text:
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text:
Calvinist Corner | www.mslick.com |
Hosea 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 Hear ye this, O priests; and hearken, ye house of Israel; and give ye ear, O house of the king; for judgment is toward you, because ye have been a snare on Mizpah, and a net spread upon Tabor. 2 And the revolters are profound to make slaughter, though I have been a rebuker of them all. 3 I know Ephraim, and Israel is not hid from me: for now, O Ephraim, thou committest whoredom, and Israel is defiled. 4 They will not frame their doings to turn unto their God: for the spirit of whoredoms is in the midst of them, and they have not known the LORD. 5 And the pride of Israel doth testify to his face: therefore shall Israel and Ephraim fall in their iniquity; Judah also shall fall with them. 6 They shall go with their flocks and with their herds to seek the LORD; but they shall not find him; he hath withdrawn himself from them. 7 They have dealt treacherously against the LORD: for they have begotten strange children: now shall a month devour them with their portions. 8 Blow ye the cornet in Gibeah, and the trumpet in Ramah: cry aloud at Bethaven, after thee, O Benjamin. 9 Ephraim shall be desolate in the day of rebuke: among the tribes of Israel have I made known that which shall surely be. 10 The princes of Judah were like them that remove the bound: therefore I will pour out my wrath upon them like water. 11 Ephraim is oppressed and broken in judgment, because he willingly walked after the commandment. 12 Therefore will I be unto Ephraim as a moth, and to the house of Judah as rottenness. 13 When Ephraim saw his sickness, and Judah saw his wound, then went Ephraim to the Assyrian, and sent to king Jareb: yet could he not heal you, nor cure you of your wound. 14 For I will be unto Ephraim as a lion, and as a young lion to the house of Judah: I, even I, will tear and go away; I will take away, and none shall rescue him. 15 I will go and return to my place, till they acknowledge their offence, and seek my face: in their affliction they will seek me early. Return to Bible Online Calvinist Corner |

subset: commoncrawl


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Item Code: #21109
Adhesive vinyl decal featuring the image shown. Great for a bumper sticker or car window! You can have it any color and a variety of sizes are available when you check out. Sizes are approximates. The background is CLEAR!
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Saturday, November 24, 2007
Dr. Drug Rep
35 comments:
Dear Dr. Carlat,
"Dr. Drug Rep" is a great article that helps to shed much light on Big Pharma's influence over medical practices in America.
I have been researching conflicts of interest in medicine over a particular environmental exposure, mold within water damaged buildings.
I contributed to the following linked article that is in this month's edition of the International Journal of Occupational and Environmental Health. The article is titled, "American College of Occupational and Environmental Medicine, A Professional Organization in Service to Industry." My contribution begins on pdf page 17.
My point in telling of the above article is that I can research and write all I want. But for one, such as yourself who has actually experienced the influence of the sirens of industry, to write of the matter carries much weight. Your words, as a former insider, will help thousands to better understand the perverse influence industry is having over science and medicine in the US today.
Thank you so much for speaking out.
Sharon Noonan Kramer - November 24, 2007 at 10:51 AM
Dr. Carlat - I commend you for coming forth on your stint as Dr. Drug Rep however, you failed to touch upon the very lethal nature of Effexor and how it has one of the most difficult withdrawals of all SSRIs. Please note my research to be found at:
http://SSRI-Research.com. Additionally, I have archived almost 9000 articles, documents, medical abstracts and legal testimony on the dangers off SSRIs, to be found at:
What is most criminal is that these drugs with BLACK BOX WARNINGS or DEATH AS A KNOWN SIDE EFFECT are being dispensed to children like candy.
There is much more for you to expose than a little hypertension caused by these drugs. Please do your own research and speak up and out. The public needs your honesty.
Lynn Michaels, Founder
Taper Safely off SSRIs
http://tapersafely.org - November 24, 2007 at 3:09 PM
Dear Dr. Carlat,
I want to thank you for a refreshingly honest article.
I'm a psychiatrist in private practice in NYC, and I don't see drug reps anymore-not since I left my inpatient position a year-and-a-half ago.
But I always figured, if you're gonna prescribe meds, they have to come from somewhere. And the pharmaceutical companies are entitled to market and make a buck just like everyone else. So if you see drug reps from all the different companies, the influence has to even out.
But in reading your article, I was convinced I'm probably wrong, and that a much more insidious effect creeps in over time. I certainly preferred some drug reps to others.
I was particularly struck, okay, terrified, by your description of the way the AMA sells information, and that that, and purchasing prescribing information from pharmacies aren't illegal. Everyone's so conscious of HIPAA laws, you'd think there would be some corresponding protection for physician privacy.
Does the AMA have access to information about all physicians, or just AMA members?
Thanks for speaking out,
Rebecca Twersky - November 24, 2007 at 8:20 PM
- Daniel Carlat said...
The AMA Masterfile includes data from all physicians in the U.S., whether AMA members or not. Here is a URL to learn more about how the AMA attains this data: https://profiles.ama-assn.org/amaprofiles/info/pdf/primarysource.pdf
The leasing of the Masterfile is nothing more than an income stream for the AMA, and there is little to say in its defense. - November 24, 2007 at 9:28 PM
- herb said...
Dear Dr. Carlat,
Thanks for presenting to me an informative and better understanding of the inside workings especially as it pertains to the practice of Psychiatry.
As a very long time support person and care giver to my spouse I can even remember way back when there were no Psychopharmacologists and the Psychiatrists still used a couch. I guess we call this progress.
Knowing intimately of my spouse's challenges over 4 decades, the inability of your profession and its science to give the patient any definitive answers other than its many theories I personally am an advocate for all treatment options knowing the difficulty to control and stabilize many of these severe mood disorders into long-term remission.
While I am not against the use of drugs and/or any therapy option deemed reasonably safe and efficacious, I am for the patient being educated to make informed decisions in collaboration with a trusted, compassionate, knowledgeable and licensed health care professional.
"Maybe. I'm sure I persuaded many physicians to prescribe Effexor, potentially contributing to blood-pressure problems and withdrawal symptoms. On the other hand, it's possible that some of those patients might have gained more relief from their depression and anxiety than they would have if they had been started on an S.S.R.I. Not likely, but possible." --- Dr. Daniel Carlat
I would also like to see the medical profession and especially the APA better regulate itself in what I also see are many improprieties not only in the pharmaceutical marketing to the professionals but also to the public and to clean up its act in the field of research with its ghost writers and so called prestigious doctors lending their names to studies.
It also happens that Effexor XR was one medication at doses as high as 900 mg per day which accorded my spouse a long-term remission of approximately one year which was unheard of in her case history before the refractory problem surfaced once again. I might also add that being knowledgeable of her blood pressure increase we were able to easily overcome that side-effect with an additional medication. I shall also point out, in my wife's case history, upon several occasions she was able to withdraw from the Effexor XR as well as other psychotropic medications without any withdrawal symptoms which most importantly brings up the importance of proper clinical monitoring of one's patient regardless of study data.
My spouse has since gone on as a study subject to have obtained pretty remarkable results and almost continuous long-term remission from a non-pharmaceutical treatment option.
Once again, thanks for your very informative article.
VNSdepression.com - November 25, 2007 at 4:34 AM
- Unknown said...
Dr. Carlat,
My first feelings when I read your article was, "oh c'mon, they are the smartest guys in school and they suddenly can't figure out they are being used for money?" Then I realized my past struggle with integrity and money. I began to see you were someone like I was, with a lot of attention given to you because of what you did on the outside (as opposed for just being valued for who you are on the inside.) Our culture is so outer focused and it is easy to get pulled into more money more stuff more prestige, etc.
Will we ever learn that we are just ok being who we are I wonder.
I knew the scrip info was for sale but didn't know how it was done. Also fascinating that the AMA is in on it. Great info there.
Thank you for putting this out there. I read that 50% of all people are now on some sort of prescription medication. Score one for the BIG PHARMA. The NY Times and its readers have a love affair with medicine in general(like follow blindly.) I think you were good to de-mystify this. - November 25, 2007 at 11:00 AM
- james gaulte said...
