Thursday, December 9, 2010

Deadly Medicine

Prescription drugs kill some 200,000 Americans every year. Will that number go up, now that most clinical trials are conducted overseas—on sick Russians, homeless Poles, and slum-dwelling Chinese—in places where regulation is virtually nonexistent, the F.D.A. doesn’t reach, and “mistakes” can end up in pauper’s graves? The authors investigate the globalization of the pharmaceutical industry, and the U.S. Government’s failure to rein in a lethal profit machine.
By Donald L. Barlett and James B. Steele•
Photo illustration by Chris Mueller
January 2011

More and more clinical trials for new drugs are being outsourced overseas and conducted by companies for hire. Is oversight even possible? Photographs © Imagebroker/Alamy, from Image Source/Jupiter Images, © Vincent O’Byrne/Alamy (skulls); © Jason Salmon/Alamy (capsule).

You wouldn’t think the cities had much in common. Iaşi, with a population of 320,000, lies in the Moldavian region of Romania. Mégrine is a town of 24,000 in northern Tunisia, on the Mediterranean Sea. Tartu, Estonia, with a population of 100,000, is the oldest city in the Baltic States; it is sometimes called “the Athens on the Emajõgi.” Shenyang, in northeastern China, is a major industrial center and transportation hub with a population of 7.2 million.

These places are not on anyone’s Top 10 list of travel destinations. But the advance scouts of the pharmaceutical industry have visited all of them, and scores of similar cities and towns, large and small, in far-flung corners of the planet. They have gone there to find people willing to undergo clinical trials for new drugs, and thereby help persuade the U.S. Food and Drug Administration to declare the drugs safe and effective for Americans. It’s the next big step in globalization, and there’s good reason to wish that it weren’t.

Once upon a time, the drugs Americans took to treat chronic diseases, clear up infections, improve their state of mind, and enhance their sexual vitality were tested primarily either in the United States (the vast majority of cases) or in Europe. No longer. As recently as 1990, according to the inspector general of the Department of Health and Human Services, a mere 271 trials were being conducted in foreign countries of drugs intended for American use. By 2008, the number had risen to 6,485—an increase of more than 2,000 percent. A database being compiled by the National Institutes of Health has identified 58,788 such trials in 173 countries outside the United States since 2000. In 2008 alone, according to the inspector general’s report, 80 percent of the applications submitted to the F.D.A. for new drugs contained data from foreign clinical trials. Increasingly, companies are doing 100 percent of their testing offshore. The inspector general found that the 20 largest U.S.-based pharmaceutical companies now conducted “one-third of their clinical trials exclusively at foreign sites.” All of this is taking place when more drugs than ever—some 2,900 different drugs for some 4,600 different conditions—are undergoing clinical testing and vying to come to market.

Some medical researchers question whether the results of clinical trials conducted in certain other countries are relevant to Americans in the first place. They point out that people in impoverished parts of the world, for a variety of reasons, may metabolize drugs differently from the way Americans do. They note that the prevailing diseases in other countries, such as malaria and tuberculosis, can skew the outcome of clinical trials. But from the point of view of the drug companies, it’s easy to see why moving clinical trials overseas is so appealing. For one thing, it’s cheaper to run trials in places where the local population survives on only a few dollars a day. It’s also easier to recruit patients, who often believe they are being treated for a disease rather than, as may be the case, just getting a placebo as part of an experiment. And it’s easier to find what the industry calls “drug-naïve” patients: people who are not being treated for any disease and are not currently taking any drugs, and indeed may never have taken any—the sort of people who will almost certainly yield better test results. (For some subjects overseas, participation in a clinical trial may be their first significant exposure to a doctor.) Regulations in many foreign countries are also less stringent, if there are any regulations at all. The risk of litigation is negligible, in some places nonexistent. Ethical concerns are a figure of speech. Finally—a significant plus for the drug companies—the F.D.A. does so little monitoring that the companies can pretty much do and say what they want.

Consent by Thumbprint

Many of today’s trials still take place in developed countries, such as Britain, Italy, and Japan. But thousands are taking place in countries with large concentrations of poor, often illiterate people, who in some cases sign consent forms with a thumbprint, or scratch an “X.” Bangladesh has been home to 76 clinical trials. There have been clinical trials in Malawi (61), the Russian Federation (1,513), Romania (876), Thailand (786), Ukraine (589), Kazakhstan (15), Peru (494), Iran (292), Turkey (716), and Uganda (132). Throw a dart at a world map and you are unlikely to hit a spot that has escaped the attention of those who scout out locations for the pharmaceutical industry.

The two destinations that one day will eclipse all the others, including Europe and the United States, are China (with 1,861 trials) and India (with 1,457). A few years ago, India was home to more American drug trials than China was, thanks in part to its large English-speaking population. But that has changed. English is now mandatory in China’s elementary schools, and, owing to its population edge, China now has more people who speak English than India does.

While Americans may be unfamiliar with the names of foreign cities where clinical trials have been conducted, many of the drugs being tested are staples of their medicine cabinets. One example is Celebrex, a non-steroidal anti-inflammatory drug that has been aggressively promoted in television commercials for a decade. Its manufacturer, Pfizer, the world’s largest drug company, has spent more than a billion dollars promoting its use as a pain remedy for arthritis and other conditions, including menstrual cramps. The National Institutes of Health maintains a record of most—but by no means all—drug trials inside and outside the United States. The database counts 290 studies involving Celebrex. Companies are not required to report—and do not report—all studies conducted overseas. According to the database, of the 290 trials for Celebrex, 183 took place in the United States, meaning, one would assume, that 107 took place in other countries. But an informal, country-by-country accounting by VANITY FAIR turned up no fewer than 207 Celebrex trials in at least 36 other countries. They ranged from 1 each in Estonia, Croatia, and Lithuania to 6 each in Costa Rica, Colombia, and Russia, to 8 in Mexico, 9 in China, and 10 in Brazil. But even these numbers understate the extent of the foreign trials. For example, the database lists five Celebrex trials in Ukraine, but just “one” of those trials involved studies in 11 different Ukrainian cities.

The Celebrex story does not have a happy ending. First, it was disclosed that patients taking the drug were more likely to suffer heart attacks and strokes than those who took older and cheaper painkillers. Then it was alleged that Pfizer had suppressed a study calling attention to these very problems. (The company denied that the study was undisclosed and insisted that it “acted responsibly in sharing this information in a timely manner with the F.D.A.”) Soon afterward the Journal of the Royal Society of Medicine reported an array of additional negative findings. Meanwhile, Pfizer was promoting Celebrex for use with Alzheimer’s patients, holding out the possibility that the drug would slow the progression of dementia. It didn’t. Sales of Celebrex reached $3.3 billion in 2004, and then began to quickly drop.

