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User:Maximilian Janisch/latexlist/Algebraic Groups/Moduli theory
From Encyclopedia of Mathematics
< User:Maximilian Janisch | latexlist | Algebraic Groups
This page is a copy of the article Moduli theory in order to test automatic LaTeXification. This article is not my work.
A theory studying continuous families of objects in algebraic geometry.
Let $4$ be a class of objects in algebraic geometry (varieties, schemes, vector bundles, etc.) on which an equivalence relation $R$ has been given. The fundamental classification problem (the description of the set of classes $A \nmid R$) has the following two parts: 1) the description of discrete invariants, which usually allow a partition of $A \nmid R$ into a countable number of subsets, the objects of which already continuously depend on parameters; 2) the assignment and study of algebro-geometric structures on the parameter sets. The second part forms the matter of moduli theory.
Moduli theory arose in the study of elliptic functions: There is a continuous family of different fields of elliptic functions (or of their models — isomorphic elliptic curves over $m$), parametrized by the complex numbers. B. Riemann, who introduced the term "moduli" , showed that an algebraic function field over $m$ (or their models, compact Riemann surfaces) of genus $g \geq 2$ depends on $3 g - 3$ continuous complex parameters — the moduli.
1 Basic concepts in moduli theory.
2 Local and global theory.
Basic concepts in moduli theory.
Let $5$ be a scheme (a complex or algebraic space). A family of objects parametrized by the scheme $5$ (or, as is often said, "scheme over Sover S" or "scheme with basis Swith basis S" ) is a set of objects
\begin{equation} \{ X _ { S } : s \in S , X _ { S } \in A \} \end{equation}
equipped with an additional structure compatible with the structure of the base $5$. This structure, in each concrete case, is given explicitly. A functor of families is a contravariant functor $M$ from the category of the schemes (or spaces) into the category of sets defined as follows: $M ( S )$ is the set of classes of isomorphic families over $5$. To every morphism $f : T \rightarrow S$ is associated a mapping $f ^ { * } : M ( S ) \rightarrow M ( T )$ which assigns to a family over $5$ the pullback, or induced, family over $T$.
Let $N$ be an object in the category of schemes (complex or algebraic spaces) and let $h _ { 1 }$ be a functor of the points in this category, that is, $h _ { M } = \operatorname { Hom } ( S , M )$. If the functor of families $M$ is representable, that is, $M = h$ for some $N$, then there exists a universal family with base $M$, and $N$ is called a fine moduli scheme (respectively, fine complex moduli space or fine algebraic moduli space). The functor $M$ is representable in very few cases. Therefore the notion of a coarse moduli scheme was introduced. $N$ is called a coarse moduli scheme if there is a morphism of functors $\phi : M \rightarrow h _ { M }$ with the properties: a) if $S = \operatorname { Spec } K = pt$ is one point (where $K$ is an algebraically closed field), then the mapping $\phi : M ( pt ) \rightarrow h _ { M } ( pt )$ is bijective; in other words, the set of geometric points of the scheme $N$ is in a natural one-to-one correspondence with the set of equivalence classes of parametrized objects; and b) for each scheme $M$ and morphism of functors $\psi : M \rightarrow h _ { N }$ there is a unique morphism $\chi : h _ { M } \rightarrow h _ { N }$ such that $\psi = \chi \circ \phi$. Coarse schemes of complex and algebraic moduli spaces are similarly defined.
Although a coarse moduli scheme uniquely parametrizes the class of objects defined by given discrete invariants, the natural family over it (in contrast to the family over a fine moduli scheme) does not have the strong universality property. A coarse moduli scheme (space) already exists in a fairly large number of cases.
Examples. 1) Moduli of algebraic curves. Let $A / R = \mathfrak { M } _ { g }$ (respectively $\overline { \mathfrak { M } } _ { g }$) be the set of classes of isomorphic projective non-singular curves (respectively, stable curves) of genus $g \geq 2$ over an algebraically closed field $K$. A family over $5$ is a smooth (flat) proper morphism of schemes $f : X \rightarrow S$ whose fibres are smooth (stable) curves of genus . Then there is a coarse (but not a fine) moduli scheme $M g$ (respectively $\overline { M } _ { g }$), which is a quasi-projective (projective), irreducible, normal variety over $K$ (see [3], [5], [6]).
2) Moduli of algebraic curves with level $12$ structure (with Jacobian rigidity). Let $f : X \rightarrow S$ be a smooth family of projective curves (respectively, a flat family of stable curves) of genus $g \geq 1$, let $12$ be an integer invertible on $5$, and let $R ^ { 1 } f \times ( Z / n Z )$ be the first direct image of the constant sheaf $Z / n Z$ in the étale topology. Then $R ^ { 1 } f \times ( Z / n Z )$ is locally free, has rank $2 g$ and is equipped with a locally non-degenerate symplectic form with values in $Z / n Z$, up to an invertible element in $Z / n Z$. A Jacobian structure of level $12$ on $x$ is an assignment of a symplectic isomorphism
\begin{equation} R ^ { 1 } f \times ( Z / n Z ) \cong ( Z / n Z ) ^ { 2 g } \end{equation}
Let $M _ { g , N }$ (respectively, $\overline { M } _ { g , N }$) be the functor of families of smooth (stable) curves of genus $g \geq 2$ with a Jacobian rigidity of level $12$. Then for $n \geq 3$ the functor $M _ { g , N }$ (respectively, $\overline { M } _ { g , N }$) is represented by a quasi-projective (projective) scheme $M _ { g , x }$ (respectively, $\overline { M } _ { g , X }$) over $\operatorname { pec } Z [ 1 / n , \xi _ { n } ]$, where $\xi$ is the inverse image of an $12$-th root of unity, that is, there is a fine moduli scheme $M _ { g , x }$ (respectively, $\overline { M } _ { g , X }$) for the smooth (stable) curves of genus $g \geq 2$ over a field of characteristic coprime with $12$, equipped with a Jacobian rigidity of level $12$. For sufficiently large $12$ the scheme $M _ { g , x }$ is smooth [5].
3) Polarized algebraic varieties. A polarized family is a pair $( X / S , \mathfrak { P } / S )$, where $X / S$ is a smooth family of varieties, i.e. a smooth proper morphism $f : X \rightarrow S$, and $\mathfrak { P } / S$ is the class of the relatively ample invertible sheaf $L X i S$ in $( S , \operatorname { Pic } X / S )$ modulo $( S , \operatorname { Pic } ^ { 0 } X / S )$, where $\operatorname { Pic } X / S$ is the relative Picard scheme and $\operatorname { Pic } ^ { 0 } X / S$ is the connected component of its zero section. In this case a functor of the polarized families $M _ { k }$, with a given Hilbert polynomial $h$, is constructed. Without additional restrictions this functor is not representable. The existence of a coarse moduli space is known (1989) only in individual cases.
For polarized algebraic varieties the idea of rigidity of level $12$ also exists.
4) Vector bundles. There are also results on moduli spaces for vector bundles of rank $12$ over an algebraic variety $x$. In this case a family over $5$ is a vector bundle over $X \times S$. Cf. [7], [10]–[14] for a description of results and more detail.
Local and global theory.
The local theory arose as the theory of deformations of complex structures (see Deformation 1) and 2)). The fundamental methods of the global theory are those of the theory of representable functors and geometric invariant theory, the theory of algebraic stacks, and the algebraization of formal moduli.
The method of construction of a global moduli space goes back to the classical theory of invariants (cf. Invariants, theory of). It is as follows. A sufficiently large family $X \rightarrow H$ is constructed which contains representatives of all equivalence classes of the objects in questions, and so that the equivalence relation on $H$ reduces to the action of an algebraic group $k$. Then the theory of actions of algebraic groups on algebraic varieties (schemes, spaces) is exploited with the aim of clarifying conditions for the existence of the quotient $H / G$ in the corresponding category. The basic tool in the construction of the family $X \rightarrow H$ is the theory of Hilbert schemes (cf. Hilbert scheme). In such an approach the difficulty in constructing the family $X \rightarrow H$ is reduced to the problem on a simultaneous immersion of the objects in question into a projective space. An important result on the possibility of such a simultaneous immersion is Matsusaka's theorem. Then the difficult problem remains of the existence of the quotient $H / G$. Here one has the notions of categorical and geometric quotients. The construction of a coarse moduli space reduces to the problem of the existence of geometric quotients; here the idea of stability of points, corresponding to the idea of orbits in general position, is used. Results concerning actions of reductive groups on algebraic varieties over fields of characteristic $0$ have been extended to the case of fields of characteristic $p > 0$.
Another approach to global moduli theory is the method of algebraic stacks, that is, a method of globalization of local deformation theory. The first step in the investigation of the representability of a global functor of families in this approach is the establishment of the algebraizability of a formal versal deformation for each object $X _ { 0 }$. The difficulty in the construction of a global moduli space is that not every factorization of the base of the family with respect to an equivalence relation is a separated space. In such cases the object representing the functor $M$ is replaced by an algebraic stack, the study of the properties of which gives some information on the moduli space.
One of the approaches to global moduli theory over $m$ is the theory of period mappings (cf. Period mapping). The fundamental object here is the classifying space $\Omega$ of polarized Hodge structures (cf. Hodge structure) of weight $k$ for given Hodge numbers. For a family $X \rightarrow S$ of polarized algebraic varieties over $m$ the periods define a mapping of $5$ onto the corresponding classifying space $\Omega$ of Hodge structures. The moduli problem reduces to the study of conditions for the period mapping to be bijective. The presence of (global) injectivity for the period mapping is the so-called local-global Torelli problem. Along this route the existence of coarse moduli spaces has been proved for curves, Abelian varieties and $K 3$-surfaces.
