and along Robert S. Kerr Lake, but the roadway was experiencing premature deterioration.
The one-year-old, 10 in. asphalt pavement placed on 8 in. of lime-treated subgrade in this location was shoving, heaving, and rutting severely.Facing imminent and complete failure of the pavement, the Oklahoma Department of Transportation (ODOT) decided to correct the problem with a 7 in. doweled jointed plain concrete pavement. Like many agencies, ODOT was facing a shortage of roadway funds and had to use maintenance funds to repair the roadway. Luckily, bids for the project came in 22.5 percent below the engineer's estimate.
Time was critical, as only 30 calendar days were allotted for the project, which involved 1.61 miles of four-lane divided highway, for a total of 7.05 lane miles. The work was done in two phases and involved moving daily traffic (estimated at 7,120 vehicles/day, of which 21 percent was truck traffic) in a two-lane, head-to-head configuration while the adjacent side was repaired.
When Duit Construction Co. arrived on the scene, the northbound lanes had to be closed before they failed completely. Duit's crews repaired and overlayed the northbound lanes first, then switched traffic and completed the southbound lanes, ultimately completing the job within the 30 day schedule.
During the planning stage, typical sections were drawn by hand in a set of contract plans just three pages long. ODOT District I Engineer Darren Saliba and his staff were credited with the idea of preparing the simple set of roadway plans in order to complete the design in a timely manner. This allowed ODOT to bid the project quickly to make the repairs before the roadway failed.
An optimized gradation mixture design using the Shilstone method were credited with creating a concrete pavement that is strong, long lasting, and cost effective. The average compressive strength of the concrete was 4,460 psi for the mainline sections. ODOT uses what is called a Class AP concrete on the shoulders. The mixture is about 1,200 psi less than mainline sections. Although there were some concerns about using dowels on such thin slabs, as well as with using a automated dowel-bar inserter, Duit credited proper stringline practices and proper maintenance of the automated dowel-bar inserter with a problem-free approach to the concerns.
One other challenge was that, just to the north of this project, there was another reconstruction project going on, making coordination of the projects challenging and adding complexity to the lane switches and overall traffic management.
Gold: US-131 Concrete Overlay, Kent County, Mich.
Contractor: Ajax Paving Industries, Inc.
Owner: Michigan DOT, Grand Rapids Region
Engineer: Michigan DOT-Grand Rapids Transportation Service Center
The Michigan Department of Transportation's (MDOT's) final link in the improvements on U.S. 131 from Ann Street in Grand Rapids to 17 Mile Road in Cedar Springs was a 6.5 in. concrete overlay project of 26 lane miles of the highway.
The U.S. 131 corridor north of Grand Rapids has experienced tremendous growth, and following that growth, traffic volumes have increased significantly.
One of the challenges of this project was a bridge over 6 Mile Road on southbound US-131. The bridge is narrow and was not able to handle conventional construction traffic configurations. The project used MDOT's split/merge traffic plan, which enabled two lanes of traffic to be maintained in each direction.
There was a considerable effort to correct the old roadway's parabolic surface, superelevation, and crown-cross slope to bring the road up to current standards.
Ajax Paving Industries, Inc. placed the 6. 5 in. unbonded concrete overlay on the existing 40-yr-old concrete pavement, using a 1 in. asphalt separator layer. The original pavement was on a 6 in. aggregate subbase on 12 in. of sand subbase.
Some full-depth reconstruction was required at areas under bridges where the roadway passed over the freeway or transitioned down to bridge decks on the freeway and over streams or local roads. (The areas requiring reconstruction used 10.5 in. of concrete.)
A Shilstone-type well-graded concrete mixture, with three aggregates, was used. The mixture, which contained 40 percent slag cement, used only 294 lb/cu. yd. of portland cement.
Prior to beginning the paving, the contractor identified areas on the existing pavement that had "tented" because of incompressibles in the old pavement joints, and improper expansion joint maintenance during the life of the original jointed reinforced concrete pavement. The repairs had to be made in a manner that the additional traffic from the traffic control switch would not degrade the roadway during construction.
The peak-hour traffic was very high, because the highway is used as a commuter route and a weekend destination route to northern areas of Michigan. The contractor handled all of the challenges presented on this project.
Reliever & General Aviation Airports
Gold: Delphi Municipal Airport Runway 18-36 Rehabilitation (AIP 1-18-0117-09)
Contractor: E&B Paving, Inc.
Owner: Delphi Board of Aviation Commission
Engineer: NGC Corp.
This airport was the first full concrete overlay to be build on an airport runway in Indiana. Initially built in the early 1970's the 2,652 ft.. asphalt pavement runway was poorly drained and in need of complete rehabilitation. The airport's consultant, NGC Corp., initially designed a 5 in. asphalt overlay over a full-depth repaired (FDR) base. Because of sharp increasing in hot mix asphalt costs, an alternate design using 5 in. of concrete on FDR was developed.
After discussions with potential bidders, a third alternate was developed for greater than 5 in. of concrete on the existing asphalt surface. When the project was let, the third alternate was 22 percent lower than the original bid for asphalt on FDR.
E&B Paving and NGC Corp. worked closely to find efficiencies and reduce the actual contract time down to 38 days, primarily by eliminating a second pavement marking application. The initial 5 in. P-501 thickness was increased to 5.75 in. to ensure a 1.25-percent cross slope from the center line, funding for which came from revising other contract items downward. The contractor paved in 20 ft.. wide lanes and placed about 1,300 lineal feet per day, completing the paving in six days.
Profilograph testing revealed extraordinary smoothness, allowing E&B to achieve a maximum 106 percent pay factor for both smoothness and strength based on P-501 percent within limit requirements. The overlay project saved the Delphi Board of Aviation Commission about $200,000 against a $900,000 rehabilitation budget. As a result of this success, three more concrete overlay projects, at this writing, have been bid at other Indiana general aviation airports.
