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Monday, April 28, 2008
Post-Deception Medicine
And in a feat of good timing, the Prescription Project has released a series of "toolkits" to help hospitals and academic medical centers create the conflict of interest policies that the parent organization now recommends. You can read more about this here.
The era of post-deception medicine is finally here.
40 comments:
- Supremacy Claus said...
These med schools are competitors, providing inferior CME. They have the credibility of Ford salesmen criticizing a Toyota.
I still await data on what harm has been done to patients or doctors by sponsored CME. In the absence of such proof of harm, the pronouncements from these academics constitute expression of mere bias, self-serving puffery, and unfair bashing of a superior competitor. - April 28, 2008 at 6:48 PM
- Unknown said...
Excellent work, Daniel. You have certainly done a lot to bring this about and to raise public awareness.
A Physician - April 28, 2008 at 6:52 PM
- Unknown said...
Dear Supremacy Claus
I have often wondered how much money you make out of the Speakers' Bureaus?
Does it feel like Christmas all year round. - April 28, 2008 at 6:56 PM
- Supremacy Claus said...
Kali: The average, adequate doctor will lose money on sponsored activities. Fees are half those earned in clinical care. These token fees represent charity, sharing and giving back for a life of high privilege.
Dan's income is so atypically, and inexplicably low, such fees may have a distortion effect on his care. Harvard residency failed to teach him enough clinical care to make his services worth as much as those of an advanced nurse practitioner. Or else, he does not know how to locate his practice in a place where he is needed. He should move to the interior of the nation for an immediate jump in income, even with the level of his Harvard skills.
You from California? - April 28, 2008 at 7:19 PM
I think the pendulum is swinging against gifts from drug companies, and I think a national recommendation for all medical schools is significant.
The schools will probably shrug their collective shoulders, some will enact new policies, and business will continue as usual.
It's hard to convince people that gifts are a bad thing, without making them feel like you think you're superior to them. It's a tricky game, so the more voices we have saying the same thing, the better.
Kudos to Carlat for taking time out of vacation to keep us up to date on drug company news. - April 28, 2008 at 8:20 PM
- Roy M. Poses MD said...
- This comment has been removed by the author.
- April 28, 2008 at 9:07 PM
- Roy M. Poses MD said...
But, after a quick read, the report does not suggest banning participation on speakers' bureaus, it just discourages it. The report puts no restrictions on company sponsored CME as long as it is accredited (and we know that accredited CME done by a MECC but sponsored by a commercial firm is often biased). Not not only does the report not ban larger conflicts of interest (consulting agreements, service on advisory boards, service on corporate boards of directors), it seems to encourage them, and does not even suggest disclosure (see page 23).
I will likely be blogging about this soon myself.
But ata school following all provisions of this report, a resident might be banned from accepting a slice of pizza from a company on whose board his or her department chair (or dean of medicine, or CEO of the medical center, or university president) sits.
By the way, not only were some of the authors of this AAMC report pharma or device executives, some other authors listed as academics are also directors of large for-profit health care corporations.
The AAMC did not see fit to disclose any potential conflicts of interest affecting the authors of this report.
It all seems a bit hypocritical, doesn't it? - April 28, 2008 at 9:08 PM
Fresh postings are always appreciated, but take time off Dr C, you need rejuvenation! Haven't you told that to a patient?
I found Dr Poses' comments above to be interesting. As I am skeptical of our alleged leaders, note a letter to the editor in the July 2007 issue of Current Psychiatry re an editorial piece by Henry Nasrallah advocating for "disruptive" new drugs. Douglas Steenblock, MD, wrote, "I do not know if Dr Nasrallah has ties to the pharmaceutical industry, but I do know that only a fierce critic of pharmaceutical companies could credibly suggest that we take steps to make this enterprise more lucrative that it already is."
He goes on to write, "With all due respect, his (Dr N's)3 ideas bore an uneasy resemblance to a corporate lobbyist's speaking points." The next sentence says it all: "His recommendation that drug companies receive a pass in terms of product liability particularly is outrageous." The editor of a fairly popular journal is advocating for this!?
Also relating to this alleged plan that is words, not deeds, until proven otherwise, is well said in a column by Catherine Fullerton, MD, also in a July 2007 piece in Clinical Psychiatry News: "Unfortunately, a financial ban is not possible as psychiatric programs and professional organizations currently struggle to find funds to support teaching and conferences...we want experts to influence both guidelines for clinical practitioners and the development of potential new therapies. Insisting on a separation may prove shortsighted."
She goes on to say, "Ignoring the issues (dialogue between industry and clinical research) leaves a vacuum into which lawyers and policy makers will rush to dictate changes that we, as psychiatrists, may not desire." Just what I would want, lawyers and politicians to set policy. People rarely influenced by money. I hope you read the sarcasm in that last sentence!
My interpretation of what is said by these supposed leaders thus far: there is more scrutiny of this matter of pharmaceutical influence in education, so we (as corrupted physicians and hospital administrators) will advise new policy and wait for the winds to die down, perhaps a new storm to divert attention, and then sit back down and enjoy the flow of dough.
I've been more than just skeptical of a popular journal like Current Psychiatry, probably forwarded to every psych resident in the U.S., propagating this subtle message through its editor.
I've asked you before, Dr C, of your take on this journal and still have no reply. The issue of advertisements in journals was debated in recent commentary postings following a posting by you, so shouldn't we be looking at that role if it (access of journals supplied in training programs) legitimately is a factor in education of residents?
I assume you'll consider an answer once back from vacation. In the meantime, is anyone else besides me both furious and distressed to read in Dr Poses's comments that it is possible that authors of the AAMC report were pharma and device executives, and other authors listed as academics are directors of large for-profit health care corporations?
Come on folks, what's the worst addiction in this culture? MONEY! You think this group, entrenched in positions of power and influence, will give in to what appears a simplistic announcement? I always hope what is posted here is true and correct.
I've seen the liars and manipulators; I'm ashamed to say they have been colleagues.
I hope this blog empowers as many as able to fight this travesty of medications trumping common sense.
First, do no harm! - April 28, 2008 at 10:34 PM
- Supremacy Claus said...
Remedies devoid of harm or even a fact have a name. Hate speech. This movement is devoid of any fact. It is left wing ideologues just spouting hate.
- April 28, 2008 at 10:34 PM
Here Here THerapy First! I agree. In meeting Dr Nasrallah myself and asking a question at a breakfast where he was paid speaker, he was blatantly blinded by bias to his drug seroquel it was obvious to me.