The compactification problem for a moduli variety $N$ is that of finding a natural and complete (projective or compact, in the theory over the field $m$) variety $M$ containing $N$ as a dense open subset, and also the description and geometric interpretation of the boundary $\overline { M } \backslash M$. In example 1) the natural compactification of the coarse moduli variety $M g$ of curves of genus $g \geq 2$ is the projective moduli variety $\overline { M } _ { g }$ of stable curves. For polarized Abelian varieties over $m$ several means for compactifying moduli varieties are known.
[1] M. Artin, "Algebraization of formal moduli 1" , Global analysis , Univ. Tokyo Press (1969) pp. 21–71 MR260746
[2] M. Artin, "Versal deformations and algebraic stacks" Invent. Math. , 27 (1974) pp. 165–189 MR0399094 Zbl 0317.14001
[3] P. Deligne, D. Mumford, "The irreducibility of the space of curves of given genus" Publ. Math. IHES , 36 (1969) pp. 75–109 MR0262240 Zbl 0181.48803
[4] J. Dieudonné, J.B. Carrell, "Invariant theory, old and new" , Acad. Press (1971) MR0279102 Zbl 0258.14011
[5] D. Mumford, "Geometric invariant theory" , Springer (1965) MR0214602 Zbl 0147.39304
[6] D. Mumford, "Stability of projective varieties" l'Enseign. Math. (2) , 23 : 1–2 (1977) pp. 39–110 MR0450273 MR0450272 Zbl 0497.14004 Zbl 0376.14007 Zbl 0363.14003
[7] D. Gieseker, "Global moduli for varieties of general type" Invent. Math. , 43 (1977) pp. 233–282
[8] D. Gieseker, "On the moduli of vector bundles on an algebraic surface" Ann. of Math. , 106 (1977) pp. 45–60 MR0466475 Zbl 0381.14003
[9] T. Matsusaka, "Polarized varieties with a given Hilbert polynomial" Amer. J. Math. , 94 : 4 (1972) pp. 1027–1077 MR0337960 Zbl 0256.14004
[10] P.E. Newstead, "Lectures on introduction to moduli problems and orbit spaces" , Springer (1978) MR546290 Zbl 0411.14003
[11] C. Okonek, M. Schneider, H. Spindler, "Vector bundles on complex projective spaces" , Birkhäuser (1980) MR0561910 Zbl 0438.32016
[12] H. Popp, "Moduli theory and classification theory of algebraic varieties" , Springer (1977) MR0466143 Zbl 0359.14005
[13] C.S. Seshadri, "Spaces of unitary vector bundles on a compact Riemann surface" Ann. of Math. , 85 (1967) pp. 302–336 MR0233371
[14] A.N. Tyurin, "The geometry of moduli of vector bundles" Russian Math. Surveys , 29 : 6 (1974) pp. 57–88 Uspekhi Mat. Nauk , 29 : 6 (1974) pp. 59–88 Zbl 0325.14016
Much progress has been made recently in the study of the moduli spaces of algebraic curves and Abelian varieties; see the appendices of [a2]. Among the most important ones are the question of the compactification of $M g$ (see the appendix to Chapt. 5 in [a1], which is an enlarged edition of [5]) and the proof that $M g$ is of general type for $g \geq 24$ [a2].
G. Faltings has constructed a compactification of the moduli space $A _ { 8 }$ of principally-polarized Abelian varieties over $2$, see [a3].
[a1] D. Mumford, J. Fogarty, "Geometric invariant theory" , Springer (1982) MR0719371 Zbl 0504.14008
[a2] J. Harris, "Curves and their moduli" S.J. Bloch (ed.) , Algebraic geometry , Proc. Symp. Pure Math. , 46.1 , Amer. Math. Soc. (1985) pp. 99–143 MR0927953 Zbl 0646.14019
[a3] G. Faltings, "Arithmetische Kompaktifizierung des Modulraums der abelschen Varietäten" F. Hirzebruch (ed.) J. Schwermer (ed.) S. Suter (ed.) , Arbeitstagung Bonn 1984 , Lect. notes in math. , 1111 , Springer (1985) pp. 321–383 MR0797429 Zbl 0597.14036
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Morgan is the second of her family to come to us for Senior Portraits. She wanted to be one of our senior models, too, and did a great job showing her classmates how easy it was to have fun in senior portraits.
The great thing about such a happy person is that it's easier to photograph them. Calm moments that erupt into spontaneous laughter means lots more fun, great creativity and a session that is bound to have plenty of excellent opportunities for great photos.
One thing we strive to do is to always create new images and location opportunities for our clients. Morgan was definitely no different, and we had more than our fair share of photo ops with her during the summer. Morgan's future plans probably include genius level work, because she's not just happy, but also quite a good student. Keep up the great work!
Want a senior portrait experience like no other? Check out our Senior Information Site!
It's no secret that the majority of our seniors are girls. Typically, guys are not that into photographs of themselves. And many of them are totally not into spending an hour or two in or at our studio. Brian was no exception to that generality.
But I do try to make it interesting for everyone. I call it "senior patter" when I'm talking with people about their lives and what's going on, their hopes and dreams. So, when I started talking with Brian, who would probably have been happier anywhere else besides where his mom had just taken him, it was only a few minutes later that we were working toward a single goal. Mom wanted pictures of her "baby," and I wanted her to have them. Engaging Brian in chatting about his dreams lead to a far less painful session than he'd imagined, and mom got some great pictures.
I use my own experiences over the years to make each person's session with us just unique enough to make it enjoyable, and often times creating a new look just for them. Overall, Brian was a happy guy. We were done soon enough, and I ended up having a reasonably good conversation with a very goal-oriented young man.
I love meeting people who know what they want. Cecelia brought a lot of outfits, her dog and a great attitude. It was a lot of fun creating new images that fit her personality.
Diana wanted to steal the dog, which was tiny (but feisty – at least at first). She carried him in a purse… one that was specifically made just for dogs his size. It was adorable.
Please, always feel free to bring your animals, your car, and your favorite outfits. We want to give you pictures that identify YOU.
You ever get the feeling that you've met someone, like in a previous life? This guy was very much like that. I felt like I knew him. But he didn't remember me, so I suppose it didn't happen. In any case, we enjoyed conversation and photos. Very smart young man, with a deep voice that commanded attention.
Expect to see more from him in the future. We had a great portrait session.
Ezra came to us from one of our senior models, Haylee.
A musician at heart, we spent some time exploring his music talents and discovering that he really looks pretty good with a guitar! And it doesn't hurt that his eyes just really light up like that. A fun session where mom helped encourage Ezra to show his true colors.
One thing we've always tried to do with senior portraits is to focus a lot on the passion of the senior's interests. Whether it's their sense of fashion, their vehicle, or their music and other activities, if it is important to them, it's important to us.
Imagine my surprise when this young man showed up with a car… that he was trying to sell. Soon. It was a comical moment to learn that Nathan was looking to get rid of his car, but he wanted it in some of his pictures. It had meant a lot to him. It may still.
But he also had a guitar and an effervescent personality. I enjoyed talking with him just as much as I did capturing his images. We kind of bonded over the car, though. Not that I wanted his car, but he wanted a great picture with it, and we delivered. His "stage shot" with the guitar was a big hit, too.
Yeah… she doesn't talk much. When she does, you definitely want to hear what she has to say. But it wasn't extensive conversation that drove this wonderful session with Jessica. She was easy to photograph because she has a great look, an excellent sense of fashion, and listened to the instructions during her session.
I sometimes think that we get great clients like this because they know what they want… specifically, they either know what they want their pictures to look like, or they trust us to create something unique and interesting for them. This was a case where both things applied.
Jessica was referred to us by one of our senior models. If you're interested in being part of our senior models program, please contact us.
Jennifer & Mike's Engagement Session: True Love?
The purpose of an engagement session for us is to show off their love without the formality of the wedding. It also gives us an opportunity to get to know the couple in a more casual environment. This usually pays off on the wedding day, because we have a more open rapport and a relaxed bring & groom.
So, when Jennifer and Mike came to us for their engagement portraits, a couple we already had some exposure to before, it was just like taking pictures of friends. There was also the requests for them to have a couple of individual portraits, as well. They're a good-looking couple and we wish them the best of luck in their future.
I suppose it is often enough that we meet interesting people. It's even better when they are also smart and opinionated. Probably pictures was not first and foremost on his mind, but he happily indulged his mom, who had some specific things in mind when they booked their session. Blaise is a techo-hip kind of guy. That intrigued me.


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In praise of the infinite game
Published by Steve Litchfield at 9:55 UTC, April 16th 2012
There's a certain class of mobile game that's often ignored. One that gets overlooked in favour of all-singing, all-dancing 3D-rendered RPG slash-em-ups and orgies of feathered destruction. It's not - quite - casual games. It's not - quite - sports games. It's not - quite - board games. Though many of those titles qualify. I'm talking about infinite games. By which I mean mobile games that you can happily play every day - forever - literally.
So, what do I mean by the 'infinite game'?
The majority of games these days are based on 'levels', the idea being that you work through each puzzle or scenario, feeding aliens or freeing birds or killing zombies, and so on. The levels start easy, usually with tutorial prompts, then gradually get harder and harder, providing more and more of a challenge, either in brain power or reaction time, until.... the game's over. You're exhausted, you've collapsed in a heap, but - you've beaten it.
If you're lucky, there's another 'mode' to play in, as another character, under a harder difficulty level, or with slightly different gameplay. And then... you've beaten that too. If you're very, very lucky, there might even be an online multiplayer mode, adding an extra human element, which can often prove a real inspiration.
But all too many game titles end up being 'done'. Game over. All challenges met, if you play the title again then you'll just be repeating what you had to do last time. In fact, you might as well delete the game from your phone. 'Finite', by definition.