“Rescue Countries”

One big factor in the shift of clinical trials to foreign countries is a loophole in F.D.A. regulations: if studies in the United States suggest that a drug has no benefit, trials from abroad can often be used in their stead to secure F.D.A. approval. There’s even a term for countries that have shown themselves to be especially amenable when drug companies need positive data fast: they’re called “rescue countries.” Rescue countries came to the aid of Ketek, the first of a new generation of widely heralded antibiotics to treat respiratory-tract infections. Ketek was developed in the 1990s by Aventis Pharmaceuticals, now Sanofi-Aventis. In 2004—on April Fools’ Day, as it happens—the F.D.A. certified Ketek as safe and effective. The F.D.A.’s decision was based heavily on the results of studies in Hungary, Morocco, Tunisia, and Turkey.

The approval came less than one month after a researcher in the United States was sentenced to 57 months in prison for falsifying her own Ketek data. Dr. Anne Kirkman-Campbell, of Gadsden, Alabama, seemingly never met a person she couldn’t sign up to participate in a drug trial. She enrolled more than 400 volunteers, about 1 percent of the town’s adult population, including her entire office staff. In return, she collected $400 a head from Sanofi-Aventis. It later came to light that the data from at least 91 percent of her patients was falsified. (Kirkman-Campbell was not the only troublesome Aventis researcher. Another physician, in charge of the third-largest Ketek trial site, was addicted to cocaine. The same month his data was submitted to the F.D.A. he was arrested while holding his wife hostage at gunpoint.) Nonetheless, on the basis of overseas trials, Ketek won approval.

As the months ticked by, and the number of people taking the drug climbed steadily, the F.D.A. began to get reports of adverse reactions, including serious liver damage that sometimes led to death. The F.D.A.’s leadership remained steadfast in its support of the drug, but criticism by the agency’s own researchers eventually leaked out (a very rare occurrence in this close-knit, buttoned-up world). The critics were especially concerned about an ongoing trial in which 4,000 infants and children, some as young as six months, were recruited in more than a dozen countries for an experiment to assess Ketek’s effectiveness in treating ear infections and tonsillitis. The trial had been sanctioned over the objections of the F.D.A.’s own reviewers. One of them argued that the trial never should have been allowed to take place—that it was “inappropriate and unethical because it exposed children to harm without evidence of benefits.” In 2006, after inquiries from Congress, the F.D.A. asked Sanofi-Aventis to halt the trial. Less than a year later, one day before the start of a congressional hearing on the F.D.A.’s approval of the drug, the agency suddenly slapped a so-called black-box warning on the label of Ketek, restricting its use. (A black-box warning is the most serious step the F.D.A. can take short of removing a drug from the market.) By then the F.D.A. had received 93 reports of severe adverse reactions to Ketek, resulting in 12 deaths.

During the congressional hearings, lawmakers heard from former F.D.A. scientists who had criticized their agency’s oversight of the Ketek trials and the drug-approval process. One was Dr. David Ross, who had been the F.D.A.’s chief reviewer of new drugs for 10 years, and was now the national director of clinical public-health programs for the U.S. Department of Veterans Affairs. When he explained his objections, he offered a litany of reasons that could be applied to any number of other drugs: “Because F.D.A. broke its own rules and allowed Ketek on the market. Because dozens of patients have died or suffered needlessly. Because F.D.A. allowed Ketek’s maker to experiment with it on children over reviewers’ protests. Because F.D.A. ignored warnings about fraud. And because F.D.A. used data it knew were false to reassure the public about Ketek’s safety.”

Trials and Error

To have an effective regulatory system you need a clear chain of command—you need to know who is responsible to whom, all the way up and down the line. There is no effective chain of command in modern American drug testing. Around the time that drugmakers began shifting clinical trials abroad, in the 1990s, they also began to contract out all phases of development and testing, putting them in the hands of for-profit companies. It used to be that clinical trials were done mostly by academic researchers in universities and teaching hospitals, a system that, however imperfect, generally entailed certain minimum standards. The free market has changed all that. Today it is mainly independent contractors who recruit potential patients both in the U.S. and—increasingly—overseas. They devise the rules for the clinical trials, conduct the trials themselves, prepare reports on the results, ghostwrite technical articles for medical journals, and create promotional campaigns. The people doing the work on the front lines are not independent scientists. They are wage-earning technicians who are paid to gather a certain number of human beings; sometimes sequester and feed them; administer certain chemical inputs; and collect samples of urine and blood at regular intervals. The work looks like agribusiness, not research.

What began as a mom-and-pop operation has grown into a vast army of formal “contract-research organizations” that generate annual revenue of $20 billion. They can be found conducting trials in every part of the world. By far the largest is Quintiles Transnational, based in Durham, North Carolina. It offers the services of 23,000 employees in 60 countries, and claims that it has “helped develop or commercialize all of the top 30 best-selling drugs.”

Quintiles is privately owned—its investors include two of the U.S.’s top private-equity firms. Other private contractors are public companies, their stock traded on Wall Street. Pharmaceutical Product Development (P.P.D.), a full-service medical contractor based in Wilmington, North Carolina, is a public company with 10,500 employees. It, too, has conducted clinical trials all around the world. In fact, it was involved in the clinical trials for Ketek—a P.P.D. research associate, Ann Marie Cisneros, had been assigned to monitor Dr. Anne Kirkman-Campbell’s testing in Alabama. Cisneros later told the congressional investigating committee that Kirkman-Campbell had indeed engaged in fraud. “But what the court that sentenced her did not know,” Cisneros said, was that “Aventis was not a victim of this fraud.” Cisneros said she had reported her findings of fraud to her employer, P.P.D., and also to Aventis. She told the congressional committee, “What brings me here today is my disbelief at Aventis’s statements that it did not know that fraud was being committed. Mr. Chairman, I knew it, P.P.D. knew it, and Aventis knew it.” Following her testimony the company released a statement saying it regretted the violations that occurred during the study but was not aware of the fraud until after the data was submitted to the F.D.A.

The F.D.A., the federal agency charged with oversight of the food and drugs that Americans consume, is rife with conflicts of interest. Doctors who insist the drug you take is perfectly safe may be collecting hundreds of thousands of dollars from the company selling the drug. (ProPublica, an independent, nonprofit news organization that is compiling an ongoing catalogue of pharmaceutical-company payments to physicians, has identified 17,000 doctors who have collected speaking and consulting fees, including nearly 400 who have received $100,000 or more since 2009.) Quite often, the F.D.A. never bothers to check for interlocking financial interests. In one study, the agency failed to document the financial interests of applicants in 31 percent of applications for new-drug approval. Even when the agency or the company knew of a potential conflict of interest, neither acted to guard against bias in the test results.