I would agree, however, that we certainly dont need to leave these policies up to politicians and attorneys, the most sociopathic of all institutions.
As a whole, at least our profession has fewer!!! - April 29, 2008 at 11:53 AM
Yes, every few years, someone like Nasrallah comes along who is so completely in a company's pocket that it shocks the conscious. Remember Norman Sussman and his year-round promotion of BuSpar (buspirone) some years ago?
- April 29, 2008 at 12:39 PM
First, mind a bit of catch-up? On January 11, 2008, and January 22, 2008, Dr. Carlat commented on the Macy Foundation's report calling for the end of commercial support of medical education. I bring your attention to criticisms of the Macy Foundation's report on a blog, Conversations on CME, at http://convcme.wordpress.com/?s=Macy&searchbutton=Go%21. I haven't figured out who writes this blog.
I appreciate Dr. Poses' scathing comments about the AAMC's latest report on financial conflicts of interest in academic medicine. By "latest", I bring your attention to a February 2008 AAMC report, "Protecting Patients, Preserving Integrity, Advancing Health: Accelerating the Implementation of COI Policies in Human Subjects Research". "This report, issued February 2008 by the AAMC and the Association of American Universities, calls on all medical schools and major research universities to develop and implement institutional COI policies within the next two years, and to refine standards for addressing individual financial COI." Go to www.aamc.org/research/coi/start.htm for links to these two reports and others. - April 29, 2008 at 12:41 PM
- Supremacy Claus said...
This is all pretty high-fallutin'. You geniuses have forgotten something. A fact.
Cite a fact of a harm done to a patient or to a doctor by this industry sponsorship. Even paranoid schizophrenic 9/11 Conspiracy theorists claim the fall of building seven was like a timed demolition sequence, and cite the melting point of metal. So far, these wackos have more facts and persuasiveness than the left wing ideologues here. - April 29, 2008 at 1:18 PM
- James M. La Rossa Jr. said...
I, too, would like to thank Dr. Poses for his comments about the AAMC's latest report on financial conflicts of interest in academic medicine. I hope he takes a moment to write Gardiner Harris of the NY Times to alert him to these facts.
- April 29, 2008 at 1:26 PM
Sorry the following is off the path of this blog discussion, but for those of you who get Psychiatric Times, there is a supplement issue out now (April 08, page 40-41) that has a wonderful piece written by a patient who's therapist passed away and how the patient struggled to deal with the loss. What I find so tragic is how both colleagues and the insurance were so clueless or callous in handling the situation.
To relate this article to this site, I believe the feedback that is offered at times by patients is worthwhile and educational. I would like to offer though, the push for changes has to come equally by your block as an invested part of this equation. If you believe that psychiatrists are not treating you as individuals, then speak out via complaints, or more outwardly, by looking for another MD if concerns are brushed off or invalidated.
There are times I wonder if this field is lost. Are we really advocates or lackeys? So will we fight for what is right, or what is convenient? As I always say, evil thrives when good men lie silent. I hope James' comment to Dr Poses to alert the media is considered.
When you think about it, we are talking about the next generation of colleagues we can protect here by pushing for these limits. - April 29, 2008 at 8:10 PM
- Supremacy Claus said...
TF: Common courtesy. If you reference an article, provide a live link to it so others may read it.
Also, feel free to turn this space into total stream of consciousness, chat room banter with totally off point references and remarks. No problem. - April 29, 2008 at 10:25 PM
- Clinton said...
Supremacy Claus, it sounds as if your mind is made up already on this issue. However, I WILL provide you with a reference... hopefully you can read it with an uncritical eye.
An ex-drug rep provides an inside look into how industry does affect doctors with gifts (utilizing their own inside-industry proof by monitoring how drug prescribing habits change over time!)
It doesn't get any more damning than this, in my opinion.
Following the Script: How Drug Reps Make Friends and Influence Doctors. Fugh-Berman A, Ahari S (2007). PLoS Med 4(4): e150.
tiny url in case that one doesn't work:
http://tinyurl.com/ywryv2 - April 30, 2008 at 4:08 PM
- Supremacy Claus said...
The article describes sales techniques. There are no data showing any harm to patients, nor any increase in cost that would not have happened from evolving standard of care, nor undue influence on the doctor.
I love Bud Light commercials. I record them to view them over and over. Bud Light gives me an immediate headache. No effective sales message could ever get me to drink Bud Light.
No drug rep could induce to start a patient or to maintain a patient on a drug that would not help that patient.
When the patient is doing well, clinical care is highly lucrative, fun, and a source of self-pride. When the patient is not doing well, clinical are is a financial disaster, hell on earth, and a disgrace to the doctor.
Find a doctor who would trade that for a sandwich or a pen, or even massive amounts of speaker fees. I will show you a failed clinician. The latter will not be prescribing much anyway. - April 30, 2008 at 11:03 PM
you're repeating yourself, sir. The bud light reference gives you away. Something new at least to entertain and enlighten?
By your standards, "when the patient is not doing well, clinical care is a disaster, hell on earth, and a disgrace to the doctor", is a falsehood, per the practice of too many psychiatrists.
When the patient is not doing well, he/she will need to come in for more visits, more interventions will be needed i.e. more drugs, the failure is passed onto the patient for not responding to the treatment for the diagnosis du jour, and the insurer will refuse more visits as the DSM 4 is not being followed per the algorithms.
I appreciate your transparency per comment to James in another posting recently. Don't rage at us though, because most of us involved in this site do care and would work with you if you are willing to listen. The law and psychiatry don't mix, sir. The law is black and white; psychiatry is gray. See the light! - April 30, 2008 at 11:19 PM
- soulful sepulcher said...
Well, TF, being that I had to basically state civil liberty speeches and basically be a mother-advocate-attorney in mental health court to prevent my daughter from a psychiatrist's discharge plan to a state institution (and won)I do believe though you are speaking general law--that law and psychiatry are in essence equally bound, because when it comes to detainment or forced medication, or malpractice, one goes hand in hand in a very not so gray area. Most people have no idea mental health courts exist. I didn't. Until I was sworn in as a Guardian ad Litem under oath that I was watching out for my daughter's interest not my own. I spent equal days in court learning the "ropes" by observation so I couldwin, the same days I was visiting in the psych wards, meeting drug reps from AstraZeneca pimping Seroquel for Borderliners.