Silver: Construction at Paulding County Regional Airport, Dallas, Ga.
Contractor: APAC – Tennessee, Inc.
Owner: Paulding County Regional Airport, Georgia
Engineer: The LPA Group Inc.
Georgia's newest airport in approximately 25 years is not only part of an award-winning master plan, but also stands as a testament of how value engineering and long-term benefits factored into the use of concrete pavements. The project also underscores concrete's sustainability benefits, as the pavement plays an important role in protecting endangered species.
The airport was planned as a key component of Paulding County's long-term economic development strategy. The master plan for 10,000 acres of planned development and greenspace received the U.S. Economic Development Administration's Excellence in Economic Development Award in 2007.
One significant challenge was to find a way to protect the Cherokee darter, a small fish on the federal endangered species list. Although the airport construction was not considered to impact directly the streams where the darters have been found, the small fish are sensitive to temperature change, and so, there was a concern that runoff from an asphalt pavement would increase the temperature of the streams. The LPA Group and the Fish and Wildlife Services, developed an innovative stormwater management plan, but there was still concern about the temperatures of the asphalt. The permitting agencies realized concrete is cooler than asphalt, which sparked interest in using concrete pavement. Also, it was determined the projected cost of an asphalt overlay in approximately 10 years would exceed the additional initial cost of using concrete, the decision was made to use concrete pavement.
The design team coordinated with the contractor and ACPA for value-engineering to meet the available funding, and as a result, the team was able to reduce the amount of steel, while still meeting FAA criteria. APAC-Tennessee placed 135,820 sq. yds. of 10 in. concrete pavement with 12.5 ft.. join spacings. One of the significant challenges was that the grand opening of the airport was set before the project was ever awarded. Interim milestone deadlines were established, and APAC-Tennessee finished the project on time. The airport was officially opened to traffic in November 2008, and since then, pilots have reported the airport runway is one of the smoothest on which they have ever landed.
State Roads
Gold: Reconstruction of U.S. 34 in Union County, Creston, Iowa
Contractor: Cedar Valley Corp.
Owner: Iowa DOT
This project generated some major concerns, because the city of Creston would have been temporarily divided in two if the highway were closed. Numerous businesses were vocal with the Iowa DOT in expressing they wanted no disruption to commerce during the reconstruction project.
The 49 ft.. back-to-back paving was staged one half at a time to maintain traffic, and the plans called for continuous access to the highway or designated side streets for all businesses and residents along the highway. The staging was developed around the concerns, and called for dividing the project into eight work areas, four on each side of the existing highway to minimize impact to local businesses.
Immediately aft.er the award of the project, Cedar Valley Corporation submitted a revised, detailed schedule to the Iowa DOT Engineer. The schedule improved constructability and expedited the construction period by cutting the staging from four phases to two. At a public meeting prior to the pre-construction meeting the contractor had the opportunity to address many of the most serious issues and concerns. With the concerns addressed, the public support grew for Cedar Valley's plan.
As the work began, heavy rains fell, and more than 50 in. of rain fell during the construction period. Adding to the challenges were "horrific" utility conflicts, which were exacerbated by different elevation conflicts and a lack of awareness where some of the certain utility locations were. Still, the revised staging enabled completion of the challenging paving project, allowing the contractor to place 8 lane miles of 9.5 in. concrete on 20 ft.. joint spacings, and at the same time, averting flooding that could have threatened the downtown area were it not for expert planning, coordination, and communications.
Silver: Reconstruction of SR-26, Riverdale City, Utah
Contractor: Geneva Rock Products and Granite Construction Company
Owner: Utah DOT
Riverdale Road, a major urban arterial in northern Utah, links four major cities to two Interstate highways, Interstate-15 and Interstate-84. As one of the most congested commercial corridors in Utah, the road carries some 47,000 vehicles per day.
The project involved reconstructing the distressed five-lane asphalt roadway into a seven-lane concrete facility. One of the challenges was that traffic on the original five lanes had to be maintained during peak hours, from 7 a.m. to 9 p.m., during the construction process. This also meant access had to be maintained to more than 50 businesses along Riverdale Road via 36 separate driveways.
Because of the volume of traffic and the concentration of businesses in the area, Geneva Rock Products and Granite Construction Co. had 82 separate concrete pavement placements. The project was completed in three phases, and involved 40,000 cu. yds. of excavation; 6 in. of untreated base course; 3 in. of ¾ in. asphalt; and cap of 10 in. to 11 in. concrete.
Crews worked seven days per week and both day and night to complete the project, which also included improvements to pedestrian facilities; landscaping; drainage; street lighting; and reconstruction of five signalized intersections.
The crews logged more than 200,000 man hours with no accidents and an exceptional safety record overall. A business district advisory committee was established to assess local business owners and operators' satisfaction with the contractor. The overall satisfaction increased as the project progressed and a 92 percent approval rating was achieved on the final vote.
The crews not only completed the three-phase job on what was the most congested roadway in Utah, but also did it in a single season. The project proved that concrete pavements can be placed with only minimal impact to the community, and stands as a shining example of a high quality, smooth, and efficient roadway that will last for many years.
Urban Arterials and Collectors
Gold: Highway 10/Connect, Detroit Lakes, Minn.
Contractor: Shafer Contracting Company, Inc. and Hoffman Construction
Owner: Minnesota DOT
Engineer: HNTB
A complex realignment project of an inter-regional corridor through a high traffic community in the west central Minnesota's lake country required skillful engineering, ingenuity, and hard work, all balanced with a sharp focus on sustainability and culture.