Thanks for your NYT article.It deserves to be widely read.I find a number of themes I have blogged about for the past 2 1/2 years played out in your article including; how meta-analysis can be and are misused,how drug companies can stack the deck and cook the books in their sponsored clinical trials, how the tenets of EBM can be perverted.I admire the courage you have to do what you did and to write about it.
- November 25, 2007 at 11:27 AM
Dear Dr. Carlat:
Thanks for an interesting article. I'm a rheumatologist and have sometimes given "drug rep talks", and I've struggled with some of the same issues you raise in your article (of note: the going rate they offer me is now an unbelievable $2000 per talk).
One aspect to giving talks that you don't mention is whether your own prescribing patterns changed as a result of giving so many talks. I've often wondered if a certain company asked me to give talks becasue I prescribed so much of their drug (IE as a reward to a loyal customer), of if it was because I didn't but they thought they could change my ways by employing me.
One other point: while the AMA does make a lot of money by selling information about physicians from their masterfile, they also offer an easy way for physicians to "opt out" and not allow anyone to have access to their prescribing information. In fairness to the AMA this point should have been made in your article.
Thanks, Dr. R - November 25, 2007 at 4:09 PM
- Daniel Carlat said...
Dr. R., Yes, you are quite right about the opt-out option. It is not easy to find from the AMA website, but the direct URL is: http://www.ama-assn.org/ama/pub/category/12054.html.
The opt-out must be renewed every 3 years, and it does not prevent drug companies from obtaining your information for uses other than giving it to drug reps in the field. In other words, opting out still allows them to analyze your prescription info for marketing purposes.
I would propose an "opt-in" rather than an opt-out process, and I would urge the AMA to not release any info at all when a physician has opted out. - November 25, 2007 at 4:53 PM
How many of those, some of whom write here, who now feel guity about having accepted money from drug companies to push their products have given any of the money back?
It's pretty easy to be contrite about unethical actions once one has resolved to retain the benefits.
JAD - November 25, 2007 at 5:36 PM
Dear Dr. Carlat,
Thanks very much for baring your soul so openly. I am a psychiatrist and was approached by a drug rep to talk about Lexapro. I declined, but have always wondered if my suspicions were correct. After reading your experience I see they were.
Joseph Arpaia - November 25, 2007 at 9:09 PM
- Dino William Ramzi said...
In any other field, would physician behavior in relationship to the pharmaceutical industry not be called simply corruption?
http://executivephysician.blogspot.com/2007/11/physicians-risk-getting-dragged-into.html - November 26, 2007 at 10:32 AM
Doctors as drug pushers? Yeah, that sounds about right.
Feel great! ... one pill at a time.
www.askyourdealer.com - November 26, 2007 at 10:33 AM
- soulful sepulcher said...
- This comment has been removed by the author.
- November 26, 2007 at 12:03 PM
- soulful sepulcher said...
I also want to make a point here, that it is not just doctors being influenced by "lunch and learns". Nurses, and staff [using a psych hospital as one example I witnessed]are often invited to the Lunch and Learn. This is where the added danger to the patient is expanded, when a nurse or psych staff attend this pharma rep "learning session" and think they've been taught something, when in fact it was medication pimping at it's finest.One can't possibly walk away from a lunch and learn promoting one psychiatric medication and take that seriously--but they do.
The scary part is, that trickle down effect. Pharma knows what it's doing, their advertising agencies are top notch.
Yes, it's conflicted and corrupt.What are consumers and complainers going to do about it?
It's not a mystery that families of patients who settled out of court cannot speak about their loved one's harm or death after being paid by Eli Lilly for example.
This is so obvious, I find it hard to believe consumers can be so un informed when taking psychotropics.
Read the Zyprexa documents hosted by Furious Seasons, and it should cause outrage enough. Then wonder why the state of Arkansas is going after Risperdal for the same reasons! - November 26, 2007 at 12:18 PM
- Unknown said...
Dear Dr. Carlat,
Thanks for your article which I read in the NY Times this morning. How lucky you are to have gotten out of that sticky, unethical situation.
As I was reading your story I had hoped your were collecting the business cards of the doctors you spoke to. Or at least kept a record of where you spoke.
Out of a sense of justice, a simple letter to each of these practitioners offering an apology or explanation in an attempt to correct a wrong, seems in hindsight (MY hindsight), a fine human act.
This excellent article does a great deal in that direction also.
But, perhaps you did write that letter...
While you were a Dr. Rep. your sales focus on your medical "audience" only gave you a partial picture of the effect of your actions and that of other MD's out their pitching at lunchtime, even at this moment.
As a patient, I was once on the receiving end of this possibly criminal, certainly greedy and unethical practice.
At one sharp point in my life a few years ago I was diagnosed with degenerative spine and bone disease, AS, various crippling types of arthritis, and Type 2 diabetes all within one month. Ugh! Within a year, I was no longer able to work (teach) and was easily granted full disability from the Social Security Administration.
When referred to a prominent rheumatologist I thought I may have found an educated person who offered me some help, primarily relief from pain and a new ability to stand and walk. Ha!
He operated an interesting clinic and I now suspect he could have been one of the Dr. Reps you describe. He treated me right out of the current research. Quoted the research to me to prove I needed certain prescriptions.
Because a percentage of women with my illnesses and abrupt life transitions are thought to be depressed, at first he proscribed Effexor for me.
That was before a long weekend break which I took off to relax at a remote cottage I had on the Puget Sound.
Second day of taking Effexor while writing I noticed initially that I was scrambling the words in a sentence. All the words were there just not in correct order. As I went on writing I became unable to write even 5 letter words with the letters in correct order. I became frustrated and frightened.
This growing inability to literally "think straight" terrified me.
I had been warned privately by a nurse in the clinic, not the physician, to be very careful if and when I stopped taking the drug. She took me aside and whispered to me to come off of it slowly if I quit taking it. She had once been given Effexor and had such incredible mental illness when withdrawing that she had to quit working for a while.
So, I spent the rest of the weekend taking a half and then no Effexor.
I reported this to the physician who was not at all impressed. He said that I must need Zoloft instead.
It took about two weeks on Zoloft for me to become a kind of sweating zombie. I could not think clearly and any effort at all produced extraordinary perspiration.
When I reported this to the physician he merely wrote the symptoms in my medical record.
Fortunately, my friends noticed the change in me and the dead white pallor. They convinced me to stop taking the drugs and assured me that anyone who had all such loss at one time would be naturally grieving and not depressed. Or certainly not clinically depressed. Where do they teach commonsense in medical school?
My experience of misdiagnosed and wrongly treated illness came from a rheumatologist. Would I have fared any better had I been referred to a psychiatrist? Do they all hear the same Pharma-prepared pseudo-scientific song and dance?
I suggest that psychiatrists and other doctors who prescribe psycho-tropic drugs to their patients take a long weekend off and try them on themselves. Record their impressions verbally, in writing.
Document the changes. They won't die from taking SSRIs, but they may get some insight into the effect of Effexor and the others on a healthy mind. After all, how positive are doctors when they even diagnose someone as "depressed"? After diabetes isn't this the next most popular, new catch-all illness for what may be perfectly normal reactions to living situations-- especially among the young? - November 26, 2007 at 12:28 PM
Dr. Carlat,
Unfortunately, it must be gratifying to garner attention as a gadfly villifying the "Big Pharma" monsters, and positing physicians as greedy numbskulls, seduced by the Dark Side. An article such as yours,really speaks only to the writer's lack of ethics, or ability to be "bought" by salespeople.
As a speaker for Wyeth, I am not "for sale" and I do not EVER say anything I don't believe. I actually educate, and attack the stigma toward psychiatric illness that health professionals all have. Many with whom I present to, really are not very skilled nor understanding of the data. When I was asked by other companies to say things that were not true, or present information that was not data I said, very simply, no.
