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2 tablespoons olive oil

1 3½–4-lb. chicken, cut into 10 pieces

Kosher salt and freshly ground black pepper

2 tablespoons unsalted butter

2 medium shallots, sliced into ¼”-thick rings

6 oz. sugar snap peas (about 2 cups), strings removed, half halved crosswise, half thinly sliced

2 heads Little Gem lettuce, halved or quartered, or 1 head Bibb lettuce, torn into 3” pieces

3 tablespoons fresh tarragon leaves

Lemon wedges (for serving)


Calories (kcal) 530 Fat (g) 17 Saturated Fat (g) 6 Cholesterol (mg) 210 Carbohydrates (g) 9 Dietary Fiber (g) 2 Total Sugars (g) 3 Protein (g) 81 Sodium (mg) 230


View Step-by-Step Directions

Heat oil in a large skillet over medium heat. Season chicken with salt and pepper and, working in batches, cook, skin side down, until underside is golden brown, 10–12 minutes. Turn and cook until other side is golden brown and chicken is cooked through, 8–10 minutes. Transfer to a plate.

Heat butter in same skillet and add shallots and halved snap peas; season with salt and pepper and cook, stirring occasionally, until shallots and snap peas are softened, 5–7 minutes. Add lettuce and sliced snap peas and cook, tossing, until just tender (or, if using Bibb lettuce, until leaves are wilted), about 3 minutes. Add tarragon and toss to combine.

Serve chicken and vegetables with lemon wedges for squeezing over.

via Chicken with Buttered Snap Peas and Tender Lettuces – Bon Appétit.

Gifts and payments to US doctors from drug firms are seen by some as encouraging unnecessary prescriptions. Do such transfers make any difference and will President Obama’s healthcare reform help, by forcing companies to disclose them?

Prescribe enough drugs and – as detailed in 1974 Senate hearings – a doctor could accumulate points to exchange for a wide range of consumer desirables – colour TVs, watches, microwave ovens, lawnmowers, golf clubs.

The hearings were part of a campaign led by Democratic Senator Edward Kennedy, and exposed a culture that, since the 1950s, had become pervasive.

In the decades that followed, the pharmaceutical industry grew and the stakes got bigger. As more information about doctors’ prescribing habits became available, more money was spent trying to influence them.

The 1990s saw the release of a number of “blockbuster” drugs, and were seen as boom years for the drug “reps” who act as intermediaries between doctors and industry, handing out samples of products and deploying a variety of studied tactics to boost both company profits and their own salaries.

Michael Oldani, who worked as a rep for Pfizer before becoming a medical anthropologist, has described how offering food and drink – free bagels, lunches and coffee coupons – was a favourite strategy.

Gifts could range from pens to bottles of wine to “unrestricted educational grants” worth thousands of dollars. “We did all sorts of crazy stuff in the industry,” Oldani says. “The regulation hadn’t caught up with us.”

Scene from Love and Other Drugs
In Love & Other Drugs, set in 1996, Jake Gyllenhaal plays a Pfizer rep selling a new blockbuster, Viagra

The gradual exposure of such practices by whistleblowers, prosecutors and the media eventually led to a series of professional and industry guidelines, targeting some of the most flagrant financial transfers. Cash inducements were made illegal in some states, and outlawed federally for prescriptions covered by the Medicare and Medicaid programmes.

Still the vast, vast majority of physicians are getting things from drug companies”

Eric CampbellHarvard Medical School

These measures, along with what many observers say has been a shift in culture, appear to have made some difference.

But doctors may still be paid for public speaking and consultancy or given funds for medical education or research.

A study by Eric Campbell of Harvard Medical School found that among a random sample of doctors, the share of those who said they had received gifts from industry fell from 83% in 2004 to 71% in 2009. The share for those acknowledging payments for services such as consulting or public speaking dropped from 28% to 14% over the same period.

Even in 2009, however, nearly 84% of respondents reported a relationship with industry. As Campbell says, “still the vast, vast majority of physicians are getting things from drug companies”.

Some relationships have led to illegal behaviour. Top pharmaceutical companies have reached settlements with the Department of Justice totalling tens of billions of dollars over allegedly fraudulent marketing of drugs, sometimes through payments to doctors.

But most transactions fall within what is professionally and legally permitted, and supporters defend them as helping the best new treatments reach people who need them.