But here's to the genuinely 'infinite' title, a game which provides a framework for your enjoyment while also supplying enough randomisation that you'll never, ever see the same screen twice, you'll never make the same move twice. Now, this randomisation can take varying forms - at its purest, it might be a random starting grid that you have to solve in some way. At its most exciting, it can be one or more phone-controlled opponents (so called AI - Artificial Intelligence) which interact with you and which you have to outwit - in a finite, level-based environment, AI can often be somewhat stupid and predictable, but in a true infinite title, the AI has never seen the game state like this either and so its responses also have an air of unpredictability.
The classic infinite game, thousands of years old, is chess, of course. Starting with familiar moves, the sheer number of pieces means that within half a dozen moves you'll be looking at a piece configuration that's unfamiliar - and within a dozen moves (assuming a decent AI opponent) you'll be way, way out of your comfort zone. But if chess sounds rather hard going, there are lighter and more colourful alternatives - Backgammon, shown below in Zingmagic form for Symbian, adding in the huge randomising factors of dice rolls, AI-responses to those rolls and a chess-like possible number of move variations.
Board games are particularly appropriate as infinite games - after all, their format and rules has been honed, in physical form, for centuries, designed to keep players amused and challenged for entire lifetimes. But there are other game categories which offer the same challenge. Sports, for example. With either a large number of players (e.g. football), a large number of objects to interact (e.g. pool/snooker/bowls), or a particularly complex environment (e.g. golf, with wind/terrain/lie), no two games are ever quite the same.
I've often used pool as a great example of an infinite game on a phone that also works as a casual title because you don't need hours to play it each time. Micropool (below, left) on Symbian, has been keeping me company in odd moments on more than a dozen smartphones over the last 6 years - and I still get a buzz and a challenge from playing it - with pool, after only two shots you've got a totally different ball configuration to that which you've ever seen before. Similar pool games exist on other platforms, of course - on Windows Phone, I've also enjoyed International Snooker (shown first below).
Also usually applicable are card games - although there are only 52 cards in a pack, it's surprising what you can do with them. For a start, there's the massive randomising effect of a good computer 'shuffle' - add in some phone AI opponents and things can get very addictive. In addition to Micropool and International Snooker, I'm also more than a little addicted to Mau Mau, shown above right, pitting my wits and luck against up to three AI opponents.
Sports games - full stop - are usually 'infinite', almost by definition, in that you never get the same game twice. Golf games are another favourite of mine, on every mobile platform - shown below is Real Golf 2011 on Symbian.
Simulations generally, not just sports titles, are usually infinite in nature, by definition, in that they rely on your inputs all the time. Infinite Flight (shown below) is a cracking title that you can genuinely spend years playing, either in five minute quick flights or in hour long full simulations of actual journeys. And with your own trajectory, course and stick inputs being added to weather that can be almost infinitely specified (and then randomised within your parameters), every trip into the air is indeed very different.
I'm sure my selection here is by no means definitive, 'infinite' games exist in many genres, but you'll get the idea. I've complained before about people criticising a mobile application for being 'too expensive' at a couple of pounds or dollars and this becomes doubly ridiculous once a purchase price applies to an 'infinite' game. I've played Micropool for approximately 27,000 minutes in the last 4 years. Working out to 0.3p per hour - some 100 times cheaper than going to the cinema, some 300 times cheaper than playing the real thing, etc. So, you see, infinite gameplay that you'll never get tired of also means exceptional value for money.
Don't get me wrong, I'm not knocking 'finite' games - the likes of Angry Birds come to mind - there's a real sense of achievement in vanquishing each level, but they offer a different kind of challenge. What I'm suggesting here is that, when looking at game's details and trying to decide whether it's worth buying (or not), you also take into consideration whether it's going to offer a fixed, finite amount of gameplay or whether every game is different to the last.
To infinity and beyond! [Sounds catchy, I really must trademark that phrase...]
Steve Litchfield, All About Symbian and All About Windows Phone, 16 April 2012
Filed: Home > Features > In praise of the infinite game
Platforms: General, S60 3rd Edition, S60 5th Edition, Symbian^3, General
Categories: Comment, Software

redpajama_set_name: RedPajamaCommonCrawl


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VeggiePharm
Discussions on potato diets, resistant starch, gut health, prebiotics, probiotics, oil-pulling, cold thermogenesis, and other affairs of plain living...
Potato Hack Info
Off-Label Drug Use
Here's the third paper I turned in this semester. 100/100 points! Again, for BIOT640, Ethical Considerations in Biotechnology. 5000-6000 words on an assigned topic. My topic was "Off-Label Drug Use" which is fitting because I did seem to turn potato starch into the #1 abused drug in the blogosphere...
This is an interesting topic, I had no idea this sort of stuff goes on and it makes me shake my head at our system of government regulation trying to keep a handle on Big-Pharma while the patient suffers.
Read only if you are very bored, or need something to put you to sleep. Don't say I didn't warn you!
Societal Issues of Off-Label Drug Use
The Patient Protection and Affordable Care Act, or "Obamacare," has changed the policy landscape of public health as medical establishments are attempting to make health care insurance more affordable (Rosenbaum, 2013). The use of prescription drugs in "off-label" applications is an area of concern under this new act. Off-Label drug use is commonplace and legal, yet there are numerous misconceptions and inconsistencies in the regulation of off-label drug use. A thorough understanding of the issues surrounding off-label drug use is vital to ensuring patients receive the best care possible under any new legislation that may arise from Obamacare.
"Off-Label drug use" is defined as the use of drugs in ways not approved by the Food and Drug Administration (FDA). Off-Label uses should not be confused with "inappropriate" or "improper" use of drugs (Beck and Azari, 1998). Drugs have been used "off-label" since the FDA began regulating drug marketing in the 1930's. The FDA does not regulate medical practices, only the sales and advertisement of drugs based on predicted outcomes (Gupta and Nayak, 2014). Physicians often use drugs marketed for a particular condition to treat completely unrelated conditions; an example is the use of antidepressants to treat gastrointestinal distress. Physicians require specialized knowledge of drugs to prescribe off-label and insurance companies will often not pay for off-label prescriptions unless their use is specifically allowed. The combination of specialist physicians and tighter controls by insurance companies is at the heart of concerns that off-label drug use will be impeded in cases where they would save lives or when more suitable drugs are unavailable. A recent paper published by the Journal of Oncology Practice highlighted the fact that, under Obamacare, "In a state without a law requiring off-label drug coverage, a patient may not have access to a life-saving medication (Hutchins, Samuels, and Lively, 2013, p. 76)." Under Obamacare, patients may not have the flexibility to see specialists and will be encouraged to use only doctors recommended by their insurance provider. This lack of flexibility is a confounder in obtaining the best care possible, especially when seeking a specialist.
Though off-label drug use has a long and storied history, there are nuances to these uses and ethical issues abound. Physicians are often reluctant to use off-label drugs as they may be held financially liable if their insurance company does not cover the use (Gillick, 2009). Biotechnology will become an increasingly important component to off-label drug use as medical care becomes tailored to the genomic traits of the patient and biotech companies produce more of the drugs used off-label (Kesselheim, Myers, Solomon, Winkelmayer, Levin, and Avorn, 2012). The legalities of off-label prescriptions and their reimbursement require thorough examination to prevent unfair advantages in different levels of insurance coverage (Gupta and Nayak, 2014). Additionally, ethical considerations, such as the issue of "orphan drugs" for rare diseases, cancer treatment where nearly 50% of drugs used are off-label, and circumstances where off-label drugs save lives though not cost-effective must be taken into account under Obamacare rulings (Mellor, Van Koeverden, Yip, Thakerar, Kirsa, & Michael, 2012). This paper will explore the issues surrounding off-label drug use so that informed decisions can be made concerning the use of off-label drugs in this new era of healthcare legislation.
The History of Off-Label Drug Use
The FDA was given authority to ensure new medications were "safe" in 1938. In 1962, the Kefauver-Harris Amendment further gave the FDA authority to ensure new drugs are "effective." The FDA only regulates pharmaceuticals, not the practicing of medicine (Gupta and Nayak, 2014). Medical doctors must rely on their own judgment when treating illnesses that don't respond to conventional drugs, or in populations/age groups not covered in the drug manufacturer's literature. Pregnant women and children, for instance, may require a drug when there is no FDA approval for these demographics. Recommended doses are often titrated to off-label levels when the FDA approved dosage is not effective (Meadows, 2007). Additionally, off-label use of drugs is commonly used in life-threatening conditions by doctors willing to try 'hail Mary' treatments (Meadows, 2007). Doctors routinely prescribe drugs from a class of drugs, or for a family of illnesses, for reasons of economics, or availability (Gupta and Nayak, 2014). Physicians get off-label information from medical journals, peers, or their intellect and observations (Kohen, et al., 2009. The passage of the 1993 Rockefeller-Levin Bill was a key event in the history of off-label drug use. It mandated that Medicare must allow off-label drugs in the treatment of cancer if the off-label use is listed in drug compendia or showed promising use in peer-reviewed scholarly articles (Meadows, 2007).
The Role of the FDA in Off-Label Drug Use
The FDA mandates that drug companies cannot advertise off-label uses of their drugs because these drugs have not been thoroughly tested to FDA standards. Off-Label uses are often safe and effective and the drug companies are fully aware of these off-label uses, however, they are not allowed to recommend their drugs in this manner (Gupta and Nayak, 2014). Pharmaceutical companies must comply with 21 Code of Federal Regulations (CFR) 202.1 in their promotional use of television, newspapers, magazines, journals, internet, and other media. The FDA's mission is to ensure drugs are sold in a way not misleading to the public or healthcare professionals (Wittich, Burkle, and Lanier, 2012).
The FDA historically has not directly regulated information contained in drug reference handbooks, major compendia, or textbooks. An exception is made when drug companies provide financial support or other benefits (Wittich, et al., 2012). Drug companies profit greatly when their products are included in medical literature and must take strides to ensure there is no conflict of interest with published medical works to avoid punitive action by the FDA. Insurance companies often rely on medical journals to decide if off-label uses are coverable under their plans, further making off-label inclusions profitable to drug companies (Wittich, et al., 2012).