The fact is "Big Pharma" is the ONLY pharma, like it or not. To pretend otherwise, or to exhort that the advances made in pharmaceutical development were possible some other way, is just bullshit. Large pharmaceutical companies are not holy, selfless, organizations, but that does not mean they cannot be useful to our patients.
Pandering to the anti-psychiatric, anti-medicine fringe, especially to spice up ones click-thoughs, or subscription numbers for other projects, is just as sleazy as what one purports to expose.
Christopher Galbreath D.O. - November 26, 2007 at 2:49 PM
I very much appreciated your article in the NY Times on your experience as a so-called educator of doctors. I am a psychologist in the private practice of psychotherapy who sometimes refers patients to reputable psychiatrists for evaluations for meds, but has been very aware of the over-selling of the effectiveness and the under-notification of the side-effects of many of the commonly prescribed psychotropic medications. One issue you didn't address in your article is that the huge amounts of money the drug companies spend on the marketing of drugs is part of the reason for the tremendous rise of health costs in our country. I don't know if you're one of the dwindling numbers of psychiatrists who actually do psychotherapy, but the use of these drugs with concurrent psychotherapy has been shown, in many studies, to be better than drugs alone. Anyway, thanks for your excellent and revealing article. I have forwarded it to all the professional organizations of which I am a member.
Stephan Tobin, Ph.D. - November 26, 2007 at 4:05 PM
Dr. Carlat,
I found your article to be a concise piece on what I have often thought. It takes a lot to constantly be aware, as a consumer, of what one's doctor is prescribing and why. While I understand why one might want a doctor to lend an air of legitimacy to those pitches, the drug companies should just put them on their payroll; then there won't be any confusion as to what the doctor's role is.
I work in the wine industry and sometimes I think there are more restrictions on what I do than in the drug trade.
In our industry what you did would be called a "consulting"; brought in to lend an air of gravitas to our product. But make no mistake, all of our customers would know, that the consultant is being paid to help pitch the product.
When a friend became a doctor and I saw the access the drug reps had in trying to establish early on a certain loyalty, that's when I started asking my doctors why they were prescribing a certain drug. Even now, I come home, research whatever drugs have been prescribed to me, call back and ask, why one over another.
I am my only advocate. - November 26, 2007 at 6:06 PM
Dr. Carlat,
THANK YOU. THANK YOU. THANK YOU for you post.
As a young physician in residency, I applaud any effort to turn medicine away from its seedy business side and let doctors get back to the practice of doing what is right for the patient. A doctor who is pressured by money or any other motive to prescribe a drug or paint data in a certain light for Big Drug is not getting the point of what it means to be a doctor and what is special about it -- i.e. it's one of the few professions where impartiality separates the good from the bad.
I believe clinically practicing physicians should not be hawking drugs and paid by Drug Cos to do it.....or at least not paid so handsomely. I can see a $50 meal for a drug you believe in, I can't see why you need $750 for it. Your article was brave and needed. We are advocates for our patients, NO ONE ELSE. The "doctor" who commented otherwise in this thread does not understand what the Hippocratic Oath is about truly.
That being said, a factor could be the prolonged doctor-creation process in this country. First, it takes very long and a huge debt trail to become a physician (for most). It is not uncommon for my co-residents to have $200,000 of debt AFTER GRADUATING RESIDENCY! When you look at dentists making $195,000 on average after four years of school. Or, even P.A. APNs or CRNA's making $120,000 if they work 60 hours/wk, can you get as mad for a doctor who is looking at $140,000 (what you make and what I am looking at unless I specialize after internal medicine residency) for taking some drug rep money here and there? Yes, you still can, but it's harder. We need to do something about the overly long and grueling way we create doctors in this country and perhaps we can get to the point where MDs are satisfied at $150,000/year.
Still, the above is a side point. I've heard it said that starving artists never complain that they never dine at the fanciest restaurants and that true doctors should be the same. The degree of detail and the AMA complicity in helping drug corps maximize every dollar they can from a drug -- whether or not indications dictate that such a drug be so profitable is a crime any Dr. Drug rep aids. - November 26, 2007 at 6:58 PM
This is a great article. I've already sent around to a lot of my friends and colleagues, including my roommate who is a drug rep for Bayer. Though not in medicine myself, I've seen the sales side vicariously through her eyes, and always felt it very unsavory, and your portrayal certainly amplifies that. I don't want her to feel bad about her job, but at the very least I think there are lessons in tact for drug reps to learn from your account.
Tangentially, I take Effexor XR, and (thankfully) am very happy with the drug. Despite not knowing whether my doctor was an attendee of one of these lunches (come to think of it, the drug companies should be obligated to provide the names of doctors who attend these lunches), I'm glad he's prescribed it for me. - November 26, 2007 at 7:39 PM
Ah! It was YOU! Now you can apologize to patients, too!
I'm kidding. A little. Maybe not that much. Back in '02 I went to see a family-practice doc about depression, and I'd hardly gotten the word out of my mouth before he was pressing Effexor into my hand. What a vile, vile drug. I took the lowest dose, gained weight uncontrollably, and felt like I spent my days smiling tolerantly at something that would never arrive. After three months I'd had enough, and tapered off. The withdrawal was astonishing. I was sick as a dog physically and emotionally. Spent a week sobbing hysterically in some crazy belief that I'd caused my 24-year-old cat's death the year before. It was absolutely nuts.
Never, ever again. I'd responded quite nicely to a tricyclic some years before, by the way. There hadn't been any medical need to boost Effexor sales with me. - November 27, 2007 at 12:13 AM
Oh, son of a bitch! I just finished reading the piece. You _knew_ about the withdrawal symptoms, and you kept on pimping the stuff! I don't understand why your patients keep going to you. A lapse in judgment like that, I have a hard time believing that's a one-time thing. That's not an honest mistake; that's a decision informed by character.
I don't understand this "mea culpa, I was like an addict, hooked on the dough" baloney, either. I'm a single mother, and I support my kid by writing freelance ed stuff. I need the money. I still turn down work that involves intellectual dishonesty or the presumption that kids can't read and imagine. This isn't hard. The sense of dismay and/or revulsion is a pretty good tipoff that a job's no good. Then I say politely, "No, I'm sorry, I can't write that." There are other jobs in the world.
I would like to know what kind of restitution you're doing. Please don't say "writing these articles". That's not restitution; that's cashing in on the confessional-memoir/medical-memoir confluence that's hot at the moment.
If you haven't made commensurate restitution, I would suggest that you figure up the amount you received from Wyeth, divide it by your hourly rate, and donate that number of hours to uninsured patients. - November 27, 2007 at 3:54 AM
- serial# said...
i love all these anonymous people who rip into dr. carlat.
my reaction to the piece is that it isn't completely plausible that he could have been as naive as he claims. what did he do at mass general, wash bed linens?
it's natural to want to make yourself the hero of your own story, especially if it's a confessional. i give him points for being open. furthermore, he paints an accurate picture of relationships that many lay-persons may not be aware of.
also, psychiatrists shoot themselves in the foot with this class of drugs by neglecting to emphasize the withdrawal effects. perhaps they should try taking them first. watching from the outside doesn't give a complete understanding of the pain involved.
patients, on the other hand, really need to take more responsibility for their pharmacological treatments. many are frightened and overly predisposed toward attributing every ache pain they have to a new medicine. and most of all, be realistic. if you are going to take one of these drugs, it is going to come along with its own set of problems. it is a trade-off and the patient must be involved in assessing whether it's worth it. doctoring requires some art and intuition, there is never complete information available. the doctor can only assist in selecting potentially appropriate agents and evaluating the effects, many of which he must rely on the patient to report.
i do like the idea of restitution by volunteering hours to the uninsured. that is a clever and balanced approach.
clyde tressler
maplewood nj - November 27, 2007 at 9:36 AM
Give me a break, Carlat. Now the world is expected to believe that doctors learn and teach and practice whatever pharma says? Hmm, Dr. Carlat is certainly enjoying a fair amount of media attention as a "whistle-blower". Seems to live for attention. Glad to see that others are onto him, too.