Interesting discussion here as usual. Sorry to disappoint you, though TF, it does seem to be the same sorry souls here commenting, but that's the way it goes sometimes. More people read than comment btw is typical blog standards. Start one! - May 1, 2008 at 2:17 AM
I appreciate your recommendations here and the other posting about starting a blog, but that is not my style for several reasons: the most important is this acceptable level of anonymity that is too opague in regards to commenters; and the other is you need to practice some maintenance of your site, in my opinion about daily, and I am a bit annoyed that Dr C's lack of commenting in between his own postings shows me either he is not interested or available.
My involvement here is the best I can offer. Tell these other people at your site to read here and participate as able and comfortable. I would hope Dr C would not mind non-clinicians giving feedback, and more press would lead to more viability and credibility.
I stand by my comments in my april 29 8PM posting: the push for changes by your block (as patients)as an invested part of this equation (getting changes in the health care system to better patient care).
Just for the record, I have had to retype those stupid word verification letters a second time at least twice since it started.
That is annoying, spammers kept out be damned!
Deeds, not words is what defines us. - May 1, 2008 at 3:12 PM
Today's citation:
"one can argue whether using unprincipled means to increase profits is socially responsible behavior. But if the reality is that maximum profits is the predominant ethos of the business world, then all of the drug company policies described in this book make sense- that is, from a business point of view."
"But the drug industry is unlike most other businesses. Drug companies aren't manufacturing toaster ovens or sunglasses, but extremely potent chemicals that people-medically ill people- require. Minor deviations from medical principles can cause widespread harm. I agree with Dr Catherine DeAngelis, the editor in chief of JAMA, who in 2000 wrote, 'Using business ethics without tempering them with the needs of society simply is not working.'"
Who, what, and when? Jay Cohen, MD, in OverDose: the case against the drug companies, 2001, page 158.
7 years old now and still as freshly applicable if said today.
These are the stuff of colleagues that should enrage and empower those with a conscience and interest in the well being of society. CME credits? That's a start. Corrupted and indifferent providers, now there's a group that needs to be monitored.
Just a thought.
Today's word verification:
(unfit for PG eyes) - May 1, 2008 at 10:24 PM
- Supremacy Claus said...
The extreme left wing organization of Dan, the APA, pulls a symposium after bullying by homosexuals.
They allow only PC orthodoxy. They tolerate no dissent.
They have no credibility. - May 3, 2008 at 9:22 AM
- Supremacy Claus said...
Most psychiatrists agree. Drug companies should provide doctors with articles on off label use.
http://www.psychiatrictimes.com/poll - May 3, 2008 at 11:25 AM
- Daniel Carlat said...
I allow all comments in the spirit of healthy and passionate debate on vital issues concerning honesty vs. deception in medicine.
However, I will delete comments that include:
1. Obscenities
2. Personal attacks (against me or anyone else)
3. Name calling
Please, let's all stay focused on issues and ideas, rather than getting bogged down in mud-slinging! - May 4, 2008 at 12:24 PM
- Supremacy Claus said...
The left wing ideologue feels free to call other people deceptive, liars, immoral. It's just that others cannot point to the hypocrisy of the left wing ideologue. Most of the posts here contain personal attacks. For example, not only personal attacks, but shunning of drug reps who did nothing wrong but point to scientific article, and ask perfectly appropriate questions on clinical goals.
This blog never points out those attacking sponsored activities of drug companies are competitors advocating for their own economic interest. If drug companies pass their funding through medical schools, left wing foundations, and self-dealing professional societies providing inferior CME programs, all argument ends. These self-dealing left wing ideologues are a trip.
This blog relentlessly produces biased hate speech totally devoid of data or facts showing any harm to doctors or patients. - May 4, 2008 at 2:04 PM
Dr Carlat,
Thank you for the clarification. Just a piece of advice: if you are going to challenge the system, get used to some mudslinging, at the very least. Similar to the saying, "you can take my gun when you pry it from my cold dead fingers", prepare for those who will come at you with, "you can take away my cash cow when I am beyond irrelevant."
That is what needs to be done, to make pharmacology not the principle, but the adjunct. As long as colleagues accept and co-sell that mental illness is a biochemical imbalance, no one of significance or importance will sign on to this challenge to control the role of big pharma in CMEs. If you have been around, you know who and what the old guard is capable of.
Watch your back in this apa committe process. Prove me wrong you are not getting set up! - May 4, 2008 at 2:35 PM
I passed out copies of the March 27 posting about S Ahari's revelations as a former rep, and yet you watch today's feasting on the rep du jour's lunch, and I don't sense a lot of concern or conscience by the readers.
Maybe Congress should pick up on this: give a free meal before they vote on the next war, and full bellies will give full support! - May 5, 2008 at 11:44 AM
Had some free time today at the office and saw this fax in our machine:
from neuroscience CME--Pharmacology of Atypical Antipsychotics: clinical impact on efficacy and safey; moderator is Charles Nemeroff and faculty is David Dunner and Daniel Haupt.
It goes on to note this activity offers CE credit for Physicians, BUT WAIT, also for psychologists, case managers, social workers, and for nurses and pharmacists. And is sponsored by BristolMyers and Otsuka Pharmaceuticals.
For those not familar with those companies, Abilify's parent.
So the point to this comment: why are CMEs offered to non-prescribing professionals, and with Abilify getting new indications what seems to be every month, what disgusting agenda are they selling now?
the site is www.neuroscienceCME.com/CM308, or call 877.cme.pros .
You wonder why I am skeptical the agenda to push widespread use of atypicals is out there. See for yourselves! - May 5, 2008 at 12:45 PM
Still with down time at the clinic, so came across this little gem in NeuroPsychiatry Reviews, April 08 issue, page 12 (www.neuropsychiatryreviews.com for you internet junkies alone):
When marketing goes straight to your head: in this little brief, it notes a study done in which participants rated their enjoyment of samples of differently priced wines, the 20 raters reported that they enjoyed the expensive version more, and fMRI confirmed the increased experience of pleasantness by showing increased blood-oxygen-level-dependent activity in the medial orbitofrontal cortex (an area of the brain believed to encode experienced pleasantness for odors, taste, and music).
So, the take home message today folks, is be sure to tell your patients that atypical antipsychotics cost a heck of a lot more than typicals, so patients can feel that pleasantness real fast! Just don't let their wallets hear the conversation.
Who thinks up this crap to study it in the first place?! If anyone hears of a study that compares Molson beer to american beers, contact me ASAP. I bet Debbie Boone would have never guessed her song would have new meaning in 2008! (you light up my life)
By the way, Dr C, are you at the APA convention so no new postings this week too? - May 5, 2008 at 1:40 PM
- Supremacy Claus said...