Pharmaceutical companies continually challenge the FDA to gain toe-holds inside the medical community. The FDA allows drug companies to establish "medical liaisons" to answer questions from physicians about off-label uses of their drugs. These medical liaisons must not be a part of the sales and marketing division. The advice given by medical liaisons must be backed by medical journals or other non-promotional material (Wittich, et al., 2012). Drug companies often sponsor "key opinion leaders" (KOL) who become subject matter experts, write journal articles, or speak at medical learning events (Ventola, 2009). Drug companies have also been known to organize events for medical establishments with their KOLs acting as independent speakers. The FDA allows drug companies to give grants to medical centers for Grand Rounds or continuing medical education events, but the full disclosure of any financial relationship is mandated (Ventola, 2009).
FDA Policy Concerning Electronic and Printed Materials
The internet age has made new inroads for drug companies to the consternation of FDA regulators. Company websites are strictly limited in what can be said about drugs the manufacturers sell, exactly as they are with printed media (Meadows, 2007). Blogs and other unregulated websites can freely dispense off-label drug use information as long as they are not acting on behalf of a drug company. Proving conflicts of interest in this area exceeds the funding and manpower of the FDA's current design (Meadows, 2007).
Scholarly journals encourage the publication of articles and studies relating to off-label uses of pharmaceuticals, and don't consider off-label drug use a derogatory term, in fact, quite the opposite. The medical establishment often finds itself at odds with the FDA's labelling of drugs and many lawsuits have been filed when outcomes are less-than-desirable. The inclusion of off-label uses of drugs in scholarly journals gives credibility to their use and gives doctors a research tool when choosing drugs. This presents no legal conflict as the FDA has formally agreed that (Meadows, 2007):
● The FDA has no oversight of the practice of medicine, including off-label use of drugs.
● The FDA acknowledges that off-label uses of drugs are the "standard of care" in many instances.
● The FDA acknowledges doctors are not responsible for disclosing their off-label use of drugs to patients.
Off-Label drug use has a long history of successful implementation despite lack of federal oversight. The FDA has continually maintained that off-label drug use is acceptable and often the best practice. Attempts to categorize off-label drug use in sweeping policy changes under Obamacare should be dealt with systematically. Policymakers must take into account historical uses of off-label drugs and become aware of the legal issues and precedents of off-label drug use.
Legal Issues Concerning Off-Label Drug Use
The FDA has the authority to use administrative and legal actions to protect the public from improper activities involving the sale of pharmaceutical substances. The FDA can punish anyone who violates FDA regulations, spelled out in 21CFR, and the FDA has the full backing of the Department of Justice. The FDA regularly issues warnings, confiscates property, withdraws drug licenses, and fines companies who violate drug labelling or merchandising law (Ventola, 2009).
While the FDA does not enforce the way doctors practice medicine, their sometimes strong-armed tactics against pharmaceutical companies dictate the way medicine is practiced at a functional level (Steinman, 2012). Even though a drug company may be fully aware that an off-label use of one of their products will save many lives, they are barred from disclosing this information unless specifically questioned by a medical doctor. All recommendations must be cited from published, scholarly journals or drug compendia (Steinman, 2012).
Below are examples of FDA actions that have affected the practice of medicine through enforcement actions on drug companies:
● Genzyme Corp, 2014, ordered to pay $22.8 million for off-label marketing. Genzyme Corp was found guilty of teaching doctors to alter one of their Seprafilm product, a bio-film used during surgeries, for use in less invasive procedures (Securities and Exchange Commission, 2010).
● Endo Pharmaceuticals Inc., 2014, ordered to pay $192.7 million for off-label marketing. Endo advertised their Lidoderm product for back pain and carpal tunnel when it was approved for complications of shingles (Department of Justice, Endo, 2014).
● Johnson & Johnson, 2013, ordered to pay $1.72 billion for off-label marketing and kickback schemes. The allegations were that Johnson & Johnson targeted their drug Risperdal to doctors treating elderly patients with depression and anxiety although Risperdal is only approved for schizophrenia (Department of Justice, Johnson, 2014).
● Amgen Corp, 2012, ordered to pay $612 million for promoting sales of drugs for off-label uses. Amgen was also found guilty of offering kickbacks to doctors who used their off-label drugs and also for defrauding Medicaid and Medicare from 2001 to 2011. The crime that Amgen committed involved their Aranesp product, a drug approved for anemia from chemotherapy. Amgen advertised it as a cure for anemia not related to chemotherapy. Aranesp raises red blood cell counts and corrects anemia for any anemic person. The prosecutor in this case made a statement that, "biotechnology giants are not above the law and my office will continue to ensure that prescriptions be written based on medical judgment—not profit motive (Department of Justice, Amgen, 2014)."
● GlaxoSmithKline, 2012, fined $3 billion for off-label marketing of several brands of drugs they sell including Paxil, Wellbutrin, and Avandia. Their crimes involved advertising these drugs for age groups and conditions not specifically approved by the FDA. They were also accused of several price-fixing schemes, kickbacks, and insurance fraud (Department of Justice, GlaxoSmithKlein, 2014).
In none of the cases presented was it noted that patients were harmed, or doctors were lied to. At the heart of these crimes was profit. The global pharmaceutical market is worth an estimated $300-400 billion (World Health Organization, 2004). Drug companies are profit-driven enterprises and are a prime target of the FDA. Downstream effects of these legal actions impact the practice of medicine by reinforcing the illegality of drug company promotions of off-label uses of drugs (Steinman, 2012).
Drug companies have attempted to turn off-label drug use into a First Amendment issue, stating that it is their fundamental right to promote legal and safe off-label uses of their drugs (Steinman, 2012). The public perception is that off-label drug use is illegal and that large pharmaceutical companies are manipulating the facts for sales. In most cases, this is nowhere near the truth. There have been cases of drug companies outright lying about their products, and for that they have been punished, but these cases are not about off-label drug use promotions. One such case involved the drug "gabapentin." The manufacturer, Pfizer, was convicted of using many different tactics to suppress less than favorable results of trials of its drug. Pfizer used scholarships and manipulated promotions to send false messages (Steinman, 2012).
Public safety and truthful advertising are at the heart of the FDA's concern over off-label drug use is. Drug companies have countered that the FDA is concerned more about the money the drug companies make than public safety. The drug companies claim that their knowledge of off-label uses come from doctors and scholarly journals, yet they are not allowed to promote these advances.
The FDA requires specific steps when a drug company wishes to market a new drug or an existing drug for new uses. These steps involve (FDA, Drug, 2014):
● Submitting "new drug application" to the FDA.
● Completion of animal testing.
● Completion of human testing.
● FDA's Center for Drug Evaluation and Research reviews tests and labeling proposals.
● FDA approves or denies the new drug application.
This simplified outline can take over ten years and over $300 million to complete. The permitting and animal process takes an average of three years and human testing is a phase-dependent process involving thousands of people over five to six years. Drug testing is a $12 billion industry in the United States (FDA, Drug, 2014).
The FDA has several programs to speed the process for new drug approvals where few or no treatments exist. These programs are Fast Track, Breakthrough Therapy, Accelerated Approval, and Priority Review (FDA, Fast Track, 2014). These expedited processes ensure speedy approval of a new drug application and final review.
Whistleblower Act
Adoption of Whistleblower, or Qui Tam rules, of the False Claims Act have cost drug companies millions of dollars and halted many illegal practices. Under this framework, private citizens or company insiders can file suit against drug companies for illegal promotion of off-label drug use. Once the action has commenced, the federal government may step in to help prosecute the case, but a substantial portion of any money seized goes to the 'whistleblower.' This system of 'bounty' for illegal acts is designed to ensure that drug companies cannot trust their people to keep secrets of illegal activity in their processes. In 2010, the drug company AstraZeneca was ordered to pay $520 million for off-label drug promotions filed under the Whistleblower Act (Kesselheim, Mello, and Studdert, 2012). The sheer number of dollars recovered under the Whistleblower act should give any drug company pause. Among 379 cases from 1996 and 2005, $9.3 billion was fined to various healthcare companies with $1 billion going directly to the whistleblowers, who are often company executives, doctors, or employees. Of the total, $3.6 billion came from drug companies (Kesselheim and Studdert, 2005).
The legal ramifications of off-label drug use extend from the FDA to drug companies to physicians and patients. While off-label drug use will certainly continue, the recent heavy fines levied by the FDA will deter drug companies from passing on off-label information to health care providers.
Ethical Considerations of Off-Label Drug Use
Ethical Use
Off-label drug use is not illegal, but is it ethical? The question of ethics, in this case, may be a bit unclear. In pediatric hospitals, nearly 50% of the prescriptions are off-label and in the fields of ophthalmology and cancer, off-label drugs are routine (Wong, 2006). Medical doctors must use their judgment in prescribing drugs off-label and ensure they have the backing of insurance underwriters and hospital management. To withhold off-label drugs is a bigger ethical dilemma than prescribing them (Rodwin, 2013).
When prescribing off-label, a physician must first weigh the risks. As these drugs have not been clinically tested for the off-label use, there is an inherent danger of unexpected consequences (Rodwin, 2013). Any time a newly introduced and "fully labeled" drug is used, there is also a risk of unforeseen consequences. It often takes several years and thousands of prescriptions before serious side-effects are cataloged. With off-label drugs, it is normally the case that these drugs have been on the market for many years and their side-effects well-known in studied populations, therefore, doctors can make intelligent decisions regarding risk. Oftentimes the off-label use is kept in a class of drugs, only the population is in question, for example, drugs approved for adults given to children in lesser dosages (Rodwin, 2013).
