Tales from Cloud Cuckoo Land: Shannon Brownlee has a lengthy piece in the Washington Monthly about the corporate corruption of scientific research. Even the editors of major medical journals know there's a problem:
As Dr. Drummond Rennie, deputy editor of The Journal of the American Medical Association (JAMA), puts it, 'This is all about bypassing science. Medicine is becoming a sort of Cloud Cuckoo Land, where doctors don't know what papers they can trust in the journals, and the public doesn't know what to believe.'
But isn't science a bastion of truth?
Such statements reflect the ideal of science, not the reality, says Dr. Marcia Angell, former editor in chief of The New England Journal of Medicine. Public protestations aside, she says, "Clinicians know privately that results can be jiggered. You can design studies to come out the way you want them to. You can control what data you look at, control the analysis, and then shade your interpretation of the results." Even the most careful research can be fraught with murky results that require sifting and weighing, a measure of judgment that the researcher hopes will bring him closer to the truth. Was this patient's headache caused by the antibiotic you gave her, or does she have a history of migraines? Is that patient's depression lifting because of the drug you are testing, or because a kindly doctor is actually listening to him?
But doesn't the peer review process keep everyone honest and insure that only scientifically sound papers get published?
When researchers submit papers to a journal, the editor has little choice but to trust the authors have employed a ruthless skepticism when viewing their own results, that they have bent over backwards to minimize self-delusion. Editors and peer reviewers can ferret out sloppy reasoning, look at how an author has designed and executed a study, and correct faulty statistics, but as Angell remarked, "We don't put bamboo slivers under their nails. If they wanted to lie, they could lie."
But, as we've seen with the recent MMR controversy, it isn't just corporate money and patent deals that drive the baser scientific instincts. Even studies funded completely by government or universities can be tainted by a researcher's agenda. If you've spent you're entire career arguing that A causes B, you're not going to be eager to publish data that says otherwise.
This is why "peer reviewed journals" have such a cache of influence. The peer review process is supposed to weed out the bad science from the good science, to reign in author enthusiasm and unsound conclusions. But in reality, it doesn't. My husband, who in his academic days did peer review, explains it like this: Rather than giving submitted papers to a broad range of general experts in a field for review, they are given to a handful of specialized experts in the whatever field the paper is in. So, for example, a paper on the effect of radiation on man in the moon marigolds wouldn't be given to a broad panel of botanists, physicists, and biologists, but to a group of scientists whose only interest is radiation and marigolds. And within very specialized fields, most of the researchers know each other. Some will love the paper just because it's written by someone they like or don't want to offend, and others will savage it because it's written by someone they don't like - or because the conclusions don't agree with their own work. An example of the former is the recent paper in JAMA that turned the most frequent causes of death from diseases into sins. One of its authors was the head of the CDC. Now, tell me, who in the public health community is going to tell Julie Gerberding that her science is flawed? No one. It takes an outsider.
None of this is new, of course. A scientist has to believe in his work in order to be motivated to do it. And the best of them have a passion for it. But even the most concrete of sciences can be influenced by observational bias, and passion can get in the way of reason, even among scientists. We, the public, have to remember that, and not treat every finding published in journals, no matter how respected, as the unimpeachable truth. (And the press needs to do the same.)
UPDATE: One of the members of the President's Bioethics Council
notes that in the case of the council, it's the scientists who are most agenda driven:
Scientists are no less drawn to power, and have no fewer agendas, than others. Indeed, years from now, when the full story of the council's work can be adequately told, I suspect it will be clear that ideological conformity has been sought at least as fervently by scientists as by any other group in our society. posted by Sydney on
4/03/2004 01:48:00 PM
Medicare and Drugs: Kay Daly argues that the Medicare drug benefit is needed to protect elderly cancer patients, who have been "overtaxed all their lives" from greedy oncologists:
The GAO said that "physicians are able to obtain Medicare-covered drugs at prices significantly below current Medicare payments, which are set at 95 percent of AWP. Wholesalers' and GPO's prices that would be generally available to physicians were considerably less than AWPs used to establish the Medicare payment for these drugs."