Because of the deference shown to drug companies by the F.D.A.—and also by Congress, which has failed to impose any meaningful regulation—there is no mandatory public record of the results of drug trials conducted in foreign countries. Nor is there any mandatory public oversight of ongoing trials. If one company were to test an experimental drug that killed more patients than it helped, and kept the results secret, another company might unknowingly repeat the same experiment years later, with the same results. Data is made available to the public on a purely voluntary basis. Its accuracy is unknown. The oversight that does exist often is shot through with the kinds of ethical conflicts that Wall Street would admire. The economic incentives for doctors in poor countries to heed the wishes of the drug companies are immense. An executive at a contract-research organization told the anthropologist Adriana Petryna, author of the book When Experiments Travel: “In Russia, a doctor makes two hundred dollars a month, and he is going to make five thousand dollars per Alzheimer’s patient” that he signs up. Even when the most flagrant conflicts are disclosed, penalties are minimal. In truth, the same situation exists in the United States. There’s just more of a chance here, though not a very large one, that adverse outcomes and tainted data will become public. When the pharmaceutical industry insists that its drugs have been tested overseas in accordance with F.D.A. standards, this may be true—but should provide little assurance.

The F.D.A. gets its information on foreign trials almost entirely from the companies themselves. It conducts little or no independent research. The investigators contracted by the pharmaceutical companies to manage clinical trials are left pretty much on their own. In 2008 the F.D.A. inspected just 1.9 percent of trial sites inside the United States to ensure that they were complying with basic standards. Outside the country, it inspected even fewer trial sites—seven-tenths of 1 percent. In 2008, the F.D.A. visited only 45 of the 6,485 locations where foreign drug trials were being conducted.

The pharmaceutical industry dismisses concerns about the reliability of clinical trials conducted in developing countries, but the potential dangers were driven home to Canadian researchers in 2007. While reviewing data from a clinical trial in Iran for a new heart drug, they discovered that many of the results were fraudulent. “It was bad, so bad we thought the data was not salvageable,” Dr. Gordon Guyatt, part of the research group at McMaster University in Hamilton, told Canada’s National Post.

In addition to monitoring trials abroad, which it does not really do, the F.D.A. is responsible for inspecting drug-manufacturing plants in other countries, which it also does not really do. In 2007 and 2008, hundreds of patients taking the blood thinner heparin, which among other purposes is used to prevent blood clots during surgery and dialysis, developed serious allergic reactions as a result of a contaminant introduced at a Chinese manufacturing facility. It took months for the F.D.A., its Chinese counterpart, and Baxter International, the pharmaceutical company that distributed the drug, to track the source of contamination to Changzhou, a city of 3.5 million on the Yangtze River.

The delay was perhaps understandable, given the manufacturing process. The raw material for Baxter’s heparin comes from China’s many small pig farms. To be precise, it’s derived from the mucous membranes of the intestines of slaughtered pigs; the membranes are mixed together and cooked, often in unregulated family workplaces. By the time the source of the contaminant was pinpointed, many more patients in the United States had experienced severe reactions, and as many as 200 had died. It later turned out that the F.D.A. had indeed inspected a Chinese plant—but it was the wrong one. The federal regulators had confused the names.

The good news was that, in this instance, the F.D.A. at least knew which country the heparin had come from. The bad news is that it does not always know where clinical trials are being conducted, or even the names or types of drugs being tested, or the purpose for which they will be prescribed once approved. Companies may withhold the foreign test data until they actually submit the application to the F.D.A. for approval. By then the agency has lost the ability to see whether the trials were managed according to acceptable standards, and whether the data collected was manipulated or fabricated.

$350 per Child

If the globalization of clinical trials for adult medications has drawn little attention, foreign trials for children’s drugs have attracted even less. The Argentinean province of Santiago del Estero, with a population of nearly a million, is one of the country’s poorest. In 2008 seven babies participating in drug testing in the province suffered what the U.S. clinical-trials community refers to as “an adverse event”: they died. The deaths occurred as the children took part in a medical trial to test the safety of a new vaccine, Synflorix, to prevent pneumonia, ear infections, and other pneumococcal diseases. Developed by GlaxoSmithKline, the world’s fourth-largest pharmaceutical company in terms of global prescription-drug sales, the new vaccine was intended to compete against an existing vaccine. In all, at least 14 infants enrolled in clinical trials for the drug died during the testing. Their parents, some illiterate, had their children signed up without understanding that they were taking part in an experiment. Local doctors who persuaded parents to enroll their babies in the trial reportedly received $350 per child. The two lead investigators contracted by Glaxo were fined by the Argentinean government. So was Glaxo, though the company maintained that the mortality rate of the children “did not exceed the rate in the regions and countries participating in the study.” No independent group conducted an investigation or performed autopsies. As it happens, the brother of the lead investigator in Santiago del Estero was the Argentinean provincial health minister.

In New Delhi, 49 babies died at the All India Institute of Medical Sciences while taking part in clinical trials over a 30-month period. They were given a variety of new drugs to treat everything from high blood pressure to chronic focal encephalitis, a brain inflammation that causes epileptic seizures and other neurological problems. The blood-pressure drugs had never before been given to anyone under 18. The editor of an Indian medical journal said it was obvious that the trials were intended to extend patent life in Western countries “with no consequence or benefit for India, using Indian children as guinea pigs.” In all, 4,142 children were enrolled in the studies, two-thirds of them less than one year old. But the head of the pediatrics department at the All India Institute maintained that “none of the deaths was due to the medication or interventions used in clinical trials.”

For years, American physicians gave anti-psychotic medicines to children “off label,” meaning that they wrote prescriptions based on testing for adults, sometimes even for different conditions. That didn’t work out so well for the children, who, when it comes to medicine, really are not just little adults. To provide the pharmaceutical industry with an incentive to conduct clinical trials on children’s versions of adult drugs, Congress in 1997 enacted legislation, known as the Pediatric Exclusivity Provision, extending the patent life of certain drugs by six months. It worked so well that the industry has, in the ensuing years, been able to put younger and younger children on more and more drugs, pocketing an extra $14 billion. Between 1999 and 2007, for instance, the use of anti-psychotic medications on children between the ages of two and five more than doubled.

A study of 174 trials under the Pediatric Exclusivity Provision found that 9 percent of them did not report the location or number of sites of the clinical trials. Of those that did, two-thirds had been conducted in at least one country outside the United States, and 11 percent were conducted entirely outside the United States. Of the 79 trials with more than 100 subjects participating, 87 percent enrolled patients outside the United States. As is the case with adult studies, many children’s trials conducted abroad are neither reported nor catalogued on any publicly accessible government database. There is no public record of their existence or their results.

