text:
'For Colored Girls', Denzel, Halle, & Tyler Perry Win At NAACP Image Awards
Tyler Perry won bigtime in the movie and TV categories, while Prince was a surprise guest to give Halle Berry the Best Actress award for Frankie & Alice as the 42nd NAACP Image Awards were announced tonight during the live broadcast from LA's Shrine Auditorium on Fox. The special was hosted by Holly Robinson Peete and Wayne Brady while performers and Presenters included Halle Berry, LL Cool J, Affion Crockett, Kimberly Elise, Kerry Washington and Vanessa Williams, Angela Bassett, NAACP Chairwoman Roslyn M. Brock, actress Loretta Devine, singer Jason Derülo, actress/singer Kat Graham, actor Dulé Hill, actor Anthony Mackie, Judge Greg Mathis, actresses Tia and Tamera Mowry, actress Sandra Oh, comedian Russell Peters and actress Anika Noni Rose. The special celebrated the accomplishments of people of color working in the fields of literature, music, television and film. Special honors included the Chairman's Award recipient Surgeon General Regina M. Benjamin and President's Award recipient General Colin L. Powell.
Outstanding Motion Picture
"For Colored Girls" (Lionsgate/34th Street Films)
Outstanding Actor in a Motion Picture
Denzel Washington – "The Book of Eli" (Warner Bros. Pictures)
Outstanding Actress in a Motion Picture
Halle Berry – "Frankie & Alice" (Freestyle Releasing)
Outstanding Supporting Actor in a Motion Picture
Samuel L. Jackson – "Mother and Child" (Sony Pictures Classics)
Outstanding Supporting Actress in a Motion Picture
Kimberly Elise – "For Colored Girls" (Lionsgate/34th Street Films)
Outstanding Independent Motion Picture
"Frankie & Alice" (Freestyle Releasing)
Outstanding Foreign Motion Picture
"Biutiful" (Roadside Attractions)
Outstanding Documentary (Theatrical or Television)
"For Love of Liberty: The Story of America's Black Patriots" (PBS)
Outstanding Writing in a Comedy Series
Aaron McGruder – "The Boondocks" – The Fund-Raiser (Cartoon Network)
Outstanding Writing in a Dramatic Series
Shonda Rhimes – "Private Practice" – Did You Hear What Happened to Charlotte King? (ABC)
Outstanding Writing in a Motion Picture (Theatrical or Television)
Michael Elliot – "Just Wright" (Fox Searchlight Pictures)
Outstanding Directing in a Comedy Series
Kevin Rodney Sullivan – "Modern Family" – Game Changer (ABC)
Outstanding Directing in a Dramatic Series
Millicent Shelton – "Men of A Certain Age" – Go with the Flow (TNT)
Outstanding Directing in a Motion Picture (Theatrical or Television)
Tyler Perry – "For Colored Girls" (Lionsgate/34th Street Films)
Outstanding Comedy Series
"Tyler Perry's House of Payne" (TBS)
Outstanding Actor in a Comedy Series
David Mann – "Tyler Perry's Meet the Browns" (TBS)
Outstanding Actress in a Comedy Series
Vanessa Williams – "Desperate Housewives" (ABC)
Outstanding Supporting Actor in a Comedy Series
Ice Cube – "Are We There Yet?" (TBS)
Outstanding Supporting Actress in a Comedy Series
Sofia Vergara – "Modern Family" (ABC)
Outstanding Drama Series
"Grey's Anatomy" (ABC)
Outstanding Actor in a Drama Series
LL Cool J – "NCIS: Los Angeles" (CBS)
Outstanding Actress in a Drama Series
Regina King – "Southland" (TNT)
Outstanding Supporting Actor in a Drama Series
Terrence Howard – "Law & Order: Los Angeles" (NBC)
Outstanding Supporting Actress in a Drama Series
S. Epatha Merkerson – "Law & Order" (NBC)
Outstanding Television Movie, Mini-Series or Dramatic Special
"Sins of the Mother" (Lifetime Movie Network)
Outstanding Actor in a Television Movie, Mini-Series or Dramatic Special
Idris Elba – "Luther" (BBC America)
Outstanding Actress in a Television Movie, Mini-Series or Dramatic Special
Jill Scott – "Sins of the Mother" (Lifetime Movie Network)
Outstanding Actor in a Daytime Drama Series
Darnell Williams – "All My Children" (ABC)
Outstanding Actress in a Daytime Drama Series
Tatyana Ali – "The Young and the Restless" (CBS)
Outstanding News/Information Series or Special
"Unsung" (TV One)
Outstanding Talk Series
"The View" (ABC)
Outstanding Reality Series
"Sunday Best" (BET Network)
Outstanding Variety Series or Special
"UNCF An Evening of Stars Tribute to Lionel Ritchie" (Syndicated)
Outstanding Children's Program
"True Jackson, VP" (Nickelodeon)
Outstanding Performance in a Youth/Children's Program Series or Special
Keke Palmer – "True Jackson, VP" (Nickelodeon)
Outstanding New Artist
Willow (Roc Nation/Columbia Records)
Outstanding Male Artist
Usher (Laface/Jive Records)
Outstanding Female Artist
Mary J. Blige (Geffen Records/Matriarch)
Outstanding Duo or Group or Collaboration
John Legend and The Roots (Columbia Records)
Outstanding Jazz Album
"From Billie Holiday to Edith Piaf – Live in Marciac" – The Wynton Marsalis Quintet & Richard Galliano (The Orchard)
Outstanding Gospel Album – Traditional or Contemporary
"You Are Not Alone" – Mavis Staples (ANTI Records)
Outstanding World Music Album
"VOCAbuLarieS" – Bobby McFerrin (Universal Music Group/Decca/Emarcy)
Outstanding Music Video
"Un-thinkable (I'm Ready)" – Alicia Keys (J Records)
Outstanding Song
"Bittersweet" – Fantasia (J Records)
Outstanding Album
"Wake Up!" – John Legend and The Roots (Columbia Records)
Outstanding Literary Work – Fiction
"Getting to Happy" – Terry McMillan (Penguin Group)
Outstanding Literary Work – Non-Fiction
"The New Jim Crow: Mass Incarceration in the Age of Colorblindness" – Michelle Alexander (The New Press)
Outstanding Literary Work – Debut Author