According to Thomas A. Scully, former CMS administrator, "numerous studies have indicated that the ...reported wholesale prices, the data on which Medicare drug payments are based, are vastly higher than the amounts drug manufacturers and wholesalers actually charge providers. That means Medicare beneficiaries, through their premiums and cost sharing, and U.S. taxpayers, are spending far more than the "average" price that we believe the law intended them to pay."
Imagine that! A government program is not operating on accurate information, but relying upon an entirely flawed system of overpayment? And we wonder why Medicare is going broke?
Medicare always claims they pay too much for everything, when in reality they pay too little. And Medicare is going broke because there are more elderly people than ever, and they're living longer than ever, not because they overpay providers, believe me. posted by Sydney on
4/03/2004 08:07:00 AM
Medpundit Ad Scandal: From the following email, I gather there's a perception floating around somewhere in the cybersphere that some of my posts may be bought:
I have a source telling me that your post of 3312004 5:19:46AM was "placed" by an ad agency. Is this true? Do you have a policy of allowing content to be placed on your site? Do you receive compensation for this? Is there a way readers might know that your posts are essentially paid advertisements?
No one pays me for any of the posts on my blog. I post things that are interesting to me and that I think readers will find interesting. I often get emails from people - other bloggers and readers mostly - who have found something interesting that they want to pass on. Sometimes I even get press releases, believe it or not. If I think it's interesting, I post it. But no one pays me for it.
The closest thing I have to advertisements are the Amazon links to the left. I do get a small percentage from any purchases made through those links, even if the items purchased aren't the items advertised, but it's a very small percentage. In a good quarter I receive about ten dollars, which I get in the form of an Amazon gift certificate. (And thanks to everyone who has purchased items through those links. The resulting gift certificates have been used to bribe my children into leaving me alone in the mornings while I blog.)
I also receive free review copies of some of the books I review. A practice which is, I believe, quite common for book reviews - and book reviews that get a whole lot more attention than my little blog gets. And I do get paid for my Tech Central Station columns, but the opinions expressed in them are entirely my own. No one at Tech Central Station ever tries to influence the tenor and tone of my columns.
If I ever do accept ads, they will be easily distinguishable as such. My opinions will never be bought. I guarantee it.
Until doctors attached electrodes deep into Matovic's brain Feb. 9, Tourette's syndrome had made everyday tasks nearly impossible and reduced him to someone in need of childlike care. That was until he was ``turned on'' by University Hospitals of Cleveland doctors.
When the electrodes first pulsed into his brain, the twitching stopped, the spasms ended, and, for the first time in years, 31-year-old Jeff Matovic was just another guy from Northeast Ohio who can once again shoot hoops with his brother.
``This has been a long, long time coming,'' Matovic said with a broad, steady smile ina news conference Thursday. ``This is truly the day of my life.''
Matovic's day was made possible by a revolutionary procedure in the treatment of Gilles de la Tourette syndrome -- a condition characterized by motor and vocal tics, which curiously can include profane outbursts.
The procedure, called deep brain stimulation, has been used for other movement disorders such as Parkinson's disease. It involves the implantation of electrodes into the part of the brain that coordinates body movements. The electrodes are attached to platinum wires that run beneath the skin from the brain to two pulse generators implanted just under the patient's collarbone.
The pulse generators, powered by batteries that last three or four years, shoot low-level electrical impulses through the wire into the patient's brain at regulated increments and levels. These pulses interrupt the brain's poorly functioning motor firings and restore them to normal -- giving the brain's symphony back its conductor.
Benders: Binge-drinking is more common among Midwesterners than any other group. By "Midwest" they mean places like South Dakota, Wisconsin, Minnesota, Iowa, and Nebraska, those cold and/or desolate parts of the Midwest. Who can blame them? posted by Sydney on
4/02/2004 08:26:00 AM
A Brigham Young University sociologist says data from national surveys show Mormon women are less likely to be depressed than American women in general and show no major differences in overall life satisfaction compared to women nationwide but do score lower on measures of self-esteem.