In the mid-90s, Glaxo conducted clinical trials on the antidepressant Paxil in the United States, Europe, and South America. Paxil is a member of a class of drugs called selective serotonin re-uptake inhibitors. The class includes Zoloft, Prozac, and Lexapro. In the United Kingdom, Paxil is sold as Seroxat. The clinical trials showed that the drug had no beneficial effect on adolescents; some of the trials indicated that the placebo was more effective than the drug itself. But Glaxo neglected to share this information with consumers; annual sales of the drug had reached $5 billion in 2003. In an internal document obtained by the Canadian Medical Association Journal, the company emphasized how important it was to “effectively manage the dissemination of these data in order to minimize any potential negative commercial impact.” The memo went on to warn that “it would be commercially unacceptable to include a statement that efficacy had not been demonstrated.” After the document was released a Glaxo spokesperson said that the “memo draws an inappropriate conclusion and is not consistent with the facts.”

“Smoke and Mirrors”

It may be just a coincidence, but as controversy swirls around new drugs, and as the F.D.A. continues to slap medicines with new warning labels—especially the black-box warnings that indicate the most serious potential reactions—most of the problematic drugs have all undergone testing outside the United States. Clinical-trial representatives working for GlaxoSmithKline went to Iaşi, Romania, to test Avandia, a diabetes drug, on the local population. Glaxo representatives also showed up in other cities in Romania—Bucureşti, Cluj-Napoca, Craiova, and Timişoara—as well as multiple cities in Latvia, Ukraine, Slovakia, the Russian Federation, Poland, Hungary, Lithuania, Estonia, the Czech Republic, Bulgaria, Croatia, Greece, Belgium, the Netherlands, Germany, France, and the United Kingdom. That was for the largest of the Avandia clinical trials. But there have been scores of others, all seeking to prove that the drug is safe and effective. Some took place before the drug was approved by the F.D.A. Others were “post-marketing” studies, done after the fact, as the company cast about for ways to come up with more positive results so it could expand Avandia’s use for other treatments. Based on the initial evaluations, Avandia was expected to—and did—become another Glaxo multi-billion-dollar best-seller.

While sales soared, so, too, did reports of adverse reactions—everything from macular edema to liver injury, from bone fractures to congestive heart failure. In 2009 the Institute for Safe Medication Practices, a Pennsylvania-based nonprofit group that monitors the prescription-drug field, linked the deaths of 1,354 people to Avandia, based on reports filed with the F.D.A. Studies also concluded that people taking the drug had an increased risk of developing heart disease, one of the very conditions that doctors treating diabetics hope to forestall. The risk was so high that worried doctors inside and outside the F.D.A. sought to have the drug removed from the market, an incredibly difficult task no matter how problematic the medicine. As always, the F.D.A. was late to the party. In 2008 the American Diabetes Association and the European Association for the Study of Diabetes had warned against using Avandia. The Saudi Arabian drug-regulatory agency yanked it from the market, and the Indian government asked Glaxo to halt 19 of its Avandia trials in that country. In September 2010 the European Medicines Agency pulled Avandia from the shelves all across Europe. The F.D.A. still could not bring itself to take decisive action. This even though the F.D.A. knew that Glaxo had withheld critical safety information concerning the increased risk of heart attacks, and the F.D.A. itself had estimated that the drug had caused more than 83,000 heart attacks between 1999 and 2007. The agency settled for imposing new restrictions on the availability of the drug in the United States. Glaxo released a statement saying that it “continues to believe that Avandia is an important treatment for patients with type 2 diabetes,” but that it would “voluntarily cease promotion of Avandia in all the countries in which it operates.”

The Avandia case and others like it have prompted the U.S. Justice Department to mount an investigation under the Foreign Corrupt Practices Act. While it is legal for doctors in this country to accept money from drug companies for acting as consultants, this is not the case abroad, where doctors often are government employees, and such payments can be considered bribes. There are other legal issues. So far, Glaxo has paid out more than $1 billion to settle lawsuits arising from claims against Avandia and other drugs. The Senate Finance Committee calculates that, since May 2004, seven drug companies have paid out more than $7 billion in fines and penalties stemming from unlawful drug dealings. Pfizer paid the largest such fine in history—$2.3 billion for promoting off-label uses of the arthritis drug Bextra.

In theory, pharmaceutical companies are barred from selling a drug for any purpose other than the one that the F.D.A. has approved on the basis of clinical testing. But the reality is different. The minute a drug receives the green light from the F.D.A. for a specific treatment, the sponsoring company and its allies begin campaigns to make it available for other purposes or for other types of patients. The antidepressant Paxil was tested on adults but sold off-label to treat children. Seroquel, an anti-psychotic, was marketed as a treatment for depression. Physicians, often on retainer from pharmaceutical companies, are free to prescribe a drug for any reason if they entertain a belief that it will work. This practice turns the population at large into unwitting guinea pigs whose adverse reactions may go unreported or even unrecognized.

To secure the F.D.A.’s approval for Seroquel, which ultimately would go to treat schizophrenia, bipolar disorders, and manic episodes associated with bipolar disorder, AstraZeneca, the fifth-largest pharmaceutical company, conducted clinical trials across Asia, Europe, and the United States. Among the sites: Shenyang and more than a dozen other cities in China, and multiple cities in Bulgaria, Estonia, Hungary, Latvia, Lithuania, Croatia, Indonesia, Malaysia, Poland, the Russian Federation, Serbia, Ukraine, and Taiwan. The F.D.A. initially approved the drug for the treatment of schizophrenia. But while schizophrenia may have opened the door, off-label sales opened the cash register. Money poured in by the billions as AstraZeneca promoted the drug for the treatment of any number of other conditions. It was prescribed for children with autism-spectrum disorders and retardation as well as for elderly Alzheimer’s patients in nursing homes. The company touted the drug for treatment of aggression, anxiety, anger-management issues, attention-deficit hyperactivity disorder, dementia, and sleeplessness. Up to 70 percent of the prescriptions for Seroquel were written for a purpose other than the one for which it had been approved, and sales rose to more than $4 billion a year.

It turned out, however, that AstraZeneca had been less than candid about the drug’s side effects. One of the most troubling: patients often gained weight and developed diabetes. This meant a new round of drugs to treat conditions caused by Seroquel. In an internal e-mail from 1997 discussing a study comparing Seroquel with an older anti-psychotic drug, Haldol, a company executive praised the work of the project physician, saying she had done a great “smoke-and-mirrors job,” which “should minimize (and dare I venture to suggest) could put a positive spin (in terms of safety) on this cursed study.” After the e-mail was disclosed, in February 2009, the company said that the document cannot “obscure the fact that AstraZeneca acted responsibly and appropriately as it developed and marketed” the drug. In April, AstraZeneca reached a half-billion-dollar settlement with the federal government over its marketing of Seroquel. The U.S. attorney in Philadelphia, where the settlement was filed, declared that the company had “turned patients into guinea pigs in an unsupervised drug test.” Meanwhile, the company was facing more than 25,000 product-liability lawsuits filed by people who contended the drug had caused their diabetes.