TF: If you had to, which neuroleptic would you choose to swallow?
Is it possible others do not care about this subject because it has no importance outside of the self-dealing coterie of left wing competitors for the CME dollar?
Is it possible that social workers are curious, and should learn more about the medications that dozens of their clients take? Is it OK that they try to answer questions about these meds with a bit more facts than available on Wikipedia? - May 5, 2008 at 2:11 PM
To answer the above question, I would choose NOT to swallow any neuroleptic unless I had to because my psychiatric illness deemed it appropriate to take such medication. That is the point I have been making for, oh, what, 2 or more months now?
Let me educate you a bit further: when non-prescribing providers learn a little bit about medication, they seem to become grandiose and tell the patient too much and are too directive with medication needs and responses. Then, they dump it on providers like me to demystify and clarify what is the reality of the treatment process, usually making it more difficult to encourage compliance.
No, the question you should be asking NOT of me but of the pharmaceutical industry is why do they continue to market to those who do not write the Rxs; or does the reality of they want to further barrage us as the providers of the pills with falsehoods and expectations the naive and ignorant believe when a rep pries with pens, props, and free food.
Do you get the concept of reciprocity, sir!? I do, and I do not like being preyed on. I doubt you would either.
My point is legit. Give facts to refute it, or move on!!! - May 5, 2008 at 5:51 PM
Interesting day for material to offer to this commentary site. Check out US News & World Report magazine's(www.usnews.com) letters to the editor for the May 12 issue.
I'm not going to type them in here, but the following quotes reveal why it will be hard if not impossible to see the APA or AMA give up Pharma money:
"I see that graduates coming out of medical school take into consideration financial reimbursment in relation to hours worked and can't help but come to the conclusion that primary care does not offer the financial rewards of other specialties" per Robert Potter Jr MD
"There are many doctors who do what is best for their patients at the expense of their finances, their sleep, and time with their families. As the trends continue, there will be far fewer. Adjusted for cost of living, I make less now as a busy family doctor than I did 10 years ago." by Hope E Ring MD
"I don't remember when seeing your family doctor or going to the hospital became an industry to be milked for stockholder profits or abused by those who influence our government for a piece of the taxpayer's pie." by Robert Seward
All of these quotes were in reference to an article in the April 7-14 issue that spoke of the dwindling committments to primary care from medical students in the past decade or so. I believe you can infer that as physicians see their income stream further squeezed by other sources, they will not give up the golden idol of the pharmaceutical industry. The entitlement alone said by colleagues is pervasive.
If you want to impact on the role of pharma, you'll have to go after health insurers at the same time, if not first. Oh, wait a minute, I forgot. We had that chance and just sat on our butts and did nothing. There's a precedence!
What a tangled web we have weaved, my poor unfortunate comrades. - May 5, 2008 at 9:58 PM
- Supremacy Claus said...
TF: Pretend everyone you know, including a trusted psychiatrist, wants you on a neuroleptic. He says, "I have no preference. They are all equally acceptable (scientifically true). You choose one. You know neuroleptics. Which one do want for yourself?"
The left wing ideologue front organizations do not want to end sponsored CME. They want the sponsorships funneled through them, so they may have their take, like a Tony Soprano. The loudest critics all are providers of inferior CME, that does not compete well. The loudest critics have to give up all their advantage from paid advertising before they get the slightest credibility. These are biased, self-dealing, misleading hypocrites. - May 6, 2008 at 8:06 AM
- James M. La Rossa Jr. said...
A universal view from the APA newsroom: very little news to report from the APA. A few impressions for what its worth:
The NIMH -- which has home turf here in D.C. -- is pushing PTSD and related disorders, in addition to Deep Brain Stimulation for Treatment Resistant Depression (with Helen Mayberg, MD).
E. Cameron Ritchie, MD, in "Psychological Effects of War: From the Battlefront to the Home Front and Back Again," was quoted as predicting that suicides among returning Iraq veterans will equal war-time casualties.
A plethora of posters for the atypicals support potential approval for other indications, including depression. Sorry TF, but all the atypicals make strong showings. Overall, the bipolar-dominated programs of the last few years have been transplanted by schizophrenia-dominated symposia under banner heads of Genetics, Chronic Disease Models, and Brain Imaging.
An interesting program put on by a new group titled "Medical Crossfire" is unique enough to warrant mention and might be a new model of things to come.
DSM-V Research Planning is underway and should be making more news but seems to be flying under the radar, which is confusing to me.
Also of note is that there seems to be less industry-sponsored programs, overall, and that firewalls between sponsors and speakers are real. As the chairman of one major dinner told me, "I don't know how XYZ Company will feel after this night is over."
I'm already en route from the meeting. No doubt that DC and others will have more to report from the last few days. -J - May 6, 2008 at 8:32 PM
thank you for your report. As I had one of the most disturbing evenings of patient care I have had in a long time. I sign off from this blog offering you and invested readers these final observations:
1. Inpatient care is a joke until proven otherwise. Patients are now being discharged with no meds and no discharge info to the outpatient provider,who is left to figure out A. is the patient stable enough to leave the office and B. what the hell happened to warrant a 3, 5 even 7 day admit that there is no substance to report for continuity of care.
2. Addiction is now a primary psychiatric disorder but can't be coded that way still, so again the outpatient provider has to explain why the 3 med regimen isn't working because the patient is only 1 week out of detox and not involved in a substance abuse program.
3. Primary care docs think they are psychiatrists and prescribe the most fascinating regimens, yet when the patient is still not better, if not worse due to side effects and/or drug-drug interactions, then the outpatient provider has to sift through the debris of clueless care interventions and explain that therapy is a treatment intervention in and of itself.
I am not suicidal, but if I don't wake up tomorrow, I hope I would be ok with that. Crestfallen is an understatement. I hope you and the rest of you can support Dr C in his efforts. I'm done with the carelessness, cluelessness, corruption, and stupidity. You are all better people than me if you can stomach this crap.
Thanks for your support and kind words these last couple of months.
SC: I wish you well in your endeavors and pursuits. I won't lie though, I won't miss your pontifications. you tried though, I'll give you that.
live well, love much, laugh often. - May 7, 2008 at 1:10 AM
- Supremacy Claus said...
TF: If someone is interfering with your clinical care, can you let me know privately without using names? The opposition to this left wing blogger is a small subset of the general defense of clinical care from the vicious enemies surrounding it. There is no path but the path of resistance. Resistance is a duty to the patient.