There is “great value” in exchanges of information between healthcare sector and industry, says Kendra Martello, a deputy vice-president at PhRMA, which represents leading pharmaceutical companies. “Better educated physicians provide better care to patients, in my view.”

A drug rep’s tale

Michael Oldani

I decided to use coffee as my gift of choice and targeted a hospital where I had established good rapport (i.e. I could walk the halls without being kicked out). I made arrangements to have coffee cards made, giving 10 free cups to any person presenting them at the coffee cart at my teaching institution. They were identified with an Antibiotic S sticker on the back. Within a month, I was clearly in demand for my coffee cards. I was receiving phone calls from residents and staff doctors for cards. I began handing them out to anyone who could write a prescription of Antibiotic S. Several weeks into the program, I received a call from the hospital pharmacy doctor, who was friendly to my company (a paid speaker), but quite upset about not receiving a coffee card. I realise now that if I was giving them to surgeons and infectious disease doctors, my pharmacy doctor was probably offended that I left her out of the loop. With the pharmacy neutralised through coffee, sales far exceeded my expectations and I achieved my quota.

Source: Thick Prescriptions: Towards an Interpretation of Pharmaceutical Sales Practices, by Michael J Oldani

Tom Stossel, a doctor and a professor of medicine at Harvard, says medicine is “incomparably better” today than it was 50 years ago, and that “all of this is thanks to the tools that physicians have gotten from industry”.

He discounts claims that payments have distorted decision making as “speculation”, says drug firms only settled to avoid being barred from government contracts, and calls criticism “mean spirited, holier-than-thou stuff”.

“Doctors could go to a restaurant, learn something, get a nice dinner – what was wrong with that? Is education better in a monastery than in a restaurant?”

It is hard to track payments over time, or to measure their impact.

However, critics say there is evidence that they affect prescribing habits, and that this drives up costs and health risks.

recent study by three US economists found that a doctor receiving payments from a pharmaceutical firm was more than twice as likely to prescribe its drugs, compared to doctors receiving no payments.

Using data from more than 330,000 doctors and 12 pharmaceutical firms, it identified 58% as having received payments. It found that payments were unlikely to represent significant opportunities to educate doctors about new drugs, and that financial gain appears to be an important motive for doctors.

Daniel Carlat, director of the prescription project at the non-profit group Pew Trusts, says research to date shows that doctors who have dealings with drugs reps “tend to prescribe differently”.

“They prescribe more drugs, more expensive drugs, more brand-name drugs, and they’re less likely to follow evidence-based practice guidelines in prescribing drugs.

“To the extent that all of those relationships lead to inappropriate prescribing… that could be a massive problem in terms of healthcare costs and also in terms of public health.”


Payments and gifts can result in individual doctors switching their “obligation” from the patient to the drug company, argues Oldani. On a general level, he says, they have fostered a “drugs first mentality” in which doctors prescribe too readily, at the expense of therapy or other treatments.

It is in this context that “blockbuster” drugs have flourished, in the US and beyond.

“The reason that there’s so much heavy marketing is that the vast majority of these ‘new drugs’ are out there are pretty much similar to what already exists on the market,” says Campbell.

Who’s Paying Your Doctor?

An investigation by BBC Panorama recently found that UK drug company GlaxoSmithKline is facing a criminal investigation in Poland for allegedly paying bribes.

A former sales rep for GSK in the Polish region of Lodz, Jarek Wisniewski, said: “There is a simple equation. We pay doctors, they give us prescriptions. We don’t pay doctors, we don’t see prescriptions for our drugs.” Wisniewski said that although on paper the payments were for educational services, the doctors understood very clearly that they must produce a certain number of prescriptions in return.

One doctor has been fined and given a suspended sentence after saying he accepted £100 ($170) for a single lecture he never gave – but only under pressure from a GSK drugs rep.

GSK said one employee had been disciplined and it was co-operating with investigations.

“If drug companies make drugs that really work, doctors will use them. They don’t have to pay doctors to know about them, they don’t have to pay doctors to use them.”

In terms of health risks, there is concern that payments can compromise the process of bringing a drug to market, and that once a drug is approved, they can encourage excessive or “off-label” use.

Oldani has written about an antibiotic that his company aggressively marketed, but which was restricted by the Food and Drug Administration shortly after its use because of its association with liver toxicity, and in severe cases, death: “Gifts included pens, clocks, free dinners, symposia with expert speakers, and post-marketing clinical grants, all of which went toward accelerating prescription growth and eventually led to severe side effects.”

