Throwback Thursday: Public Schoolhouse Rock!

I was going to call this a "Timewarp Tuesday" posting, but since it's Thursday, I'll call it "Throwback Thursday" instead. Anyway, since Yahoo! retired it's free web-hosting service Geocities, I used the opportunity to revisit every single post I have done since I first began blogging on September 15, 2005. The reason was because I had archived a host of different files and news articles on Geocities and elsewhere, and because I did not wish to pay Yahoo to house those things (I already maintain another website dedicated to New York City's illegitimate, involuntary HbA1c tracking plan that patients CANNOT opt out of, stopnyca1ctracking.org, and I have a LOT of unused storage space there). Anyway, that required me to visit every single posting I have ever done in order to identify posts that contained links to the now-defunct Geocities sites and migrate the files elsewhere, if necessary.

Although I consider myself a good judge of sources and links I feature in my postings so those I use are much less likely to expire, many do end up being relocated at some point. One example was a 2007 Express Scripts study that evaluated the impact that generic insulin could have on U.S. pharmaceutical spending. Express Scripts remains a vital, profitable company (they've grown, too, having acquiring the PBM business from WellPoint earlier this year), but they relocated the reports I had cited to a slightly altered location, meaning the old links were dead.

The sheer number of links made this a time-consuming and interesting process. The good news is that more than 98% of the links in every archived post has been verified or updated to ensure they still work, and hopefully well into the future. I relied heavily on the Internet Archive (http://www.archive.org/) in many cases, and even used the Internet Archive's links for URL's I felt were likely to expire or be relocated in the future, so they'll remain relevant into the future.

As part of the process, I also had the opportunity to review some posts that I'd long since forgotten about, but still put a smile on my face. One of those is the subject of today's "Throwback Thursday" posting, and that was a rather amusing YouTube posting (one of my first to feature videos) called "Schoolhouse Rock vs. Public Schoolhouse Rock" from October 23, 2007, a little over 2 years ago. The posting says it all, but see if you don't find this one amusing!!

Open Enrollment and The Many Layers of the U.S. Healthcare Bill

As many people know, Congress has supposedly been working to address healthcare reform ever since President Obama gave his first U.S. press conference earlier this year. Much has been said about it, including more than a few legitimate (and illegitimate) critiques. But this bill is really a monster, and includes a number of seemingly unrelated items to healthcare reform. Since Congress hasn't accomplished all that much this year (besides bickering with each other), there is some effort to throw everything into the bill since it may very well be the ONLY piece of legislation Congress actually votes on this year.

But aside from efforts to address universal coverage, what else is in there?

A few things that people with diabetes may wish to beware of.

Well, its October 28, 2009, and we're reaching the last stretch of the year. Presently, this is the time many people are faced with what's known as "open enrollment" for healthcare plans and various other employee benefits.

The New York Times "Well" Health Blog writes that several experts in the field of employee benefits are saying "When Your Open-Enrollment Envelopes Arrive, Open Them".

They argue that "Doing nothing is no longer an option. Many companies insist you fill out open-enrollment forms even if you intend to stay with the same benefits package. What's more, with so many changes and cost increases on the horizon, you owe it to yourself and your family to take a close look at your options."

An article cited offers some suggestions on how to handle the changes and avoid huge cost increases.

In a subsequent NY Times article by Lesley Alderman, the journalist writes:

"The time-honored 'evergreen' option — defaulting to your current plan — may simply no longer be an option. Either your employer no longer even offers that plan, or the terms may be so radically different that you may no longer want it. With so much in flux, this may be the year you will need to switch health plans."

For many of us with chronic conditions, Flexible Spending Accounts (FSA's) are a huge benefit, and if this is an option offered that you don't presently take advantage of, and you have diabetes, you might very well consider participating. These so-called FSA's provide you with the ability to pay for any deductible amounts, as well as all of your co-pays for testing supplies, medicines, numerous doctors visits, labwork, etc. and even things like contact lenses, glasses, or dental work -- all using pre-tax dollars, thereby reducing your income tax liability.

Congressional Healthcare Reform Could Kill Tax-Advantaged Flexible Spending Accounts (FSAs)

This year, I expected to use more of my FSA balance with my high-deductible insurance plan that was introduced this year (in June), and I'll naturally order more glasses and contact lenses as I normally do every year. Although I try to budget things as closely as possible, it's never exactly been a scientific procedure determining co-pays with a brand new healthcare plan, as well as costs for everything else. Most employers set caps on the plan amounts employees can contribute since they have to front-load those dollars for all of their employees, but the caps set may be different for every company.

Although I have a high-deductible insurance plan ($2,500), because my employer picks up the cost of anything over $500 (which is an administrative hassle, but at least I don't have to pay for all of it) that means I'll still have some money left over, and I plan to use as much as I possibly can so I don't have to forfeit much.

Because I expect to have enough left over, I'm seriously considering splurging and getting a high-tech (and expensive) lancet device called the Pelikan Sun. Fellow d-blogger Amy Tenderich reviewed the product a while back. That will cost about $200 plus a few lancet disks at about $50/each (I don't think this device enables perpetual re-usage of the same lancet that most ordinary devices do, but then again, I should remember change the lancet more than once per year anyway). I think this will be an easier claim for my FSA given that it is already an FDA approved device, and it fits clearly within the "diabetes supplies" category as defined by the IRS.

Next year, however, assuming Congress finally gets around to passing a healthcare "reform" bill, The Wall Street Journal is reporting that members of the Senate Finance Committee are proposing to cap tax-free FSA contributions at $2,500 per year.

That's well above the amount typically put in the accounts now, according to a Senate Finance staffer. (Presently, there is no statutory cap, although most employers set caps on the plan amounts since they are required to pre-pay the amount for all of their employees enrolled in the plans at the beginning of the year, even though it's deducted from participating employees' paychecks during the course of the year.)

But what that Senate staffer failed to mention is the fact that the Senate bill would also provide no inflation indexing of that cap, so if medical cost inflation continues at roughly 8% per year, the $2,500 turns into just $1,250 in 9 years, which as a number of editorials have rightly noted, virtually kills the Flexible Spending Account program over time.

The editorials also rightly note that this change unfairly punishes people who have chronic diseases -— people who, according to the Robert Wood Johnson Foundation, incur annual out-of-pocket expenses averaging about $4,400. We are talking about people with diabetes, families with autistic children, asthmatics who need to buy expensive nebulizers and inhalers, and cancer patients and others.