"The Warmth of Other Suns: The Epic Story of America's Great Migration" – Isabel Wilkerson (Random House)
Outstanding Literary Work – Biography/Auto-Biography
"You Don't Know Me: Reflections of My Father, Ray Charles" – Ray Charles Robinson, Jr. (Crown)
Outstanding Literary Work – Instructional
"A Boy Should Know How to Tie a Tie: And Other Lessons for Succeeding in Life" – Antwone Fisher (Touchstone, An Imprint of Simon & Schuster)
Outstanding Literary Work – Poetry
"100 Best African-American Poems" – Nikki Giovanni (Sourcebooks MediaFusion)
Outstanding Literary Work – Children
"My Brother Charlie" – Holly Robinson Peete, Ryan Elizabeth Peete (Authors), Shane W. Evans (Illustrator) (Scholastic Press)
Outstanding Literary Work – Youth/Teens
"Condoleezza Rice A Memoir of My Extraordinary, Ordinary Family and Me" – Condoleezza Rice (Random House Children's Books)
Tyler Perry has confounded the powers that be for quite some time; he should own a studio at this point because he is fairly astute at BO metrics & the funding of critically acclaimed projects like this.
From Director Jon Wilkman, recent interview:
"Jon Wilkman: We found people who were under-represented. Oscar Micheaux, the African-American filmmaker (early 20's – 1940's), really represents the power of the movies. Because he got inspired to make movies by seeing BIRTH OF A NATION. Black viewers were not seeing themselves accurately depicted on screen. He said 'I think we can find an audience out there.' The movies should include everyone, depicted fairly. He started making movies, showing them in tiny towns.
Q: Tyler Perry has been shaking up the box office and everybody was shaking their heads for a while. It sounds familiar.
Jon Wilkman: Tyler Perry is the (Hollywood) great god-son of Oscar Michaeux, and I bet he knows who Oscar Micheaux is! It is exactly that story — 'I know my audience, it's not being fully served, and I am going to make those films.'"
Straight up racism by the NAACP.
It would be great if the award categories expanded to include at least one foreign category to acknowledge some of the excellent work around the world.
and congrats to Antwone Fisher on his win..I have gifted his book twice already to young relatives.
Actually, the NAACP Awards do have a Foreign Film Catagory. This year's nominees were: A Barfoot Dream, Biutiful, Four Lions, Mother and Outside the Law. The winner was Biutiful.
They do:
Outstanding Foreign Motion Picture
"Biutiful" (Roadside Attractions)
thx 2 u both
If Caucasians had their own "whites only" awards ceremony, or worse, their own White Entertainment Television network, non-whites would be screaming "RACIST" from the rooftops.
Minorities: you honestly want equality? This is not how you do it.
Really, Ace. Then why don't you tell people of color "how it is done". I can only assume you know very little about the lack of job opportunities for people of color in this business. And although there is some obvious attempts of diversity in network television and major motion pictures, for many, the industry is still viewed as "whites only, and I must add, "women over the age of 35 need not apply." Why don't you take some time and actually watch network television and go to some movies. Do you see a decent amount of performers of color is lead roles? I doubt it. But you appear to be the kind of person who doesn't really pay attention to things like that until minority sensitive causes are brought up. You're probably the type of person who says, "Hey, you've already got a black president. what else do you want?" Let me list some network show for you: "How I Met Your Mother" no person of color as a series regular. "Two and Half Men". no person of color as a series regular. "Cougar Town", "The Middle", "Raising Hope" on and on and on. And don't get me started about the disparity in salaries. And when there is a diverse cast, there's usually only one person. "Rules Of Engagement" is a perfect example. It's a little better on basic cable. You should study the issue a little further before making the ignorant comments you've made. But I have a feeling you are a lost cause when it comes to racial awareness.
U.A., we agree on many things in other posts on other topics, and I know you're intelligent and well-spoken, so let me try to clarify a couple of things. Just as the "David Duke" comment below reeks of racism toward me (in a pretty ironic sort of way), the people who are arguing my points are also mostly taking cheap shots (Charlie Sheen quotes – really?) and name-calling.
But what you just wrote: I agree with most of it.
My observations regarding BET and The NAACP awards was simply that they're as "in-your-face" racist as any entertainment content that blacks complain about whites, to the point of being obvious with an "I dare you, white people, to criticize these things." They're not racist in an ugly way, but when you single out or intentionally disclude a race – that's racism, no? None of you can honestly sit there and say it's not. The definition of racism applies both ways, to all parties. Just because (any of) you are a minority does not give you carte blanche to do something in the name of racial balance, which you would be offended by if that other person did it. That's hypocrisy. My comparison to an all-white awards program or TV network is apt: if we had a White Television Network, or a Caucasian (or Jewish) Entertainment Achievement Awards ceremony… Well, obviously nobody would dare. And why? Because that's racist.