Physician, heal thyself: The issue is not that pharma companies pay doctors to speak on behalf of their drugs, but that SOME doctors have appallingly WEAK ETHICS. On interviews about this blog, this psychiatrist readily projects his own deficit upon the rest of his profession. DON'T paint us all with the same offensive and dirty brush. Not only is it a psychological mistake, it's a logical fallacy: Association does not prove causation. Just because a minority of doctors' moral compasses point whichever way money flows, the majority doesn't follow. One bad apple does NOT spoil the barrel--throw out the bad apple.
I am a physician fed up with being told how to do everything by everyone who thinks they know better or that they know I can't possibly be trusted do anything right: How to practice medicine (& how much my work is worth) by Medicare, HMOs, and many non-physicians, and how to make good moral decisions by the Pope and the AMA (and after this, probably Congress--oh, the irony!). That's what always happens after this sort of "expose". No rational thought, just knee-jerk throw-the-baby-out-with-the-
Mandating (as some suggest) the publication of physicians' names who "take" pharma money doesn't prove they are "biased". Most researchers and doctors are ethical & serve the greater good.
Continuing Medical Education lectures are often catered by pharma. So what? CME lectures must be unbiased, speakers must disclose all financial ties to their topic, and topics must stick to FDA-APPROVED drug use labelling (this is the only "message" FDA permits drug reps to sell, so of course, it's "on message") or the speaker must state that a use is "off-label". If the lecture doesn't meet these ethical criteria, it can't be used for CME credit.
Many pharma reps are nice people, who believe they are helping others. It is clear to most physicians when they're being "sold", and most are willing to sit through a nice rep's "message" to glean the useful information or the free samples for patients who can't even afford generics (an increasing number). It takes a lot more than a sandwich to influence my care of patients (or being paid an honestly-earned speaking fee--set by me, not the rep--for preparing an unbiased lecture instead of earning more money in the office). When a rep has said I had to use only company slides and talk nice about his drug, you know what I said? Nope. Homey don't play dat. My slides, my talk, my fee, it's CME, or no deal. Goodbye. And if I don't use a drug, I don't see the rep.
Most physicians prescribe on the basis of clinical guidelines and solid science. Regardless of who funded it, science has to meet rigorous and public peer review to be considered valid. And there isn't enough money coming from outside of pharma to research the drugs we need or even fund some medical school training. Congress won't pay for it. There is more to sensationalist "whistle-blower" stories like this than ever gets to the public. My fellow American, do your own research and think with your own head. Skepticism goes both ways. - November 27, 2007 at 11:13 AM
Follow the link to the AMA's Physician Data Registry opt-out page, which may be accessed from the homepage as well, on the right hand column... - November 27, 2007 at 12:08 PM
1. Do you feel any ethical remorse in regards to any money you received for your article?
2. Wouldn't it make sense for drug companies to use doctors who prescribed their drug often? A person with little clinical experience prescribing the drug would make for a weak speaker.
3. Your disdain for drug companies and drug representatives seems extreme. How will doctors be properly educated on the benefits and side effects of medicine without interaction with drug reps?
4. I think you are right about a lot the excesses of the industry and its marketing, but your indictments are too broad...especially since they are based on a personal story and not facts. - November 27, 2007 at 2:21 PM
clyde, some of us stay anonymous because we prefer not to leave pieces of our medical histories floating around publicly on the internet. Not attached to our names, anyway.
- November 28, 2007 at 1:55 PM
Dear Dr. Carlat,
Keep the money and keep writing. I took 3 months to get off of Effexor XR at 225mg daily and I had all the horrible side effects. With the short half life of Effexor, a day where you forgot your pill in the AM and left for the day was a nightmare. I don't know if my DR. listened to a rep. like you or was selling it like you. I went off Effexor because I was inspired by another Times writer, Kira Salak, "The Vision Seekers" 9/12/2004 to travel to Peru to see a shaman and drink ayahuasca to cure my depression. That worked. I haven't heard of anyone promoting that alternative. My psychiatrist didn't want to hear about it when I came back. My trial and success seems as valid as the random choices in the approved medication matrix of today. We and our parents put so much thought, effort and investment into choosing our educational sources to achieve professionalism. it's a pity when as professionals we compromise our parents efforts promoting misinformation in so many business fields. - November 28, 2007 at 3:11 PM
- Unknown said...
Dr. Carlat,
I had to write to thank you for your recent article in the New York Times. It is rare today to see such integrity and a willingness to go public about pharmaceutical marketing. I own and operate www.paxilprogress.org, which is a peer support web site for antidepressant withdrawal. It is the misinformation that doctors have received on this category of drugs that created the huge need for those suffering in withdrawal to seek out their peers for firsthand, unbiased information. This is what paxilprogress is all about. Thousands of ssri users supporting each other through withdrawal. Most have given up on their prescribing psychiatrist, since denial of withdrawal is rampant. So they go it alone, with the help of those who have been there before them.
My son is a survivor (just barely) of Paxil withdrawal. My husband is hopelessly addicted to Effexor. Even the smallest weaning amount causes a suicidal reaction.(never suicidal prior to Effexor...mild depression) You can imagine my horror when I discovered the truth behind these drugs. As a nurse of 24 years I trusted my fellow medical professionals. That trust almost cost my son his life. Some, even with full disclosure may choose to take an ssri, and that is their choice. But they have the right to know the good, the bad and the potentially ugly before making that decision.
I speak out at every opportunity I get so that others will have full disclosure of potential side effects and adverse reactions . This is a basic right of all patients. Hopefully your article is the beginning of a change in how drugs are marketed. I wish there were more doctors who were willing to look beyond the lunch and see the facts.
Thank you - November 29, 2007 at 6:34 PM
Very Interesting Article! I greatly enjoyed your frank self-examination. I am an academic Ob/Gyn sunspecialist and have been asked to do lunch talks as you describe. The company that asked me insisted that I use their slides, something that made me feel ethical discomfort because of the difference between my expressing my opinion and my expressing the company opinion.
I have found, however, that some companies, including Wyeth, will pay an unrestricted grant for a physician to give grand rounds at a teaching hospital, often on a subject only tangentially related to their product (or sometimes not at all related). The grant to the medical school usually includes travel expenses and a modest honorarium for the speaker. They have absolutely no say in the content of the talk. I have found this arrangement acceptable in the past. I am wondering if you or others finds this objectionable and the reasons why. - November 30, 2007 at 8:39 PM
- K.X.F.X. said...
"To see how I made an extra $30,000 in 2002, click here."
Doctor -- any chance you'll be directing any of those cruelly-gotten gains to an awareness campaign so that (apparently naively) trusting patients are made aware of the drug's utterly devastating withdrawal effects before they're put upon this path?
I have a million "if only-s" after my absolutely grueling struggle to kick Effexor, but the largest one of all is, if only I'd had all the facts. I would never in a million years have started taking this drug had I known. All I can do now is share my cautionary tale. - January 23, 2008 at 2:56 PM
I find it VERY interesting that a Psychiatrist is commenting on hormone Replacement Therapy issues???
Secondly, it is very appauling for a physician to bash drug companies when he "spoke" for them for years, but once removed from their speaker's list (for questionable reasons), he now bashes other physicians for educating others as speakers??? Wow, how hypocritical! - August 25, 2009 at 1:12 PM
Dr. Carlat, I find it hard to believe that your experience with the pharmaceutical industry resulted in the kind of epiphany that you have described. Do you really mean to say that prior to your "awakening" circa 2002, you had no suspicions, objections, dissatisfactions, or reservations about eating all those lunches/dinners in medical school, residency, and beyond? About actually spending a substantial amount of time with reps? About taking all that cash for doing something that you knew was clearly marketing and not educational? About watching one industry devour another? About engaging in "professional" endeavors that your father likely would never endorse? I just don't believe that you were so oblivious to what you were doing. I think it is a clever historical revision to frame it as such, simply because most of your readers probably wouldn't understand your deeper devotion to psychiatry; and despite most of your ranting, it's likely that your readers cannot understand the depth of your disgust with psychiatry. In my own experience, the discomfort of even casual conversation with most reps felt slimy from my first encounters with them in medical school, and the sliminess only intensified throughout my psychiatry training. I'm guessing that you had a similar experience and that you were keenly aware of all that was going on around you.....and that your luncheon speaking was the ultimate effort to immerse yourself into the pharma culture....which is what you needed, in the end, to be able to launch your current projects (which I'm sure your father is proud of).