Ethical Salesmanship
The lines between ethical and legal become blurred when pharmaceutical companies provide the information. If a doctor is prescribing off-label based on a recommendation from a peer-reviewed journal, it is seen as legal and ethical. When a doctor prescribes off-label solely because a drug company recommends it and offers financial recompense for its use, it is most definitely illegal and unethical. Even in this case, it may be safe, but here, clearly, the emphasis is on the monetary transaction. There have been many attempts in the past to curtail this type of behavior (Rodwin, 2013). The monitoring and reporting of off-label prescriptions have become standard practice in many healthcare centers. Insurance companies have instituted policies in which drug companies do not profit from off-label prescriptions any more than standard prescriptions. Legislation has been introduced to require drug companies to pay for independent tests of off-label drug uses when a certain level of prescriptions have been written off-label. Additionally, drug companies are advised to issuing warning for off-label uses that have been seen as unsafe (Rodwin, 2013).
Governmental Ethics
The ethics of off-label drug use has been questioned in the United States Armed Forces. Several instances of off-label uses have resulted in unintended consequences and are seen as the "agent orange" of the day by many veteran watchdog groups. Prophylactic administrations of drugs to counteract expected attacks by nerve and biological agents have been used widely since the Gulf Wars of the 1990's and 2000's (Food and Drug Administration, 2009). Pyridostigmine, a drug approved for muscle weakness, was regularly administered to combat troops in the1990's wars to ward off effects of nerve agents, but now blamed for thousands of cases of Gulf War Syndrome. In 2003 the FDA approved pyridostigmine to increase the chances of combat troops surviving a nerve agent attack. Pyridostigmine now comes with specific instructions for the situations this drug may be used in and exact dosages (Food and Drug Administration, 2009).
The US military has also come under scrutiny for its off-label use of a broad spectrum antibiotic ciprofloxacin. Ciprofloxacin was administered to thousands of troops after the 9/11 attacks in an effort to ensure they could survive an anthrax assault (Gebhardt, 2005). Military doctors used ciprofloxacin at many times the recommended dosage for prolonged times which caused widespread destruction of the immune systems of those taking the drug (Centers for Disease Control, 2002). The loss of critical immune system protection caused many confirmed cases of autoimmune diseases and mental disorders in troops returning from combat stations (Nass, 2002). The Veteran's Administration has issued "watch lists" for those who were prescribed ciprofloxacin and anthrax vaccines in this manner (Air Force Times, 2013).
Ethics in Scholarly Journals
The efficacy of peer-reviewed journals alone as a source of off-label drug use information has also come under scrutiny. The peer-review process has failed on many occasions as drug companies have sought publication for positive trial results and quashed negative results. They have also provided misleading data for poor outcomes in studies, suppressed safety risks, and hired ghostwriters for peer-reviewed journal entries (Ventola, 2009).
Scholarly journals are plagued by articles written for ulterior motives such as off-label drug use. Drug companies profit greatly when researchers mention their drugs in a favorable way, and these drug companies often won't wait for the articles to get written (Flaherty, 2013). Drug companies hire writers to write articles for submission to peer-reviewed journals and fail to disclose the financial relationship. In many instances, side effects and serious risks are hidden. These questionable tactics cast a shadow over all peer-reviewed journals when they come to light. The FDA relentlessly pursues drug companies who use these tactics to market drugs off-label, and have brought many to justice. One of the more egregious cases involved Dr. Scott Reuben. In 2010, Dr. Reuben was sentenced to six months in prison and fined $400,000 for willfully submitting falsified drug trials to dozens of medical journals (Department of Justice, Reuben, 2010).
In general terms, the legal issues of off-label drug use are placed on the drug companies and the ethical considerations are borne by prescribing physicians and pharmacists. Ethical dilemmas can be avoided if doctors use established methodology regarding off-label uses of drugs and follow the guidelines of their medical establishment. Doctors who continue to fall for the "wooing" and kickbacks from drug companies are committing unethical acts. The FDA allows for drug companies to answer physician's questions regarding off-label uses of their products. The FDA does not condone active marketing by drug companies or drug company representatives who persuade doctors to use drugs in an off-label manner.
Insurance Companies' Policies Regarding Off-Label Drug Use
Medicare and Medicaid have historically been the "powerhouses" in the insurance world. These two programs are backed by the federal government, and smaller insurance companies follow their lead. It is important to look at how these industry leaders handle off-label drug use claims. Nearly all off-label drug use could be stopped dead in its tracks if insurance companies refused to pay for the drugs (Keech, 2006).
Prior to the adoption of Obamacare, Medicare and Medicaid both would reimburse the appropriate use of off-label prescriptions. They both used the criteria that the prescriptions must be recommended in peer-reviewed journals articles. Until 1993, Medicare and Medicaid utilized a case-by-case review for off-label drug reimbursements, but the passage of the Omnibus Budget reconciliation Act that year allowed for across-the-board off-label reimbursements. Since 1993, 39 states have enacted similar laws to allow state-run insurance programs the same leniency in reimbursing for off-label drug use (Keech, 2006).
Provisions under Obamacare are loosely worded with regards to off-label drug use and reimbursement, deferring to individual states policies. As only 31 states have policies at present, this leaves a tremendous gap in the care promised by Obamacare (Hutchins, 2013). In states with no statutes concerning off-label drug use, patients in those states may not have access to lifesaving drugs. The ambiguously worded provisions of off-label drug use under Obamacare are a major change from the concrete terms used by Medicare and Medicaid. While Obamacare is not designed to replace Medicare and Medicaid, these federally operated insurances are in flux with current trends in reimbursement (Hutchins, 2013).
While Medicare and Medicaid have always been transparent in their dealings with off-label drug use reimbursements, private insurers have not been so forthcoming (American Society of Clinical Oncologists, 2006). 50% of the surveyed medical professionals remarked they had changed treatment strategies due to non-coverage of off-label prescriptions by private insurers (Cohen, Wilson, and Faden, 2009).
Insurance fraud is a common crime in the pharmaceutical industry. Billions of dollars have been recovered in Whistleblower Act lawsuits and even the largest, most respected drug companies have been implicated. In 2008, Merck Pharmaceuticals was forced to pay $399 million for a Medicaid rebate scam it operated for nearly ten years. Merck admitted guilt in a $650 million settlement involving insurance fraud, kickbacks, and off-label drug use promotions (Department of Justice, Merck, 2014).
Under Obamacare, all eyes will be on Medicare and Medicaid in the legal battles over off-label drug reimbursements. Many lobbyist groups have already begun launching impressive initiatives to either loosen or strengthen the reimbursement of off-label drug prescriptions. One of the most vocal "pro off-label litigants" is the American Society of Clinical Oncologists who have shown that nearly 50% of drugs given in cancer treatments are of the off-label variety. Any reduction in reimbursements, they claim, would cause undue hardships to nearly every cancer patient in America (Keech, 2006).
Off-Label drug use is a mounting concern as the healthcare landscape changes under Obamacare. Off-Label drug use has a long history in US medical care with many off-label uses of drugs being the "standard of care." The FDA does not regulate the practice of medicine, only the selling of drugs, and has shown its authority in going after biotechnology giants in the pharmaceutical world. Legal and ethical arguments are being presented to lawmakers now. Key decisions are presently being made regarding off-label drug use under Obamacare. It is in everyone's best interest to have a full understanding of the issues surrounding off-label drug use. Medicare and Medicaid can no longer be relied on to provide guidance as smaller, private insurers come onto the scene with the same federal backing enjoyed previously by only Medicare and Medicaid. The medical establishment is in a dangerous time in that precedents set now could affect the lives of many in the future. As more and more Whistleblower cases come to light putting the term "off-label drug use" in the public vernacular, a negative connotation is starting to form. Perhaps a better choice of words for these non-FDA approved prescriptions would be in order. The goal of Obamacare is to give Americans access to affordable, quality health insurance, and to reduce the growth in health care spending (Rosenbaum, 2011). If this goal is to be met, the complications and inequities of off-label drug use must be identified and corrected.
Air Force Times, "New FDA warnings on Cipro may tie into Gulf War illness ..." 2013. Retrieved from http://www.airforcetimes.com/article/20131101/NEWS/311010018/New- FDA-warnings-Cipro-may-tie-into-Gulf-War-illness
American Society of Clinical Oncology. "Reimbursement for cancer treatment: coverage of off- label drug indications." Journal of Clinical Oncology 24.19 (2006): 3206-3208.
Beck, J. M., & Azari, E. D. (1998). FDA, off-label use, and informed consent: debunking myths and misconceptions. Food & Drug LJ, 53, 71.
Cohen, Joshua, Andrew Wilson, and Laura Faden. "Off-label use reimbursement." Food & Drug LJ 64 (2009): 391.
Danés, I., Agustí, A., Vallano, A., Martínez, J., Alerany, C., Ferrer, A. & Bosch, J. A. (2013). Available evidence and outcome of off-label use of rituximab in clinical practice. European journal of clinical pharmacology, 69(9), 1689-1699. DOI 10.1007/s00228-013-1518-4.
Department of Justice. "Amgen Inc. Pleads Guilty to Federal Charge in Brooklyn…" 2014. Retrieved from http://www.justice.gov/opa/pr/2012/December/12-civ-1523.html
Department of Justice. "Endo Pharmaceuticals and Endo Health Solutions to Pay ..." 2014. Retrieved from http://www.justice.gov/opa/pr/2014/February/14-civ-187.html
Department of Justice. "GlaxoSmithKlein to plead guilty and pay $3B… " 2014. Retrieved from http://www.justice.gov/opa/pr/2012/July/12-civ-842.html/
Department of Justice. "Johnson & Johnson to pay more than $2.2B" 2014. Retrieved from http://www.justice.gov/opa/pr/2013/November/13-ag-1170.html
Department of Justice. "Merck to pay more than $650M..." 2014. Retrieved from http://www.justice.gov/opa/pr/2008/February/08_civ_094.