The goal of this design-bid-build project was to improve safety and mobility along the Highway 10 corridor. The project design balances mobility on Highway 10 with access for local traffic movements, and of course, harmony with the surrounding cultural and natural resources.
This complex project required careful coordination of several different features, including: demolition of five businesses and nine residential properties; realignment of 1.5 miles of railroad tracks; improvement of the busy intersection of Highway 59 and Highway 34; and construction of a five lane bridge over two railroads. Other features includes: realignment and new construction of the highway; realignment of Pelican River; construction of water retention ponds, vortex systems and a rain garden; and reconstruction of the historic Big Detroit Lake scenic overlook.
Shafer placed a total of 12 lane miles of concrete pavement with joint spacings of 15 ft.. In addition to the scale and complexity of the project, there were also a number of details that could have affected the schedule. For example, the project was constructed in a fully developed business district dependent on summer tourism and Highway 10 traffic. Business owners were concerned about access, and so the project was completed in a large number of construction phases, which made coordination a challenge. Short work schedules and the major environmental considerations also added to the complexity, as did the unusual aspects of moving 1.5 miles of double main railroad tracks, having to adjust the location of proposed underground utilities because of conflicts with abandoned systems, and coordination with railroad specifications.
Even so, the project was completed safely, efficiently, and ahead of schedule. The contractor also earned 83% of the available incentive possible for ride quality, which underscored the quality and attention to detail that went into the project. As a result, Minnesotans and visitors to the area have a corridor that showcases a perfect balance of mobility, sustainability, and the culture of this unique and picturesque region.
Silver: Reconstruction of SR-66, Diamond Ave., Evansville, Ind.
Contractor: E&B Paving, Inc.
Owner: Indiana DOT
Engineer: Woolpert, LLC/CTE and AECOM
Reconstruction of a busy urban roadway can be challenging, and even dangerous under any conditions, but particularly so when it's built under traffic.
E&B Paving had to completely remove an existing 9-in. concrete roadway, then construct a new road that included four new travel lanes, center median island, and new turn lanes. Other elements of the project included improvements at four major intersections, reconstruction of ramps, street approaches, driveways, curbs, sidewalk, and installation of new signs and signals.
Much of the first season in 2007 was devoted to construction of the nine modified manholes, which also involved excavation and sheeting to a depth of approximately 45 ft. The second season in 2008 focused on the concrete pavement placement. Early in the project, E&B requested and received changes to the maintenance of traffic, which allowed one phase of the project to be eliminated. Safety also was a major concern, and so at the contractor's request, the speed limit was reduced to 30 mph.
The actual concrete paving, the placement of 13.2 lane miles of 11 in. concrete with 18 ft.. joint spacing, was all completed at night. Crews paved from 7 p.m. to 4 a.m. to accelerate construction and accommodate local traffic and business access.
The contract completion date requirement was June 1, 2009, but the project was 98 percent complete seven months ahead of schedule. Experience, skill, and attention to detail created a pavement that will play a vital role in mobility and commerce for many years.


text:
RIM has unveiled a couple new smartphones today that are said to be the thinnest and most powerful Blackberry devices yet. The two smartphones are also the first to use the new Blackberry 7 OS. The smartphones are the new Blackberry Bold 9900 and 9930.
"The new BlackBerry Bold smartphones and BlackBerry 7 OS are inspired by millions of customers around the world who want the ultimate combination of performance, functionality and style," said Mike Lazaridis, President and Co-CEO, Research In Motion. "These fully-loaded and beautifully crafted smartphones offer a highly refined user experience with blazingly fast performance, a brilliant touch screen and an outstanding typing experience."
RIM says that the new devices are only 10.5mm thick and that the materials used on the smartphones are optimized for quality and durability. Both smartphones have 1.2GHz processors inside, use new Liquid Graphics Touch screens, and also support 4G HSPA+ mobile networks. The new Liquid Graphics touchscreen is a key new feature of the devices and is powered by Blackberry OS 7 according to RIM. The screen offers responsive touch navigation and is up to the task of mobile gaming too. RIM claims that the screen is good for up to 60 fps performance for video and gaming and the screen has 287dpi.
Of the two new smartphones, the 9900 supports HSPA+ networks and the 9930 supports CDMA EV-DO Rev. A and HSPA + global roaming on GSM/UMTS networks. Both devices also have integrated NFC technology that will let the smartphone be used for mobile payments and a lot more. Other features of the two phones include an integrated compass, APIs to allow the developers to take advantage of the hardware the phone offers, and support for HD video.
Both the 9900 and 9930 share most of the same specifications. The screen is a 2.8-inch unit with a 640 x 480 resolution. They have the QWERTY keyboard that Blackberry devices are famous for and an optical track pad. The smartphones also have 8GB of on board storage, a microSD card slot with support for up to 32GB cards, and a 5-megapixel rear camera. That camera will record 720p video. Other features include 802.11a/n Wi-Fi and Bluetooth.
Another feature of the new OS is BlackBerry Balance, which is the part of the OS that separates personal from business content. That allows the user to have one device for both parts of their life. Balance works along with BlackBerry Enterprise Server 5.0.3 allowing the remote wiping of data on the smartphone if lost or stolen.

subset: commoncrawl


text:
Benjamin Clip-on
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We use a mixture of Italian and Chinese acetate to ensure your frames last as long as you love them (and that's a long time!).
Ollie Quinn eyewear is a truly global product. We know that talent doesn't come from just one place, so by carefully hand picking the highest quality parts from all around the world, we've been able to create a premium product and keep the price affordable.
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We recommend comparing the measurements of your current glasses to the frame measurements on our website, as this will give you an idea for how a pair will fit you.
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text:
While the rest of the federal government shut down Monday, the U.S. Supreme Court was open for business as usual — at least long enough to hear two cases argued.