Pfizer said in a statement that it used training and monitoring to comply with the law, and partnered with doctors “to educate other health care providers regarding important safety and effectiveness information”.

“Pfizer is committed to fairly compensating health care professionals, clinical investigators and research institutions for the work they do to advance human health and patient care,” the statement said.

One category of drugs for which overprescription has become arecognised problem is opioid painkillers. Rates of opioid addiction and overdose deaths have risen sharply, with some users switching toheroin when they cannot access prescription drugs.

“This epidemic began in the late 1990s in response to a pharmaceutical industry-funded campaign that led the medical community to believe that opioids were safe and effective for very common chronic conditions,” says Andrew Kolodny, chief medical officer at Phoenix House, which works to help drug abusers.

Influential doctors paid by industry headed “professional societies that issued consensus statement calling for aggressive prescribing”, he says.

While no-one has quantified the overall financial and health-related consequences of payments, concern over conflicts of interest led to a push for disclosure in the US.

Later this year, under a little-known provision of President Barack Obama’s healthcare reform called the Sunshine Act, industry payments to doctors will be published on a public website.

There’s basically a financial impetus that’s going to push for this kind of activity unless it’s made illegal”

Marc RodwinAuthor, Conflicts of Interest and the Future of Medicine

The measure may already be having an impact. Research by Pro Publica, an investigative news organisation, recently showed that some of the biggest pharmaceutical firms had dramatically scaled back payments for promotional talks.

And British firm GlaxoSmithKline – which in its efforts to boost prescriptions was recently accused of bribing doctors in China and paying state-employed doctors to work as sales reps in Iraq -announced in December that it would stop paying physicians to promote its drugs, while also decoupling compensation for reps from the number of prescriptions written.

PhRMA is concerned that the Sunshine Act may have a “chilling effect” on the exchange of information, saying some doctors are refusing medical article reprints from drug reps because these can be seen as “transfers of value”.

But experts say drug firms may be spending less because they have fewer expensive, patented products coming on to the market.

And industry critics worry that the Sunshine Act could simply legitimise payments, that companies may spend more on marketing directly to patients, and that despite guidelines and firewalls they may still be able to steer medical practice using funds labelled for education or research. Spending may shift to more unregulated markets in the developing world.

“There’s a lot more money now and there’s a lot more sophistication about how to influence judgement, and this is being deployed,” says Marc Rodwin, a law professor who has written about conflicts of interest in medicine in the US, France and Japan.

“There’s basically a financial impetus that’s going to push for this kind of activity unless it’s made illegal.”

Arthur Caplan, head of medical ethics at New York University, says that impetus will endure in the US as long as it relies on a market model, instead of the large government purchases used in Europe that drive down the cost of drugs.

He thinks that faced with the prospect of payments being disclosed, “most doctors will stop” taking them, though more through pressure from peers than from patients.

But, he adds, as pharmaceutical firms “shift to marketing to the patients and lobbying, they can easily make it up”.

via BBC News – Should drug firms make payments to doctors?.

Hospital bed - with hand-washing gel
Regular hand-washing is key to preventing the spread of infection

Doctors and nurses should do more to stop hospital patients developing infections, an NHS watchdog says.

The National Institute for Health and Care Excellence has issued “quality standards” on measures including hand-washing and catheter insertion.

About 300,000 patients develop an infection in England each year while being treated by the NHS.

Prof Gillian Leng, of NICE, said it was unacceptable that rates were still so high.

Rates of MRSA and Clostridium difficile – the most well-known hospital-acquired infections – have fallen significantly in recent years, but one in 16 people treated in the NHS picks up an infection.

‘Hinder recovery’

Infections can occur during invasive procedures or when devices such as urinary catheters are fitted, and can then be passed on to other people.

Healthcare-associated infections are still a very real threat to patients, their families and carers and staff”

Prof Gillian LengNICE

These include pneumonia and infections of the lower respiratory tract, which account for 23% of the total, urinary tract infections (17%) and surgical site infections (16%).

Prof Leng, who is deputy chief executive and director of health and social care at NICE, said: “It is unacceptable that infection rates are still so high within the NHS.

“Infections are a costly and avoidable burden. They hinder a patient’s recovery, can make underlying conditions worse, and reduce quality of life.”

The NICE standards say people should be prescribed antibiotics in accordance with guidelines and healthcare workers should follow procedures – including hand-washing – to cut the risk of infection when devices such as catheters are inserted.