Now, if your argument(s) is that not enough people of color are represented in entertainment – specifically in TV & films – then I completely agree with all of you. But it's economics: my other comments about mass audience supporting these projects applies. Advertising funds television, not the other way around. With TV, advertisers know who (what race, age, gender, etc) are watching what programs, and how and where to spend their advertising dollars. If they find that minorities are buying their products in greater numbers, they will produce more mainstream TV with minorities, and in more prominent roles. The tail does not wag the dog in Hollywood (in almost all cases), money does.
For the record I am a white male, and I'm the least racist or bigoted person you will know. Whether you groan at that statement, whether you agree with me or not, because of my color-blindness I feel I am objectively fair. Can you all say the same? As I'm not black, I can't begin to claim to know what blacks know or feel about their journey and life. Obviously, there are still people in this country who are purposefully racist, and there are lots of whites who don't understand that the things they do and the way they think might be construed as racist by minorities. This is a problem and process of education (or lack thereof) and is constantly changing.
But all of that is a social issue. My original observation was/is about the entertainment industry being run on money, not racism. There is some racism, there is some ageism, there is some protectionism, there is some nepotism… just like any other industry. But at the end of the day, TV shows and movies that (are speculated to) make the most money are the ones that will get produced, no matter the content nor the color of anyone's skin.
I'll leave it at this: instead of the name-calling and personal insults, it would be best if all sides could sit down over a couple of beers and LISTEN to each other without prejudice; put the shoe on the other foot; put yourself in that other person's situation and see things from that other person's point of view. We would all learn a lot from and about each other. Education – that's what will help create equality, not sticking a big middle-finger in your (perceived) adversary's face.
I believe you are right that there is discrimination. But with around 10 to 12% of the population and most of that in the ghettos with no or little education. What representation on screen would you consider fair?
They do. It's called The Oscars…duh winning!
I love how someone says something stupid like this every year. ABC, CBS, NBC, FOX and the CW are basically the White Entertainment Networks. You just can't call them that. Wake up, Ace.
Yawn. Your trolling needs some originality
David Dukeer, "Ace"
I love how idiots like Ace expose themselves while trying to complain against racism. The irony is staggering.
And yet you, and the two commenters above you, don't ever seem to understand comments like this. You immediately think "racist" and don't think any deeper than that.
Reverse racism is still… racism. Blacks want to be recognized by the entire industry for outstanding entertainment? Then produce some outstanding entertainment. If you can prove you have the audience for it, those projects will get produced. Hollywood doesn't care what films (or TV) it makes, only that they make money. I could (again) go into a long diatribe about the films Hollywood would make if there was/is an audience who will pay to see them, but take my word for it here.
Were there any outstanding "black" films this year? Sure that's a subjective question, and although the Academy voters can be shallow and swayed by a good Oscar campaign, they also know quality filmmaking. As do we all.
Minorities constantly spout off about the lack of minorities in film/TV. That may be true, but the real question is why. You may cry "racism", but the fact is that minority films (generalizing here) do not make the box office money needed to consider green-lighting those projects. Some happen, sure, and some are very good. But for whatever reason (I honestly believe it's the lack of a large enough paying audience), they don't make enough money. And that's the reason they don't get made, not racism. So the minority response is to create and perpetuate something (or -things) that are obviously and distastefully racist? Hollywood producers are much more greedy than they are racist.
You minorities have outstanding, quality projects? BRING THEM. And I don't mean Tyler Perry kind of projects, I mean stuff that will stand toe-to-toe with films like the top ten nominated films this year. I'll bet you think/believe that black people "were robbed" at this year's ceremony. Let me tell you something, everyone thinks "their people" were robbed. (Chris Nolan not getting nominated for director, for example, but the film won most of its nominated awards…)
It's very, very difficult to break into Hollywood – for all races. As a producer and audience member, I want a good story. I couldn't care less what color your skin is. Bottom line is, you should quit bitching and playing the race card, and instead bring some quality projects to the table that a mass audience wants to pay to see. Otherwise, you're stuck with Tyler Perry (who makes money on ALL of his projects, btw).
And watch your tone with the name-calling. It shows how sophomoric you are. You have no idea who I am.
I have to partially agree with Ace. The issue is not in front of the camera but behind it. If there were more Tyler Perrys out there finding a way to do their thing their way, then you can more presence in front of the camera. Granted, he's not writing or producing much mainstream award bait but he's out there. He's talented actresses to work. That's key. He's providing them with some pretty meaty roles.
HOWEVER, I disagree with Ace in saying that Hollywood can't make money off of "black movies". There is an audience — and it isn't just a black one. Movie audiences either want to be entertained or they want to watch a compelling and/or enjoyable story unfold onscreen. It's simple as that. Whether they be black, white, asian, native american or indian…a compelling and/or enjoyable story is just that.
Unfortunately, much of Hollywood is of the same mindset as Ace but with more people of color (of all races) behind the scenes, things can change.
Typical redneck thinking. Keep it classy, Ace.
Which part was "redneck thinking"? The parts where you completely agree with and support two of my points just a few comments down from here?
Wow…I had no idea Sofia Vergara was African American.
N, read the last line — the award is for COLORED people, not just African-Americans.