It is hardly the first time that the high court was the macho guy in town, staying open when the rest of the government was closed. The reason appears to be tradition, albeit a modern tradition.
The late Chief Justice William Rehnquist used to go slightly bonkers at the notion that the nation's capital would shut down for 6 inches of snow or less. A native of Wisconsin, he was quite simply appalled at the way Washingtonians reacted to bad weather. So, in his 19 years as chief justice, the court simply stayed open, and often when there was a lot more snow than 6 inches.
Rehnquist and fellow justices used to bet on how much white stuff there was, with a delegation of law clerks sometimes dispatched to the court's front steps to measure the snow with a ruler.
Rehnquist's successor, Chief Justice John Roberts, as it happens, was a Rehnquist clerk, and appears to be following in his onetime boss's footsteps.
But not foolishly.
On Monday, after the morning's public session was over, and the wind and rain increased, the court shut its doors at 2 p.m. The Marble Palace, as it is sometimes called, will be closed Tuesday, when Hurricane Sandy is expected to be in full force.
The arguments scheduled for Tuesday will now take place on Thursday, the next open day. No need to dilly-dally!
Copyright 2021 NPR. To see more, visit https://www.npr.org.


text:
GearWrench Oil Pressure Check Kit
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text:
Wednesday, February 2, 2011
FDA Rejects Contrave for Obesity--Big Mistake
FDA's excessive caution was motivated by its experience having been burned by the Fen-Phen fiasco. This was a weight loss drug widely prescribed in the 90s that was pulled from the market after studies showed it caused fatal lung and heart valve problems.
This new drug, however, is a combination of two medications that have already been widely prescribed and are fairly safe: Wellbutrin and naltrexone. Psychiatrists are familiar with both of them. We prescribe Wellbutrin for depression and smoking cessation, (and off-label for weight loss, for which it has shown efficacy as a stand alone), and we prescribe naltrexone for alcoholism.
As you can see from information published on Clinicaltrials.gov, Contrave is simply a combination of Wellbutrin 400 mg with Naltrexone at a couple of different doses, 48 mg and 16 mg. Clinical trials showed that Contrave helped 50% of obese patients lose 5% of their body weight, while only 10% of patients on placebo lost that much weight. The FDA's advisory panel voted to recommend approval, but the FDA demurred, saying that the company, Orexigen, will have to conduct a huge placebo-controlled long term study to make sure the drug doesn't cause heart attacks (one of Wellbutrin's well-known side effects is a slight increase in pulse and blood pressure, although there were no heart attacks in the Contrave clincial trials).
In my opinion, the FDA made the wrong decision. Obesity is a public health catastrophe, and Contrave's approval would have been predicated on conducting post-marketing safety studies anyway. The good news is that patients can ask doctors to prescribe them the constituents of Contrave, both of which are available in generic form--burpropion and naltrexone. Presumably, this generic combination will be much cheaper than Contrave's pricing anyway!
35 comments:
- moviedoc said...
I agree. Fixed-dose combos are rarely a good idea, and bupropion XL generic comes in 450mg, naltrexone in 50, pretty close to the rejected preparation. Keeping them separate also means a patient who needs opiate analgesia post-op or post injury can continue to beneifit from the bupropion during temporary discontinuation of the naltrexone.
- February 2, 2011 at 10:03 AM
- pacificpsych said...
I'm thinking this post is some kind of joke. Why would you suddenly post a pro new-mostly-useless-drug, anti-caution post? It almost sounds as though you're paid by the manufacturers of Contrave, which of course you're not. There must be some other purpose here... Maybe you're trying to point out something about the problems in non-psychiatric drugs...to see if your post will elicit objections, or if those are only reserved for psychiatry...
- February 2, 2011 at 1:06 PM
- Daniel Carlat said...
Actually, I'm quite serious about this post. I think Contrave should have been approved. Combining Wellbutrin and naltrexone was not something the average doctor would have ever thought of for an obesity treatment, so this counts as an uncommon example in which a company had a bright and non-trivial idea for a combination of two existing products. As psychiatrists, we see obese patients all the time, and the more I have to offer them, the better.
- February 2, 2011 at 1:17 PM
- moviedoc said...
I'm glad to hear I didn't fall for a joke, but the fact that the average doc might not have thought of it implies we need more effective dissemination of such info, not a new commercial product. Or are you thinking the inevitable TV ads might be a good way to get us all up to speed?
- February 2, 2011 at 1:23 PM
- SteveBMD said...
I have to agree with pacificpsych and moviedoc.
It's a gimmick, Dr Carlat, pure and simple. Why do you think that "combining Wellbutrin and naltrexone is not something the average doctor would have thought of"? It's because the data (about two drugs that are already available and have been for years!) have been hidden from those doctors (and the public) for the purposes of financial gain for Orexigen's shareholders. - February 2, 2011 at 1:31 PM
- aek said...
Different point of view here. Although this wasn't the basis of the rejection, I'm glad that it wasn't approved because fundamentally, nutrition and eating are not medical issues. Nutrition should not be medicalized except as a true last resort.
I'd much favor a public health/primary care/corporate approach to weight/metabolic derangement by making processed food-like products higher priced/taxed - ergo more inaccessible, subsidizing fruit, vegetable and nut growers, eliminating the big three ag subsidies (wheat, soy, corn) and heavily marketing a no added sugar diet (making fruit the sole source of dietary sugar which allows hunger and appetite to self regulate, and which mostly eliminates blood glucose peaks and valleys). Finally, the new USDA guidelines do address upping fatty fish intake, but along with increasing n3 fatty acids, the consumption of n6 fatty acids must be dramatically decreased. That means minimal to no corn, soy and other seed oils.