Death Toll

The only people who seem to care about the surge of clinical trials in foreign countries are the medical ethicists—not historically a powerhouse when it comes to battling the drug companies. A team of physician-researchers from Duke University, writing last year in the New England Journal of Medicine, observed that “this phenomenon raises important questions about the economics and ethics of clinical research and the translation of trial results to clinical practice: Who benefits from the globalization of clinical trials? What is the potential for exploitation of research subjects? Are trial results accurate and valid, and can they be extrapolated to other settings?” The Duke team noted that, in some places, “financial compensation for research participation may exceed participants’ annual wages, and participation in a clinical trial may provide the only access to care” for those taking part in the trial. In 2007, residents of a homeless shelter in Grudziadz, Poland, received as little as $2 to take part in a flu-vaccine experiment. The subjects thought they were getting a regular flu shot. They were not. At least 20 of them died. The same distorting economic pressures exist for local hospitals or doctors, who may collect hundreds of dollars for every patient they enroll. In theory, a federal institutional review board is supposed to assess every clinical trial, with special concern for the welfare of the human subjects, but this work, too, has now been outsourced to private companies and is often useless. In 2009 the Government Accountability Office conducted a sting operation, winning approval for a clinical trial involving human subjects; the institutional review board failed to discover (if it even tried) that it was dealing with “a bogus company with falsified credentials” and a fake medical device. This was in Los Angeles. If that is oversight in the U.S., imagine what it’s like in Kazakhstan or Uganda. Susan Reverby, the Wellesley historian who uncovered the U.S. government’s syphilis experiments in Guatemala during the 1940s, was asked in a recent interview to cite any ongoing experimental practices that gave her pause. “Frankly,” she said, “I am mostly worried about the drug trials that get done elsewhere now, which we have little control over.”

The pharmaceutical industry, needless to say, has a different view. It argues that people participating in a clinical trial may be getting the highest quality of medical care they have ever received. That may be true in the short term. But, unfortunately, the care lasts only until the trial is completed. Many U.S. medical investigators who manage drug trials abroad say they prefer to work overseas, where regulations are lax and “conflict of interest” is a synonym for “business as usual.” Inside the United States, doctors who oversee trials are required to fill out forms showing any income they have received from drug companies so as to guard against financial biases in trials. This explains in part why the number of clinical-trial investigators registered with the F.D.A. fell 5.2 percent in the U.S. between 2004 and 2007 while increasing 16 percent in Eastern Europe, 12 percent in Asia, and 10 percent in Latin America. In a recent survey, 70 percent of the eligible U.S. and Western European clinical investigators interviewed said they were discouraged by the current regulatory environment, partly because they are compelled to disclose financial ties to the pharmaceutical industry. In trials conducted outside the United States, few people care.

In 2009, according to the Institute for Safe Medication Practices, 19,551 people died in the United States as a direct result of the prescription drugs they took. That’s just the reported number. It’s decidedly low, because it is estimated that only about 10 percent of such deaths are reported. Conservatively, then, the annual American death toll from prescription drugs considered “safe” can be put at around 200,000. That is three times the number of people who die every year from diabetes, four times the number who die from kidney disease. Overall, deaths from F.D.A.-approved prescription drugs dwarf the number of people who die from street drugs such as cocaine and heroin. They dwarf the number who die every year in automobile accidents. So far, these deaths have triggered no medical crusades, no tough new regulations. After a dozen or so deaths linked to runaway Toyotas, Japanese executives were summoned to appear before lawmakers in Washington and were subjected to an onslaught of humiliating publicity. When the pharmaceutical industry meets with lawmakers, it is mainly to provide campaign contributions.

And with more and more of its activities moving overseas, the industry’s behavior will become more impenetrable, and more dangerous, than ever.

Tuesday, December 7, 2010

What In the World Are They Spraying ? The Movie Favorite

The Chemtrail /Geo-Engineering Coverup Revealed.By now everyone has seen crisscrossing streaks of white clouds trailing behind jet aircraft, stretching from horizon to horizon, eventually turning the sky into a murky haze. Our innate intelligence tells us these are not mere vapor trails from jet engines, but no one yet has probed the questions: who is doing this and why. With the release of this video, all of that has changed. Here is the story of a rapidly developing industry called geo-engineering, driven by scientists, corporations, and governments intent on changing global climate, controlling the weather, and altering the chemical composition of soil and water all supposedly for the betterment of mankind. Although officials insist that these programs are only in the discussion phase, evidence is abundant that they have been underway since about 1990 and the effect has been devastating to crops, wildlife, and human health. We are being sprayed with toxic substances without our consent and, to add insult to injury, they are lying to us about it. Do not watch this documentary if you have high blood pressure.

Monday, December 6, 2010

Everything Is A Lie: The Deliberate Intent To Deceive People Is At An All Time High

From pollution to politics, the era of deception and duplicity has reached new heights and hijacked almost every form of media in the world. In the last frontiers for truth such as the internet, disinformation operations are in full swing to discredit and destroy any semblance of authentic and factual information available to the public.

How many more lies will people around the world accept as truth? Some say a global awakening is taking place, but at what cost? Will it take the destruction of most of the earth and its resources before people are enlightened?

The escalating media and political reports are so far fetched, cunning, and so beyond reality, it's as if each is trying to top the other with one sinister plot after the next. To demonstrate the outright lies by national governments and the media, let's take three examples from the last year alone, including the H1N1 scandal, airport body scanners and the BP oil disaster.

The H1N1 Scandal

Last year, the H1N1 scandal reached its pinnacle in the fall of 2009 when the world united on the internet with a consensus and practical understanding of the World Health Organization's orchestratration to deceive the masses. From radio, internet, television, newspapers, magazines, outdoor posters, signage and promotions, you could not escape the flu hype campaigns so diligently pursued by all the malicious agendas at play who only wanted one thing - to promote a dangerous H1N1 vaccine. After hundreds of reports exposed the criminal activity by all levels of government, we left the same people in power to do it all over again.

According to preliminary reports, another round of pandemic vaccine campaigns are scheduled for the 2010/2011 season and they're already underway. However, there appears to be a recombination that has changed the H1N1 lab created virus into a more lethal form and it is not a hoax, but it may be yet another CDC lab experiment.

The CDC has recently issued a Health Advisory in connection with two summer outbreaks of H3N2 in Iowa. Other reports from Russia and India indicate that a real epidemic may be upon us if the virus steadily recombines and acquires new genetics. Even though a new strain may have accidentally evolved in eggs, reassortment of H1N1-H5N1 has been a legitimate concern for years. The WHO first suggested the reassortment of H1N1-H5N1 in 2004.