The awards is for people of color – that could be Asian, Latino, African-American, etc.
2011 and there's still an African American only awards show and the Oscars had three African American's on stage… For as far as we've come we're a long way from where we need to be…
2011 and not only don't people get the purpose of the Image Award but still refer to it as an African-American only awards show.
And exactly how many minorities were nominated for an Oscar and how many minorities are leads on network television?
The real question to ask is how many African-Americans gave Oscar-worthy performances or even got Oscar-worthy roles in 2010?
A lot of deserving white folks got edged out of the Oscars too, like Christopher Nolan, snub city.
And there are FOUR network pilots with African-American leads which you'd know if you actually read Deadline.
I'm black and I'm tired of people moaning.
How many black people are given the opportunity?
Ace- and obviously I realize I'm responding to a lower form of intelligence, NAACP were created to combat the LACK of ethnic presence at the Oscars and other award shows. So they could do things like say ACCEPT IN FRONT OF AN AUDIENCE unlike Hattie McDaniel who won best supporting actress yet COULDNT get the award in a room full of white people & had to accept in a different place all together.
Know the history before you spew nonsense
The key word here: History. And I agree that there was a reason for creating the NAACP Image Awards back in the day. But these days… no. The point has been well made/taken, and these days everyone is welcomed in all phases of all entertainment awards.
And if the "C" of NAACP stands for all colored people, where were the Asians in the NAACP awards? Don't you think they're pissed off that they weren't "fairly represented" in the ceremony… or the nominations… or the presenters… just exactly as blacks feel about the Academy Awards? Sure, a token Latino filmmaker or actor was included, but pretty much everyone else – overwhelmingly African American. Just which colored people are we talking about here?
You see my point? It's pretty obvious.
Pull your head out of your denial and start intersecting with reality. Go through a studio's executive offices and see how many non-whites are there making decisions! 100% of the decisions in Hollywood are made by white people. Is there a single black executive with the power to greenlight a motion picture?
I'm disgusted by people like you, Ace. After a century of white filmmakers demeaning and degrading black people on screen (when they weren't ignoring our existence altogether)while white America denied it or didn't care, now you've got the gall to preach to us about how to end racism? The way to end racism is for white people to own up to their responsibility for it and stop being selfish and hateful and insecure.
You're a fool, Ace, I'm sorry to be so blunt but it is true. People like you with your thoughtless insensitiviy, willful ignorance, and heartless refusal to understand what the situation is like for non-whites in Hollywood are the major obstruction to our ability to participate in this industry in a substantive way.
We all support this industry with our boxoffice dollars and ad dollars. We should all have an equal opportunity to participate.
Just a question, you claim to be a producer who doesn't care what color someone's skin is, so how many projects do you have in which the lead or subject matter is non-white?
Zzzzzzzzz…. You can't even stir me with that diatribe. Heard it all before. You reply to my post, but you have no specific response to anything I said? Sounds more like you, personally, don't want an "equal opportunity to participate" in Hollywood, you want Affirmative Action. Your inclusion to participate isn't a payback for your contributions to movie tickets, it's based on a prospective project that will likely make money – enough upside potential to make their financial risk worth it.
You think Hollywood isn't fair to minorities? Okay, example: a friend of mine (white male) goes to Paramount to pitch his writing work to a show runner. Alas, he doesn't get the job. Since he's not black, he can't complain about not getting the gig because he's black (effectively, "playing the race card"). He didn't get the job because, perhaps, there's someone more talented than he, or with a better project than he. Ever think about that? Ever think about how competitive Hollywood is for everyone? When nobody takes my calls, I don't get to say, "it's because I'm not Jewish." That's whiny bullshit. Look, Hollywood is full of powerful white guys (mostly Jews, but who's counting) because it was started by powerful (and talented) white guys. Just like politics in America. Just like industry in America.
I'm not preaching to you on how to end racism. I'm suggesting you look at the problem from the other person's point of view. How do non-blacks perceive the NAACP awards? Do you think non-blacks perceive BET as racist? Do you even give a crap what non-blacks think? From the demeaning tone of your comment, I'd say 'no'.
Just what is your suggestion of how "white people [should] own up to their responsibility for [racism]"? (I can't wait to hear this one…)
And allow me to answer your question about powerful blacks greenlighting a project: Antoine Fuqua, Denzel Washington, Will Smith, Jada Pinkett Smith, Spike Lee… They don't have to be executives to get a project greenlit, only powerful and talented – which all of these people (and more) are. You simply choose to ignore these facts to satisfy your argument.
As to your last question, the answer is moot. No matter how I answer, you'll either call me a liar or bigot/racist. I do not have the power to greenlight any project. But if I did, it would probably be a story about a white person/people. Why? Because I'm white, and white culture is what I know best. If I tried to produce a story about black people or culture, it would ring untrue – and rightly so. That fact doesn't make me racist.
Every year, strides are made to include more women and minorities in the upper-echelons of the entertainment industry. A woman actually won Best Director last year – unheard of! But if you truly want equality in Hollywood, propping up an archaic (and, perhaps, offensive) symbol of "the way it was" isn't going to help your case today, nor heading into the future. You wanna play with the big boys? Then toughen up, quit bitching and do your very best work – just like everyone else.
It kinds annoys me when people rick are saying that was only 3 African minorities on stage at the oscars. No offense but exactly how many minorities are a list? Yeah like 3. It's not really racist. Just Hollywood
Hollywood has a system of racism and exclusion. It IS really Hollywood. Just Racist!