- May 7, 2008 at 4:24 AM
- James M. La Rossa Jr. said...
TF: two quick questions. One, can you give me an example of a "classic" primary care physician's prescribing mistake? And, two, your comments about comorbid substance abuse is proof positive that the DSM-V needs to address carefully and transparently a new subset of problems that only you and clinicians like you can tell them. I would highly suggest that the DSM-V editors set-up an efficient means of communicating with physicians on the front-lines and not just the usual experts. Hang in there. Peace, j
ps--can we move any APA debate to DC's the more recent posting? - May 7, 2008 at 10:11 AM
- soulful sepulcher said...
Therapy First, I wrote this with you in mind, keep on fighting the good fight.
- May 8, 2008 at 3:02 PM
- Psychiatrist in Iowa said...
I'm new here, but love the tone. I'm amazed that psychiatrists supposedly understand rationalization and denial, but employ it full-force where the drug industry is concerned. They remind me so much of the politicians who fervently believe that the perks received from lobbyists have absolutely no effect on their judgment...rrrright.
Sometimes I feel like I'm the last person left who hasn't fallen prey to the invasion of the mind snatchers. Good to hear from some likeminded souls. - May 17, 2008 at 3:34 PM


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It may sound insignificant, but keep in mind the cost of replacing all of the items you threw away when you moved, like cooking spices and cleaning supplies.


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Any personal information you provide to us including and similar to your name, address, telephone number and e-mail address will not be sold or rented to any entities or individuals outside of our organization except as noted below.
Our Service Providers. We may share your personal information with companies (including our affiliates) that perform services on our behalf, for example, companies that help process credit card payments. Our service providers are required by contract to protect the confidentiality of the personal information we share with them and to use it only to provide specific services on our behalf. Business Transfers. Your personal information may be transferred to another entity (either an affiliated entity or an unrelated third party) in connection with a merger, reorganization, dissolution or similar corporate event. If such a transfer were ever to occur, the acquiring entity's use of your personal information will still be subject to this Privacy Policy. Government and Legal Disclosures We may disclose the personal information we collect through this Site, when we, in good faith, believe disclosure is appropriate to comply with the law (or a court order or subpoena); to prevent or investigate a possible crime, such as fraud or identity theft; to enforce our Terms and Conditions or other agreements that govern your use of this Site; or to protect the rights, property or safety of our company, our users, or others.
We are not responsible for the content of external internet sites. You are advised to read the privacy policy of external sites before disclosing any personal information.
A "cookie" is a small data text file that is placed in your browser and allows us to recognize you each time you visit this site (personalization, etc). Cookies themselves do not contain any personal information, and we do not use cookies to collect personal information. Cookies may also be used by 3rd party content providers such as newsfeeds.


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Swedish activist receives Nordic Free Software Award 2011
Erik Josefsson.
Photo: Håkan Lindgren
Erik Josefsson is the winner of the Nordic Free Software Award 2011. With the award, the Swedish Foundation for Free Culture and Free Software (FFKP) honours Josefsson for his achievements as a campaigner for freedom in the information society.
"We are proud to honour Erik for the tremendously important work he has done over the past ten years", says FFKP Executive Director Jonas Öberg. "Erik has an exceptional ability to understand and explain the link between policy and technology. We are hugely grateful for his work. He is an inspiration to all of us."
From a career as a professional double-bass player, Josefsson gradually moved to full-time activism for freedom in the information society. He founded the Swedish Foundation for a Free Information Infrastructure (FFII Sweden) in 2004. Listed among Sweden's 30 most influential people during the European debate about software patents in 2005, Josefsson is among Europe's foremost defenders of software freedom.
As an activist in Brussels, Josefsson was instrumental in getting the European Parliament to reject the Software Patent Directive in 2005. More recently, he prevented the EU from passing a law to cut off people's Internet access without due process, and is currently campaigning against ACTA.
Josefsson currently works as an adviser on Internet policies for the Green/EFA Group in the European Parliament. He is busy building tools such as ParlTrack that make the Parliament's processes transparent to citizens. "This information holds real power", says Henrik Sandklef, Vice President of the Free Software Foundation Europe (FSFE). "Understanding how the Parliament works is very important for the Free Software movement. Erik does a great job of explaining software freedom to politicians, and helping freedom campaigners to understand Europe's power structure."
Every year since 2007, FFKP has used the Nordic Free Software Award to honour people, projects and organisations in the Nordic countries that have made a prominent contribution to the advancement of Free Software. Previous winners of the award are Bjarní Runar Einarsson (2010), Simon Josefsson and Daniel Stenberg (2009), Mats Östling (2008), and the Skolelinux project (2007).


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Initial Page Name for wiki
If you want the first wiki page name to be something other than the
wiki name, you can specify it here. This name will become the first
page of the wiki for every created instance of this wiki.
If you leave this field blank, the initial page name will be the wiki name, unless you select
a page in the 'initial page' field.


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Anesthesiologist - Locums - Cambridge, MA
Job Id:
Position: Anesthesiologist Location: Boston, MA
MPLT Healthcare is looking for Physicians who Understand the Urgency, Never Give Up, and Have the Courage to Excel in the forever changing medical industry! We have numerous opportunities for an experienced Anesthesiologist with highly competitive pay rates in Boston, MA.
Position Details:
- 8 hour shifts
- Call needed
- Cases: General, Limited PEDs, Spinal, Epidural, OB, Neuro, CV/Vascular
The benefits of working with MPLT Healthcare include:
- Flexibility – work when, where and how often you'd like to work
- Paid malpractice insurance
- Pre-paid travel and housing expenses
- Competitive compensation paid on a weekly basis
- One-on-one attention and 24-hour access to your personal MPLT Healthcare consultant
- Dedicated medical staff services that assist with credentialing and facility paperwork
About MPLT Healthcare
MPLT Healthcare specializes in placing well-qualified physicians and advanced practice clinicians in locum, locum-to-perm and direct hire staff and leadership positions while making this process as seamless as possible for our clinicians and client facilities.
Don't delay, apply today!


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Aroma: Clear your mind with our Meditation aromatherapy blend. Made with pure Sandalwood and Neroli, this blend can help quiet the mind and invite a sense of peace.
Ingredients: Escents' Aroma Blend made with the 100% pure essential oils of sandalwood and neroli.