Useful Illnesses: The Army (or more precisely, the Reserves and National Guard) has a worker's comp problem:
But Pentagon data and interviews with soldiers at six bases in the United States and Europe show combat wounds represent a minority of casualties during wartime. The Pentagon 'Operation Iraqi Freedom U.S. Casualty Update' on Tuesday listed a total of 2,998 soldiers wounded in action, in comparison to the 18,004 medical evacuations described by Winkenwerder.
The Pentagon defines a casualty as 'any person who is lost to the organization by having been declared dead, duty status-whereabouts unknown, missing, ill, or injured.'
More mundane wartime injures seem more prevalent: back and neck injuries, torn knees and elbows, heart and lung problems and mental problems like post-traumatic stress disorder that may not be diagnosed for months after returning from combat.
Sounds like the same kind of complaints I find myself filling in on worker's comp forms. People are often dissatisfied with their care and their progress in worker's comp injuries, too. In fact, they sound an awful lot like the National Guard and Reservist complaints that are being given a Congressional airing. It makes one wonder how much of the disgruntlement is due to a general dissatisfaction with their lot rather than real medical issues. Most National Guard and Reservists sign up thinking they'll never see action, let alone deployment overseas. (There really is a difference between the real army and what the English call the "territorial army." ) And it's been the National Guard and Reservists who have been loudest in their complaints, from worrying about anthrax vaccinations to complaining about the length of their deployment. They are some very unhappy campers. posted by Sydney on
4/02/2004 08:05:00 AM
There is growing evidence that the condition may be inherited. Studies suggest parents with one child with autism are 100 times more likely to have another child with the condition compared with other families.
However, scientists agree that the condition is complex and that more than one gene is involved.
Dr Joseph Buxbaum and colleagues at Mount Sinai School of Medicine in New York carried out genetic tests on 411 families, who have members with autism.
They found that they all had variations in the SLC25A12 gene, which is involved in the production of ATP.
The researchers suggested this flaw could disrupt the production of the fuel needed by cells. They said even minor disruptions could affect the ability of cells to function properly.
However, the researchers said the genetic variations they identified in this study appeared to be quite common.
By themselves, they do not cause autism. They said people with autism probably had this and other genetic mutations. posted by Sydney on
4/01/2004 09:37:00 AM
Health Insurance Conundrums: I've put down some more thoughts on the difficulties faced by small businesses when it comes to healthcare insurance, over at Tech Central Station.
I agree with one of the commenters that the real solution is to divorce healthcare insurance from employment and make each person responsible for purchasing their own, just as we do with auto insurance and homeowner's insurance. But, until that day comes, the reality is that health insurance benefits are a critical factor in attracting employees. And in the current climate, small businesses are at a distinct disadvantage as a result. posted by Sydney on
4/01/2004 09:32:00 AM
This Just In: Immunizations do not cause diabetes. There never was any good evidence that they did. Now, there's very good evidence that they don't, and it's time to move on to better things:
The scientific community should now move on to the most important tasks: identifying the genetic, immunologic, and environmental phenomena that are actually responsible for the development of diabetes and finding the means to prevent and treat this chronic disorder,' Levitsky adds.
CR*P: The latest hot trend in cardiovascular risk prediction, C-reactive protein, is coming under fire:
In the latest research, Danesh and his colleagues used data from an Iceland study of heart disease that began in 1967. They compared 2,459 people who had a heart attack or died of heart disease over 20 years of follow-up with 3,969 participants who did not have a heart attack. Frozen blood samples were tested for CRP levels.
The researchers calculated that those with higher levels of CRP had a 45 percent increased risk of heart disease compared with those with the lowest levels. The researchers also analyzed 22 studies on the topic and found that patients with higher CRP levels had a 50 percent higher risk of heart disease.
That is far less than the early studies indicated. Eleven of the 22 studies analyzed were done before 2000, and together they showed a 100 percent increase in risk, or a doubling of the danger, the researchers said.
"It's a cautionary tale about how high the bar really needs to be before we roll out scientific advances into the community and into the clinic," Danesh said.