Thanks for the clarification, but I hope you don't walk around saying "COLORED people" in your daily life.
N, sometimes I do. And what do you think the "C" in NAACP stands for?
the NAACP stands for the National Association for the Advancement of Colored People. it was created during a time when we were called "colored people". but the good thing about that term is that it includes ALL people of color. whether they be Latin, Asian, Native American etc.
I love the NAACP Image Awards and believe they are a vibrant and important honor for our industry, regardless of one's skin color.
That said, I do wish the awards were more encompassing of all of the diversity (including Asians, Native Americans, Latinos/Chicanos) who make a vital contribution to Hollywood. Sometimes I get frustrated when the NAACP, in its social advocacy role, only speaks up when it comes to black-affected issues, seeing has how they could be more relevant and powerful by speaking out when it comes to injustice as it affects anyone of any race, gender or creed.
The same logic, by extension, could apply to its doling out of these awards. Broaden the criteria and broaden those who are eligible for it. That can only serve to raise the stature and relevance of the NAACP in terms of these Hollywood awards. (And in other realms a similarly applied way of thinking could also elevate the NAACP's broader social justice mandate in 2011 and beyond. )
Just my two cents.
Idris Elba, yeahhhhhh!!!!
Really? How so? The NAACP awards has honored people of different races. Sofia Vergara, who is a white Latina, won this year in an acting category. Past recipient for awards have been white.
Did you look at who the president of the NAACP is?
Amazingly, people like you can't seem to get it through your head that award shows like the ALMA Awards, which honors Latin performers, the Asian Excellence Awards, and the NAACP Image Awards are designed to recognize people of color because they are often not given recognition for their efforts.
I wonder when St. Patrick's Day, which honors the Irish, rolls around do you protest?
I wonder what kind of flack it would cause if there was award called THE GREAT WHITE ACHIEVEMENT AWARD? Now that would be a CHARLIE SHEEN IE: train wreck for sure.
Ace is a producer? Wow, sounds like a bored assistant, intern or mailroom clerk. Who cares who you are. If you were of any importance you wouldn't have time to participate in a battle of words on here! Go back to school because I doubt that you are producing anything noteworthy. I work for an A-list producer and no way would he, a CE, or DoD have time to do what you have done. If we were all treated equally then there would not be a need for these organizations. But we are not, so get over it. I LOVE THE NAACP IMAGE AWARDS!!!!!!!!
Comments are closed.


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Samuel W. Patterson, 87, Hollidaysburg, died Saturday in Frederick, Md.
He was born in Alexandria, son of the late Samuel and Mary Catherine (Winters) Patterson. He married D. Eleanor Berkheimer on Dec. 31, 1946, in Alexandria, and she died in 2010.
Surviving are two daughters: Donna Jean Meyers and husband, Thomas, in South Carolina and Donna Kay Hammel in Maryland; seven grandchildren; six great-grandchildren; two sisters: Shirley Brooks of Altoona and Jean Myers of Alexandria; and two brothers: William and James, both of Alexandria.
Article Photos
He was preceded in death by an infant granddaughter, Stacey Ann Myers; and a son-in-law, Roy Hammel, in 2008.
Samuel was a 1943 graduate of Alexandria High School. He was a U.S. Navy veteran of WWII and retired from SKF, Altoona. He was a member of Zion Lutheran Church and a former member of the Chimrock Squares dance group.
Samuel enjoyed woodworking, farming and hunting.
Friends will be received from 1 until the 3 p.m. funeral service Wednesday, Oct. 10, 2012, at Sorge Funeral Home Inc., Hollidaysburg. Interment will be at Blair Memorial Park.
Memorials may be made to the American Heart Association.

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text:
by Mike Masnick
Tue, Nov 14th 2006 7:06pm
Remember the rumor, kicked off by Mark Cuban, that Google was holding back $500 million from YouTube in escrow to deal with potential copyright infringement lawsuits? Yes, the same claim that Google CEO Eric Schmidt clearly denied was true last week. Well, it seems that when he called it false, it appears he only meant the number, not the concept. Today it came out that Google has actually put aside a little over $200 million in an escrow account, almost exactly as the original email Mark Cuban posted described. It's to handle potential legal costs associated with copyright lawsuits. While it's not nearly as much of the deal as originally suggested, it still is a significant chunk. There's a second interesting tidbit in the article as well. While some had suggested that YouTube actually has been profitable, apparently, the company was so hard up for money, it needed to borrow $15 million between the time the deal was announced just over a month ago and its closing of the deal yesterday.
If you liked this post, you may also be interested in...
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- House Intel Committee Says Snowden's Not A Whistleblower, 'Cause He Once Emailed His Boss's Boss
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Reader Comments (rss)
(Flattened / Threaded)
Mark Fletcher, Nov 14th, 2006 @ 7:42pm
Escrow in acquisitionsIn my experience, it's common place for a percentage of the acquisition price to be held in escrow for a period of time after the close. For both acquisitions I was a part of, the escrow amount was 10% of the acquisition price, held for a year. If I'm doing my math correctly, $200M is around 12% of the acquisition price, which seems somewhat ordinary.
mark, Nov 14th, 2006 @ 7:44pm
And?Why is this not responsible for goog? Sounds like a solid idea from my point of view.
Re: And?Why is this not responsible for goog? Sounds like a solid idea from my point of view.
Not saying it's not responsible. Just noting that it was denied, and then done anyway.