Given that studies are providing evidence of much higher levels of gluten sensitivities in people with ASDs and their families, cholesterol derangements in people dx with schizophrenia, bipolar and MDD, and fairly strong possibly bidirectional correlations between CVD and depression, shouldn't addressing diet play a more prominent role in treatment?
Eating is enmeshed in culture, society and lifestyle. Optimal lifelong eating habits and nutritional patterns can certainly be modeled, taught, encouraged and maintained.
We continue to focus on weight loss instead of looking at permanently correcting eating patterns and allowing for weight regulation to occur as one of the results, along with metabolic re-regulation, minimizing chronic inflammation and improving immune status.
One of your colleagues, Emily Deans, is a Harvard educated psychiatrist who is now blogging about psychiatry and nutrition at Evolutionary Psychiatry (link at my name). Id' be interested in your impression. - February 2, 2011 at 1:48 PM
Shouldn't all weight management programs also have diet and exercise components? A weight reduction clinical trial for patients with "Uncomplicated Obesity" that is not holistically designed doesn't make sense because it avoids life-style management all together.
So what would be the relative weight loss results if the study cohorts were also placed on exercise and proper nutrition programs as part of the study design? If I'm the FDA, I'd tell Orexigen to do that kind of integrated study and get back to us.
Moreover, a 5% weight reduction success target enabled by a no doubt expensive drug formulation seems pretty modest to me. I.e., couple hundred bucks a month for Contrave in perpetuity for maintaining a 15-25 pound differential? For a 300 to 500 pound person? Without the lifestyle changes?
Meh... - February 2, 2011 at 3:36 PM
- Daniel Carlat said...
All good points here.
I'm all for diet and exercise as preferred alternatives, and I also understand that simply putting two existing meds together does not represent the pinnacle of pharmaceutical science. But 5% weight loss is better than nothing, and this in itself will reduce mortality from heart disease in a significant number of people.
More broadly, just because pharma has plenty of ploys up its sleeve does not mean that we should resist efforts to market incremental improvements--as long as the marketing is done ethically and without the use commercial cme and hired guns. In this case, we see a marginally effective medication for a catastrophic public health problem. Why not approve it with the stipulation that the company do its post-marketing safety studies? - February 2, 2011 at 4:13 PM
- moviedoc said...
Yet another angle: 3-4 years ago Hythiam started promoting their patented Prometa protocol which calls for flumazenil + hydroxyzine + gabapentin to treat meth, ethoh, and cocaine addiction. All 3 drugs were off-patent like bupropion and naltrexone. Why didn't this company just patent the use of the combination and avoid the need for FDA approval? Or maybe they did get a patent and will sue any of us who try to use it.
- February 2, 2011 at 4:35 PM
Re: Danny, "All good points here."
The larger systemic issue is the benefit/cost ratio of these reformulations. My favorite analogy is the Lovaza scam:
I suppose you could come with an argument for Lovaza's marginal utility over fish oil caps. But does it actually make sense to prescribe?
Contrave is Lovaza but for a different disorder. Prescribing it over a generic mix would seem to be another pathological contribution to an economically out of control health care system. Maybe FDA considered that without letting on. But if they did, it would not bother me.
In the end, Big Pharma wields the Big Media Club even when the message defies common sense. - February 2, 2011 at 5:54 PM
- pacificpsych said...
If we're seriously going to debate this pill...
If someone weighs 200 pounds and they wanted to lose 10 pounds, they could do so by the amazing miracle cure of walking one hour a day. If they walked at a moderate pace of 3 MPH, they'd burn according to one calculator over 400 calories. Let's say just 300.
Twelve days like that, assuming intake = caloric need to remain at same weight, they'll have lost one pound. One hundred and twenty days, there go the 10 pounds.
One year, thirty pounds.
Cost = one pair of good walking shoes, one hat, sunscreen. And some willpower. Hmmm..... - February 2, 2011 at 6:25 PM
- Dr John said...
Dr Carlat, can you present some data to support your contention that a 5% wt reduction by any means or one driven by meds rather than exercise and diet reduces mortality? I would challenge this contention but maybe I am wrong. I understand your desperation to do anything to tackle the problem of obesity but this would seem to be a poor investment.
As to aek's comments, I share your sentiment on the drug's failure to be approved but lack your enthusiasm for the nanny state and subsidies of any kind. People tend to be pretty good at finding enjoyment in things that are bad for them regardless of big brothers attempts at punishing them economically.Tax peoples favorite sin and they just find a different flavor of sin. - February 2, 2011 at 7:02 PM
Very, dangerous, path, you are taking here. Supporting the use of antidepressant and opiate antagonists for weight loss is only playing in the hands of pharma, just trying to get more indications for meds and just further patent access.
Why not just use Topamax. And, while the risk for seizure with buproprion has been low, using a 400mg dose as a first dose seems rather risky to me.
All in all, I find this post baffling at the very least. - February 2, 2011 at 8:11 PM
I agree with pacificpsych:
TELL THEM TO GO TO THE GYM! - February 2, 2011 at 8:39 PM
Lately I've seen some clinicians and researchers approach obesity as an eating disorder in terms of offering cognitive and behavioural interventions, and this seems to work.
Given the scale of the problem, I agree that there should be some public health initiatives in place but good luck with the regulation of junk food, additives, high-fructose corn syrup, etc: the food industry is at least as gigantic as pharma. In my corner of the world, a publicly-funded phone helpline has just opened up for food and exercise coaching - hopefully this yields some results, because our obesity problem is quickly approaching that of the US in scale.
5% loss seems modest, considering that this is roughly the same number you get with a low-fat diet and/or mild daily exercise while keeping your intake the same, plus taking this medication alone, as pointed out above, will not necessarily lead to lifestyle changes. - February 2, 2011 at 8:43 PM
- moviedoc said...