Department of Justice. "Ruebins sentenced on health care fraud" 2010. Retrieved from http://www.justice.gov/usao/ma/news/2010/June/Reuben%20Scott%20Sentencing%20PR.html
FDA. "Fast Track, Breakthrough Therapy, Accelerated Approval ..." 2014. Retrieved from http://www.fda.gov/ForPatients/Approvals/Fast/default.html
FDA. "Drug Process Approval," 2014. Retrieved from http://www.fda.gov/Drugs/DevelopmentApprovalProcess/
Food and Drug Administration, "Bioterrorism and Drug Preparedness; FDA Approves Pyridostigmine Bromide as Pretreatment Against Nerve Gas" 2009.
Flaherty, D. K. (2013). Ghost-and guest-authored pharmaceutical industry–sponsored studies: abuse of academic integrity, the peer review system, and public trust. Annals of Pharmacotherapy. Retrieved from http://aop.sagepub.com/content/47/7-8/1081.short
Gebhardt, DOE. "Off-label administration of drugs to healthy military personnel. Dubious ethics of preventive measures." Journal of medical ethics 31.5 (2005): 268-268.
Gillick, M. R. (2009). Controlling off-label medication use. Annals of internal medicine, 150(5), 344-347. doi:10.7326/0003-4819-150-5-200903030-00108
Gupta, S. K., & Nayak, R. P. (2014). Off-label use of medicine: Perspective of physicians, patients, pharmaceutical companies and regulatory authorities. Journal of pharmacology & pharmacotherapeutics, 5(2), 88. doi: 10.4103/0976-500X.130046.
Hutchins, V. A., Samuels, M. B., & Lively, A. M. (2013). Analyzing the Affordable Care Act: Essential Health Benefits and Implications for Oncology. Journal of Oncology Practice, 9(2), 73-77. doi: 10,1200/JOP.2012.000881.
Keech Jr, John A. (2006) "ASCO Advocacy for Coverage of Off-Label Oncology Drug Uses." Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793631/
Kesselheim, A. S., Myers, J. A., Solomon, D. H., Winkelmayer, W. C., Levin, R., & Avorn, J. (2012). The prevalence and cost of unapproved uses of top-selling orphan drugs. PloS one, 7(2), e31894.
Kesselheim, Aaron S, and David M Studdert. "Whistleblower-initiated enforcement actions against health care fraud and abuse in the United States, 1996 to 2005." Annals of internal medicine 149.5 (2008): 342-349.
Kesselheim, A. S., Mello, M. M., & Studdert, D. M. (2011). Strategies and practices in off-label marketing of pharmaceuticals: a retrospective analysis of whistleblower complaints. PLoS medicine, 8(4), e1000431, doi: 10.1371/journal.pmed.1000431
McKenney, D. (2013). Off-Label Drug Promotion and the Use of Disclaimers. Tex. L. Rev., 92, 231.
Meadows, W., & Hollowell, B. (2007). 'Off-label'drug use: an FDA regulatory term, not a negative implication of its medical use. International journal of impotence research, 20(2), 135-144.
Mellor, J. D., Van Koeverden, P., Yip, S. W. K., Thakerar, A., Kirsa, S. W., & Michael, M. (2012). Access to anticancer drugs: many evidence‐based treatments are off‐label and unfunded by the Pharmaceutical Benefits Scheme. Internal medicine journal, 42(11), 1224-1229. doi:10.1111/j.1445-5994.2012.02751.x
Nickle, S. B., Peterson, N., & Peterson, M. (2014). Updated Physician's Guide to the Off-label Uses of Oral Isotretinoin. The Journal of clinical and aesthetic dermatology, 7(4), 22.
Rodwin, M. A. (2013). Rooting Out Institutional Corruption to Manage Inappropriate Off‐Label Drug Use. The Journal of Law, Medicine & Ethics, 41(3), 654-664.
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public Health Reports, 126(1), 130.
Schirmer, P. L., Mercier, R. C., Ryono, R. A., Nguyen, N., Lucero, C. A., Oda, G., & Holodniy, M. (2012). Comparative assessment of antimicrobial usage measures in the Department of Veterans Affairs. Infection control and hospital epidemiology, 33(4), 409-411.
Securities and Exchange Commission." 2010. Retrieved from http://www.sec.gov/Archives/edgar/data/732485/000095012310103135/b82631e10vq.htm
Steinman, Michael A et al. "Narrative review: the promotion of gabapentin: an analysis of internal industry documents." Annals of Internal Medicine 145.4 (2006): 284-293.
World Health Organization, "WHO Pharmaceutical Industry." 2004. Retrieved from http://www.who.int/trade/glossary/story073/en/
Wong, D. "Some ethical considerations for the "off‐label" use of drugs ..." 2006. Retrieved from
Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2012). Ten common questions (and their answers) about off-label drug use. In Mayo Clinic Proceedings.Vol. 87, No. 10, pp. 982-990. Elsevier.
Ventola, C. L. (2009). Off-label drug information: Regulation, distribution, evaluation, and related controversies. Pharmacy and Therapeutics, 34(8), 428.
Posted by Tim Steele
Labels: school papers
Dr. B G November 7, 2014 at 1:43 PM
With my 'white collar' assistance, it is true 'I did seem to turn potato starch into the #1 abused drug in the blogosphere'!
I hope you stick the science. Thank you for all that you do
Tim Steele November 7, 2014 at 2:57 PM
Hey! Don't get an 'whistleblower' ideas! If the FDA comes knocking on my door, I'll know who sent them.
I'm still trying to figure out what to do with the Billion$$$ I made off of PS.
Dr. B G November 8, 2014 at 11:21 AM
You are the consummate counter detailer ;) I've been jealous for a while ahah lol
Alis'N1derland November 7, 2014 at 1:53 PM
I'm new to your blog, through elliebelly. I've been reading it with great interest. As a retired professor, just wanted to say that posting your papers is a great idea and I'm enjoying reading them.
Great to meet you! Glad you like the papers, I wanted to post them more just so I wouldn't lose them. One more paper to go, and the semester is over in just three weeks. I've really been impressed with the University of Maryland's use of on-line classrooms in their graduate program. It's really just like attending classes without the hassle of having to drive and sit through three hours of lecture twice a week. I highly recommend this way of learning to anyone who wants to pursue an advanced degree and still has to work full-time.
Gemma November 8, 2014 at 12:59 AM
Cool text, Tim.
Re science of potato starch: maybe the reserch has not yet said all about the secret role of polysaccharide particles inside the human body :-)
Tim Steele November 8, 2014 at 8:42 AM
Or just that no one has thought to look!
So many secrets left to unlock.
Ashwin Patel November 23, 2014 at 11:52 AM
Great Read Tim. While on the subject of Drug Abuse and "off Label drug use", what do you think of using the drug ACARBOSE (prevents digestion of Starch by inhibiting Pancreatic Alpha-Amylase and Alpha-glucosidase enzymes in the small intestine) taken before each high Starch (or Carbohydrate) meal to convert ALL the starch into Resistant starch for the "good bugs" further down in the colon to feed on and have a party? One way to get a bucketload of Butyrate if you have already done the "weeding" and "feeding"!
Tim Steele November 23, 2014 at 3:21 PM
Hey Ashwin -
The issue of starch enzyme inhibitors has come up numerous times. I think they would be a bad way to get prebiotics. Here's why.
When 'regular old starch' gets in the large intestine, it is nothing special. It gets degraded by just about every microbe we own. Almost all human gut bacteria have SuS genes and starch degrading pathways. It's probably natural amounts of starch that escape digestion that fuel most people's microflora on a typical western diet.
I think it is an amazing concept that beans, a starchy food, have built-in alpha-amylase inhibitors. So a meal of beans will get you all kinds of fiber and some regular starch to fuel microbial action.
Maybe in a natural setting, there are just enough starch enzyme inhibitors to make a perfect balance. But I think intentionally 'gaming' the system to dump a massive amount of a starch that should never get to your colon in a huge amount is probably not beneficial.
So, ACARBOSE. I have to say I don't like it. If you want to eat low carb, just eat low carb. Don't find ways to prevent digestion of carbs.
I'm not sure if you have time for much reading, but here is a great paper on the starch utilization pathways of human bacteria which shows that RS2, RS3, inulin and all the other little fibers are important.
Thank you very much for your reply Tim. I will find time to read the article in the link. Just to elaborate further.........."But I think intentionally 'gaming' the system to dump a massive amount of a starch that should never get to your colon in a huge amount is probably not beneficial"
Isn't taking large and "un-natural" quantities of Raw Potato starch (not found in any diet on this earth or practiced by the ordinary man/woman on the street) the same thing?
Anyhow, my question relates to obtaining high levels of Butyrate in the right place in the Colon. If Butyrate proves to be the miracle ingredient that it is purported to be, then I predict Acarbose and similar "Starch Blockers" may be used in the future to "cure" certain conditions that Butyrate may help treat. You have a fine list of conditions that may benefit on this blog.
Tim Steele November 24, 2014 at 11:49 AM
I'm just not sure enough to recommend it. Resistant starch naturally gets to the large intestine where it must be broken down in stages. Regular starch should never really end up in the large intestine, it should be degraded by enzmes and absorbed as glucose in the small intestine.
Structurally there are differences in the was regular starch and RS are built. I just don't have a good feel for what happens when regular starch is placed in the large intestine.
There was a commenter on FTA who was using starch blockers last year. When she started using potato starch, she noticed an immediate increase in flatulence. So this told me that her gut was not configured yet to handle large amounts of resistant starch.
The only reason I keep talking about RS2, is that I think it is a very important aspect of creating a more balanced ecosystem, I don't think it's simply just about increasing butyrate. And I don't consider 20-40g of raw potato starch all that unnatural. It's the amount of RS2 found in a fairly small potato, a single green plantain, a handful of tiger nuts, or a raw yam of the type normally eaten raw. The only thing unnatural is that we have stopped eating foods that contain RS2 and 3 for the most part.