Despite completing my psychiatry training relatively recently (in Boston), I only inadvertently discovered you and your blog and report within the last 6 months (and in somewhat of a strange way, as I was googling "psychology physical examination," a topic that I find way more fascinating and enveloping that your idealization of psychology prescribers). Since reading your blog and book (purchased with much hesitancy, although I was grateful for your essential message in the end), I've gone through several stages of emotional evolution regarding one issue in particular: prescribing. At first, like most psychiatrists, I was enraged by your casual endorsement of psychology prescribing, and you are well aware how much it makes psychiatrists' "blood boil." Without going into much more depth, the way I see your two-front approach to "reforming" psychiatry is that it is actually a perfect recipe for stirring up the profession (of mental health, that is): behead pharma, and empower psychology. These are the most potent aspects of your movement. But your plan for solving the mental-health crisis through psychology prescribing is bad. Perhaps if I have the stamina at some point, I'll outline a better way to do this without 1) creating pseudo-prescribers out of psychologists and further complicate the arena of psychopharmacology, and 2) destroying the MD psychiatrists and the PhD psychologist in favor of an army of hybrid mental health professionals that a) can't talk to physicians and b) aren't respected by psychologists anymore than psychiatrists currently are(n't). - October 29, 2010 at 8:27 PM
- Daniel Carlat said...
I only wish you would unveil yourself so that we could carry on a productive debate. You are obviously articulate and intelligent. There are many places where we could carry on a debate, such as Psych Times, Clinical Psych News etc...
Danny Carlat - October 29, 2010 at 8:46 PM


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That mortal man should feed upon the creature that feeds his lamp, and, like Stubb, eat him by his own light, as you may say; this seems so outlandish a thing that one must needs go a little into the history and philosophy of it.
It is upon record, that three centuries ago the tongue of the Right Whale was esteemed a great delicacy in France, and commanded large prices there. Also, that in Henry VIIIth's time, a certain cook of the court obtained a handsome reward for inventing an admirable sauce to be eaten with barbacued porpoises, which, you remember, are a species of whale. Porpoises, indeed, are to this day considered fine eating. The meat is made into balls about the size of billiard balls, and being well seasoned and spiced might be taken for turtle-balls or veal balls. The old monks of Dunfermline were very fond of them. They had a great porpoise grant from the crown.
The fact is, that among his hunters at least, the whale would by all hands be considered a noble dish, were there not so much of him; but when you come to sit down before a meat-pie nearly one hundred feet long, it takes away your appetite.
Only the most unprejudiced of men like Stubb, nowadays partake of cooked whales; but the Esquimaux are not so fastidious. We all know how they live upon whales, and have rare old vintages of prime old train oil. Zogranda, one of their most famous doctors, recommends strips of blubber for infants, as being exceedingly juicy and nourishing. And this reminds me that certain Englishmen, who long ago were accidentally left in Greenland by a whaling vessel—that these men actually lived for several months on the mouldy scraps of whales which had been left ashore after trying out the blubber. Among the Dutch whalemen these scraps are called "fritters"; which, indeed, they greatly resemble, being brown and crisp, and smelling something like old Amsterdam housewives' dough-nuts or oly-cooks, when fresh. They have such an eatable look that the most self-denying stranger can hardly keep his hands off.
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Strong cheese of England : matching answer – Crossword-Clue
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Breaking & Entering Reported in Williamstown
WILLIAMSTOWN, Mass. - Williamstown Police are urging residents to remain vigilant after another breaking and entering was reported over the weekend.
Police responded to a residence at Stetson Court on Saturday evening, Feb. 13, at about 6:27 after the caretaker called to report somone inside the building. The individual fled the scene without confronting the caretaker, said police, and a search was conducted with the help of the K-9 unit's Blue and Officer Michael Ziemba.
The suspect was not found but police were contacted again at about 10:32 about a past burglary on Chapin Court.
Both incidents were forced entries and are under investigation. Police encourage residents to report any suspicious activitings
Tags: break-ins, buglaries |
Crime Watch Page Created for North Adams
NORTH ADAMS, Mass. — There's a new crime watch page on Facebook for city residents.
The page was created by Jennifer Breen Kirsch, a local attorney who's become active in crime prevention after her parents' home was broken into days after Christmas. Kirsch, working with the city and local organizations, has spearheaded the community watch group.
The community effort has been prompted by a wave of break-ins that came to public attention last fall after a number of break-ins in Clarksburg and Stamford, Vt. A suspect believed to be the culprit in the majority of them — and dozens of others through Berkshire and Bennington (Vt.) County — was arrested and charged. However, several of those burglaries have not be resolved and numerous others have occurred in Williamstown, North Adams, Adams and Cheshire over recent months.
North Adams held a community meeting on Thursday night at City Hall to discuss crime and neighborhood action to prevent it.
The new Facebook page states:
Please join the new Neighborhood Crime Watch Group sponsored by Mayor Dick Alcombright, the NAPD through Officer Mark Bailey and Commissioner E. John Morocco, community representative Jenn Kirsch, and the NBCC, through Ashley Benson and Al Bashevkin. To find out more, please post questions and we will quickly reply. Our goal is to reduce the crime rate, as a community, in conjunction with City Hall and the NAPD. We need volunteers and neighborhood captains to run meetings. If you are interested, Officer Bailey, along with members of the team, will conduct a meeting for you and your neighbors, at your home. Let's unite under this common goal to reduce crime in our city! |
Tags: break-ins, buglaries, Veremko, crime watch |
North Adams Urging Crime Watch
NORTH ADAMS, Mass. — The city is hosting a community meeting on Thursday, Feb. 11, at 6 p.m. at City Hall to discuss neighborhood safety and crime watches. Mayor Richard Alcombright, whose home was burglarized last spring, talked a little about the issue at Friday's Northern Berkshire Community Coaliton forum.
The call for a crime watch is prompted by a spike in burglaries in the city and other parts of Berkshire County and Southern Vermont. The first indication of a rise in the area began last fall with a series of break-ins, many of which police say are linked to a Pittsfield man, Stefan Veremko. More recently, homes in North Adams, Adams, Cheshire and Williamstown have been broken into, including the parents of Jennifer Breen Kirsch.
Kirsch, a former Middlesex prosecutor, criticized the handling of the case and is now spearheading efforts to develop local crime watches.
"I think it's a bold attempt. We're going to bring the city, we're going to bring the private citizen, the Community Coalition together and, hopefully, folks will show up and consider the neighborhood watch as a solution to stopping crime in their neighborhoods," said Alan Bashevkin, executive director of the coalition, of next week's meeting.
Public Safety Commissioner E. John Morocco urged residents to contact the police about starting a neighborhood watch.
"Call us up. We'll show you [how] and we'll guide you through it," he said. "And we won't just leave. We'll show up every month at your meeting. ... But it takes a neighborhood to start a neighborhood watch program it takes somebody to step forward and say 'we're going to do this' and get the neighbors to show up."
In any case, said Morocco, "don't leave your car unlocked, don't leave your house unsecured."
Breaking and enterings, or B&Es, happen anytime, he said. "The recent rash were more bold, daytime, but they happen all times of day and night."
The commissioner said about 85 to 90 percent of all crimes - domestic violence, child abuse, larceny - here and nationwide can be attributed to substance abuse.
Liz Shiner of the Elizabeth Freeman Center, said domestic violence has increased and that the county's rate for retraining orders is 40 percent above the statewide rate. The center would be willing to teach neighborhood crime watches how to deal with domestic violence, she said.