Apparently, Max Baucus want to end the practice of allowing people to put money into FSA's, which allow employees to pay for co-pays, deductibles as well as everything from cosmetic dental work to surgery using tax-free dollars (well, technically, they're pre-tax dollars which reduces your taxable income, not tax-free dollars).

Diabetes supplies ranging from glucose tablets, lancet devices, and a host of other things all fit under this broad umbrella definition, and frankly, this program has saved me a lot in tax liability and has helped me to weather the ever-growing cost increases in healthcare costs much easier than I could have without it.

As might be expected, a trade organization called "Save Flexible Spending Plans" which launched a companion Web site, savemyflexplan.org. The site is the brainchild of the Employers Council on Flexible Compensation, a group of plan sponsors and third-party administrators that want to preserve and expand tax-favored employer-sponsored benefits, as they stand to loose out if these plans are reduced.

Catch the "Save Flexible Spending Plans'" commercial here:



Critics argue that this organization is nothing more than an organization of people who stand to loose if this piece of legislation passes. That may be so, but the mystery is what the final cost of the Healthcare bill will look like for taxpayers. We may see little, if any tax benefits for those of us whose medical expenses have gone up thanks to ever-higher deductibles and employers who continue to deal with cost increases by using a flexible spending account that apparently, Congress wants to kill.

Anyway, for those of you who are now faced with open enrollment decisions, all of this is some food for thought!!

On Google Voice

I have a shocking admission to make: I have a life outside of diabetes. Yes, it's true, and I have interests that have nothing to do with the big D. This post is about one of these items.

I have been what could be described as a fairly heavy Google user. I'm not talking about using Google's core search engine, but my blog is hosted on Google's Blogspot, I rely on Google's reader to keep up with the hundreds of blogs I follow, I've had a Gmail account since they first began offering them a number of years ago (although truth be told, Gmail is NOT my primary e-mail account, I just don't dig its interface), I have a number of documents, spreadsheets, Powerpoint presentations and PDFs on file with Google Docs (and it also doubles as a great tool to convert Microsoft Office documents into PDFs) -- you can also share spreadsheets there which theoretically would make it a potentially useful tool to share your blood glucose logs with a doctor or diabetes educator (assuming they're online, which may not be the case), etc., etc., etc. Sure, other blog hosting services may have newer or better features, and there are some annoying limitations when it comes to Google Docs' spreadsheets that limit its practical usage (too few lines in their spreadsheet, as I've discovered), but for me, the key is having it all located in a central location with a single login. Plus, all of these things are paid for by Google's efficient advertising machine, so it costs me as an end-user absolutely nothing.

Anyway, a few weeks ago, I got my invitation to Google Voice, but it took me a while to warm up to it. For those of who who haven't seen the internet chatter about Google Voice, it's been billed by some fans as the next "category killer" application. Personally, I don't see that happening, but as I've toyed around with the application and become more familiar with it, I've started to realize the potential value of this service and I really do like some of its features.

What does Google Voice do?

Well, in short, it's something of a telecommunications service that officially launched on March 11, 2009. I say something of because it does not provide you with a phone or even the service, and you do need internet access to use it. If the power is out and you don't have a Blackberry/iPhone, then your access to the control panel on Google Voice is more limited, and you still need to pay someone else for basic phone service.

Although Google Voice officially launched, I think for the moment, it's open only by invitation (anyone can request an application, but I believe those with Gmail accounts are considered sooner than those who aren't). In essence, the service enables you to choose a dedicated Google Voice telephone number, which you can control and access online. From there, you can then add many different numbers to which calls made to your Google Voice number are then forwarded. But you can also control which calls go through to you, and which ones go directly to voicemail (which, naturally, you can customize), and you can also set the hours when calls are forwarded to your different numbers. This means you can have calls from family members go through directly all the time to all of your different phones (your cell phone, your office phone, your home landline number, even a "gizmo" as Google calls them) and these will ring simultaneously until you answer one of these phones or the call rolls over to your Google voicemail. From there, it gets even more interesting. For example, your voicemail messages are accessible online, and Google also transcribes the voice message into text for you (if you want that). This sounds nifty if you get hundreds of calls all day, but the real selling point for me was the simple cost of making long-distance calls, which is completely free in the U.S. and Canada (I think Puerto Rico and the Virgin Islands are also included in that).

I realize the days of long-distance costing a fortune has long since gone the way of the Ford Edsel, but have you ever looked at your landline (for those of you who even have one) or your cell phone bill? There are so many taxes and they nickel and dime you on everything. International calls aren't free on Google Voice, but the rates are incredibly low. For example, $0.02/minute to much of Western Europe (except cell phones, which cost more to call), and further, to places like the Philippines, calls are $0.11/minute, and the price you pay does not include any other miscellaneous taxes that occur with regular long-distance services. Plus, these calls can be initiated on your cell or other phone (as well as online), so you could theoretically call abroad on your cell at rates that are among the lowest I've seen anywhere (just pay attention to the minutes you're using!). To make a call, you type in the number you want to call online, or call your own Google Voice number and hit the * key and a menu will guide you through the process. A few seconds later, you get a call back. Plus, the person you're calling will see your Google Voice number on their caller ID.

Although services like Vonage, Comcast Digital Voice, Time Warner Digital Phone, Cablevision Optimum Voice, MagicJack, etc. also do this, these companies also control the rates, which can vary considerably, and they haven't been shy (at all) about raising their rates in recent years. And you pay a minimum even if you don't make any calls. With Google Voice, you only pay if you make an international call, but your domestic calls remain free.

There are some other nifty features. For example, you can conference call simply by having people calling you. There is no apparent limit, and you can conference in only those you want to be in on the call, and add new participants in whenever they call in.

The downsides: well, you are ceding a boatload of data over to Google, and Google's privacy policy doesn't offer tremendous protection. (Some people who are Twittering every mundane detail about their lives may not even consider this a big deal ... until it's too late!) But then again, neither does SBC or Verizon, although one could argue these companies are drowning in data and they have yet to figure out what do do with it all. Google, on the other hand, might. It's also possible that more advertising could emerge on top of Google Voice services. But its a consideration for some.

The other downside, for the moment anyway, is that you cannot yet port your existing number as your Google Voice number, although they claim that is in development. As the various videos online suggest, the service isn't perfect. Transcription, for example, doesn't work perfectly. Oh, and the choice of numbers isn't ideal. For those of us in New York City, for example, you cannot get a number with a 212, 917, 646, or even a 718 area code. In fact, I wasn't sure they even had a NYC area code available, and I didn't relish having a 914 or 516 area code, but alas, I did find they had 347 area codes (which is an overlay prefix for the 718 area code). Anyway, its not perfect, but is pretty cool. Especially the free calls!!