If this is really the case, how will the public react after all the lies from health agencies who have sworn to protect us? Will they hype another vaccine and if so, will the public even respond?

Body Scanners

They've been approved all over the world and marketed as the next greatest airport scanning technology. The U.S., U.K., Russia, Australia, Europe and Canada have all installed airport body scanners which have potentially devastating health effects.

Many of these scanners are reportedly using terahertz (THz) waves, the radiation that fills the slot in the electromagnetic spectrum between microwaves and infrared. Evidence suggests that although the forces generated are tiny, resonant effects allow THz waves to unzip double-stranded DNA, creating bubbles in the double strand that could significantly interfere with processes such as gene expression and DNA replication.

As the path toward rolling out wider use of whole-body scanners in U.S. airports ran through the White House, Obama expedited their deployment because the Department of Homeland Security (DHS) and Transportation Security Administration (TSA) didn't need legislation from Congress to start using the devices at any of the 560 U.S. airports.

The White House ignored all the scientific evidence presented which suggested negative health effects. Politicians and regulatory agencies then covered up the bad publicity on naked body scanners and focused on the presumed benefits under the guise of public safety.

Privacy commisioners and airport authorities have also insisted that there were no risks of images being stored or personal details being revealed to security screeners. Now there's new evidence to show that the scanners can do just that.

According to a CNET report, another federal agency, the U.S. Marshall's service, admitted that it had actually stored over 30,000 images recorded by a full-body scanner used at a Florida courthouse.

A watchdog group called the Electronic Privacy Information Center (EPIC) obtained over 100 of the images and states on its web site that, "The images, which are routinely captured by the federal agency, prove that body scanning devices store and record images of individuals stripped naked." The group has filed a lawsuit to suspend the deployment of body scanners at airports.

EPIC also discovered that the TSA actually specified to manufacturers that the machines have the ability to send and store images. The TSA says that these functions are only for testing and training and insists on its web site that the airport body scanners are delivered to airports with storage and recording functions disabled.

Again, the upper levels of the echelon are caught lying and deceiving, yet they are still left to their own devices to further manipulate and continue misrepresenting facts to the gullible public.

BP Oil Disaster

When news unfolded about the April 20, 2010 BP oil disaster, it went from bad to worse. Instead of immediately mobilizing for action in the face of a massive public health threat, the response was to cover-up, deny and respond with ignorance. After all the public will always believe them, or so they thought.

The Obama administration, Interior Secretary Ken Salazar, U.S. Coast Guard commandant admiral Thad Allen, energy and climate-change policy adviser Carol Browner, BP and all their contituents conspired to deliberately mislead the public from the inception of the disaster to present day. What's worse is they all agreed to further disseminate toxins in the Gulf by spraying 1.8 to 2 million gallons of the neurotoxin Corexit which was exposed by over a hundred scientists, toxicologists and other experts who have unequivocally classified the irresponsible aerial spraying of the chemical dispersant as a large-scale, uncontrolled non-consensual human and environmental experiment is being conducted in the Gulf region.

The media was grossly censoring the extent of the devastation in the Gulf. The poisons--oil and corexit are destined to spread globally, but honest reporting was and still is restricted, and many independent investigators have been arrested. Read 30 Facts Evidencing that The Gulf Oil Crisis Was Planned.

On June 12, 2010, The Institute of Atmospheric Sciences and Climate (ISAC) released "Risk of Global Climate Change By BP Oil Spill", a document detailing how the BP spill may cause irreparable damage to the Gulf Stream global climate thermoregulation activity. Read Gulf Loop Current Destroyed: May Lead To Shut Down of Atlantic Thermoregulation, Rapid Cooling.

According to Dr. Gianluigi Zangari, an Italian theoretical physicist, and major complex and chaotic systems analyst at the Frascati National Laboratories in Italy, the Loop Current in the Gulf of Mexico has stalled as a consequence of the BP oil spill disaster. Zangari notes that the effects of this stall have also begun to spread to the Gulf Stream. This is because the Loop Current is a crucial element of the Gulf Stream itself and why it is commonly referred to as the “main engine” of the Stream.

The concern now, is whether or not natural processes can re-establish the stalled Loop Current. If not, we could begin to see global crop failures as early as 2011.

Zangari's assessment is based on daily monitoring of real-time data oceanographic satellite public data feeds called “Real-Time Mesoscale Altimetry” from the Jason, Topex/Poseidon, Geosat, Follow-On, ERS-2 and Envisat satellites.

These satellite feeds are captured and made publicly available by NASA, NOAA and by the Colorado Center for Astrodynamics Research (CCAR) at the University of Colorado at Boulder.

The CCAR is now being accused of scientific fraud and tampering of data directly associated with the events surrounding the Loop Current phenomenon and its current anomalies. Various reporters have spear-headed the charge including radio personality Dr. Bill Deagle who has featured Dr. Zangari on his radio show The Nutrimedical Report where he detailed the events leading up to the destruction of the Loop Current in the Gulf.

Dr. Zangari has stated that he will no longer use CCAR data due to its unreliability.

Organized and Professional Disinformation Operations

Well-funded and highly-organized disinformation operations are in full-swing throughout the internet. From forums to comment boards and even professional websites that have only one purpose: Defame, distract, and destroy the truth.

However organized, the tactics are very predictable in a world filled with lies and half-truths. This, sadly, includes every day news media, one of the worst offenders with respect to being a source of disinformation.

Disinformation campaigns are launched against those seeking to uncover and expose the truth and/or the conspiracy. The H1N1 scandal was a prime example of how hundreds of operations can be launched to sway opinions on the facts. For every fact-based article on the realities of the H1N1 vaccine, there were both very primitive and sophisticated counters on message boards, comment forums and hundreds of alternative and mainstream websites.

Stephen Barrett's and supporters such as and are examples of websites which promote both synthetic and organic disinformation on almost any topic that does not concur with mainstream thought.

There are specific tactics which disinfo artists tend to apply, as H. Michael Sweeney has brilliantly detailed. Also included with this material are eight common traits of the disinfo artist which may also prove useful in identifying players and motives. The more a particular party fits the traits and is guilty of following the rules, the more likely they are a professional disinfo artist with a vested motive. People can be bought, threatened, or blackmailed into providing disinformation, so even "good guys" can be suspect in many cases.

A rational person participating as one interested in the truth will evaluate that chain of evidence and conclude either that the links are solid and conclusive, that one or more links are weak and need further development before conclusion can be arrived at, or that one or more links can be broken, usually invalidating (but not necessarily so, if parallel links already exist or can be found, or if a particular link was merely supportive, but not in itself key) the argument. The game is played by raising issues which either strengthen or weaken (preferably to the point of breaking) these links. It is the job of a disinfo artist to interfere with these evaluation... to at least make people think the links are weak or broken when, in truth, they are not... or to propose alternative solutions leading away from the truth. Often, by simply impeding and slowing down the process through disinformation tactics, a level of victory is assured because apathy increases with time and rhetoric.