Morocco shared some interesting information about how Veremko allegedly plotted the numerous burglaries across the county and into Vermont over the past year.
According to Morocco, Veremko kept a notebook with a list of likely houses. He'd case the house and look up the phone numbers, call and track when they weren't home. "He'd do his homework," said Morocco. "He was probably the most sophisticated burlglar I've ever seen."
Veremko is being held on $250,000 bail after being arraigned on numerous charges relating to the break-ins.
Tags: break-ins, buglaries, Veremko, crime watch |
Veremko Arraigned, Held on $250K
PITTSFIELD, Mass. — Here's a name familiar to many in Clarksburg and Stamford — Stefan Veremko.
Veremko was arraigned in Berkshire Superior Court on Monday afternoon multiple charges related to numerous burglaries across the county between last June 1 and Nov. 19, 2009. The Pittsfield man is suspected in some of the break-ins and attempted break-ins in both Clarksburg and Stamford this past fall. He's also facing charges in the Bennington, Vt., area.
The 28-year-old had not-guilty pleas entered on his behalf for 15 counts of breaking and entering in the daytime with intent to commit a felony; 14 counts of larceny in building; 11 counts of malicious destruction of property worth more than $250; 15 counts of receiving stolen property worth more than $250 and single counts each of possesion of ammunition without a firearms identification card, cruelty to animals and being a common and notorious thief (we'll have to look that one up).
Judge John A. Agostini ordered that he be held at the Berkshire County House of Correction on $25,000 cash or $250,000 surety bail. He also was ordered to stay away from the many victims, as well as to have no contact with them if he posts bail.
As most will remember, Veremko was arrested after an off-duty probation officer said he saw him fleeing a building in Lenox with a full pillow case. Veremko allegedly stopped and switched license plates but the officer noted the number and he was arrested at his Dartmouth Street residence.
The investigation was conducted by members of the Lenox, Pittsfield, Dalton, Lanesborough, Stockbridge, West Stockbridge, Williamstown and Clarksburg police departments and state troopers assigned to the Lee barracks.
Tags: break-ins, buglaries, Veremko |
Break-Ins Reported in Williamstown
WILLIAMSTOWN, Mass. — A Cobbleview Road residence was broken into late Wednesday afternoon as police were investigating an earlier burglary on the same road.
Police were at the first residence at about 5 p.m. when a neighbor reported the motion lights coming on at another Cobbleview Road home. As officers approached the residence, they heard what sounded like a person running from the area into the woods. A search was conducted by second-shift officers, including Officer Michael Ziemba and Blue, and North Adams Police officers but no suspect was found.
The house had been forcibly entered and property stolen. The state police Crimes Services Section was contacted to assist in the investigation.
Williamstown Police are asking residents to be alert to unusual or suspicious vehicles and to contact the police at 413-458-5733 to report any suspicious activity.
Tags: break-ins, buglaries, crime watch |


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Sunday, October 01, 2006
5 Comments:
hello Mona
i am a grad student in america and i am writing a paper on the affect of the occupation on palestinian health. i am currently looking for empirical data regarding the matter- can you suggest some sources for me?
Thanks!! -
Are you by any chance related to dr. Jehad al-Farra???
By LadyCroc, at 10/14/2006 10:06 PM
Dr. Elfarra,
I heard your recent interview on Democracy Now! I was happily surprised to hear you, I have read your blog before and am grateful you were able to do the interview.
I hope this interview will help to make people more aware of your struggles in Palestine.
In solidarity,
Sara Kenney -
Watch TerrorStorm on google video's
It is Pat's birthday on November 6, and elections are the day after. It gets me thinking about a conversation I had with Pat before we joined the military. He spoke about the risks with signing the papers. How once we committed, we were at the mercy of the American leadership and the American people. How we could be thrown in a direction not of our volition. How fighting as a soldier would leave us without a voice… until we get out.
Much has happened since we handed over our voice:
Somehow we were sent to invade a nation because it was a direct threat to the American people, or to the world, or harbored terrorists, or was involved in the September 11 attacks, or received weapons-grade uranium from Niger, or had mobile weapons labs, or WMD, or had a need to be liberated, or we needed to establish a democracy, or stop an insurgency, or stop a civil war we created that Somehow our elected leaders were subverting international law and humanity by setting up secret prisons around the world, secretly kidnapping people, secretly holding them indefinitely, secretly not charging them with anything, secretly torturing them. Somehow that overt policy of torture became the fault of a few "bad apples" in the military.
Somehow back at home, support for the soldiers meant having a five-year-old kindergartener scribble a picture with crayons and send it overseas, or slapping stickers on cars, or lobbying Congress for an extra pad in a helmet. It's interesting that a soldier on his third or fourth tour should care about a drawing from a five-year-old; or a faded sticker on a car as his friends die around him; or an extra pad in a helmet, as if it will protect him when an IED throws his vehicle 50 feet into the air as his body comes apart and his skin melts to the seat.
Somehow the more soldiers that die, the more legitimate the illegal invasion becomes.
Somehow American leadership, whose only credit is lying to its people and illegally invading a nation, has been allowed to steal the courage, virtue and honor of its soldiers on the ground.
Somehow those afraid to fight an illegal invasion decades ago are allowed to send soldiers to die for an illegal invasion they started.
Somehow faking character, virtue and strength is tolerated.
Somehow profiting from tragedy and horror is tolerated.
Somehow the death of tens, if not hundreds, of thousands of people is tolerated.
Somehow subversion of the Bill of Rights and The Constitution is tolerated.
Somehow suspension of Habeas Corpus is supposed to keep this country safe.
Somehow torture is tolerated.
Somehow lying is tolerated.
Somehow reason is being discarded for faith, dogma, and nonsense.
Somehow American leadership managed to create a more dangerous world.
Somehow a narrative is more important than reality.
Somehow America has become a country that projects everything that it is not and condemns everything that it is.
Somehow the most reasonable, trusted and respected country in the world has become one of the most irrational, belligerent, feared, and distrusted countries in the world.
Somehow being politically informed, diligent, and skeptical has been replaced by apathy through active ignorance.
Somehow the same incompetent, narcissistic, virtueless, vacuous, malicious criminals are still in charge of this country.
Somehow this is tolerated.
Somehow nobody is accountable for this.
In a democracy, the policy of the leaders is the policy of the people. So don't be shocked when our grandkids bury much of this generation as traitors to the nation, to the world and to humanity. Most likely, they will come to know that "somehow" was nurtured by fear, insecurity and indifference, leaving the country vulnerable to unchecked, unchallenged parasites.
Luckily this country is still a democracy. People still have a voice. People still can take action. It can start after Pat's birthday.
Brother and Friend of Pat Tillman, Kevin TillmanBy Neutralsam, at 10/22/2006 9:44 AM
Very nice! I like it. dodge dakota engine
By Ziomal, at 11/01/2006 12:37 AM


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Nike, Inc. is an American multinational corporation that is engaged in the design, development and worldwide marketing and selling of footwear, apparel, equipment, accessories and services. The company is headquartered near Beaverton, Oregon, in the Portland metropolitan area, and is one of only two Fortune 500 companies headquartered in Oregon. It is one of the world's largest suppliers of athletic shoes and apparel and a major manufacturer of sports equipment, with revenue in excess of US$24.1 billion in its fiscal year 2012 (ending May 31, 2012). As of 2012, it employed more than 44,000 people worldwide. The brand alone is valued at $10.7 billion making it the most valuable brand among sports businesses.
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By now, you have likely seen news reports questioning whether flossing is necessary for your oral health.Our expert dentist wants to remind patients that our office offers thorough oral cancer screening as part of our comprehensive dental health services. Like with every form of cancer, early diagnosis can have a profound impact on the success of your treatment. Regular screenings are your first line of defense against oral cancer and our doctor is here to help.