Anyway, that's my non-D related post for today. See, I told you I have interests that have nothing to do with diabetes! To get your Google Voice invitation, visit http://www.google.com/voice.

Catch this NYTimes/CNBC video overview of Google Voice here:

A Letter to Nick Jonas

First, be advised that some of you may not like this posting. If you don't, feel free to read something else. I don't expect Nick Jonas or his Disney-paid publicist to notice it either, but I need to get this off my chest.

I openly admit it: I think Nick Jonas (and his brothers) is creepy, and I also side with comedienne Kathy Griffin on their so-called "purity" rings (the rings supposedly signify that they will wait until marriage to have sex), see her "colorful" comments on that here. As it turns out, the acerbic, red-headed comedienne was right, this is/was pure bull$#!t -- catch this excerpt from a British teen-tabloid for more on that. But I'm not naïve: I realize they're the latest boy-band craze that makes pre-pubescent girls' hearts flutter, and I could live with that. But what gets me is when all of it's just a snow-job presented as legitimate philanthropy.

They're just the latest in a long line of boy-band and singer sensations. History is full of them: the Jonas Brothers aren't the first, and most certainly won't be the last, and like it or not, their days in this role are numbered, as there's many eager would-be stars only too ready to replace them. We need look back no further to 1997 when another brother band called Hanson dominated the charts with a song called "Mmm Bop" that had the same effect on tween girls at the time.

Back in the 1970's, my sister was briefly in love with another teen idol by the name of Shaun Cassidy, when he performed his #1 hit single "Da Doo Ron Ron" and then later appeared on TV on the Hardy Boys/Nancy Drew show, I thought the shreeks coming from her would deafen me. Fortunately, they didn't. Two decades earlier, there was another teen boy-idol named Ricky Nelson, who began his career on his parents' Ozzie & Harriet TV show, and then later cashed in on his celebrity by extending it (quite successfully) to music and enjoyed success into the 1960's. My mother claims she thought (at the time) he was soooo cute.

But the sad reality is that the Jonas Brothers aren't entirely organic (and they weren't all that successful) until a senior Disney exec named Bob Iger came along with lots of cash and a master plan to create and leverage tween "franchises" across multiple media channels that was well-documented in The Wall Street Journal and other business media (see here for one such story). This plan really began with "High School Musical", then "Hannah Montana" and has since been extended to the Jonas Bros. These figures are emblazoned on products galore and it just so happens that the whole diabetes thing fits quite neatly into this squeaky-clean picture. But be assured, Nicky Jonas (and maybe his parents) is cashing in on it.

The Jonas boys (and their parents) aren't stupid, but they aren't exactly as philanthropic to the larger diabetes community as they seem to suggest. In fact, it's rumored that Nick Jonas got a fat check for $500,000 from the JDRF to do the Congressional testimony although detailed evidence to back that up is hard to come by, as the 990 annual filings with the IRS for nonprofits on file for JDRF don't require that level of specificity. That cost (if it was incurred) could potentially be included in another line-item on the financial statements, and even then, it might have been payable to some other entity, like the firm who booked him for JDRF (or even to an advertising agency), and it might also be blended with other expenses in the same broad category, since line-item reporting is fairly broadly defined.

This past summer, there was all kinds of internet chatter on the web, Twitter, Facebook and elsewhere about how Nick Jonas' had testified with JDRF before the Senate Committee on Homeland Security and Governmental Affairs on June 24, 2009 ("Type 1 Diabetes Research: Real Progress and Real Hope for a Cure") about his fairly brief life with diabetes (at least one kid who was YOUNGER than him who also testified has lived more years with diabetes than Nick Jonas has). He also appeared at the National Press Club on August 21, 2009 and the news and video clips were then subsequently shown all over the web (which fits in perfectly with Bob Iger's original plans for the Jonas "franchise"), and plenty of bloggers wrote about it like it was really news. Truthfully, I really wanted to vomit from it all.

Yes, the supposedly über talented pre-teen idol even wrote and performs a 'touching' song about his oh-so optimistic outlook on life with type 1 diabetes called "A Little Bit Longer" about how we'll have to wait just "a little bit longer" for a cure, but that will be alright in the end. That's supposed to be an inspiration to all the other people with type 1 that, in his words (from his Congressional testimony) "they can live with diabetes and still make their dreams come true". More cheerleading is not what people with diabetes lack, what we lack is truthfulness and honesty about the situation from almost everyone. My friend Deb Butterfield (author of "Showdown With Diabetes") once eloquantly wrote:

"Using reassuring voices and sweet smiles, nurses convey the message that if you do as you're told, then everything will be okay – just as in the NDEP campaign, they are telling their patients that diabetes is controllable, and if they control it, they will be fine. But the truth is that no study, not even the Diabetes Control and Complications Trial, has ever been able to show that diabetes management can prevent complications."

It is this lack of honesty that helps to explain the meteoric rise of all the diabetes blogs and various other social networks serving the diabetes community, as thousands now flock to these things to share stories about what a crock the "5 year" promise is, and how no one believes it. But someone hasn't filled Nicky Jonas in on this little tidbit yet!

My response to Nick's supposed philanthropy: fine, if you were paid by JDRF, fess up, give all of it back and admit it, and if you're really so generous to the cause, donate all the money you now get from the Bayer Diabetes Care endorsements to JDRF or the DRI. Maybe, in 30 more years, and there's still no cure (which may be likely), you can then put your songwriting and performance skills into that. I have some ideas I'm more than willing to share (including one for a song listed below)!

Trust me, Nicky, even with millions of dollars from all your endorsement deals and Disney promos, those unsubstantiated claims aren't terribly comforting, they grow ever more irritating as time goes by. Plus, your "simple-wins" (the tagline from your Bayer Diagnostics campaign) may not be enough to protect YOU from complications, bud. Maybe you'll be able to extend your window of fame, but the odds aren't really in your favor -- if you don't believe me, just ask former 1970's teen-idol Leif Garrett, who was once in a similar place as you are now!

I have no complaint about legitimate philanthropy, but when you're getting paid (handsomely) by charitable organizations and also endorsing diabetes products, but acting like it's genuine charity work, then I take issue.