I thought diet + exercise were pretty much acknowledged to flop. I think it's more likely the pill(s) vs. bariatric surgery. How is that combo supposed to work, anyway? BTW: old-fashioned venlafaxine IR works for some.
- February 2, 2011 at 8:59 PM
- Unknown said...
I for one truly appreciate the professionals who are addressing the RESPONSIBLE solution: Diet and Exercise Obesity is caused, except for RARE cases of underlying pathology, by unhealthy diets: they eat the WRONG amounts of food, and unhealthy, i.e. fried, and processed foods diets lacking whole grains and fruits and vegetables, and fail to exercise! A pill of any kind is not going to fix the underlying cause of their obesity...Lifestyle and BAD choices. Drugs are a way to avoid responsibility for how one's choices have everything to do with the person who is morbidly obese. How is it justifiable to medicate rather than address the real issue?
I have been overweight and unhealthy much of my life; and it was not until I ate better and moved my ass that I became healthier and happier. I now wear the same size clothes I wore as a teenager, and am the healthiest I have been my entire adult life. Thank God, I did not resort to a quick fix, like phen-fen, or any other "medical" solution to my lifestyle issues... - February 2, 2011 at 10:31 PM
they could do so by the amazing miracle cure of walking one hour a day.""
THANK YOU! (Daily walking is free too except for the cost of the shoes.) And what about the benefits of exercise on muscle tone, cardiovascular health, mood and cognitive function, and Growth Hormone release? - February 2, 2011 at 10:47 PM
- Asslete said...
In skilled and cautious hands, a hammer and chisel can shape beauty out of boulders. But in the hands of the masses, that same hammer and chisel create little more than gravel and dust. Contrave, like the psych-meds we discuss here, had the potential to help, when used sparingly and skillfully. But the FDA rightfully recognized that we physicians as a whole, and the minute-rice masses we serve, could not be trusted with this particular hammer and chisel.
Contrave-The Good:
Across 3475 patients exposed, and 2313 patient years of exposure, Contrave consistently demonstrated clinically meaningful weight loss. And I do emphasize "clinically meaningful" to Dr. John contention. Across all studies, patients on Contrave lost an average of 5-9% of their body weight. They dropped A1C by .6%. They reduced CRP by 7-20%. They lost 11% body fat compared to 4% for placebo…and they lost 15% visceral body fat compared to 5% placebo.
Those are some damn decent numbers…and if you look at the work from Avenell, Eliat-Adar, or the US Cancer Prevention Study…you could argue those are life-saving numbers.
Contrave-The Bad:
Those were 3475 potentially fortunate patients to have been placed on Contrave. About half of them lost 5% or more of their body weight. But what about the rest…the 12-20% who lost no weight and may have actually gained weight? Would it bother you to know that in the one study that included "intensive lifestyle intervention" the average placebo percent weight loss was quite close to the weight loss achieved in other studies of Contrave users who did not have meaningful lifestyle intervention. It would appear that good old fashion, "eat less, exercise more" works quite well…for those willing to do it. Would it bother you to know that the majority of patients studied were female, yet it is men who are at the greatest risk for CVD from obesity…and CV risk seemingly from Contrave based on the Major CV events reported to the FDA? Or how about the relative risk of ischemic heart disease at 1.3 for Contrave over placebo?
Contrave-The Ugly
Getting back to those 3475 patients…for the most part, they were obese but not too ill. The list of excluding illnesses, lab values, and medications is larger than…(insert inappropriate fat joke here). They were so exclusive, that in my mind, there remains a great unknown for how Contrave would work amongst actual "real people with real illness" or for that matter, how would Contrave work for the millions of mildly overweight people who would no doubt be lined-up around the block of the nearest Medi-fast weight loss center just to lose 5 pounds before bikini season.
I say it is best to let Contrave's carcass lay decomposing at the feet of the FDA.
For those willing to study the science…for those willing to be selective…for those willing to be cautious…it's mighty easy to RX generic bupropion sr and naltrexone together. I use this combo with reasonably good results. But like most psychiatrist, I convince myself that I know how to wield my hammer and chisel, and select the right boulder…often ignoring the pile of gravel and dust that gathers on my shoes. - February 2, 2011 at 11:02 PM
Movie Doc,
Perhaps diet and exercise have flopped because many medical professionals are having people do the same things that don't work.
For example, this study show that a Paleolithic diet had success over the typical low fat, high carb ADA diet
According to Chris Kresser, who owns the Healthy Skeptic, http://thehealthyskeptic.org/the-top-3-dietary-causes-of-obesity-diabetes:
* Reduced HbA1c more than the diabetes diet (a measure of average blood glucose)
* Reduced weight, BMI and waist circumference more than the diabetes diet
* Lowered blood pressure more than the diabetes diet
* Reduced triglycerides more than the diabetes diet
* Increased HDL more than the diabetes diet
At the end of the trial, 8 out of 13 patents still had diabetic blood glucose levels. However, in this study the patients had well-established diabetes for an average of 9 years. Over time diabetes progresses to beta cell destruction, which reduces insulin output. Once this point has been reached, dietary changes can be helpful but cannot completely reverse diabetes.
Regarding exercise, Mr. Kresser, makes the point on his site, http://thehealthyskeptic.org/how-to-lose-weight-and-prevent-diabetes-in-6-minutes-a-week, that while low intensity cardio is beneficial health wise, it doesn't contribute to weight loss. He provides links to studies showing that High-intensity intermittent training may work best.
Obviously, personal experience doesn't make for a study but that definitely has been true in my case.
Anyway, I realize this is not a one size fits all solution. And obesity can get to the point where only surgery will work.
But my point is that obviously, with the huge increase in obesity and diabetes, the same old, same old solutions are not working.
Dr. Deans, you have a great site by the way. You might want to look at the Healthy Skeptic Site as it sounds like your philosophies are quite similar.