In your screening, our doctor will check your lips, tongue, gums, mouth, and throat for any abnormalities that could be or become cancerous. We will give careful consideration to any symptoms you may be experiencing. If you have experienced any oral cancer symptoms for more than a week without improvement, schedule an appointment and tell your dentist immediately. Symptoms that could indicate oral cancer include:
- Ear pain
- Unexplained mouth bleeding
- Mouth sores that don't heal
- White or red patches in your mouth
- Dramatic weight loss
- Lumps or swellings in or around your mouth
- Sore throat without other sinus symptoms
- Sensation of something caught in the back of your throat
- Pain or difficulty in swallowing, speaking, or moving your jaw or tongue
One adult American dies of oral cancer every hour. Though anyone can develop oral cancer, some factors can increase your risks. Some of the most common risk factors include: genetic predisposition, prolonged sun exposure, unhealthy diet, and excessive consumption of alcoholic beverages. Oral cancer is more common in men than women. Patients with gastro-esophageal reflux disease (GERD) are at increased risk. Users of tobacco in any form are six times more likely to develop oral cancer than non-users.
Whatever the cause, the success of treatment depends on the size, type, and stage of the cancer. Early detection can play a critical role in your successful recovery. When found in early stages, oral cancers have an 80 – 90% survival rate. The primary reason for this is that early detection leads to earlier treatment. Oral cancers that are found in early or precancerous stages can often be removed and require less invasive procedures to treat. Later stages of cancer are likely to be larger and more complex and often have spread far beyond your mouth.
We are accepting new patients. If you would like more information about oral cancer and oral cancer screening, contact our office for a consultation.


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Nocking an Arrow
A nocked arrow should be positioned about a quarter inch above the arrow rest on the bow handle.
- On most bows, a small brass band called a "nocking point" is crimped onto the bowstring to mark the correct position.
- To nock the arrow:
- Grasp the arrow between the thumb and index finger of the right hand (if you're a right-handed shooter).
- With your left hand, hold the bow parallel to the ground about waist high, string toward the body.
- Lay the arrow shaft on the bow's arrow rest.
- Align the slot in the nock with the string, while making sure that the cock feather points up (while the bow is parallel to the ground).
- Pull the arrow back until the string snaps into the slot.


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COVID-19's rapid sweep across the country has forced optical practices to make rapid clinical management decisions. Some optometrists temporarily shuttered their businesses due to the pandemic, while others began to offer emergency appointment services and telehealth.
As mandatory restrictions begin to lift in many locations, optometrists are beginning to open their doors for routine care. But this time around they will implement strict social distancing guidelines and take unprecedented precautions to limit the spread of infection.
Some of the Changes You Should Expect to See
1) Signage throughout the office spelling out new steps and protocols to ensure maximum safety for staff and patients alike.
2) Social distancing will be the new norm. Packed waiting rooms will be a thing of the past. Instead, clinics will be spacing out seating to reduce capacity and scheduling in longer intervals to minimize patient interactions. Some clinics may ask patients to wait in their cars until they receive a text message from the office stating that they can come in.
3) Certain practices will require appointments for individuals to see and try on the array of frames and sunglasses at the dispensary. Bookings will be in 15-20 minute increments, accessed by one individual at a time.
4) Methods will be introduced to decrease the number of surfaces a patient touches. This will include leaving the clinic's front door open (or replacing it with a motion-activated door), facilitating cashless payments, and encouraging patients to fill out registration forms online.
5) Patients who aren't feeling well or who have been in contact with someone who is ill will be asked to reschedule their appointment two to three weeks in the future.
6) Measuring one's temperature at the entrance will become commonplace — this goes for both staff and patients. Though not the most reliable screening tool, as those who are asymptomatic can still spread the virus, it will identify some people who aren't well. Anyone registering 100.4° or above will be sent home.
7) There will be more time between appointments, to allow the staff to thoroughly clean and disinfect before and after each patient's visit.
8) Many eye practitioners will be wearing safety goggles and face masks, particularly during any up-close contact with the patient. Patients may also be asked to wear masks.
9) Individuals with suspected ocular infections will be put in a special containment area.
10) Practices will frequently wipe down any patient area, including chairs, counters and doorknobs. Every exam room will be completely disinfected between appointments. In the dispensary, frames will be promptly disinfected after patients touch them.
11) Patients will be requested to wash or disinfect their hands upon entering the office and when entering different rooms. Midtown Eyecare in Tulsa has strict hygiene and sterilization protocols in place to prevent the spread of COVID-19 and other infections.
If you're dealing with a vision or eye health issue and need to visit Midtown Eyecare, or if you would like some more information on how we have adapted our practice due to COVID-19, please don't hesitate in contacting us. We'll be happy to assist you however we can.
Midtown Eyecare serves patients from Tulsa, Oklahoma.


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Accucold 11 Cu.Ft. Chest Freezer EL31LT
Accucold11 Cu.Ft. Chest Freezer EL31LT
Made in Denmark with extra thick insulation for proper cold storage
(85cm H x 131cm W x 69cm D)
Manufactured for us in Denmark by ELCOLD, Accucold EL31LT is a -45º C capable chest freezer built with solid insulation for laboratory and life science storage applications.
This 11.1 cu.ft. chest freezer uses static manual defrost cooling to maintain constant temperature, with an externally controlled digital thermostat to ensure easy temperature monitoring. Extra thick 4 ½" thick insulation offers added efficiency and reliability. Additional features include a solid, easy-grip handle complete with factory installed lock, a sturdy set of casters, and counterbalanced hinges for comfortable loading and unloading. This unit includes a factory-installed probe hole to allow users to install their own monitoring equipment.
The EL31LT is UL-S listed to ANSI-NSF standards for commercial use and is designed to operate between -10º C and -45ºC. Additional sizes are available. Browse our website to explore more options.
NOTE: Accucold freezers are purpose-built to the support meeting the current CDC (Centers for Disease Control) guidelines for the storage of vaccines. At this time, Accucold refrigerators have not been evaluated to the new NSF 456 standard. As referenced in the current Vaccine Storage and Handling Toolkit, these units incorporate several key features for stable operation.
Height of Cabinet | 33.5" (85 cm) |
Width | 51.38" (131 cm) |
Depth | 27.25" (69 cm) |
Capacity | 11.1 cu.ft. (314 L) |
Defrost Type | Manual |
Door | White |
Cabinet | White |
US Electrical Safety | UL |
Canadian Electrical Safety | ULC |
Sanitation | UL-S |
Amps | 7.2 |
Voltage/Frequency | 115 V AC/60 Hz |
Weight | 150.0 lbs. (68 kg) |
Shipping Weight | 157.0 lbs. (71 kg) |
Parts & Labor Warranty | 1 Year |
Compressor Warranty | 5 Years |
Thermostat Type | Digital |
Refrigerant Type | R290a |
Refrigerant Amount | 2.82 oz. |
High Side PSI | 342.0 |
Low Side PSI | 174.0 |
UL-S listed to NSF/ANSI-7 standards
Low temperature operation is ideal for a variety of laboratory, life science, and industrial applications
4 1/2" thick walls for added efficiency and stable cooling
Keyed lock on the handle for reliable security
Factory-installed 1/2" probe hole located on the right side to accept user-provided monitoring equipment
Electronic controls for precise temperature management, with temperature readout and controls externally located for added convenience
Easy and safe loading and unloading with a lid that remains open when lifted past 45º angles
Four solid wheels included for optional mobility
Static cooling for a stable interior
Environmentally friendly design with no ozone-damaging chemicals
Environmentally friendly hydrocarbon-based refrigerant for a greener footprint that meets current CARB regulations
Select How Many You Want and Click Add To Cart
Order Confirmation:
As soon as you place your order, you will receive an order confirmation e-mail This means that we have received your order in our system and pre-authorized your credit card for the purchase. As soon as we receive your order, we automatically check at the warehouse to confirm that it is in stock and available for immediate shipment. If your item(s) are available for immediate shipment (within 5 business days), we will process the charges and submit the order for shipment.