B, Nov 14th, 2006 @ 8:10pm
PriceyI can't imagine a website like YouTube could be very cheap to run at all. All that storage pace, bandwidth and I believe the software that converts a multitude of video types to flv (the flash video type) costs a hefty sum, unless they programmed it themselves of course.
I guess ads on YouTube could rake in alot of money...
Rico J. Halo, Nov 14th, 2006 @ 8:20pm
from a peons point of viewIt's nice work if you can get it. The rest of us just go day to day earning enough to pay for a hosting service for our blog, DSL for home and a 15 year old sports car for the weekends. Congrats! ~RJH http://www.thatpoliticalblog.com
Alex Austin (profile), Nov 14th, 2006 @ 9:20pmAbout software to convert multiple formats to flv, ffmpeg works pretty well for me. Besides, Google Video does that anyway.
Devin, Nov 15th, 2006 @ 1:22am
Re:ffmpeg doesn't convert several formats with proprietary codecs.
Rob Hyndman, Nov 15th, 2006 @ 3:40am
What he saidMark is right. The holdback is very plain vanilla.
The new about YouTube being cash flow negative is interesting, though. In the weeks leading up to the sale lots of folks in the 'sphere made much hay out of a suggestion that it was cash flow positive.
Plus ca change ....
Michael Long, Nov 15th, 2006 @ 4:56am
PublicAlmost wish the actual amount hadn't been made public though. Nothing like knowing $200 million dollars is out there just waiting to be had to bring in the sharks, each and every one hoping to tear off a chunk...
phreaki, Nov 17th, 2006 @ 6:25pm
Re: PublicOh yeah, they'll be circling the 200M like the piece of flesh that it is.
Then again, if Mark Cuban knew about it the sharks have been circling around for months. It's always good when the wrong amount of money is circulated so that people know where the leaks come from.
Making Sense of the Youtube Acquisition, Nov 17th, 2006 @ 6:23pm
Cash strapped but still worth 1.65B?If Youtube was struggling for cash why would Google pay 1.65B? They could have negotiated their way to a much smaller sum, couldn't they? When you are desperate for cash you can still sell yourself for $1.65B? Its doesn't add up.
There was an article in the Mercury http://www.mercurynews.com/mld/mercurynews/business/15919012.htm
where the folks at Fox said that they were not approached by Youtube for a possible acquisition. If you are cash strapped wouldn't you approach all and sundry for a purchase?
The Youtube acquisition was a BIG thank you from the Google guys to Sequoia?
Fixed, Nov 19th, 2006 @ 8:04pm
Agree with post 10 above...Somone please look in the Sequoia Capital guys. I have a feeling they where behind this deal from start to finish. What any easy way to get more Google stock at steap discount...Google shareholders wont complain either.
Dempsey, Nov 19th, 2006 @ 10:56pm
I know nothing about M&A but,Isn't $1.65 billion in stock options not actually "paying" anything. No cash is exchanged (and aren't there restrictions on YT creators on cashing in?) If the 2.0 bubble bursts in the next year, this purchase will get cheaper. Correct?
John, Nov 20th, 2006 @ 2:17am
I know nothing either, but..If there is a bubble and you have overinflated stock but also profits, you would want to use this (your stock) to make acquisitions. Ideally the acquisition target is also over priced and hopefully worthless. Then when the stock market crashes you can "write off" the acquisition and set it against your huge tax bill. So you can pay your (cash) tax bill with last years overinflated stock.
chris, May 21st, 2007 @ 6:30pm
trade googlea 4th grader can trade google. Learn flags and pennants. Here is last weeks google chart with technical analysis.
I trade goog once per day. 70% of the time i am right.
Happy trading.
Bob, Dec 19th, 2007 @ 6:51pm


text:
Dean Epps, during the takeover, the students were given a lot of notoriety, a lot of press, I mean, and the administration and the faculty wasn't looked at too well. What was your reaction to what was going on?
Well, I, as one viewed the entire process the strike as a process it becomes rather disconcerting to a faculty member because of what's happening. The, the press, as you know, seems to enjoy the--
You can't say that.
When one looks at the, the strike as a process, ah, it becomes rather disconcerting for a faculty member or for a member of the administration because the press, it seems, ah, enjoy the confrontation and have no interest in seeing it resolved. The, the students of course are there they are absolutely confident about their own positions, ah, they are, they want immediate solutions. They, they, they're not, ah, ah, amenable to a resolution over a period of time. They want it done immediately. And if you take someone who's 20 years-old who is, ah, who has a television camera on him every evening at 6 o'clock and has a microphone in front of his mouth and there's a reporter standing there writing down every word, they become very difficult to, ah, to negotiate with. And therefore you have these non-negotiable demands emerging. And, ah, I'm sure they get a great deal of satisfaction out of seeing themselves on, on the press. The faculty and administration have to be restrained under those same circumstances. And in fact they have difficulty getting their message over to the media because the media is interested in what the students have to say. So, I, I think that on balance the, the faculty and the administration are at a disadvantage always in these kind of situations because the press regards the student as the, as the hot item of news. And that was true in this, in 1968 in this situation too.


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This article was published online first at www.annals.org on 17 June 2014.
From Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs or the U.S. government.
Acknowledgment: The authors thank Dr. Mark Helfand for providing comments on an earlier draft of this manuscript.
Financial Support: By the U.S. Department of Veterans Affairs, Veterans Health Administration (VHA) Project ESP 05-225.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0558.