Prof Leng added: “Although there have been major improvements within the NHS in infection control, particularly in relation to Clostridium difficile and MRSA bloodstream infections in the last few years, healthcare-associated infections are still a very real threat to patients, their families and carers and staff.

“This quality standard gives primary, community and secondary care services the most up-to-date advice on the best ways to minimise the risks of infections.”

Tom Sandford, director of the Royal College of Nursing in England, said: “Infection prevention and control are key to patient safety and need to be prioritised by every health service organisation.

“It is vital that all health care workers are actively involved in upholding infection control and hygiene standards and nursing staff have been at the forefront of many successful efforts to reduce infections and promote patient safety.

“Infection prevention and control are serious issues that require clear leadership.

“All health employers should provide leadership at a local level and support their staff in adhering to NICE’s quality standard, from making sure they receive relevant training to allowing them the time to follow the correct procedures.”

via BBC News – Hospital infection rates must come down, says watchdog.

 Pensions Minister Steve Webb: “People are living a lot longer so we have to make sure they have up-to-date information”

Retirees could be issued guidance on how long they are likely to live, a government minister has said.

Pensions Minister Steve Webb warned people often underestimate how long they might live and can be left without enough savings.

Estimates of life expectancy would be based on factors such as gender, where they live, and whether they smoke.

The information would help them plan their finances more efficiently, according to the minister.

“We don’t have a lot to go on” when planning for retirement, he told the BBC, suggesting that “we might think perhaps about how long our grandparents lived, and of course in the generation since then people are living a lot longer”.

“People tend to underestimate how long they’re likely to live,” he explained, “so we’re talking about averages, something very broad-brush.

“Based on your gender, based on your age, perhaps asking one or two basic questions like whether you’ve smoked or not you can tell somebody that they might, on average, live for another 20 years or so.”

The Lib Dem minister said people would be given an idea of their life expectancy as part of plans outlined in the Budget for pensioners to get face-to-face consultations with an adviser.

Pensioner couple

The consultations would be paid for by the pension schemes themselves and any discussion of life expectancy would be handled sensitively, he emphasised.

But he added: “There’s no point being all British and coy about it.”


The minister acknowledged that “few of us have got a pensions pot big enough to buy a fancy sports car” but that the money accumulated could be “significant”.

He had previously been criticised for saying he was “relaxed” about retirees deciding to use their money to buy Lamborghinis if they wish.

The objective was to “help people to make the right choices” whilst “moving away from nannying people”.

Pension schemes explained

  • Final-salary scheme: Guaranteed pension based on earnings at end of your career and length of service. Also known as defined benefit schemes
  • Career average scheme: Guaranteed pension based on your average pay over your career
  • Defined contribution scheme: Determined by contributions and investment returns. Usually worth less than final-salary pensions. Savings used to buy an annuity, or retirement income – until now


Life expectancy estimates already play a large part in determining annuity rates – the rate of exchange the provider uses to convert a pension pot into an income.

New freedoms unveiled in the Budget will make such advice more important, Mr Webb argued.

Last month, the chancellor announced he would get rid of rules that force most people to use their pensions pot to buy an annuity, which guarantees an annual income.

The new rules will make it easier for people to spend their pensions however they choose, but critics say it could leave people struggling if they make ill-informed decisions.

The changes are due to come in from April 2015, subject to consultation.

‘A lot more detail’

Labour supports the scrapping of annuity requirements, but shadow work and pensions secretary Rachel Reeves has urged the government to provide “a lot more detail about what that will mean in practice”.

The party wants the consultation to consider whether the move helps lower and middle income taxpayers, whether people who want to buy an annuity under the current system can do so, and what provision is made for advice.

Figures from the Office of National Statistics show that life expectancy is rising steadily, with women born now projected to live a year more than if they had been born four years ago.

For men, the gap is narrowing more rapidly. A man born in 2014 can expect to live 17 months longer than if he was born in 2010.

The government recently succeeded in getting the Pensions Bill through Parliament, which will increase the state pension age to 67 between 2026 and 2028, eight years earlier than originally planned.

The legislation also introduces a single-tier state pension from 2016.

via BBC News – Pensioners could get life expectancy guidance.

Have we reached ‘peak beard’?

The ebb and flow of men’s beard fashions may be guided by Darwinian selection, according to a new study.

The more beards there are, the less attractive they become – giving clean-shaven men a competitive advantage, say scientists in Sydney, Australia.