We utilize appropriate physical, electronic, and procedural safeguards to help protect against the loss, misuse, or alteration of any information you may provide at our site. We use industry-standard, 128-bit Secure Sockets Layer (SSL) encryption technologies when transferring and receiving customer data.
Order Shipment:
If your order is stock and we process the charges to your credit card, it will ship within five business days from the date of your order. We will send you tracking information within 24 hours of your order leaving the warehouse to the e-mail address you've provided when checking out. If you do not receive tracking information from us within six business days of your order, feel free to follow up with us at email@example.com
Taxes on Shipping:
We do not charge taxes on shipping.
Taxes regarding product sales:
We charge taxes, but only for a few states. Let us explain, we are sales tax-free for 48 out of 52 US States and Territories. There are 4 states in which we are required to collect sales tax for because we either have a physical location, dropshipper, or nexus located in those states. Moreover, the states we collect sales tax for are Virginia, California, New York, and New Jersey. Taxes will vary from state, county, and district were you live. If you'd like more details on the tax rates please visit our tax details page.
Additional Tax Info:
We are 100% sales tax-free for all states other than the 4 states listed above, ALL OTHER STATES ARE FREE FROM SALES TAX. If you'd like more details please visit our tax details page.
Good Wine Coolers is dedicated to ensuring that the thousands of products we store in our warehouse are in stock and ready-to-ship. However, sometimes demand outpaces supply and we fall short. Backordered items are still available for purchase online and will ship as soon as they become available.
If an item is backordered, we try to be as clear and accurate as we can on the item´s product page to give you estimated delivery dates. Items that are currently backordered are listed on the product page with an "Expected to ship on (Date)" near the item description area and can sometimes be added on your order´s email confirmation link. Please be aware that delivery dates on backordered items are approximate and subject to change.
There are times when a shipment of backordered products is unexpectedly delayed from our vendors and your promised delivery date may change. If this happens, we will send you an email indicating which item have been delayed and its new estimated shipping date. If the new shipping date is unacceptable to you, you can contact our Customer Service team at 866-652-7188
Please inspect the packaging of your item(s) when they arrive, if you notice any damage you should make note of it when signing for delivery. If your item(s) do arrive damaged, please send 3-5 photos including multiple angles of the damaged area to email@example.com and we will help with filing and processing a claim on your behalf.
Note that the option to report damage claims is only available for 5 days after delivery.
Cancellations & Refunds:
If you're not satisfied with an item that you purchased you can initiate a return within 30 days after delivery for a refund as long as the item is in its original condition and packaging. Items that have been used or modified in any way may not be returned. Orders returned, for reason other than a defective item (upon receiving), are subject to a restocking fee that is equal to 38% of the price of your order. You (the buyer) are responsible for any return freight (shipping) costs for BOTH directions (from the warehouse to you, and back to the warehouse). The purchase price minus these fees and costs will then be refunded to you when the warehouse processes your item (product must be returned within 30 days, new, unused, and in original packaging). Refunds will only be issued to the original credit card that you use when placing your order. Orders canceled later than 12 hours after purchase are subject to a 18% cancellation administration fee.
Please make sure to measure the necessary space requirements, etc. before purchasing! After 30 days, we will help administer a return only if the item is damaged and still under manufacturer's warranty. The manufacturer's warranties vary from 1-3 years depending on the company.
Custom Made Products and Products Made to order:
We will not be allowed to return or cancel these orders because they are made specifically for your unique situation and/or customized for your own unique needs. As you probably are aware additional labor, time, and materials are required to make sure these products are made especially for you :-)
Please feel free to contact us with any questions
E-mail: firstname.lastname@example.com
Phone: 866-652-7188
How am I able to place an order?
After you've discovered an item you'd like to purchase, click on the order button. Make sure you follow after the guidelines on the order page. In the event that you are requesting more than one item, please utilize our "add to cart" feature. In-stock goods are usually sent 2-5 business days after we get the ordering request.
What service do you use to process orders?
All orders requested on our site are handled and carried out through an approved Visa, MasterCard, American Express and PayPal procedure. At the point of offering the card information for a sale, if it has not expired and is valid, it will be pre-approved and charged when the processing is carried out.
What types of payment do you acknowledge?
We acknowledge and accept an extensive variety of payments including: Visa, MasterCard, American Express, Diners Club, Discover Card, JCB International card, and in addition PayPal.
What are the costs of shipping?
We provide you with free shipping on all wine coolers to all the lower 48 states in the U.S.
Do you charge sales tax?
Yes, but only for a few states. Let us explain, we are sales tax-free for 48 out of 52 US States and Territories. There are 4 states in which we are required to collect sales tax for because we either have a physical location, dropshipper, or nexus located in those states. Moreover, the states we collect sales tax for are Virginia, California, New York, and New Jersey. Taxes will vary from state, county, and district were you live. If you'd like more details on the tax rates please visit our tax details page.
What about other states sales tax?
We are 100% sales tax-free for all states other than the 4 states listed above, ALL OTHER STATES ARE FREE FROM SALES TAX. If you'd like more details please visit our tax details page.
What is a white glove delivery?
Our White Glove Delivery service, we'll have your item into your home for you, unpack it, inspect it, place it where you want it to be, and dispose of the packaging. Delivery is set up by an appointment so make sure to give us a good contact number for the unit you order. Once we reach out to you we'll set a date that works best for your schedule. Please also note that there may be Stair Charges that apply for locations with 5 or more stair steps.
How and Where do you ship your coolers from?
Our various wine cooler and wine refrigerator manufacturers ship exactly to the address you provide at check out, for most of our customers they choose to send it directly to their home. This helps to increase the delivery time of arrival instead of first directing it through our office. This helps our customers save both time and cash and is the way we have the capacity to offer you such low costs.
Would you be able to ship to a P.O. Box/APO address?
As of now, goods ordered can't be shipped to P.O. boxes and/or APO/FPO.
When will you be able to process the order(s) I requested?
After we've successfully received your payment for the item(s) you ordered you will get an email confirming your payment after you have made a purchase. Next, your order request will be processed and forwarded out to our storehouse 2-5 business days after the transaction is complete.
When will you contact me to confirm my order requested?
If the product and/or item you requested has alternatives that weren't outlined when making an order prior to shipping your order, a customer service agent from GoodWineCoolers.com will email you the specifics of your order and estimated time for delivery. Additionally, all normal orders will always receive a confirmation email once your order ships. Please be sure to check your inbox or spam folder when checking for email receipt.
When will I be reached with regarding the delivery time?
24 hours after the product and/or item you requested has shipped, we will email you with your shipping details. This gives you the opportunity to effectively track the day by day progress of your order from our facility to your door step. For huge (over 250lbs) and large orders which include cargo shipping orders, our shipping organization may call you beforehand about the shipping and delivery to arrange a helpful conveyance time for you and your schedule.
What do I do if my goods are harmed, damaged or faulty upon delivery?
We highly recommend that you thoroughly check the packaging of your item(s) when they arrive, if you sense any damage you ought to make note of it when signing the delivery form. On the off chance that your item(s) do arrived faulty or damaged, please send photographs to firstname.lastname@example.com immediately (same day) and we will get in touch with you at the earliest opportunity to help you with an exchange.
How do I return a product?
If you happen to be unsatisfied with your purchased product(s) for any reason (other than a defective product), you can return it within 30 days upon the receiving of your item. Orders returned are charged based on the restocking fee that is equivalent to 38% of the cost of your order. You (the customer) are liable for any cargo return costs for BOTH directions (from the facility it was ordered from to you, and back to the stockroom). The total cost of purchase price minus these fee charges and expenses will then be refunded or sent back to you when the facility processes your product(s) (item must be returned within 30 days, new, unused, and in original packaging). Refunds will only be provided to the same credit card that you utilized when putting in your order.
Please we advise that you quantify the vital space needed for your item before buying! Following our 30 day policy, we will help assist in a return only IF the product is harmed, faulty or damaged and still under manufacturer's guarantee or manufacturer's warranty. The manufacturer's guarantees and manufacturer's warranty differ from 1-3 years depending on the organization.
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