I would like to see research into the starch blockers. It may be something big I am overlooking. I wonder, for instance, if you eat 100g of starch alongside starch blockers, how much is actually blocked?
If you ever see any info on this, I'd love to see it.
Gemma November 24, 2014 at 11:50 AM
As to treating certain conditions with alpha amylase inhibitors... would not the soil based Streptomyces be more useful, if they find their way into the gut? Acarviosin: http://en.wikipedia.org/wiki/Acarviosin
Streptomyces is such a versatile microbe! Produces natural antibiotics, antifungals, and some carb blockers. Almost as if it wants to be the biggest, baddest gut bug who shows up in the large intestine and says, 'no thank you, I have brought my own food!'
Streptomyces dines alone. lol
Found in PrescriptAssist for sure, haven't seen it in any others.
Tim Steele November 24, 2014 at 12:59 PM
I started to look into ACARBOSE and the first PubMed paper I find was actually on a different type of enzyme inhibitor called Miglitol, and has this rather ominous conclusion:
http://livertox.nih.gov/Miglitol.htm
"The reason why miglitol rarely causes liver injury is not known, but is likely related to its rapid renal clearance and absence of hepatic metabolism. While similar to acarbose (which does cause liver injury) in its mechanism of action, miglitol is a structurally distinct synthetic pseudopolysaccharide."
So, Acarbose causes liver injury? More searching:
"Acarbose is an oligosaccharide of microbial origin and is minimally absorbed, so that systemic toxicity and liver injury were not expected and remain unexplained. Liver injury from acarbose is clearly idiosyncratic and may relate to an immunological reaction to the bacterially derived oligosaccharide molecule."
OK, that scares me!
Lots of papers on Acarbose and liver injury, but it seems an uncommon side effect.
http://livertox.nlm.nih.gov/Acarbose.htm
http://www.uspharmacist.com/content/c/10086/?t=men's_health,diabetes
Ashwin Patel November 26, 2014 at 5:36 AM
Acarbose is a Prescription medicine licensed for the treatment of type two diabetes and needs to be prescribed to qualifying patients by a Registered medical professional.. I am not suggesting widespread use of Acarbose or other Starch blockers to modulate the composition of the gut microbiome and as a result the metabolites made by the microbes from substrates that arrive into the colon after processing in the mouth, Stomach and Small intestine. Starch blockers from natural sources are not necessarily "safe" or non toxic, weather via Probiotics (as suggested) or via plant metabolites (Polyphenol Flavonoids are known to posses Glucosidase inhibitory properties). In fact, Acarbose is an oligosaccharide formed by strains of the genus Actinoplanes (Bacteria) . However, it would be better to take a standardise pure extract than to try a hit and miss approach with probiotics or other sources. I do not know of any drug that comes without side effects. Dose determines the Poison. Even too many Carrots can be Toxic!!
However, Acarbose and other Starch blockers appear present as very attractive tools to test how the composition of the Gut microbiota could be modulated to our advantage.
Acarbose Enhances human Colonic Butyrare Production
http://jn.nutrition.org/content/127/5/717.long
Changes of Fermentation Pathways of Fecal Microbial Communities Associated with a Drug Treatment That Increases Dietary Starch in the Human Colon
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC91421/
Gemma November 26, 2014 at 9:21 AM
@Ashwin
Any studies on acarbose (perhaps + PS) on treating certain conditions?
Here one (a bit old) :
Butyrate increases, which is desirable in the colon, but what about the decrease in propionate, which surely play a role too (maybe an action on liver)?
On Streptomyces: if acarbose is a single weapon, Actionobacteria possess many other. Do they use them if facing the Enemy?
Tim Steele November 26, 2014 at 9:48 AM
Ashwin - Those are great, thanks, and I get your point. I can see it being used therapeutically and supervised, like before and after an FMT or colonoscopy/antibiotics treatments. I would have a hard time recommending OTC starch blockers as a general way to increase prebiotics, but supervised and maybe short-term...sure.
I also wonder if PEG, the stuff the give to clean you out before a colonoscopy wouldn't be helpful to some as well. It completely breaks down the biofilm and flushes the entire mucous layer away. Could be useful in "Weeding." Heck, how many millions of colonoscopies go on anyway without any thought to rebuilding the flora afterwards?
Would be an easy study. Team up with a colonoscopy doctor and have him administer Acarbose as a post-treatment supplement and check gut flora against controls that get nothing extra.
I wonder if OTC starch blockers are different from Acarbose? The person on FTA said she noticed absolutely no difference when taking starch blockers. The study Gemma linked said this:
"Side Effects of Acarbose Treatment. The severity of abdominal symptoms was recorded by each volunteer and classified semiquantitatively as mild, moderate, marked, and severe according to the system of Lasser et al. (20). In the 4th week of the acarbose period, flatulence was present in all 12 subjects (10 moderate, 2 marked) and abdominal discomfort was reported by 5 of 12 volunteers (4 mild, 1 moderate), whereas during the control period these symptoms occurred in 6 (5 mild, 1 moderate) and 3 (2 mild, 1 moderate) subjects, respectively. Mild diarrhea was present in 2 cases during both study periods. Severe side effects were not noted by any volunteer."
This makes it look as if the gut flora is indeed adapting to higher amounts of starch!
Looking on Amazon, I'll bet the stuff you can buy on-line is no good!
http://www.amazon.com/s?ie=UTF8&page=1&rh=i%3Aaps%2Ck%3Astarch%20blocker
It all looks like "Diet Pills" to me.
You may be onto something here, Ashwin!
A proprietary alpha-amylase inhibitor from white bean (Phaseolus vulgaris): A review of clinical studies on weight loss and glycemic control
Contains good description od Acarbose and also other natural plant-based starch blockers.
Interesting to say the least.
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FOUNDATION_EXPORT double Pods_YBTableViewController_ExampleVersionNumber;
FOUNDATION_EXPORT const unsigned char Pods_YBTableViewController_ExampleVersionString[];

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State officials are allocating $383,000 to provide emergency call boxes, satellite phones, and all-terrain vehicles to help victims of shark attacks on the Outer Cape – but nothing so far to prevent them.
Six Outer Cape towns are getting the money, including Truro and Wellfleet, where major shark attacks took place last summer. On August 15, a 61-year-old man in the water off Truro was seriously injured by a great white shark, sustaining wounds to his hip and torso that required extensive hospitalization. On September 15, a 26-year-old man in the water off Wellfleet was killed by a great white shark.
The other recipients of the grant are Chatham, Orleans, Eastham, and Provincetown.
Sharks have become prevalent during the last several years in the waters off the Outer Cape, drawn by tens of thousands of seals that sharks like to eat. Swimmers, surfers, kayakers, and boogie boarders have had close encounters with great whites.
Some Outer Cape residents are conducting a GoFundMe campaign to try to raise money for two sonar-detecting alert buoys that could provide warning to beachgoers of the presence of a shark. The campaign is called the Arthur Clever Buoy Pilot. It derives its name from Arthur Medici, the 26-year-old Brazil native who was living in Revere at the time he was killed by a great white shark last September; and Clever Buoy, a product made by a company called Smart Marine Systems, in Australia.
As of Wednesday afternoon, organizers had raised about $36,000 of their $200,000 goal.
In Chatham, at the elbow of Cape Cod, where its south coast rounds the bend north and starts up the Outer Cape, some town officials want to install a barrier to prevent sharks from going from Nantucket Sound south of the town up an inland waterway into Oyster Pond, which has a sandy area called Children's Beach.
As for the items the state is willing to fund immediately, they are designed to get treatment for a shark attack victim, in hopes of preventing the victim from bleeding out.
Several Outer Cape beaches have iffy cell phone service, so call boxes and satellite phones are meant to get word to a local fire department that can send an ambulance quickly. All-terrain vehicles would help rescuers get a victim from the waterside to a beach parking lot, where an ambulance or helicopter could then take a victim to the hospital.
Officials of Governor Charlie Baker's administration noted Tuesday that the $383,000 allocation responds to requests made by towns on the Outer Cape.
"Our administration is pleased to provide funds to address critical infrastructure equipment needs as it relates to the safety of all Massachusetts residents and visitors. We are grateful to our partners at the local level and in the Legislature for continuing to work together with us to address this important issue," Lieutenant Governor Karen Polito said in a written statement.
Local officials are pleased with the quick action of the administration but they don't imagine that it solves the shark problem.
"This is a good first step," state Senator Julian Cry (D-Provincetown) said in a written statement.


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 What are the Requirements of the Stainless Steel Centrifugal Pump - Croos Pump (Shanghai) Co., Ltd.
In many product delivery systems, a similar device is used, which is a stainless steel centrifugal pump. Especially for liquid material delivery, the advantages of stainless steel centrifugal pumps are very prominent. Of course it is not perfect, and there are some areas for improvement.
The stainless steel centrifugal pump is installed directly on the pipe in the ground, and once it is started, the solution can be pumped into the pump from the container. In the case of oil delivery, it will be vaporized because of its strict specification for the suction process. Therefore, the suction range of the stainless steel centrifugal pump should be controlled within 4.5 meters.
For stainless steel centrifugal pumps, we need to improve the problem of low suction, high resistance and high energy consumption. If these deficiencies can be eliminated completely, the stainless steel centrifugal pump will achieve the perfect state. In general, stainless steel centrifugal pumps are arranged in a low - to - high way, but it's not in the pipeline, it's going to be different. If the seal cooling water imports and exports are set in horizontal symmetry, the stainless steel centrifugal pump can be connected to the import and export. If it is high and low, generally it is the principle of low advance.
The mechanical seal of the stainless steel centrifugal pump is the screw sleeve. According to the rotation, the screw is transported from the inlet to the outlet. That is to say, the one which closes to the stainless steel centrifugal water pump mechanical seal friction vice joint is import.