It would seem true in almost every instance, that if one cannot break the chain of evidence for a given solution, revelation of truth has won out. If the chain is broken either a new link must be forged, or a whole new chain developed, or the solution is invalid an a new one must be found... but truth still wins out. There is no shame in being the creator or supporter of a failed solution, chain, or link, if done with honesty in search of the truth. This is the rational approach. While it is understandable that a person can become emotionally involved with a particular side of a given issue, it is really unimportant who wins, as long as truth wins. But the disinfo artist will seek to emotionalize and chastise any failure (real or false claims thereof), and will seek by means of intimidation to prevent discussion in general.

It is the disinfo artist and those who may pull their strings (those who stand to suffer should the crime be solved) MUST seek to prevent rational and complete examination of any chain of evidence which would hang them. Since fact and truth seldom fall on their own, they must be overcome with lies and deceit. Those who are professional in the art of lies and deceit, such as the intelligence community and the professional criminal (often the same people or at least working together), tend to apply fairly well defined and observable tools in this process. However, the public at large is not well armed against such weapons, and is often easily led astray by these time-proven tactics. Remarkably, not even media and law enforcement have NOT BEEN TRAINED to deal with these issues. For the most part, only the players themselves understand the rules of the game.
Twenty-Five Rules of Disinformation

1. Hear no evil, see no evil, speak no evil.

Regardless of what you know, don't discuss it -- especially if you are a public figure, news anchor, etc. If it's not reported, it didn't happen, and you never have to deal with the issues.

2. Become incredulous and indignant.

Avoid discussing key issues and instead focus on side issues which can be used to show the topic as being critical of some otherwise sacrosanct group or theme. This is also known as the 'How dare you!' gambit.

3. Create rumor mongers.

Avoid discussing issues by describing all charges, regardless of venue or evidence, as mere rumors and wild accusations. Other derogatory terms mutually exclusive of truth may work as well. This method works especially well with a silent press because the only way the public can learn of the facts are through such 'arguable rumors'. If you can associate the material with the Internet, use this fact to certify it a 'wild rumor' from a 'bunch of kids on the Internet' which can have no basis in fact.

4. Use a straw man.

Find or create a seeming element of your opponent's argument which you can easily knock down to make yourself look good and the opponent to look bad. Either make up an issue you may safely imply exists based on your interpretation of the opponent/opponent arguments/situation, or select the weakest aspect of the weakest charges. Amplify their significance and destroy them in a way which appears to debunk all the charges, real and fabricated alike, while actually avoiding discussion of the real issues.

5. Sidetrack opponents with name calling and ridicule.

This is also known as the primary 'attack the messenger' ploy, though other methods qualify as variants of that approach. Associate opponents with unpopular titles such as 'kooks', 'right-wing', 'liberal', 'left-wing', 'terrorists', 'conspiracy buffs', 'radicals', 'militia', 'racists', 'religious fanatics', 'sexual deviates', and so forth. This makes others shrink from support out of fear of gaining the same label, and you avoid dealing with issues.

6. Hit and Run.

In any public forum, make a brief attack of your opponent or the opponent position and then scamper off before an answer can be fielded, or simply ignore any answer. This works extremely well in Internet and letters-to-the-editor environments where a steady stream of new identities can be called upon without having to explain critical reasoning -- simply make an accusation or other attack, never discussing issues, and never answering any subsequent response, for that would dignify the opponent's viewpoint.

7. Question motives.

Twist or amplify any fact which could be taken to imply that the opponent operates out of a hidden personal agenda or other bias. This avoids discussing issues and forces the accuser on the defensive.

8. Invoke authority.

Claim for yourself or associate yourself with authority and present your argument with enough 'jargon' and 'minutia' to illustrate you are 'one who knows', and simply say it isn't so without discussing issues or demonstrating concretely why or citing sources.

9. Play Dumb.

No matter what evidence or logical argument is offered, avoid discussing issues except with denials they have any credibility, make any sense, provide any proof, contain or make a point, have logic, or support a conclusion. Mix well for maximum effect.

10. Associate opponent charges with old news.

A derivative of the straw man -- usually, in any large-scale matter of high visibility, someone will make charges early on which can be or were already easily dealt with - a kind of investment for the future should the matter not be so easily contained.) Where it can be foreseen, have your own side raise a straw man issue and have it dealt with early on as part of the initial contingency plans. Subsequent charges, regardless of validity or new ground uncovered, can usually then be associated with the original charge and dismissed as simply being a rehash without need to address current issues -- so much the better where the opponent is or was involved with the original source.

11. Establish and rely upon fall-back positions.

Using a minor matter or element of the facts, take the 'high road' and 'confess' with candor that some innocent mistake, in hindsight, was made -- but that opponents have seized on the opportunity to blow it all out of proportion and imply greater criminalities which, 'just aren't so.' Others can reinforce this on your behalf, later, and even publicly 'call for an end to the nonsense' because you have already 'done the right thing.' Done properly, this can garner sympathy and respect for 'coming clean' and 'owning up' to your mistakes without addressing more serious issues.

12. Enigmas have no solution.

Drawing upon the overall umbrella of events surrounding the crime and the multitude of players and events, paint the entire affair as too complex to solve. This causes those otherwise following the matter to begin to lose interest more quickly without having to address the actual issues.

13. Alice in Wonderland Logic.

Avoid discussion of the issues by reasoning backwards or with an apparent deductive logic which forbears any actual material fact.

14. Demand complete solutions.

Avoid the issues by requiring opponents to solve the crime at hand completely, a ploy which works best with issues qualifying for rule 10.

15. Fit the facts to alternate conclusions.

This requires creative thinking unless the crime was planned with contingency conclusions in place.

16. Vanish evidence and witnesses.

If it does not exist, it is not fact, and you won't have to address the issue.

17. Change the subject.

Usually in connection with one of the other ploys listed here, find a way to side-track the discussion with abrasive or controversial comments in hopes of turning attention to a new, more manageable topic. This works especially well with companions who can 'argue' with you over the new topic and polarize the discussion arena in order to avoid discussing more key issues.

18. Emotionalize, Antagonize, and Goad Opponents.

If you can't do anything else, chide and taunt your opponents and draw them into emotional responses which will tend to make them look foolish and overly motivated, and generally render their material somewhat less coherent. Not only will you avoid discussing the issues in the first instance, but even if their emotional response addresses the issue, you can further avoid the issues by then focusing on how 'sensitive they are to criticism.'