AA - February 3, 2011 at 4:52 AM
- Dr John said...
Asslete, that was a great post. Those numbers are cosmetically significant and maybe even "clinically meaningful" although I am not sure what that term means here. What I want to know is has anyone ever shown that reducing an obese persons body wt by 5% results in a significant reduction in mortality or disease related morbidity of any kind i.e. stroke, MI ect ect?
If no one has I like other posters really question the approach of giving costly meds for marginal benefit.
I think Becky Murphy hit a home run. I am a pragmatist and will do whatever works but like her I don't think anything really works but eating less and moving your ass a lot more. That is why this is such a difficult problem to tackle.
We have evolved in such a way as to be good at storing excess calories. A stable food supply has turned what was once a genetic asset to a modern day liability. - February 3, 2011 at 11:41 AM
- moviedoc said...
Apparently a lot of psychiatrists (not me) prescribe metformin to counteract weight gain associated with psychotropics. How about a head-to-head between metformin and bupropion/naltrexone? And Dr John, who's to say the latter won't work by making you want to eat less and move your ass more?
- February 3, 2011 at 2:21 PM
- Asslete said...
Dr. John
There are countless studies that have demonstrated both decreased morbidity and decreased mortality with even modest intentional weight loss. This is one is perhaps most well known:
But with that said...there are also several studies that suggest weight loss makes no difference. Here is one such study:
Sure "eat less exercise more" makes the most sense, much like "let's talk about your horrible marriage, job, child abuse before we put you on Prozac" makes the most sense. But common sense is seldom common. And so both Docs and Patients seek out more quick fixes that may or may not be more harmful than helpful.
I never sleep well at night doing this job...but I think I'd be worried if I did. - February 3, 2011 at 6:31 PM
- Joseph P Arpaia, MD said...
I do a lot of work with patients who have behavioral issues, weight control being one of them. I have been adding the combination of Wellbutrin and Naltrexone to the behavioral advice for a couple of years.
Two points
1) The dosing is not "cookie-cutter". I have patients who do really well with very small amounts of naltrexone sometimes obtained at a compounding pharmacy. The ratio of Wellbutrin and naltrexone also varies widely. So a combination pill is just another patent extender, and reduces the ability of the clinician to adjust dosing.
2) I have used naltrexone a lot because I treat behavioral disorders such as addiction, eating disorders, ... . Naltrexone can make a big difference, in the context of a motivated patient who is working hard in a behavioral program. I have not seen it do anything long-term to change people's behavior when they were not motivated or in the absence of a behavioral program. - February 4, 2011 at 8:33 PM
I'm pleased to see that AA referenced a Paleo diet.
In my own n=1 of being overweight from childhood on, but always having been active, I stumbled onto a Paleo type diet when I trialed a gluten-free, no added sugar diet for a month after getting a big jolt from pre-op labs and a medication-related fast weight gain. I discovered that I craved added sugar foods, and it took a full month before my senses of taste and smell reset and inappropriate hunger and food cravings went away. I did not count calories, but ate only whole foods, no seed oils, started taking omega 3 fatty acids while upping fatty seafood, and then learned that I needed to bring the omega 3 to omega 6 fatty acids to a 1:1 ratio. Kept a food/nutrient diary until me new eating patterns were well established and optimized and only supplement what I can't get via food (vitamin D, B12 - deficiency brought on by prescribing a PPI as coverage for NSAIDs). My body fat and BMI dropped to within the lower end of normal, I have no more food cravings, and I haven't regained weight. My activity increased only with a reduction in back and large joint pain.
Eating a Paleo style diet allows me to eat a rich diversity of foods in limitless cultural and social ways. But as I revisited the nutrition literature, I discovered just how wrong conventional wisdom (in medicine, nursing and allied health professions) is.
Along the way, my lipid profile and metabolic profile became optimal (a cardiologist told me that I'd live forever) from starting out with several risk factors for metabolic syndrome. I'm now on no meds, and at this juncture, am not deemed at risk for any chronic diseases other than osteoarthritis, which was in progress from early adulthood.
You do recall that cholesterol is essential to brain structure and function, yes? (grin)
As I've been reading scientists who investigate and report on Paleo nutrition, I'm learning that my experience is pretty close to the norm.
None of the physicians I saw ever expressed interest in my diet, asked me what I did, advised dietary or activity interventions, or offered anything other than medication.
The kicker: I used to teach undergraduate basic nutrition to allied health and nursing students. And regarding clinical nursing, what I know now about nutrition makes me regretful regarding what I never even knew to offer to patients to enhance theirs.
But I do know this: eating is enmeshed in daily life. Medications, enteral feeding, gastric surgeries, etc. don't address the fundamental, elemental role of eating. And that's at the root of obesity, diabetes, CV disease, and other metabolic and inflammatory derangements. - February 5, 2011 at 7:26 PM
I assume you are well aware that companies whose drug approvals have been granted with the requirement that they conduct post-marketing safety studies have, for the most part, not conducted those studies and have suffered no ramifications or penalties for not living up to their end of the bargain. Since I assume you know this, I wonder why you would suggest that the manufacturer of this particular drug would be any different.
I also find it curious that you are so blindly accepting of a drug just because you happen to prescribe its individual components. Perhaps rather than thinking, "We prescribe this all the time... it's obviously safe," you might explore the other side of that coin --> "We prescribe this all the time. Maybe we shouldn't. Maybe we should examine our practices more closely. Maybe we should examine the drug company-funded studies of the drugs we prescribe more closely. Maybe the FDA sees something we don't see."