If the stainless steel centrifugal pump adopts a two-mechanical seal, So its pipeline and import and export position are closer to both the static and static ring, which can be easily confused. At this time, it is necessary to determine the correct exit position according to the rotation of the pump ring on the mechanical seal ring. Generally speaking, the inlet position of the stainless steel centrifugal pump mechanical seal flushing solution is near the contact area of the static ring, which is more obvious when used.


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China News Portal China News Portal
Speeding up the formation of a uniform system of rules in the region-- the relevant responsible person of the Ministry of Commerce introduced the relevant situation of the RCEP negotiations
2019-11-07 08:34 | gov.cn
Recently, the 15 (RCEP) member states of the Regional Comprehensive Economic Partnership Agreement have concluded negotiations as a whole, and public opinion is highly concerned about this. On November 6, the Information Office of the State Council held a regular briefing on the policy of the State Council, inviting Wang Shouwen, vice minister of commerce and deputy representative of the international trade negotiations, to brief him on the RCEP negotiations and answer questions from reporters.
The RCEP negotiations were launched by 10 ASEAN countries in 2012, inviting Australia, China, India, Japan, South Korea and New Zealand to participate in the negotiations, with the goal of further improving on the basis of the "10 / 1" free trade agreements signed with these countries. Reach a modern, comprehensive, high-quality, mutually beneficial new large-scale free trade agreement. The negotiations began officially in 2013 and have gone through seven years this year. During these seven years, three leaders' meetings, 19 ministerial meetings and 28 rounds of formal negotiations have been held.
"the leaders' meeting officially announced the conclusion of the negotiations among the 15 member states as a whole, which marks a major breakthrough in the construction of a free trade zone with the largest population, the most diversified membership structure and the greatest development potential in the world." Wang Shouwen said. According to 2018 data, the population of RCEP15 member countries reached 2.2 billion, GDP reached 29 trillion US dollars, exports reached 5.6 trillion US dollars, and attracted foreign investment flow of 370 billion US dollars. These indicators basically account for about 30% of the global total. Some are slightly less than 30%, and some are slightly more than 30%. "so when RCEP15 is completed, it will be the largest free trade zone in the world." Wang Shouwen said.
"next, the 15 member states will complete consultations on a few remaining issues by the end of this year, complete the text review as soon as possible, and speed up the necessary domestic procedures for signing, with the goal of formally signing next year." Wang said that the 15 member states will also continue to maintain contacts and consultations with India and strive to resolve the remaining problems in a mutually satisfactory manner, and they very much welcome India's accession to the agreement as soon as possible.
At present, all parties have high expectations and evaluation of RCEP. What benefits may be brought to the countries of the region and the development of regional economy and trade after the signing of this agreement in the future? "the conclusion of the RCEP agreement will be of great benefit to our region, to China, and to the world economy and trade." Wang Shouwen said.
For the region, first of all, RCEP15 countries are a collective upgrade of the existing "10 / 1" free trade agreements, which will form a unified system of rules within the region. Secondly, it will contribute to the construction of supply chains and value chains within the region, which will have great benefits for the flow of goods, technology, services and capital within the region, including the cross-border movement of people.
For China, last year, China's investment in these 14 countries reached US $16 billion and attracted US $14 billion in regional foreign investment.This is conducive to China's stable foreign trade, stable foreign investment, and the development of healthy, sustainable, and stable foreign trade and investment relations. It means a lot. For consumers and for enterprises that rely on the import of raw materials and components from these regions, costs will be greatly reduced and will benefit from the removal of tariff and non-tariff barriers.
As far as the world is concerned, global unilateralism and protectionism are on the rise, the global economy is under great downward pressure, and the growth rate of trade has dropped significantly. As an important result of regional integration, RCEP will have great benefits in boosting the confidence of the world economy and the confidence of investors. At present, among the RCEP15 countries, there are both developed countries and least developed countries. The level of economic development is very different, and the cultural background and political system are different. The fact that these diverse countries can come together and reach such an agreement is also of great and far-reaching significance for the formulation of global economic and trade rules in the future.
There is a footnote in the joint statement of the leaders' meeting, which describes that the agreement has 20 chapters. "as can be seen from the title of these chapters, this agreement meets the negotiating guiding principles originally set by the leaders, and it will be a comprehensive, modern, high-quality and mutually beneficial free trade agreement." Wang Shouwen said: "the agreement also incorporates provisions on economic and technological cooperation and gives some transitional arrangements to least developed countries such as Laos, Myanmar and Cambodia, including the provision of more favorable conditions for these members. To enable them to better integrate into regional economic integration. " (reporter Qi Zhiming)
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AI pox test, intelligent customs clearance. The stories of "buying and selling" that have been changed by the Internet
How to promote cross-border trade through e-commerce? How to make the business of small and medium-sized enterprises no longer difficult to do? How can the residents of western counties and even villages buy good and cheap goods? The second Hongqiao...
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China-Pakistan Economic Corridor's largest transport infrastructure project Peshawar-Karachi highway Sukul to Multan section ("Sumu section" highway) held a completion ceremony in Islamabad, Pakistan, on the 5th. After it is officially opened to...
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Boost the confidence of the world economy, produce the effect of "trade and investment creation", and benefit Chinese consumers and import and export enterprises. At a regular policy briefing held by the State Council on the 6th, the relevant person...
China's market is so big and open, we must plough deeply-- the story of foreign exhibitors from the Expo
From enjoying the "dividend" of the huge Chinese market to catching up with the "hitchhiking" of the upgrading of Chinese consumption, from experiencing the continuous optimization of the business environment to actively fulfilling corporate social...
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At present, the national autumn harvest has basically come to an end, and reporters recently felt in the fields of some grain-producing areas such as Hunan, Fujian, and Heilongjiang that with the deepening of structural reform on the supply side of...
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The "Great" change in the "small" Day-- feeling the changes of people's livelihood from the celebration of the 70th Anniversary of the Founding of the people's Republic of China
On the 6th, a large-scale achievement exhibition celebrating the 70th anniversary of the founding of the people's Republic of China was held at the Beijing Exhibition Hall. Among them, some of the exhibition boards and exhibits that reflect the...
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When the Machine has a "brain"-- the intellectual creation of the first Line of observation from the Expo
On the second session of China International Import Expo, the intelligence industry giants from all over the world have come up with the top products: the world's largest bucket shovel, the most sophisticated smart chips, the most advanced "wisdom...
4 billion euros is just the beginning.
On the 5th local time, the Chinese government successfully priced 4 billion euros of sovereign bonds in Paris, France. This is an important action taken by China to support the construction of an international financial center in Paris and to deepen...
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On November 6, the Financial Stability and Development Board of the State Council (hereinafter referred to as the Financial Commission) held its ninth meeting to study and implement the spirit of the fourth Plenary session of the 19th CPC Central...
Communication: China-South Korea Relations: curling reflecting Cold Moon Mutual Learning and Common Development
Sino-ROK relations have historical accumulation, realistic foundation, and potential for development. The poem by Xu Yun, an ancient Korean poet, "every picture of the liver and gallbladder, curling reflects the cold moon," describes the traditional...
Ministry of Foreign Affairs: the signing of the China-EU Agreement on Geographical indications demonstrates the determination of the Chinese Government to protect intellectual property rights
Foreign Ministry spokesman Geng Shuang said on the 6th that the signing of the China-EU Geographic indications Agreement fully demonstrates the firm determination of the Chinese Government to continue to deepen reform, open wider to the outside world,...
Li Zhenghong, president of the all-China Federation of Taiwan Enterprises: deeply felt the mainland's concern for Taiwan compatriots
Li Zhenghong said: the Taiwan exhibition area of the China Pavilion, through pictures and texts, videos, and other forms, In recent years, the mainland has fully demonstrated that in "implementing the measures of benefiting the people and gradually...
Li Keqiang meets French President Macron
Li Keqiang said that China and France are both permanent members of the UN Security Council and major economies in the world. During Mr. President's visit to China, President Xi Jinping had in-depth exchanges with you and achieved fruitful results....
Interview: "the Chinese Market is very attractive to European countries"-- an interview with Von Drachek, Chairman of the House of Representatives of the Czech Parliament
"the Chinese market is huge and growing, and it is very attractive to European countries." Radek von Drachek, chairman of the Czech House of Representatives, said in an exclusive interview with Xinhua reporters during the second session of China...
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There are many subjects to collect, weak security, and there is an urgent need for strong legislation-who will protect our biometric information?
At present, are citizens' fingerprints, facial features and other biometric information at risk of being overcollected? Which subjects are obtaining our biometric information? In what aspects does the relevant information protection need to be...
The overall physical health status of students in the whole country shows a trend of "gradual improvement".
The reporter learned from the Ministry of Education on the 6th that the qualified rate of the national students' physique standard test in 2018 was 91.91%, and the excellent and good rate was 30.57%. From 2016 to 2018, the overall physical health...
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China holds the rotating presidency of the Earth observation Organization in 2020
The 16th Plenary session of the Earth observation Organization ((GEO)) opened in Canberra, Australia on the 6th, at which China officially took over the rotating president of the Earth observation Organization (GEO) in 2020. ,
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text:
Q: Prestashop link employees to Customer Groups I am looking for a way to link Customer Groups to Employees.
My Customers are assigned to Groups and those groups can only see certain product categories. Which means my customers can only see certain products depending on which category they are assigned to.
Now when an employee creates an order for a customer, they can pick any product that they want when the "search products" in the order form.  My product categories fail and it creates lots of problems for my business.
So i want my employees to be assigned to the customer groups.  What i did is a added a column in my ps_employee called "id_default_group" (same column name as the one in the ps_customer) and i added the appropriate IDs.
My question is what do i have to do in the php files to look for this column?
PrestaShop version 1.6.1.6

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