19. Ignore facts presented, demand impossible proofs.

This is perhaps a variant of the 'play dumb' rule. Regardless of what material may be presented by an opponent in public forums, claim the material irrelevant and demand proof that is impossible for the opponent to come by (it may exist, but not be at his disposal, or it may be something which is known to be safely destroyed or withheld, such as a murder weapon.) In order to completely avoid discussing issues, it may be required that you to categorically deny and be critical of media or books as valid sources, deny that witnesses are acceptable, or even deny that statements made by government or other authorities have any meaning or relevance.

20. False evidence.

Whenever possible, introduce new facts or clues designed and manufactured to conflict with opponent presentations -- as useful tools to neutralize sensitive issues or impede resolution. This works best when the crime was designed with contingencies for the purpose, and the facts cannot be easily separated from the fabrications.

21. Call a Grand Jury, Special Prosecutor, or other empowered investigative body.

Subvert the (process) to your benefit and effectively neutralize all sensitive issues without open discussion. Once convened, the evidence and testimony are required to be secret when properly handled. For instance, if you own the prosecuting attorney, it can insure a Grand Jury hears no useful evidence and that the evidence is sealed an unavailable to subsequent investigators. Once a favorable verdict is achieved, the matter can be considered officially closed. Usually, this technique is applied to find the guilty innocent, but it can also be used to obtain charges when seeking to frame a victim.

22. Manufacture a new truth.

Create your own expert(s), group(s), author(s), leader(s) or influence existing ones willing to forge new ground via scientific, investigative, or social research or testimony which concludes favorably. In this way, if you must actually address issues, you can do so authoritatively.

23. Create bigger distractions.

If the above does not seem to be working to distract from sensitive issues, or to prevent unwanted media coverage of unstoppable events such as trials, create bigger news stories (or treat them as such) to distract the multitudes.

24. Silence critics.

If the above methods do not prevail, consider removing opponents from circulation by some definitive solution so that the need to address issues is removed entirely. This can be by their death, arrest and detention, blackmail or destruction of their character by release of blackmail information, or merely by destroying them financially, emotionally, or severely damaging their health.

25. Vanish.

If you are a key holder of secrets or otherwise overly illuminated and you think the heat is getting too hot, to avoid the issues, vacate the kitchen.
Eight Traits of the Disinformationalist

1) Avoidance

They never actually discuss issues head-on or provide constructive input, generally avoiding citation of references or credentials. Rather, they merely imply this, that, and the other. Virtually everything about their presentation implies their authority and expert knowledge in the matter without any further justification for credibility.

2) Selectivity

They tend to pick and choose opponents carefully, either applying the hit-and-run approach against mere commentators supportive of opponents, or focusing heavier attacks on key opponents who are known to directly address issues. Should a commentator become argumentative with any success, the focus will shift to include the commentator as well.

3) Coincidental

They tend to surface suddenly and somewhat coincidentally with a new controversial topic with no clear prior record of participation in general discussions in the particular public arena involved. They likewise tend to vanish once the topic is no longer of general concern. They were likely directed or elected to be there for a reason, and vanish with the reason.

4) Teamwork

They tend to operate in self-congratulatory and complementary packs or teams. Of course, this can happen naturally in any public forum, but there will likely be an ongoing pattern of frequent exchanges of this sort where professionals are involved. Sometimes one of the players will infiltrate the opponent camp to become a source for straw man or other tactics designed to dilute opponent presentation strength.

5) Anti-conspiratorial

They almost always have disdain for 'conspiracy theorists' and, usually, for those who in any way believe JFK was not killed by LHO. Ask yourself why, if they hold such disdain for conspiracy theorists, do they focus on defending a single topic discussed in a NG focusing on conspiracies? One might think they would either be trying to make fools of everyone on every topic, or simply ignore the group they hold in such disdain. Or, one might more rightly conclude they have an ulterior motive for their actions in going out of their way to focus as they do.

6) Artificial Emotions

An odd kind of 'artificial' emotionalism and an unusually thick skin -- an ability to persevere and persist even in the face of overwhelming criticism and unacceptance. This likely stems from intelligence community training that, no matter how condemning the evidence, deny everything, and never become emotionally involved or reactive. The net result for a disinfo artist is that emotions can seem artificial. Most people, if responding in anger, for instance, will express their animosity throughout their rebuttal.

But disinfo types usually have trouble maintaining the 'image' and are hot and cold with respect to pretended emotions and their usually more calm or unemotional communications style. It's just a job, and they often seem unable to 'act their role in character' as well in a communications medium as they might be able in a real face-to-face conversation/confrontation.

You might have outright rage and indignation one moment, ho-hum the next, and more anger later -- an emotional yo-yo. With respect to being thick-skinned, no amount of criticism will deter them from doing their job, and they will generally continue their old disinfo patterns without any adjustments to criticisms of how obvious it is that they play that game -- where a more rational individual who truly cares what others think might seek to improve their communications style, substance, and so forth, or simply give up.

7) Inconsistent

There is also a tendency to make mistakes which betray their true self/motives. This may stem from not really knowing their topic, or it may be somewhat 'freudian', so to speak, in that perhaps they really root for the side of truth deep within.

I have noted that often, they will simply cite contradictory information which neutralizes itself and the author. For instance, one such player claimed to be a Navy pilot, but blamed his poor communicating skills (spelling, grammar, incoherent style) on having only a grade-school education. I'm not aware of too many Navy pilots who don't have a college degree. Another claimed no knowledge of a particular topic/situation but later claimed first-hand knowledge of it.

8) Time Constant

There are three ways this can be seen to work, especially when the government or other empowered player is involved in a cover up operation:

* ANY NG posting by a targeted proponent for truth can result in an IMMEDIATE response. The government and other empowered players can afford to pay people to sit there and watch for an opportunity to do some damage. SINCE DISINFO IN A NG ONLY WORKS IF THE READER SEES IT - FAST RESPONSE IS CALLED FOR, or the visitor may be swayed towards truth.

* When dealing in more direct ways with a disinformationalist, such as email, DELAY IS CALLED FOR - there will usually be a minimum of a 48-72 hour delay. This allows a sit-down team discussion on response strategy for best effect, and even enough time to 'get permission' or instruction from a formal chain of command.

* In the NG example 1) above, it will often ALSO be seen that bigger guns are drawn and fired after the same 48-72 hours delay - the team approach in play. This is especially true when the targeted truth seeker or their comments are considered more important with respect to potential to reveal truth. Thus, a serious truth sayer will be attacked twice for the same sin.

Remarkably, even media and law enforcement have NOT BEEN TRAINED to deal with these issues. For the most part, only the players themselves understand the rules of the game.

Marco Torres is a research specialist, writer and consumer advocate for healthy lifestyles. He holds degrees in Public Health and Environmental Science and is a professional speaker on topics such as disease prevention, environmental toxins and health policy.