Nick Jonas may or may not be the next Leif Garrett (who got arrested in the Los Angeles subway system for heroin possession, talk about tween idols in decline), but perhaps in 30 years he'll consider writing a different, more honest song about life with diabetes entitled "It's always just 5 more years away!".

Who knows, I might actually PAY to download a song like that to my iPod, and I would definitely promise NOT to change the station if I heard it as I do with all of his music today!


P.S. It's not my intention to turn this post into a flame-war. Everyone is entitled to their own opinions, as am I. But please realize that I DO moderate comments on this blog, so try to keep comments relevant and ideally, substantiated if you try to challenge me on something!

2009 Mid-Year Progress Report: Part 1

At the end of 2008, I didn't do my annual review of the diabetes cure-advancement and treatment landscape (you can catch my 2007 summary, my 2006 summary and my 2005 summary), a tradition I began in early 2006 and continued for several years afterwords where I highlight some of the diabetes-related developments (from my perspective, naturally) during the preceding year and share my thoughts and insight into the coming year. Most of my readers know that my observations are far from casual, they are based on a thorough review of these trends for the past year (often more) and have a solid basis to substantiate them. Since we're now more than 3/4 into 2009, there's little point in trying to recap last year, as we'll be ready for a recap of 2009 in just a few months! But I can provide some perspective on where things stand right now, and perhaps frame where they're likely to be going in the foreseeable future.

Let me begin by saying that I had a very good reason for not writing a summary of 2008. I was in the process of moving into a new place. But United Moving didn't do the work for me, I did the move mostly by myself, and mostly when I had free time (meaning on the weekends and evenings). Of course, I still had a job to occupy my time during normal business hours. That resulted in blogging taking a back seat. Although I've since resumed, I haven't posted quite as often as I did, say, in 2005 or 2006 because the Diabetes OC community has grown so much since then that having thoughtful and unique content becomes more important today. Not all of my posts are the cheery, uplifting ones that some readers are necessarily seeking (that's never really been my focus or specialty ... there are plenty of others to fill that need, however), but from my perspective, I DO believe there is good news on cure-related progress to share. The challenge: where do I begin?

Some Good Sources for Research Progress Updates

First, let me share some places you might wish to be aware of related to progress reports. Ironically, I discovered these not from the JDRF website, but largely by accident. But this stuff is worthy enough of sharing with others -- the JDRF "shareholders"!!!

A while back, I have mentioned the Juvenile Diabetes Research Foundation (JDRF) New England project/blog, which had some very interesting presentations from their annual update near Boston this year. In fact, I lifted some of the New England chapter content and inserted it into my aforementioned blog posting. However, a few days ago, I received my college alma matter's alumni bulletin (the Bentley University Observer, page 12, although I found it took a long time to download). Anyway, that contained an interesting article I wanted to share with everyone (I scanned it, and you can download only that page/article here). Apparently, some faculty and students from Bentley were asked by the Bay State branch of the JDRF New England chapter to help create some online audio and video content for that particular blog. As might be expected, the article notes that the JDRF New England chapter's blog has since been recognized by other chapters throughout the U.S. and as an example of JDRF "best practices". We can certainly hope to see more of this type of stuff from JDRF's national organization in the future, and possibly other chapters following this lead, so that's good news indeed!

While some of my blogging peers (Kerri Morrone-Sparling of SixUntilMe.com, Manny Hernandez of TuDiabetes.com and a few others) have already joined, in 2006, JDRF's National organization evidently established a YouTube channel which anyone can join and follow at http://www.youtube.com/user/jdrfonline. That was done without much fanfare, but they've been better about putting some video content which is available to everyone (I don't find the TV commercials all that interesting, but some of the other stuff is).

Now, I could be mistaken, but the photo of the person on this YouTube channel appears to be Aaron Kowalski, who is perhaps best known for his work behind the "artificial pancreas" project, but has also been involved in the SmartCells/SmartInsulin deal signed last year. Anyway, the YouTube channel has some videos from JDRF's 2009 Annual Research Roundtable which took place in June 2009, including a short speech by international chairwoman Mary Tyler Moore, the new CEO Alan Lewis' 2009 State of the Foundation Address, and one from Dr. Richard Insel who is the Executive Vice President of Research for the organization. To the best of my knowledge, this is the first year that JDRF has featured videos of these speeches and presentations. I hope to see much more of this stuff in the future, but this is indicative of progress being made, although much of the work began under previous CEO Arnold W. Donald.

Finally, I would share a blogger who is relatively new to the diabetes blogging scene, Joshua Levy. He started a blog last June which can be found at http://cureresearch4type1diabetes.blogspot.com/. I knew of Josh, who has type 1 diabetes himself, from the Islet Foundation's Public Message Forum, and he is also a member of the Nathan-Faustman Yahoo! Group. Anyway, in the past, I followed his updates via an RSS feed of his Wiki updates/changes which alerted me of changes to his website related to diabetes. But his blog has some groundbreaking content, with the next item listed being a case-in-point.

JDRF-Backed Transition Therapeutics' Islet Regeneration Treatment Looks Dead for Type 1, Perhaps Not for Type 2

I generally share Josh's outlook and his definition of a cure, and although I don't always agree with everything he concludes, I'd say that 95% of the time, I do. Often, Josh has some observations which are well ahead of the public statements made by the JDRF or the researchers (not ALL research is funded by JDRF, even though much is). For example, he concluded (and I agree with him) that the JDRF's Transition Therapeutics islet regeneration treatment (based on gastrin, as Alan Lewis talks about) looks dead, at least for people with type 1 diabetes. See his posting here for more on that. Note that JDRF's 2009 Annual Update (which took place this summer) was still talking about this treatment, but as Josh writes:

"Transition Therapeutics is researching using a combination of two drugs to cause beta cell regrowth in an attempt to cure type-1 and type-2 diabetes. As of May 2009, they had officially marked their phase-I human trial for type-1 diabetes as closed. I haven't seen any published results for it, but I'm still looking. However, actions speak louder than words, and Eli Lilly (working with Transition Therapeutics) started a clinical trial in February 2009 using Transition Therapeutics's TT-223 product, but only for people with type-2 diabetes.

Also, in May 2009 they announced that JDRF and Transition Therapeutics had agreed that JDRF would stop funding clinical development of TT-223. Transition Therapeutics and JDRF terminated their agreement. Eli Lilly is taking over support for TT-223, but is applying the technology only to type-2 diabetes.