This might be why we’ve hit ‘peak beard’”

Prof Rob BrooksUniversity of New South Wales

When “peak beard” frequency is reached, the pendulum swings back toward lesser-bristled chins – a trend we may be witnessing now, the scientists say.

Their study has been published in the Royal Society journal Biology Letters.

In the experiment, women and men were asked to rate different faces with “four standard levels of beardedness”.

Both beards and clean-shaven faces became more appealing when they were rare.

The pattern mirrors an evolutionary phenomenon – “negative frequency-dependent sexual selection”, or to put it more simply “an advantage to rare traits”.

The bright colours of male guppies vary by this force – which is driven by females’ changing preferences.

Scientists at the University of New South Wales decided to test this hypothesis for men’s facial hair – recruiting volunteers on their Facebook site, The Sex Lab.

Affleck and Clooney
Hirsute film stars George Clooney and Ben Affleck were said to have fuelled the beard boom

“Big thick beards are back with an absolute vengeance and so we thought underlying this fashion, one of the dynamics that might be important is this idea of negative frequency dependence,” said Prof Rob Brooks, one of the study’s authors.

Luckily in real life, we never mate with an average. We mate with an individual”

Prof Rob BrooksUniversity of New South Wales

“The idea is that perhaps people start copying the George Clooneys and the Joaquin Phoenixs and start wearing those beards, but then when more and more people get onto the bandwagon the value of being on the bandwagon diminishes, so that might be why we’ve hit ‘peak beard’.”

“Peak beard” was the climax of the trend for beards in professions not naturally associated with a bristly chin – bankers, film stars, and even footballers began sporting facial hair.

Some say the Rubicon was crossed in January when Jeremy Paxman, the BBC Newsnight presenter, shaved his beard off, saying “beards are SO 2013″.

Paxman’s beard – which briefly trended on Twitter – sparked a debate about pogonophobia - the fear of beards.

Jeremy Paxman’s beard briefly trended on Twitter

In this latest experiment, 1,453 women and 213 men were asked to rate the attractiveness of different samples of men’s faces.

When Greece’s economy tanked – did beards take off? That’s something we’re going to look at”

Prof Rob BrooksUniversity of New South Wales

Some were shown mostly “full” beards. Others were shown mostly clean-shaven faces. A third group were shown an even mixture of all four varieties – clean-shaven, light stubble, heavy stubble and full beard.

Both women and men judged heavy stubble and full beards more attractive when they were rare than when they were common. And likewise for clean-shaven faces.

Negative frequency-dependent preferences may therefore contribute to changing beard fashions, Prof Brooks concluded.

“We know beards go through cyclical fashions. People used to speak about a 30-year timescale,” he said.

“There is a wonderful paper studying photographs of men from 1871 to 1972 in the Illustrated London News. Sideburns moved on to moustaches, then full beards.

“In the 1970s it was handlebar moustaches. In the 80s it was Magnum PI moustaches. In the 90s we saw a lot of clean shaven men, and now big bushy beards are back.”

Four levels of beardedness

The recent boom may have its roots in the financial crisis of 2008, Prof Brooks suggests.

“I think one of the reasons beards have made a comeback now is that it’s a difficult time.

With female hair colour, there is speculation that red, brown and blonde spread via their novelty”

Prof Rob BrooksUniversity of New South Wales

“Young men are competing to attract someone when work is not easy to come by. So we might expect some aspects [of masculinity] to get turned up to eleven.

“After the Wall Street Crash in the 1920s there is some circumstantial evidence that beards got big again. So maybe economic conditions have set the stage for the recent comeback in beardedness.

“When Greece’s economy tanked – did beards take off? That’s something we’re going to look at.”

One of the paradoxes of evolution is that genetically strong traits favoured by one sex do not simply become fixed in the other – a level of diversity is often maintained.

Though beard styles are of course not spread via genes, there may be other visible human traits which are.

“With female hair colour, there has been speculation that red, brown and blonde spread via their novelty – but the evidence is very ambiguous,” Dr Brooks told BBC News.

His team plan to continue their pogonophilic investigations and are looking for volunteers for their latest experiment testing how people like faces with varying levels of beardedness.

“Heavy stubble seemed to be the best in our last study. Maybe a 5-10 day growth. But those describe average tendencies,” he said.

“Luckily in real life, we never mate with an average. We mate with an individual.”

via BBC News – Beard trend is ‘guided by evolution’.






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