How to Use: Aroma Blends can be used in a variety of ways. To wear as a perfume apply 1-2 drops on pulse points or dilute in a carrier oil if you have sensitive skin. To create your own custom bath and body products, choose any of Escents' unscented product and add 6-8 drops per 30ml or 1oz of product. You can also add 4-6 drops of any essential oil blend to an aromatherapy diffuser to scent your space or add directly into a bath.
Do not take internally. Keep away from eyes. Use sparingly. Keep away from children. If irritation develops, discontinue use.
Note: Sample Dots and Sample Vials are only available as an add on to orders - we do not ship these individually.
All orders are shipped from our warehouse in Vancouver, BC, Canada through Canada Post. Please note that shipping times are estimated from the date that the order leaves our warehouse, not from the date the order is placed. You can upgrade to Express shipping for faster delivery.
Orders are considered delivered when the shipping carrier provides confirmation that the package was successfully delivered to the address provided in the order.
If Canada Post is unable to deliver the package after numerous failed delivery attempts, the cost of reshipping will be at the expense of the customer.
Escents Body Products Inc. is not responsible for nonreceipt of orders due to improperly submitted, inaccurate and/or incomplete shipping addresses.
International guests (including those in the United States) are responsible for all import duties levied by customs. Orders may be held at the border, which can increase estimated delivery times.
We want you to love your new product as much as we do, that's why Escents offers returns for exchange at our retail stores within 30 days, with a valid receipt and unopened and unused merchandise.
Escents Body Products Inc. reserves the right to inspect all returns/refunds before issuing an exchange. Online purchases require a Return Authorization # from Head Office. Please email email@example.com to obtain your RA#.
Escents Body Products Inc. will not refund original shipping and handling fees on returns except in the case of manufacturer's defect. If your order arrives damaged from transit, or if you are missing an item that was on your invoice, please contact Customer Service..


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Handmade Swarovski Crystal earrings
You are protected every time you make a purchase on Poshmark.
We will give you a full refund if your item never ships or does not match the listing description. Otherwise, all sales are final. The policies and systems we have in place to protect you are called Posh Protect.
Refund Policy
When you make a purchase on Poshmark, we don't release payment to the seller until you tell us you've received your order as described. You have 3 days after delivery to inform us if the item has been misrepresented by reporting the problem in the Poshmark app or website with supporting photos. If we verify your claim, we'll send you a label to return the order to the seller and refund your payment. All returns must be shipped back within 5 days of approval to be eligible for a refund.
What is covered
If any of the following pertain to your order, please report the problem in the Poshmark app or website immediately:
- Undisclosed damage
- Incorrect or missing item
- Item not as described
- Item is not authentic
If no claim is made within 3 days of delivery, payment will be automatically released to the seller. Once payment has been released, all sales are final and no refunds will be provided.
Item does not fit / changed mind
If the item is just not your style or does not fit you, we unfortunately cannot accept a return. You can always re-list the item on Poshmark!
Trades and Offline Transactions
Posh Protect does not cover trades or transactions completed off of the Poshmark platform. When payment for the full value of items is not exchanged through the Poshmark platform, we cannot guarantee that both parties will ship and transact as promised. You bear all risks associated with any such transactions.


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Fashion Rings 51749 (12 units)
MyWholesaleFashion.com specializes in hair and apparel accessories, jewelry, and make-up trends. Most of our products re-sold by the dozen unless otherwise specified. We are a wholesale distributor for all the products we carry. Please feel free to contact us if you have any questions and we are constantly updating our website with the latest trends, so please make sure to keep up with us!
We are working hard to bring a wider selection of products and more inventory for our customers. If you are looking to purchase in a bigger volume of a certain product and our shopping cart is notifying you there is not enough inventory or stock available to purchase please feel free to e-mail us back with the product name so we can further assist you with your purchase. Thank you for your patience and understanding while we continue to grow and provide you with quality products with the lowest prices possible.


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Looking for a free dental clinic in Mill Spring, NC? You're not alone. Millions of people struggle to afford dental care, but there are a number of free dental clinics available in Mill Spring to help.
Free dental clinics offer a variety of dental services, including preventive care (cleanings, checkups, and X-rays), restorative care (fillings, crowns, and bridges), extractions, and emergency dental care.
What types of dental dental clinics do you provide on the website?
1. Free Dental Clinics: Dental services free for low-income individuals and families.
2. Sliding Fee Scale: Offers dental services at a discounted rate based on the patient's income.
3. Low Cost Affordable: Dental clinic that offers dental services at a lower cost than regular dental clinics.
4. Non-Profit: Funded by donations and grants, so they are not profit-driven.
Please note: This is not an exhaustive list of all free dental clinics in North Carolina. For more information, please contact your local health department.
We did not find any dental clinics in Mill Spring. Use the search box below to find affordable dentists, or view the closest dental clinics to Mill Spring below the affordable dentist search. We list the distance of each clinic from Mill Spring. Closest Dental Clinics to Mill Spring
Select a state:
Enter a zip code:


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Product information
Our orange, in a shimmering pearl finish, faceted round plastic craft beads measure 10mm diameter and have a 2mm hole which runs through the center of the bead. These plastic craft beads are made in the USA with high-quality non-toxic plastic and come in packs of approx. 225 beads. Craft Beads are ideal for making necklaces, bracelets, key chain and other jewelry projects, as well as holiday decorations, home bedazzling and many other craft ideas. They are also perfect for children's craft projects and church or activity camps. Craft Beads come with a smaller hole, so they will fit on a range of threading material like elastic cord, stretchy cord and jewelry wire.
- SHAPE: 10mm faceted round with a 2mm hole
- STYLE: Orange in a pearl finish
- MATERIAL: Polystyrene plastic - made in the USA
- QUANTITY: Approx. 225 beads per pack


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Furniture Hire
Customised furniture and stand upgrade solutions for your next event
Customised furniture and stand upgrade solutions for your next event
Our white Octanorm booths are currently in high demand at various South East Queensland venues and by event organisers for their sleek, corporate styling. The Octanorm booth system has many advantages including the ability to print directly to the wall panels if required. We also have a vast array of Octanorm hire additions that enhance booth functionality to help create the perfect display for your next trade show. For more information or to hire our exhibition booths for trade shows and expo's click here.
Read More >Our black fabric display panels and boards come in various sizes and can be installed in ways to suit your display. Our largest board is 2.4m x 1.2m and is Velcro, screw and staple compatible. They can be installed to stand individually, or joined to create seamless walls. We often use our display boards and walls to create art shows, wall partitions and booths for event , poster boards and temporary walling. you can view our hire range here and please contact us for more information.