Requests for Single Reprints: Devan Kansagara, MD, MCR, Portland Veterans Affairs Medical Center, Mailcode RD71, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239; e-mail, firstname.lastname@example.com.
Current Author Addresses: Dr. Kansagara, Ms. Freeman, and Ms. Relevo: Portland Veterans Affairs Medical Center, Mailcode RD71, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239.
Dr. Papak: Department of Medicine, Portland Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239.
Dr. Pasha: Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, PV350, Portland, OR 97239.
Dr. O'Neil: Portland Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road (R&D 66), Portland, OR 97239.
Dr. Quiñones: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode CB669, Portland, OR 97239.
Ms. Motu'apuaka: Oregon Evidence-based Practice Center, 325 SE 162nd Avenue, Portland, OR 97233.
Dr. Jou: Department of Medicine, Portland Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road, P3-GI, Portland, OR 97239.
Author Contributions: Conception and design: D. Kansagara, J. Papak, M. O'Neil, J.H. Jou.
Analysis and interpretation of the data: D. Kansagara, J. Papak, A.S. Pasha, M. O'Neil, M. Freeman, R. Relevo, J.H. Jou.
Drafting of the article: D. Kansagara, A.S. Pasha, M. O'Neil, M. Freeman, J.H. Jou.
Critical revision of the article for important intellectual content: D. Kansagara, J. Papak, M. O'Neil, M. Freeman, A. Quiñones, M. Motu'apuaka, J.H. Jou.
Final approval of the article: D. Kansagara, M. O'Neil, A. Quiñones, M. Motu'apuaka, J.H. Jou.
Provision of study materials or patients: M. Freeman.
Obtaining of funding: D. Kansagara.
Administrative, technical, or logistic support: J. Papak, M. Freeman, R. Relevo, A. Quiñones, M. Motu'apuaka.
Collection and assembly of data: D. Kansagara, J. Papak, A.S. Pasha, M. Freeman, R. Relevo, A. Quiñones, M. Motu'apuaka, J.H. Jou.
Background: Guidelines recommend routine screening for hepatocellular carcinoma (HCC) in high-risk patients, but the strength of evidence supporting these recommendations is unclear.
Purpose: To review the benefits and harms of HCC screening in patients with chronic liver disease.
Data Sources: MEDLINE, PsycINFO, and ClinicalTrials.gov from inception to April 2014; Cochrane databases to June 2013; reference lists; and technical advisors.
Study Selection: English-language trials and observational studies comparing screening versus no screening, studies of harms, and trials comparing different screening intervals.
Data Extraction: Mortality and adverse events were the outcomes of interest. Individual-study quality and the overall strength of evidence were dual-reviewed using published criteria.
Data Synthesis: Of 13 801 citations, 22 studies met inclusion criteria. The overall strength of evidence on the effects of screening was very low. One large trial of patients with hepatitis B found decreased HCC mortality with periodic ultrasonographic screening (rate ratio, 0.63 [95% CI, 0.41 to 0.98]), but the study was limited by methodological flaws. Another trial in patients with hepatitis B found no survival benefit with periodic α-fetoprotein screening. In 18 observational studies, screened patients had earlier-stage HCC than clinically diagnosed patients, but lead- and length-time biases confounded the effects on mortality. Two trials found no survival differences between shorter (3- to 4-month) and longer (6- to 12-month) screening intervals. Harms of screening were not well-studied.
Limitations: Only English-language studies were included. The evidence base is limited by methodological issues and a paucity of trials.
Conclusion: There is very-low-strength evidence about the effects of HCC screening on mortality in patients with chronic liver disease. Screening tests can identify early-stage HCC, but whether systematic screening leads to a survival advantage over clinical diagnosis is uncertain.
Primary Funding Source: U.S. Department of Veterans Affairs Quality Enhancement Research Initiative.
Hepatocellular carcinoma (HCC) incidence and mortality have increased internationally over the past 4 decades (1–2), with localized tumors accounting for most of the increase (3). The rationale for screening is that imaging tests, such as ultrasonography, may identify patients with early-stage HCC (4), and several potential options exist for treating patients with early-stage HCC, including liver transplantation, radiofrequency ablation, and liver resection (5). Several professional societies currently recommend HCC screening using imaging studies and tumor markers, primarily in patients at higher risk for HCC due to chronic hepatitis B or cirrhosis (5–7). However, recommendations for HCC screening remain controversial, in part because of concerns over the quality and paucity of existing evidence and because concerns about overdiagnosis and patient harms have been raised in other cancer screening programs (8–12).
We conducted a systematic review of the published literature to better understand the incremental benefits and harms of routine HCC screening compared with clinical diagnosis.
This manuscript is part of a larger report commissioned by the Veterans Health Administration (13). A protocol describing the review plan was posted to a public Web site before the study was initiated (14). The analytic framework that guided this review was developed in collaboration with a panel of technical experts and is provided in Figure 1 of Supplement 1.
We searched MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from database inception to June 2013. We updated the MEDLINE, PsycINFO, and ClinicalTrials.gov searches in April 2014. The detailed search strategy is provided in Supplement 2. We obtained additional articles from systematic reviews, reference lists of pertinent studies, reviews, and editorials and by consulting technical advisors.