So the news from Transition Therapeutics for type-1 diabetics is not good. I will move Transition Therapeutics to my 'boneyard' of research that has not panned out if there is no good news in the next 6 months."

So far, JDRF has been pretty quiet about their decision to stop funding Transition Therapeutics, but unless something changes, we can probably conclude it is dead (at least for type 1 diabetes). For those interested in more background on this, and perhaps its applicability towards type 2, catch a video here for more details.

Exsulin Is Still Progressing

Not to worry on the regeneration front (at least not yet!), however, Exsulin Corp. (the name given to the treatment formerly known as INGAP) announced it's regeneration treatment is entering a second Phase 2 human clinical trial in people with type 1 diabetes (see here and here), so even if JDRF isn't behind this particular treatment, the progress will continue. The good news is that Dr. G. Alexander Fleming, Kinexum's CEO (and former Chair of professional education and training for FDA's Center for Drug Evaluation & Research [CDER] among other things), which is the company behind Exsulin Corp., is among the brightest people in diabetes research and knows this subject far better than most, as he also has intimate knowledge of the Food and Drug Administration, and can therefore help maneuver through this dysfunctional regulatory agency better than perhaps almost anyone else, so we can expect to hear more news from Exsulin in the coming year.

Before I get too far, though, let me take a step back and note that before we can get to regeneration (that's a separate topic I'll address in another blog posting I'll put in Part 2 or 3 of this subject), we need to acknowledge the not-so-little problem of autoimmunity, for which there are several possible treatments in various stages of clinical trials.

Consensus on What Will Be Required to Cure Type 1 Diabetes

Let me begin by acknowledging something that the consensus among most diabetes "experts" seems to be that a definitive therapeutic approach to a "cure" for diabetes will have to include a treatment(s) to control the autoimmune response that causes type 1 diabetes (T1DM) combined with another treatment(s) to replace and/or restore lost pancreatic beta cells, and in the case of type 2 diabetes, another treatment to also address the underlying metabolic defects as well. As a well-known diabetes (she's actually an immunologist) researcher, Dr. Denise Faustman, suggested in an interview with dLife (towards the end of the interview), that she expects it to be entirely possible for several autoimmunity "cures" to emerge although she declined to speculate on when such treatments might emerge. But we're closer today than we have been in decades!

First, I should begin by noting that the JDRF has a graphically-rich page on it's website dedicated to biotechnology and pharmaceutical "Industry Development and Industry Partnerships" that has updates on cure therapeutics which I highly recommend visiting: (click on the JDRF website and from there, select the "research" tab, and select "Industry Partnerships" or simply see click here. Because JDRF has an unfortunate habit of reorganizing it's website leaving some of its links dead, I felt it was useful to provide more detail than I have in the past).

First and foremost, on the autoimmunity front, inflammation is hot!

It's no secret that the drug industry is in the doldrums these days, with many blockbusters whose patents are due to expire soon and nothing much in the pipelines to replace these cash cow blockbusters. But one therapeutic area which seems to very hot these days is in drugs and biotech medicines to treat "inflammation".

Merriam-Webster defines the medical term "inflammation" as "a local response to cellular injury that is marked by capillary dilatation, leukocytic infiltration, redness, heat, pain, swelling, and often loss of function and that serves as a mechanism initiating the elimination of noxious agents and of damaged tissue."

In short, it's an immune response by the body used to heal infections or other ailments. Under normal circumstances, inflammation serves a protective purpose, so it should not necessarily be viewed as a bad thing. Inflammation helps to rid the body of infections and to heal itself, but too much of anything can have the opposite effect, having a destructive rather than protective effect. Both type 1 and type 2 diabetes have inflammation issues which lead to beta cell destruction, although the origins for inflammation in each disease is apparently quite different, as more recent research seems to suggest. At present, approved treatments for inflammation in each disease are mostly non-existent except for a few ailments such as cancer, although others for different autoimmune diseases have also started to emerge. Several aimed at addressing type 1 diabetes are in various stages in development.

Historically, the medical profession has treated most forms of inflammation the same way. The term "anti-inflammatory" usually refers to the property of a substance or treatment that reduces inflammation. In fact, anti-inflammatory drugs make up about half of all analgesics sold (including many over-the-counter products), remedying pain by reducing inflammation as opposed to opioids which affect the brain. Among the more common, over-the-counter ones are ibuprofin (brand names include Advil and Motrin) and naproxen sodium (brand name Aleve).

But this approach, to use a metaphor, is akin to sending out an entire army (using immunosuppresant drugs that largely shut the entire immune system down) to do the job that a single soldier with highly specialized skills could have done alone, and it also leaves patients prone to infections and other illnesses because the effectiveness of their own immune system has been reduced.

During the late 1980's and 1990's, newer research revealed that we could selectively target certain leukocytes (white blood cells) that caused specific types of cancer. The result was a gold mine for the drug and biotech industries, with extremely costly (and lucrative) medicines which seemed to work wonders for a handful of patients as well the bottom line of drug/biotech companies alike! But that business model has run into limits of governments and healthcare providers worldwide and their willingness to pay outrageous sums of money to save a mere handful of ill patients with specialized cancers. Like it or not, one might call this a form of performance-based medicine.

Certainly, an immunologic intervention resulting in an effective modification of the underlying immune process could potentially interfere with the etiology of an autoimmune disease and thereby preserve beta cell function, and/or set the stage for successful beta cell regeneration and/or replacement, or both. Ideally, immunotherapy offered to type 1 diabetes patients could be aimed selectively at salvaging the remaining beta cell mass (if any exists), while also creating a state of "immune tolerance" for the insulin-producing beta cells as immunologists refer to it. (The term "immune tolerance" collectively refers to the safeguards that the immune system naturally possesses to protect from harming self.)

A Newer Approach to Immune Tolerance

In contrast to immunosuppressant therapies which essentially shut the immune system down, immune tolerance therapies are designed to work in a different way. Rather than suppressing the immune system as a whole, these newer treatments aim to suppress only those parts of the immune system responsible for the autoimmune attack (or perhaps prevent it in the first place). The goal is to stop the autoimmune disease while leaving the body's infection and disease-fighting abilities intact.

Although a variety of approaches to immune tolerance have been successful in rodent (or even in some larger animal) models of autoimmune diseases, or in pilot clinical studies, to date, the achievements in larger human clinical trials have been rather modest. Researchers have learned that the similarities between mouse and human immune systems are pretty limited.