Lately, you seem eager to rip apart the claims of others who write books, etc., but you do not apply the same critical eye and detailed references to support your argument when the topic is your own view of the way things are/should be. You seem eager to provide citations/references to back up your arguments as you tear others to shreds, but I rarely see citations or literature references given when you are making the "trust me, I'm a psychiatrist... and because I prescribe it/do it, it is safe/good" argument I am seeing too much on this blog of late. I am very disappointed. - February 5, 2011 at 9:03 PM
Becky Murphy said:
"A pill of any kind is not going to fix the underlying cause of their obesity...Lifestyle and BAD choices."
You just nailed it. This is why this post rubbed me the wrong way. It's such a typical psychiatric response to a problem - throw another pill at it and pretend that the pill doesn't just cover up the symptoms. People don't get better that way, Dr. Carlat. They may feel better, but they don't GET better.
What happens when they stop the drug and gain all of the weight back, plus some additional pounds? Or are you suggesting they should take this drug for the rest of their lives? Either way, you're not treating the problem, you're treating the symptoms. Because it's faster and more lucrative to treat symptoms, as you acknowledge in your book. - February 5, 2011 at 9:18 PM
What? Another drug or combination of drugs or re-combination of drugs - big pharma working overtime to improve our health? Becky Murphy and Dr. John said it all much better. So I'll just add: NIH R&D = $28.5 billion, CDC and FDA combined = $600 million. Or, welcome to America (land of embarrassing health indicators) where an ounce of preventative funding makes the pharmaceutical stockholders cringe and run for the nearest lobbyist. The running does do wonders for their metabolic balance, though, so maybe there is some good in here after all...
- February 7, 2011 at 11:31 AM
Interestingly, on the blog entry on AOL by Dr. Carlat, http://www.aolhealth.com/2010/12/07/how-to-get-the-truth-out-of-your-psychiatrist/, he talks about a study that said that if patients asks psychiatrist what type of treatment they would chose for themselves. they would take a wait and see attitude.
I am curious in light of that study if patients are offered the same opportunity. For example, instead of automatically offering Wellbutrin to an obese patient, does Dr. Carlat take that approach with this person, particularly if the person is otherwise stable healthwise?
Asslete, am I interpreting the studies correctly that the ones for Contrave ran about 6 months? That is certainly better than the typical 8 drug week studies but still, that is not nearly enough time to prove whether a drug works or not.
AA - February 8, 2011 at 9:52 AM
I am currently a public health candidate (MPH) and an orthopedic surgeon. I have serious trouble believing that obesity is a true epidemic at all.
For someone who is sincerely against the abuse of prescription medications, perhaps you should become more aware of the abuse of the "obesity epidemic." Somehow, I think that some of the commentators here and perhaps yourself have heard of this before. Its a shame then that you are so concerned with obesity.
There is no causal linkage between obesity and heart disease. Obviously heart disease is a multi-system problem and discovering underlying causes can be difficult because they may be masked by multiple factors-epigenetic factors of the environment, exercise, diet, etc as well as genetic predisposition, etc.
However, being fat alone should be the cause for concern and certainly losing weight does not guarantee no onset of CVD. - February 9, 2011 at 8:59 PM
- gewisn said...
i suppose we shouldn't be surprised at the theme of the posters in this anti-pharma blog.
But on another note, I have to admit naivete. I don't know the science showing that weight-loss through medication gets the same health benefits as weight loss through diet and exercise. Are they the same? I'm sure some assume "yes" and some assume "no," but I don't know what the science shows. Can anyone direct me to such studies?
Also, is there any way to "convince" (or force) insurance companies to give patients a choice between benefits of paying for a medication or paying for attendance at a gym? Suppose an insurance company gave you back $5 for every 30 min session on a cardio machine or exercise class at a gym, up to $40/week? Its amazing what you can get people to do for CASH. This principle has filled the pages of psychology journals for generations, since "psychology" is largely the science of paying college sophomores to do ridiculous things for cash. - February 11, 2011 at 9:57 AM
Yes, Gewisn, it is indeed amazing what people will do for cash. Psychiatry and the rest of medicine are learning this lesson over and over again with the new revelations and exposés of each passing month.
- February 16, 2011 at 1:51 AM
To the poster who wrote there is no causal link between obesity and heart disease I would strongly disagree. Obesity is an independent risk factor for cardiovascular disease. In combination with other independent risk factors it is associated with insulin resistance, diabetes and dislipdemias. I'm not sure what they are teaching you in your MPH program.
- February 16, 2011 at 6:17 PM
To those who so strongly believe that obesity causes the world's problems, remember that obesity is a risk factor. I am aware of no science that states it is the CAUSE of heart disease, diabetes, etc. If anything, isn't it possible that obesity is another symptom? Some studies show that some diabetics gain the weight AFTER diabetes has begun to develop.
This obesity crisis is concerning, in that people are focusing on "fatness" rather than on health. They are not the same thing. Shame on any doctors/nutritionists/psychiatrists who are looking for a way to blame the patient. If they are fat and healthy, leave them alone. If they are fat and sick, treat the sickness. Encourage EVERYONE to be active, not just fat people. Don't do harm to fat people by treating for "diseases" like obesity that could merely be a symptom. You don't die of being fat (unless you are at the point of having crushed airways or starve to death because you cannot move to feed yourself), you die of the disease that came along with the fatness (i.e. stroke, heart attack). Common sense, people. Don't medicalize a risk factor by calling it a disease in its own right.
Also, Linda Bacon has done some great work collecting medical studies on weight loss/health. Weight loss does not usually lead to long-term health by itself; the lifestyle change (with or without weight loss) does. - February 18, 2011 at 3:13 PM
- Nesbitt Photography said...
I realize this is an old thread but could someone answer this question... Can you take contrave and topomax?? I don't have seizures I take topomax for migraines. But I was reading on the website don't take with anti seizure meds? Can someone explain?
- June 29, 2015 at 2:16 PM


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