That's a fair criticism. Tests that are touted as predictors of future disease really should be held to a high standard. If 33% of people who never get disease have high CRP levels compared to 44% of people who end up with disease, then its predictive value is rather limited. (The study's abstract is here.)
The authors of the study aren't shy about pointing this out:
'There's no good scientific reason to be using it as a predictive test,' said Dr. John Danesh, one of the British researchers at the University of Cambridge.
Danesh and his colleagues said groups that recommend the test should rethink their advice.
Which has Dr. Paul Ridker, the biggest CRP proponent in the country, and not coincidentally holder of a patent for a high-sensitivity CRP test, riled:
The authors "have the nerve to say it's not comparable to other risk factors, but it's exactly the same as blood pressure," says Paul Ridker of Boston's Brigham and Women's Hospital and a pioneer of CRP testing.
The nerve of them! To challenge the media's favorite Harvard cardiologist. Judging from the CNN article, there was quite a bit of pressure at the American Heart Association/CDC panel to adopt CRP more enthusiastically:
Dr. Thomas Pearson of the University of Rochester said the panel noted the weakness of the evidence and urged further study when it drew up the guidelines. He said the panel members were criticized as "way too conservative, stodgy and sticks-in-the-mud" by those who wanted more widespread testing.
"I think this is validating our conservatism," he said.
Yes, it does. And good on them for ignoring the name calling and sticking to reason in adopting their guidelines.
UPDATE: A reader comments:
Each year I accumulate a list of questions to take to my next annual physical. This year's exam was two weeks ago, and the value of CRP testing was on my list. (Interestingly, when I went to the Quest Diagnostics office for a blood draw a week ahead, there was a poster on the wall of the examining room that was basically an advertisement for CRP testing. I now wonder if Dr. Paul Ridker might somehow have had an involvement. In response to my question, I learned they are doing quite a few more of them these days.)
I went into the exam understanding that CRP is an enzyme produced in the liver in response to inflammation just about anywhere in the body, and that there was some association with inflammation in coronary arteries. I wondered how the test result would in fact be actionable.
I was not surprised to hear my physician say the evidence didn't yet seem to show a sufficiently high predictive value for the test relative to coronary artery disease for it to be used routinely for that purpose--that if an elevated result came back in my case, it would not be very useful to him in terms of further tests or altering the existing medication regimen.
There is limited evidence that walnuts can reduce the risk of heart disease -- but there is enough information for food companies to say so on their packages, U.S. regulators said on Wednesday.
The decision marks the first time the Food and Drug Administration has given final approval for food companies to list supported, but not definitive, evidence on the health claims of their products.
...In the walnut decision, the FDA will permit companies to state on packages of chopped and whole walnuts that "supportive but not conclusive research" shows eating 1.5 ounces (42 grams) of the nut each day could help fight heart disease.
But the anti-walnut lobby is not happy:
But consumer groups say such unsubstantiated claims are unnecessary and can confuse the public, which they complain is already bombarded by nutritional information.
The public doesn't know the difference between "supportive" and "conclusive?" Actually, this is much more honest labelling than most drugs are required to provide.
American consumers bargain hunting for prescriptions from these foreign sources increasingly find that the pharmaceuticals have expired, been diluted or contaminated, or even replaced with counterfeit medications. While HealthCanada regulates many pharmacies in Canada, many "cross border" pharmacies that primarily import drugs for sale to American seniors, are not regulated by either HealthCanada or the FDA. With no regulatory oversight, it is possible that consumers could unknowingly receive their prescription in the wrong dosage or in the worst case, be given the wrong drug entirely.
The FDA has seen a 300 percent increase in counterfeit cases over the past three years, many of which involve well-organized criminal operations that ship finished drug products that resemble legitimate drugs but may contain inactive ingredients, incorrect ingredients, improper doses or be otherwise contaminated.