Read More >If you are looking to hire quality furniture for your next exhibition or event, our newly updated 2024 catalogue is for you. Simply choose what you'll need, complete and return the order form, and we'll sort out the rest. All you'll need to do is turn up. Download our Hire Catalogue.
Read More >


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Transfer Services
Transfer domains securely after the completion of a sale.
Perfect for both buyers and sellers: Our reliable Transfer Service provides secure notification of the purchase price and the seamless transfer of the domain ownership.
- Includes purchase agreement and personal support for a seamless and professional transfer
- Available also for domains purchased externally: reliable transfer protection for domain purchases outside of our platform
- Free and automatic domain Transfer Service for all domains purchased via Sedo
- Maximum security when paying for and transferring the domain
Peace of Mind for Marketplace Deals
As soon as the buyer and seller have reached an agreement using our trading platform, our free Transfer Service ensures secure payment and transfer of the domain.
Our Transfer Service includes a purchase agreement specifically tailored to domains and web projects. You will also be assigned a dedicated Sedo representative for any questions concerning payment and the technical transfer until the domain ownership has officially changed hands.
- Free and secure: reliable service for all domain purchases and sales made through Sedo
- Payment of the domain purchase price to our neutral account
- Seamless transfer of the domain ownership to the buyer
- Individual purchase agreement and dedicated representative for during the Domain Transfer
Sedo Transfer service is included free of charge as long as the domain purchase was made on our platform (standard marketplace pricing applies).
Protection for Deals Made Outside of Sedo
Use our reliable Transfer Service even for agreements reached outside of our platform. Set up a customer account – and we will ensure a secure and hassle-free domain transfer.
You benefit from maximum security even when agreements are made outside of our platform, regardless of your role in the transaction. We always ensure that sellers securely receive payments. And buyers can be certain of acquiring ownership of their new domain quickly and easily.
- Affordable and guaranteed to be secure
- Reliable payment and domain transfer
- Purchase agreement and dedicated representative throughout the transfer of domains
- Service fees can be split between buyer and seller
Fees start at just 3% of the domain purchase price
Do you want to move your domain to a new provider?
Our professionals will help you with the domain transfer process.
Domain Purchase Agreement
Upon agreement, both the buyer and seller will receive a free purchase contract from us, specifically tailored to domains or web projects at no additional charge.
Payment to Neutral Account
The buyer pays the domain's agreed purchase price by wire transfer, PayPal or credit card into a neutral account provided by Sedo.
Trouble-free Domain Transfer
Our transfer specialists work with both partners and their web hosting companies or registrars to quickly and safely transfer the domain.
Payment to the Seller
The seller is paid as soon as the buyer is registered as the new owner and assumes full control of the domain. It's that simple!
With Sedo's transfer service, I was able to use Paypal to quickly transfer the money for my domain hassle-free.
My transaction within the Sedo Transfer Center progressed with no problems whatsoever. Thanks to the personal contact with the transfer expert, I was always informed about every step of the domain transfer
After selling my domain on Sedo, I was paid in timely manner and found the transfer process to be highly professional.
Frequently asked questions (FAQ)
You will find the most frequently asked questions on the topic of domain transfer here.


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Thyristor Module Semikron SKKT 72B/08E and Replacement
Semikron Product Type | SKKT 72B/08E |
Average forward current, ITAV/IFAV (Tcase) | 70A (85ºC) |
Voltage, VRRM/VDRM | 800V |
Circuit | |
Package, Dimensions L×B×H | SEMIPACK 1 93x20x30 |
Datasheet | |
Replacement AS ENERGITM | AMKT 72B-08E |
Add to Cart | on request |
Module Semikron SKKT 72B/08E is a dual thyristor SCR module in a standard housing SEMIPACK 1.
Thyristor module AMKT 72B-08E AS ENERGITM is a replacement, analogue, alternative and equivalent semiconductor device for SCR module SKKT 72B/08E Semikron.
The thyristor modules are characterized by high electrical and thermal cycling capability, meaning high reliability and long lifetime in intensive operation modes. The thyristor modules are housed in a industry-standard housing making it easy to integrate the device into existing equipment.
The main (power) terminals are on the top of the case and are marked as 1, 2, 3 (common anode-cathode, cathode, anode). The control terminals are marked as K1, G1, K2, G2.
Dual thyristor modules are used in various power equipment - power and control units, power regulators, AC regulators, DC motors control, AC motor soft starters, converters, controllers of blast furnaces or chemical processes, welding equipment, and as rectifiers for AC converters.
Our modules are offered in several dual and single device topologies for almost all phase control or rectifier applications.
Our company provides a quality guarantee for thyristor / diode modules of 2 years from the date of purchase. When supplying thyristor / diode modules, if necessary, we provide technical passport and certificate of conformity.
The final price for thyristor / diode modules depends on the class, quantity, delivery terms, manufacturer, country of origin and form of payment.
General specifications of Thyristor Module SKKT 72B/08E and Replacements:
Thyristor module specifications | SKKT 72B/08E | |
Maximum allowable average forward current (Case temperature) | ITAV/IFAV (Tcase) | 70 A (85ºC) |
Repetitive pulsed reverse voltage; Repetitive pulsed closed state voltage | VRRM/VDRM | 800 V |
Surge on-state current | ITSM/IFSM | 1450 A |
Safety factor | I2t | 10.5 kA2·s |
Threshold voltage | VT(TO) | 0.90 V |
On-state slope resistance | rT | 3.5 mΩ |
Turn-off time max | tq | 80 µs |
Junction temperature | Tvj max | 125 ºC |
Thermal resistance, junction to case | Rth(j-c) | 0.37 ºC/W |
Design (switches) | - | dual component |
Type (circuit diagram) | - | thyristor-thyristor |
Weight | W | 95 g |
Package, Dimensions, mm | L×B×H | SEMIPACK 1 93x20x30 |
Replacement AS ENERGITM | type | AMKT 72B-08E |
Datasheet |
Part numbering guide for thyristor–thyristor modules AMKT:
M | – | Semiconductor Type: Module. |
KT | – | Topology of internal connection: Thyristor–Thyristor. |
72 | – | Rated current (ITAV), A. |
B | – | Option of another numbering of the control pins: "6" – HK2; "7" – G2. |
8 | – | Voltage class (VRRM/100). |
E | – | dv/dt class: D: 500 V/µs E: 1000 V/µs G: 2000 V/µs |
Possible alternatives, replacements, analogue, equivalent products:
List of series of power thyristor modules with similar parameters and housing sizes.