But according to the NIH Autoimmune Diseases Coordinating Committee, the range of potential therapeutic approaches available to treat autoimmune disease is expected to expand rapidly during the next decade as a consequence of progress in genetic and immunologic research conducted in the public and private sectors. These therapies are likely to include drugs, biologic agents, gene-based delivery systems, immunomodulation, cell-based treatments, tissue and organ engineering procedures, as well as therapies based on complementary and alternative medicine.

I've shown the following chart many times, but I use it for a reason: 2010 is the estimated time that some of the newer autoimmune treatments are expected to emerge, with more likely in the following years.



The question is if this is more of a retrospective look with a short window into the coming years, where is the future headed?

Here's where my references to some past efforts comes in. For example, in June 2009, I reported on some progress the JDRF had made with it's Industry Discovery and Development Partnership (IDDP) program (see here), whereby JDRF provides early-stage research funding to drug and/or biotech companies working on technologies and therapeutic candidates in an effort to provide incentives to more risk-averse drug and biotech companies to help commercialize products that would help facilitate JDRF's cure-related goals.

As a result of the trends noted above, a more mass-market approach to treatment seems to be taking place now. The basic idea is that these treatments will be delivered to a larger audience, but in order to do this, the costs must come down significantly. As a result, some are testing meds that were tried and approved for one condition to test their applicability in others. More recently, drug companies have engaged in trials to try and expand the market on certain existing drugs (for example, Gleevec, a drug that treats leukemia and other cancers) is reportedly being tested to treat the autoimmune response that causes type 1 diabetes in recently-diagnosed patients, and more recently, trials were announced to examine the use of several Rheumatoid Arthritis drugs such as Embrel, Remicaid, and Humira to see if they might also work in type 1 diabetes, not to mention other autoimmune diseases. It is very tempting to believe that one drug might treat another autoimmune disease, but as researchers have learned the hard way in the case of Lupus, that some drugs actually made the disease worse, not better. But the basic idea is that by ramping up production by leaving production up to drug and biotechnology companies, the cost can be brought down enough to make these drugs cheaper while also enriching biotech and drug companies by making their drugs applicable towards other types of autoimmune diseases. I could talk about each of these, but the reality is that right now, they're all in various stages of clinical trials. None is ready to address type 1 diabetes autoimmunity, but these could emerge in the coming years.

Autoimmunity "Cures" are Closer, But Not Likely Around the Corner

One of Josh Levy's postings summarizes some possible autoimmunity treatments in late-stage clinical trials. However, he includes some which aren't being tested with JDRF's help. To give you some idea of just how far along these are, consider that the following 4 programs are all now in Phase III Human Clinical Trials (note that there are a number of others in Phase I or Phase II Human Clinical Trials which I haven't even addressed here):

* Diamyd's GAD65 (several different studies; note: Josh considers this which is being trialed as a vaccine to be an autoimmunity treatment, I am not convinced yet, but let's see where it goes!)
* TolerRx/GlaxoSmithKline's CD3 (several different studies)
* MacroGenics/Eli Lilly's CD3 (several different studies)
* Teva/Andromeda Biotech's DiaPep227

He states "Now, make no mistake, these trials do not (emphasis mine) mean a cure is right around the corner." I'll borrow Josh's comment because he said it as well as I could:

"It is important to remember, however, that although there are four treatments in Phase-III trials, we are not close to a cure or established type 1 diabetes. All of the clinical trials in Phase-III and Phase-II are targeted at honeymoon type 1 diabetes; none at established cases. Even with that restriction. None of the treatments in Phase-III trials resulted in cures during their Phase-II trials. They all extended or increased the honeymoon phase in some way."

However, while his caveats are important to keep in mind, they DO demonstrate the type of quantifiable progress that has been lacking for a very long time on the autoimmunity front, and do suggest that quantifiable progress is being made (the same could NOT be said as recently as a decade ago).

A case-in-point: MacroGenics/Eli Lilly's teplizumab treatment is not without adverse events, no matter how glowing some reports may be. For example, a friend of mine who attended the Children With Diabetes Friends For Life Conference in Orlando this year said "Dr. Harlan from NIH wisely pointed out at CWD FFL that the anti-cd3 drugs can cause recurrent mononucleosis which can increase one's propensity to develop lymphoma. Why would someone put their child at risk for that simply for a year and a half of extended honeymoon?"

As I responded, "The issue is that they first seek approval on newly-diagnosed patients for anti CD-3 treatments, and then, will ultimately extend it to others, possibly long-standing T1DM patients if past drug approval history is any guide. This remains an area of discovery, and I suspect, we'll find that some treatments work for certain patients, while others will not. Of course, no one seems to question using Lantus (insulin glargine rDNA origin), a completely man-made creation for an entire lifetime which also has proven mitogenic effects, which I also find questionable for a relatively small improvement in HbA1c ... that logic also escapes me, but I am one of the few who seems to question this." At least there has finally been some attention paid to this, although most Lantus supporters cannot seem to be convinced otherwise, and most seem to make excuses for the technology rather than acknowledging the legitimacy of the question. That's a separate conversation, however.

Ultimately, what is likely to come out of the different autoimmunity-related trials is more refinement and perhaps better definitions on just which patients each treatment is likely to work, and perhaps improvements to these, with more similar types of treatments to follow. Also, hopefully, the adverse events from the early autoimmunity treatments can hopefully be reduced and/or eliminated.

I will follow-up on this Progress Report with a Part 2 in the coming months which will address another part of the cure equation (perhaps regeneration or replacement of insulin-producing beta cells), so be sure to check back!

Fallout from New Healthcare Plans ... Yet Again?!

Last year, I lamented (see here and here) about a new healthcare provider, and many people commented. As I may have mentioned, on June 1, 2009, my employer switched healthcare plans and providers for the third time in the past 3 years. That's why I laugh at President Obama's speeches where he says if you like your doctor, you won't have to change with healthcare reform. He can't make such claims, because it's not necessarily true. Anyway, I can't really blame my employer's decision to switch again this year, as the company has done it's best to contend with healthcare costs which have consistently risen much faster than the rate of inflation. To add to this, as a relatively small employer (fewer than 50 employees), those costs have jumped significantly faster than they have for larger corporations, who can negotiate better deals because their business is big enough to be missed. This year, my employer decided upon a high-deductible ($2,500.00 for both medical and pharmacy benefits, with certain exemptions which I'll address in a minute, but I hadn't realized there were two separate deductibles that had to be met) plan that has out-of-network healthcare coverage, so at least I didn't have to find a new endo or any other doctors, as I did when I was switched to Empire Blue Cross/Blue Shield, part of the Anthem family which is owned by the for-profit corporation Wellpoint, Inc. The new plan is from Emblem Health, which is the product of a merger between two New York-based insurers: Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP).