At a press briefing held at the American Pharmaceutical Association's annual meeting in Seattle this week, Neupert recommended that consumers looking for low cost drugs online shop only at pharmacies certified through the NABP's VIPPS program. VIPPS-certified online pharmacies provide consumers seeking online savings confidence that their orders will be processed by a licensed pharmacy with policies implementing all applicable federal and state regulations.
Sure, Drugstore.com has a self-interest to protect, but the advise is still good advise, especially with the recent problems that have been surfacing with counterfeit drugs. Although, even traditional pharmacies have had problems with counterfeits from their wholesalers, at least if they're certified there's some accountability. You can access the VIPPS here.
posted by Sydney on
3/31/2004 08:19:00 AM
Paternalism in Medicine: Trent over at The Proximal Tubule is planning a series of posts on paternalism in medicine. His most recent post is a very libertarian stance on prescription drugs:
In medicine, doctors, with an assist from the federal government, have a dominant position with regard to the patient and have a unique amount of control over their paying customers. Many people may disagree with this characterization, but I fail to see anything different in spite of recent efforts to change this relationship. Patient autonomy does not exist in any way like it should.
In no area is this more apparent than in the prescription-only status of most medicines. It always amazes me that this fact is never called into question, especially among my medical school colleagues. There is no shortage of debate in and about medicine on just about any other topic, but we accept this culture of the gatekeeper almost without question. You would think just once you would here somebody say, "Doesn't anybody find it odd that it is illegal for this patient to by this drug unless I write it down on a little piece of paper and then sign it?" Maybe I lack imagination, but I can't think of another aspect of the human experience where one set of people, not members of the government, wield that amount of power over others.
I can't say I agree with all of his points. There are some drugs, like prescription allergy medication, and ulcer medication which are fairly harmless and don't really need monitoring or the help of a doctor to decide whether or not they're needed. But there are others - heart medications, cancer drugs, blood pressure drugs, etc. that either need the expertise of a physician to make the correct diagnosis for their appropriate use or that need to monitored closely for potential side effects. Even drugs as seemingly benign as blood pressure drugs need to be monitored periodically to make sure they aren't having adverse effects on the kidneys or, in some cases, the heart or the balance of the body's electrolytes. That isn't being paternalistic, just responsible.
Uses of Pain: Last fall, the Orlando Sentinel published a series on Oxycontin abuse that ended up being chock full of errors. Slate takes a look at the "Oxycontin-addiction crisis" and finds it to be, like the Orlando Sentinal series, mostly hype:
Indeed, various media outlets-from NPR to the New York Post-claim that numerous new OxyContin addicts have been created by doctors who cavalierly prescribe the drug.? Articles or news segments assert that overdose frequently occurs among the innocent patients of careless doctors, but the profiled "victims" are overwhelmingly prior drug users who now get their fix by snorting or shooting OxyContin.? The featured subjects almost always turn out-like the Sentinel's-not to be "accidental" addicts but just plain druggies.? ( In a 2001 story about the supposed "epidemic" in Appalachia, the New York Times Magazine didn't cite a single case of doctor-caused addiction; instead, it portrayed "casual" drug users who faked pain or otherwise illegally obtained OxyContin in a sympathetic light, claiming these "accidental addicts" didn't know that prescription opiates are addictive! )
While it's true that most people who abuse prescription narcotics have a history of substance abuse, it's also true that in this day and age it's much easier to dupe a doctor into giving you the good stuff. Now that pain is touted as the "fifth vital sign," (an unmeasurable vital sign, I might add) doctors are reluctant to seem insensitive, even though there may be plenty of signs that all is not on the up and up with the patient. I once worked with a colleague who had a patient tell him that one of his other patients was selling her narcotics at their workplace, yet he kept refilling her prescriptions. When I asked him why he said , "That's just hearsay. She's in pain and needs them." He felt as the physician who had interviewed and examined her he knew what he was doing, and it was the right thing in his mind. He just didn't believe his other patient.