Series | ITAV/IFAV (Tcase) | VRRM/VDRM | Topology | Dimensions, mm | Package | Datasheet |
SKKT 72B/08E | 70 A (85ºC) | 800 V | thyristor-thyristor | 93x20x30 | 1 | |
AMKT 72B-08E | 70 A (85ºC) | 800 V | thyristor-thyristor | 93x20x30 | 1 | |
MTT-80-8 | 80 A (86ºC) | 800 V | thyristor-thyristor | 92x20x30 | 1 |
High Power Semiconductors AS ENERGITM
Our company is engaged in the manufacturer and sale of wide range of power semiconductors (power thyristors, modules, rectifier diodes, avalanche, rotor and welding diodes, triacs etc.) currents up to 15000A and voltages to 9000V, and air and water heatsinks to them.
You can buy semiconductor devices in any volumes, and when ordering large lots, the price will be lower. We have earned the trust of customers and supply products all over the world.
For questions regarding the acquisition of Power Modules, Diodes, Thyristors, send an email request to:
And we will provide you a commercial offer for delivery.
For a large number, we will provide an individual price!!!
We are open to manufacture products at our production facilities
according to your requests and technical task.
Photo Gallery
The photo gallery shows many different semiconductor devices, semiconductor chips and SCRs produced by AS ENERGITM, examples of test reports.
Why choose AS ENERGITM
- Own production facilities, including semiconductor silicon chips production
- European brand - 100% quality, favorable price, short production terms
- Over 20 years of experience in the semiconductor industry
- Clients from more than 50 countries trust us
- 20000 items in the product line for currents from 10A to 15000A, voltages from 100V to 9000V
- We produce analogues of other manufacturers' products
- Guaranteed certified quality, warranty period of operation - 2 years
Quality Warranty
Our products are certified and correspond to international standards.
Our company provides a quality guarantee for products of 2 years.
We provide certificates of conformity, reliability reports, data sheets and technical passports at the request of the customer.
Each product is tested for the main parameters, and Test reports of the parameters for each product are provided.
Geography of partnership
AS ENERGITM company manufactures and supplies power semiconductors to more than 50 countries around the world.
Logistics and Delivery
We deliver our products all over the world with the services of logistics companies: DHL, TNT, UPS, EMS, Fedex, Aramex.
Products can be delivered by any means of transport: air, sea, rail and road.
AS ENERGITM Semiconductors Manufacturing
Our products range includes rectifier diodes, phase control thyristors in disc and stud design, avalanche diodes and thyristors, fast switching, high frequency thyristors, fast recovery, welding and rotor diodes, triacs, bridge rectifiers, power modules (thyristor, diode, thyristor-diode, IGBT), and air and water heatsinks to them.
Power diodes and thyristors are produced for currents from 10A to 15000A, voltage range from 100V to 9000V.
Power diode and thyristor modules are produced from 25A and up to 1250A, voltage range 400V - 4400V.
The range of power semiconductors also includes equivalent, replacement, analogue and alternative semiconductor devices of global manufacturers.
Featured Products:


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Hurricane season in 2018 was brutal. We saw eight hurricanes, with Florence and Michael producing the most significant damage.
Hurricane season this year begins on June 1.
Last month, California's governor, Gavin Newsom, declared a state of emergency in preparation for the 2019 wildfire season. The declaration allows him to waive environmental restrictions "to speed up fire prevention projects …" according to CBS Los Angeles.
Notice the key concept in that announcement: Preparation.
With a couple of months' lead time, even the most unprepared homeowner can take steps to keeping his or her family and home safe during natural disasters.
Family first
We've all seen the news reports about people who wait until the last minute to stock up on supplies when a killer storm is expected. Don't be one of them, facing picked over hardware items and empty shelves at the grocery store.
First, make a plan. Questions to have the answers to include:
How will we contact one another?
It is especially important for children to know the plan in case of an emergency. Designate one adult family member to be the designated contact. Ready.gov recommends choosing someone who lives out of town in case cell service is down in your area.
Write down the contact's phone number and a reminder of the meeting spots and keep it in your child's school bag. Cell phones may not be working
Where will we meet?
If your children are older, pick a meeting spot that's close to home and an alternative spot that is outside the neighborhood in case roads are blocked.
If we have to evacuate, what is the best route?
Plan your route before disaster strikes. Figure out where you can go if evacuation is ordered. Think friends, family members or a hotel. The experts at Ready.gov suggest that you "Choose destinations in different directions so that you have options during an emergency."
Always follow the instructions of local officials and remember that your evacuation route may be on foot depending on the type of disaster.
Always keep enough fuel in your car to get to your destination.
Do you have emergency supplies set aside? You'll need a lot more than water if the power is out for any length of time. Find a list of what to set aside for emergencies at Fema.gov.
Keep an emergency survival kit in the trunk of your automobile (especially if you live where earthquakes occur). Include, at the very minimum a portable radio, cell phone charger, matches, flashlights and batteries, blankets, extra shoes and socks in case you need to walk to your destination and drinking water.
You'll find a list of other items to include at Almanac.com and on the National Safety Council's website.
Don't forget the pets
Although many Americans consider their pets as part of the family, they're frequently left off the to-do list when considering prepping for the expected or unexpected that nature throws our way.
So, we've compiled that list for you and your pets:
- Ensure that each of your pets is microchipped. Then, if a hurricane or other natural disaster is expected, ensure that they're wearing collars with up-to-date identification tags firmly attached to the collars.
- Don't leave your pets behind if you need to evacuate. Have a plan on where you will take them before finding shelter for yourself. Ideas may include hotels that allow pets, boarding facilities outside of the danger zone, a friend or relative's home, also outside the danger zone.
- Keep a pet emergency kit. You can buy them online or create your own. TheSeniorDog.com has a brilliant list of items you'll need in your kit.
Get more tips at ASPCA.org.
Items you'll need for an insurance claim
Do you have an inventory of all of your belongings? If not, get that done now, before hurricane and wildfire seasons arrive. Photographs or video are ideal ways of cataloging your belongings. Be sure to include purchase dates and places and serial numbers.
If you need help visit the Insurance Information Institute's website.
Then, keep copies of other important documents such as your driver's license, insurance paperwork, bank account numbers, the deed to your home or your mortgage company's contact information, vital statistics documents (birth, marriage, citizenship or Green Card).
Go to Fema.gov for more information on how to protect important documents and which ones you may need during and after a disaster.