While high-deductible plans sound pretty bad, the fact that my employer is picking up the cost of anything over my individual deductible amount of $500.00 means they are paying the 500.01 to $2,500.00 (they are picking up a deductible portion for family coverage as well, but that's not relevant for me, so I don't recall the amount) not covered by my insurer, so it's not as bad as having to meet all of that out-of-pocket. But anything applied towards the medical deductible (or the pharmacy deductible) is not based on the billed amount (or the retail Rx price in a pharmacy) amount, but my new healthcare plan's "usual and customary" plan allowance amounts, which are often much less than the provider's billed (or, as I'll explain in a minute, the retail price of some drugs).

My employer's decision was based on simple mathematics, as the decision to cover the deductible amounts over my $500.00 medical and pharmaceutical deductibles is still far cheaper than it was to renew with the old provider (Empire/Anthem/Wellpoint). However, the administative component of this decision has been cumbersome to say the least. Since June, I've been required to submit claims to my insurance company, as well as to a Health Reimbursement Arrangement (HRA) administrator, who fortunately also handles my Flexible Spending Account (FSA) administration, but sometimes my insurer is slow to process the claims and send out an Explanation of Benefits (EOB), which I then need to send to my HRA and FSA administrator to get my money back and receive the benefits of my employer's assuming some of the costs. Fortunately, I can scan the various documents and send them to the administrator via e-mail, so there aren't extensive delays on that end of things. My insurer does send out an EOB automatically for all medical claims, but does NOT do so automatically for pharmacy claims, so I am forced to request pharmacy EOBs in order to submit them. Now, I can barely keep track of all these acronyms, let alone the claims, so it's kind of an administrative hassle, and yet we wonder why the U.S. "system" is so inefficient?

Fortunately, refills of my prescriptions were transferred from my old insurer's in-house pharmacy benefits manager ("PBM", yet another acronym!), WellPoint NextRx (which was sold in March to Express Scripts) and transferred automatically to my new insurer's PBM, so I was able to order refills without much difficulty or interruption. Fortunately, I ordered a last round of supplies with my old insurer Empire before my coverage with them was terminated, so I was stocked up with a 90-day supply of insulin, needles, testing supplies as well as an ACE inhibitor prescribed to preserve my kidneys, and a statin which my lab results suggest really isn't necessary, but I've been compliant nevertheless as long as I don't have to endure any annoying side-effects like muscle-aches, which I did experience with Zocor (simvastatin). I used Lipitor (know generically as atorvastatin calcium) which was on Empire's most costly drug tier, but had no side effects. My former insurer from 3 years ago also encouraged me to order a strength that was twice of what is required, then simply split the tablets in half (apparently the cost of a 20 mg tablet sells for the same as a 40 mg tablet) which cut my co-payments in half as well. But that isn't even on the formulary for my new plan, so I wanted to find something else, which fortunately are growing (by 2013, Lipitor itself will go generic).

But with my new healthcare plan, I discovered that (fortunately) insulin, syringes and the like are not subject to my new plan's pharmacy deductible, and are priced at a very low co-payment amounts, even though there are no generic insulins sold. I'm not sure why this is the case, but it may be a New York State law that mandates it. If we were allowed to shop for healthplans across state lines, that protection might disappear, as employers could theoretically "shop around" for states that have few insurer mandates. I learned about the separate pharmacy deductible since I'd assumed the new plan would work in a similar manner to my old one, and sent all my prescriptions (including testing supplies) to Medco Health Solutions, the PBM for Emblem Health (my new insurer). I quickly discovered that first, Medco cannot even fulfill orders for diabetes testing supplies for Emblem Health, so I asked my endo for a new script (I suppose I could have asked Medco to return it to me or transfer it to a yet-to-be-identified supplier), and then I made a few calls to my new insurer. I discovered that Emblem Health had an arrangement with CCS Medical, which is a Clearwater, FL based direct-to-consumer provider of medical supplies, with particular focus on diabetes supplies -- CCS is now operating under bankruptcy protection, but it's reorganization plans are focused almost exclusively on direct-to-consumer diabetes supplies and services, as well as ostomy supplies for those who require them. (The company also handles insulin pumps and other related supplies, such as IV prep and the like). CCS handled my testing supplies, and charges no co-payment and covers 100% of the cost, although the company does not carry Agamatrix Wavesense meters, which I would prefer if given a choice, so it's back to the One Touch products. However, Medco still handles drugs for Emblem Health, and I was rudely alerted to the fact that the "usual and customary" price for the ACE inhibitor (used to protect the kidney function in many patients with diabetes) lisinopril or statins are NOT exempt from the deductible as diabetes medicines and syringes/pen needles are.

Aside from the extraordinary markup on generics, I also discovered the brutal world of economics at work here. For example, in addition to the ACE inhibitor, my endo prescribes a statin, but the one I was using was not even on the formulary of my new plan (Lipitor was in the most expensive drug tier of my old plan, but it was still covered), but I averted what would have been a bill for $294 by cancelling the order as soon as I saw it on Medco's website and learned that certain prescriptions aren't covered until the deductible is met. I avoided a bill for almost $300.00 and quickly asked my endo about a generic alternative OTHER than Zocor (simvastatin). He suggested pravastatin (brand-name Pravachol), and I ordered it via the mail-order (virtually all scripts with this new plan must be filled via mail-order, as there is a $500.00 annual cap on scripts filled in retail pharmacies like Walgreens or CVS) and I submitted that via mail-order. When I got Medco's invoice, I also learned just how profitable generics really are for PBMs like Medco. $119.00 for a 90-day supply of a generic statin, and pretty much the same for a generic ACE inhibitor, and that's at Emblem Health's negotiated price. But after doing the math, I've decided that regardless of how close (or far away) I am to the pharmacy deductible amount, it simply isn't worth ordering a generic from Medco again -- even if it does apply towards the pharmacy deductible. Even if I never reach the pharmacy deductible amount, I'd still save quite a bit of money by filling those prescriptions elsewhere.

For example, generics are available at Target, Wal-Mart and even many supermarkets for $4.00 each, so even if I have to pay that out-of-pocket each month (or once per quarter), that's still less than half as costly ($48.00) as my recent 90-day fill of just one generic prescription with Medco.