But there is another sort of misuse of narcotics that occurs by patients who are not intentional drug addicts but who have doctors as eager as my former colleague to eliminate all pain - and those are patients whose pain is magnified by their psychology. I admitted one such patient just this morning for a colleague. The ER called to say she had fallen in the night. They couldn't find any broken bones, but she refused to move for them. Wouldn't sit up, wouldn't stand up, wouldn't roll over. The pain was too much. They said she had a history of multiple falls, ever since she had a stroke last year. And a history of chronic pain. When they read me the list of her medication, it became obvious why she's been falling so much. She was not only on Oxycontin, but on a sleeping pill and a sedative for anxiety. No doubt, she's in pain, but its root is not likely to be physical since all of those pain medications aren't alleviating it. And in fact, they are probably harming her by impairing her ability to walk safely and to think clearly - clearly enough to come to terms with the impact of her stroke, which is most likely the true source of her pain. It's people like this who are harmed the most by the belief that all pain is created equal. That's why I find it hard to get too worked up by DEA efforts to hold doctors accountable for their narcotic prescribing habits. posted by Sydney on
3/30/2004 08:56:00 AM
What is new is the involvement of doctors in fulfilling the desire for self-transformation. In recent decades, doctors have become much more comfortable giving physical treatments to remedy psychological and social problems. They give synthetic growth hormone to short boys to remedy the stigma of being short; perform rhinoplasty to remedy the stigma of having a 'Jewish nose'; and give Propecia to middle-aged men to remedy the stigma of having a bald head. Now that the enhancement of psychological well-being has come to be regarded by some as a proper goal of medicine, the range of potentially treatable medical conditions has expanded enormously.
Is the success of these technologies a problem? In many cases, no. Some of these drugs and procedures alleviate the darkest kinds of human misery. For every person using an anti-depressant to become 'better than well', there is another using the same drug for a life-threatening depression. And if sex reassignment surgery can effectively relieve a person's suffering, then the question of whether or not it is treating a proper illness seems rather beside the point.
Yet it is hard to remain completely untroubled by all this medical self-transformation. One worry is about what the philosopher Margaret Olivia Little calls 'cultural complicity'. As hard as we may find it to condemn individuals who use drugs and surgery to transform themselves in accordance with dominant aesthetic standards, on a social level these procedures simply compound the problems they are meant to fix. The more East Asians who get plastic surgery to make their eyes look more European, for instance, the more entrenched the social norm that says East Asian eyes are something to be ashamed of. The same goes for light skin, large breasts, Gentile noses or a sparkling personality.
Take Your Vitamins: Researchers are saying that vitamin E can reduce the risk of prostate cancer:
'We found that the men who had higher serum (blood) levels of vitamin E had a lower chance of getting prostate cancer.'
There are two principal forms of vitamin E. There is alpha tocopherol and gamma tocopherol.
v They found that men with the highest levels of alpha tocopherol in their system were 53% less likely to get prostate cancer later on (natural levels of alpha tocopherol). Those with highest levels of gamma tocopherol in their blood had a 39% lower likelihood of developing prostate cancer. amma tocopherol represents about 20% of the vitamin E in blood.
Experts say Vitamin E Supplements may not be the best source as they contain active and inactive form of the vitamin. They say products such as sunflower seeds are also high in selenium and other vitamin E rich foods provide other essential nutrients as well.
The study was presented at a conference, so it's impossible to tell how clinically significant those difference may be. They may only represent a few percentage points difference in prostate cancer incidence. And there are other things to consider when taking vitamin E:
Because vitamin E can thin the blood, high doses might increase the risk of abnormal bleeding.
The main concern in this regard is combining vitamin E with other agents that thin the blood such as warfarin (Coumadin) or aspirin and other traditional NSAIDs (e.g., ibuprofen, naproxen).
In fact, research with the combination of vitamin E and aspirin suggests that an increased bleeding effect occurs even with relatively low doses of both agents.
Use caution also when combining vitamin E with herbal supplements thought to thin the blood, which theoretically could increase bleeding risk. These herbs include feverfew, garlic, ginkgo, ginger, Panax ginseng, licorice, and many others.
While we're talking about vitamin E, there's another important issue to consider.
People continue to report they have been advised at the doctor's office to stop taking their vitamin E.