Fortunately, I am able to absorb the prices using pre-tax dollars with my FSA, but since my employer's HRA only applies to medical benefits (not pharmacy benefits), the wise choice is to fill all of my prescriptions for generic drugs at one of these places. In fact, Wal-Mart's mail-order pharmacy sells a 90-day supply of lisinopril and pravastatin for $10.00 each, which amounts to $80.00/year for a year's supply of both, which even less than the $96.00 it would cost at retail pharmacies. Even though Wal-Mart doesn't have a single retail store anywhere in New York City, I can order these via the Wal-Mart's mail-order pharmacy as easily as I can order from Medco, and let's face it, I would have to use a LOT of costly prescription drugs other than insulin, syringes and testing supplies to meet the $2,500.00 deductible amount, so next time, I'm ordering from Wal-Mart's mail-order pharmacy, and Medco will have to find some other sucker to pay those outrageous prices. That's one reason, I believe, Adam J. Fein, Ph.D., who is founder and president of Pembroke Consulting, Inc., a Philadelphia-based management advisory and business research firm (he also has an informative blog at http://www.drugchannels.net/) and he forecasts that Wal-Mart is expected to grow even more in the coming years, largely at the expense of smaller chains. Right now, Wal-Mart is not even among the top 3 (those are CVS, Walgreens and Rite Aid), He writes that "Wal-Mart has made price matter by starting a generic prescription price war. Wal-Mart is willing to accept lower-than-normal profits on generic scripts in exchange for market share." He also notes that "Walgreens is moving in this direction, too." I live a block from Walgreen's, but I prefer mail-order, as it's easier.

I wish this kind of story wasn't so commonplace, but the simple reality is that my story is hardly unique. I don't know what the future will bring, but for the foreseeable future (at least until June 2010), I will order from a host of different suppliers: insulin and needles from Medco, generic drugs from Wal-Mart's mail-order pharmacy, and diabetes testing supplies from CCS Medical. I will submit these claims to my insurer, my HRA (at least my pharmacy orders), and my FSA, and and I'll have to see what, if anything, happens with plans on healthcare reform. I'm not holding my breath that we'll see any meaningful reform to address runaway costs, because right now, the only thing Congress seemst to care about is universal coverage, not runaway cost containment.

The End of My Reverse Commute May Be In Sight!

So, thinking about my bud George Simmons' "No D-Day" event and what to address in my posting today, and I'm using this opportunity to talk about myself (for a change), and more specifically, my company's planned relocation from the suburbs to the big city, New York City (more specifically, the borough of Manhattan, also known as New York County). I mentioned this in another post from 9/28/2009, but that was only in passing, so you may have missed it.

As more and more businesses have moved out of big cities nationwide into suburban locations, one might assume that a reverse commute would be infinitely easier because theoretically, you're moving against traffic, but the reality isn't quite so rosy. A number of studies over the years have back found that an overwhelming majority of corporate relocations into suburban office parks were typically made within a few short miles of the town that the Chairman/CEOs called their primary residences. Indeed, some suburban locations such as Stamford, Connecticut, are just next door to such infamous towns as Greenwich, CT, which is CEO-Central by most measurements. Earlier this year, The Wall Street Journal reported that Stamford was calling itself (at least locally) "Wall Street North" and has now been forced to try and reinvent itself, mainly to contend with the many problems the financial services industry now faces. Interestingly, that city has successfully landed the filming of several TV shows, among them such trashy daytime shows as "The Jerry Springer Show" and "Maury".

Anyway, the challenge for reverse commuters is first, most transit systems were designed to move large numbers of people into the central cities in the morning and out of the central cities in the evening. The number of commuter trains, buses, subways etc. going in the the opposite direction during those hours are relatively few. Mass transit is simply not coordinated to make reverse commuting in the opposite direction terribly easy. Try taking Boston's "T" commuter trains from Boston into say, Newton, MA in the morning or getting a commuter train FROM the main line into Philly from suburban towns like Haverford, PA at night. It can be done, but the number of trains going in that direction are stacked roughly 8:1 to move commuters INTO the central city in the morning (not so much out) and in the opposite direction in the evening. Traffic patterns validate this, of course, but its a bit like saying that there are no riders because there is no demand, instead of asking if demand might be there if it was more practical to take the train in that direction?

Anyway, one of the downsides of reverse commuting is that it's a big hassle because I HAVE to drive, and my social life outside of work (at least during the week) is pretty limited as a result. One of the supposed benefits of big-city living is supposed to be utilization of frequent, low-cost mass transit, whereby one can read the newspaper or listen to their iPod on the way into work. In the evening, there are plenty of social options that I have foregone to work in the 'burbs, whether it's art exhibits, numerous shows or events, or simply grabbing a beer with friends (who all work in town) after work. In good weather it's great, but in lousy winter weather, its even better because using mass transit means not having to drive on icy freeways or to clear the snow that's accumulated on my car after the snow falls all day on it. Oh, yeah, and its supposedly more "green", too. But since I reverse commute, I'm stuck driving, which I hate. But that's about to end, soon, and I'm pretty psyched about it!!

The lease for my company's Class A office space expires officially in November. Thanks to a weak commercial real-estate market, it happens to be an opportune time to be looking for office space in Manhattan, so this has oppened an opportunity that was once assumed to be out-of-reach for many smaller businesses, including the firm where I work. The only issue now: WHERE in the city will we be? The landlords are seemingly willing to negotiate on most anything that would have been unthinkable just a few years ago, so they haven't signed anything quite yet.

So, with this move, I think my social life will likely improve, my commuting cost will likely decline and most importantly, my commuting aggravation level will plummet. Right now, the only uncertainty is timing (and of course, the final destination, will that be mid-town, downtown -- all TBD right now) of the move. Because the real estate market is weak, the company can also extend the time in our current location on a month-to-month basis so we are likely to remain in suburbia until the end of the year. But the sooner this moves happens, the better!

So I'm really looking forward to having a new office in Manhattan, and not having to drive (or should I say crawl) on the Long Island Expressway (surely that's a misnomer) twice a day. Anyone care to join me after work for a beer when it happens?!

Let me just close by sharing this YouTube clip of Jennifer Saunders (best known for her role as Edina Monsoon on the BBC comedy Absolutely Fabulous, not to mention as the voice of the Fairy Godmother in the animated hit movie Shrek 2). In this video, she parodies Madonna's performance of her video & song "Hung Up":