This advice seems to be based on a 2001 clinical study published in the New England Journal of Medicine. The study results have been interpreted as suggesting that vitamin E might impair the ability of certain cholesterol-controlling drugs to raise levels of the most protective form of HDL cholesterol (the good kind). posted by Sydney on
3/29/2004 08:24:00 AM
Feel the Burn: Researchers say that stretching before exercise doesn't prevent injury:
Researcher Stephen Thacker with the Centers for Disease Control and Prevention said he found no benefit in stretching.
Athletes who stretch might feel more limber, but they should not count on stretching to keep them healthy, he said.
People who stretched were no more or less likely to suffer injuries such as pulled muscles -- even though people think that stretching prevents such injuries, Thacker said.
At Summit Mall last month, it was the day a ruckus over a sliver of chicken sandwich sent a regular shopper into yearlong exile and sparked a call for reinforcements from Fairlawn police that authorities have since tried to keep quiet.
But Jean Coleman -- the 71-year-old Akron woman at the epicenter of it all -- has a different idea.
She wants the whole world to know that the threat that brought nearly half of Fairlawn's fleet of police cruisers to the mall's defense began when her 68-year-old sister asked a restaurant worker for a second helping of a chicken sandwich sample.
The paper presents a completely one-sided version of the incident, complete with crazy all-capital letter writing:
All of a sudden, this woman was yelling: `YOU ATE THAT! YOU CAN'T HAVE ANOTHER ONE!' ''
Coleman -- who is 5 foot 4 and 130 pounds -- rushed to the aid of her little sister.
Both women took their stand in front of the sample lady who was guarding what remained of the chicken sandwich slivers.
And Coleman admits, she yelled right back.
``I told her, `I DON'T CARE IF YOU GIVE IT TO US! YOU'RE NOT WORTHY TO GIVE IT TO US!' ''
More than a month later, Coleman is still seething.
She sure is. Seething so much she's managed to convince the newspaper to publish her wrath in a big above the fold page one story. It's a story the newspaper loves to tell. The little guy vs. the big bad corporate meanies (the mall, in this case.) There's got to be more to this story than the little old lady is telling, though. She must have been pretty abusive if the security guard asked her to leave. And she must have been doubly abusive to the security guard if he had to call the police to get her to leave. And as it turns out, she was:
Actually, even shoplifting isn't sufficient misconduct to cause a customer to be banned from shopping for a year, said Summit Mall Manager John Vavrus.
``If something happens in a store,'' he said, ``it's usually between the tenant and the customer.''
Fairlawn police were called to the fracas, Vavrus said, to end the very public confrontation because ``we were trying to be compassionate.''
....At Charley's Steakery, a woman who said she was a manager but would identify herself only as ``Rose'' said she was not sure she could talk about restaurant rules regarding free samples.
``I do respect all the older people,'' Rose said. ``They're our customers and our job is to be nice to them.''
But she said Coleman ``went berserk.''
...The Fairlawn police report describes Coleman as an ``irate customer'' who was ``very argumentative with both officers.''
Although the paper treats this as a little guy vs. the big guy story, this woman was actually abusive to several people who are probably lower on the economic food chain than she is, (The mall in question is in a very high-priced neighborhood) - the restaurant employee, the security guard, and the two policemen. Now, there is absolutely no reason that any business should allow customers to abuse their staff. This woman deserves to be banned from the mall. There are plenty of other places to shop around here and maybe, just maybe, with the knowledge that she can be banned for bad behavior from shopping in any of them, she'll behave herself next time.
The country's top public health agency is considering establishing a handful of regional centers, including one in Cleveland, to augment its operations in Atlanta, Health and Human Services Secretary Tommy Thompson disclosed Friday during a meeting with The Plain Dealer editorial board.
Though short on details, Thompson said the regional network would work closely with the Centers for Disease Control and Prevention, tracking and investigating diseases in the various geographic areas. Like much of the expansion in the public health system in recent months, this idea was suggested after the Sept. 11 and anthrax attacks severely strained the country's laboratory and surveillance systems.