Detailed inclusion and exclusion criteria are provided in Supplement 3. We included English-language, controlled clinical trials and observational studies that assessed the effects of screening on HCC-specific and all-cause mortality in adult populations. We used the term "screening" to include any surveillance or screening program in which specific tests (ultrasonography, computed tomography, magnetic resonance imaging, or α-fetoprotein measurement) were performed explicitly to detect HCC in asymptomatic patients. Studies had to include a comparison group of patients who did not have routine screening. We excluded observational studies that did not consider important confounding factors, such as age, sex, and liver disease severity. Because we anticipated few clinical trials comparing screening versus no screening, we also included trials comparing frequencies of screening. We included studies of any population with chronic liver disease with or without cirrhosis but excluded studies of patients with prior HCC. We also searched for systematic reviews and primary studies that focused on potential harms of HCC screening.
Seven investigators reviewed the titles and abstracts of citations identified from literature searches. If at least 1 reviewer indicated that a citation may be relevant, a second reviewer screened the citation for concordance. Two reviewers independently assessed the full-text articles for inclusion using the eligibility criteria in Supplement 3. Disagreements were resolved through consensus.
From each study, we abstracted study design, objectives, setting, population characteristics (including sex, age, race or ethnicity, and liver disease cause and severity), patient eligibility and exclusion criteria, number of patients, years of enrollment, method and frequency of screening, adjusted and unadjusted mortality, and adverse events. A second author checked each entry for accuracy.
Two reviewers independently assessed the quality of each trial by using a tool developed by the Cochrane Collaboration (15). We resolved disagreements through discussion. Each trial was given an overall summary assessment of low, high, or unclear risk of bias. Two reviewers graded the strength of evidence for outcomes by using published criteria that consider the consistency, coherence, directness, and applicability of a body of evidence as well as the internal validity of individual studies (16).
We adapted existing tools to assess the quality of observational studies (17–19). We do not report an overall summary assessment for observational studies because there are no validated criteria for doing so.
We qualitatively synthesized the evidence on the benefits and harms of HCC screening. Clinical heterogeneity and the small number of trials precluded a meta-analysis of the findings.
The U.S. Department of Veterans Affairs Quality Enhancement Research Initiative supported this review but had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
The electronic and manual searches yielded 13 801 total citations, from which we identified 286 potentially relevant full-text articles. Twenty-two primary studies contained primary data relevant to the efficacy of HCC screening and met our inclusion criteria (Figure).
Summary of evidence search and selection.
RCT = randomized, controlled trial.
Two trials and 18 observational studies provided very-low-strength evidence from which to draw conclusions about the mortality effects of HCC screening compared with no screening. The trials had substantial methodological flaws that threatened their internal validity, and their findings have limited applicability beyond the patient population with hepatitis B. The observational studies, most of which included patients with cirrhosis and hepatitis B, hepatitis C, or alcoholic liver disease, showed that screening detects patients with earlier-stage disease, who more frequently receive curative therapy. However, it is impossible to say whether the longer survival in patients with screen-detected disease was a true effect of screening or reflects lead- and length-time biases inherent to all observational studies, as well as selection biases that were common in many of the studies.
Two community-based trials compared the effects on mortality of screening versus no screening (20–21). Both were conducted in China in areas with high prevalence of HCC, and most participants had hepatitis B with or without cirrhosis (Table 1 of Supplement 4). One cluster randomized trial recruited screening group participants (n = 9757) from 1993 to 1995 and offered them serum α-fetoprotein testing and ultrasonography every 6 months. Participants in the control group (n = 9443) were not made aware of the study nor actively followed. Death from HCC occurred less frequently in the screening group (83.2 vs. 131.5 per 100 000 person-years; rate ratio, 0.63 [95% CI, 0.41 to 0.98]).
However, the trial had several serious methodological limitations that gave it a high risk of bias (Table 2 of Supplement 4). One major concern is whether patients in both groups had the same risk for HCC. There is no information about randomization technique or allocation concealment and very little information about the baseline characteristics of the 2 groups, which is especially important in cluster randomized trials. Another concern is that weak methods used to ascertain the outcome measure—death from HCC—could have introduced bias. If deaths were underreported in the control group, results could have been biased toward the null. On the other hand, if outcome adjudicators were not blinded, more deaths in the control group could have been misclassified as HCC-related, especially because the symptoms that define stage III HCC (cachexia, jaundice, and ascites) overlap substantially with symptoms of end-stage liver disease and no data were provided about liver disease severity in either group. Selective reporting and analysis of favorable outcomes were other concerns. Although the authors reported that vital status was available for all patients, overall mortality was not reported and there was no statistical adjustment for the effects of clustering. Finally, the study is less applicable to patients in the United States, in whom cirrhosis and thus HCC are usually secondary to hepatitis C, and the results probably have limited applicability to contemporary practice, in which the threshold for imaging for symptoms may be lower and the number of patients with incidentally discovered HCC on imaging is higher.
The second trial used patient-level randomization stratified by township to assign patients with hepatitis B from 1989 to 1992 to the screening intervention (n = 3712), which consisted of serial α-fetoprotein tests followed by ultrasonography for high α-fetoprotein values, or the usual care group (n = 1869) (21). The population-based cancer registry used active case-finding techniques, and mortality was ascertained through the cancer registry and a population-based vital status registry. Cancer staging and cause of death were assessed by personnel blinded to intervention status. Only 28.8% of screening group participants completed all scheduled testing, but all participants completed at least 1 screening test. Fewer patients had stage III HCC in the screening group (19.8% vs. 41.0%; P value not reported). Hepatocellular carcinoma mortality was similar in both groups (1138 vs. 1114 per 100 000 person-years; P = 0.86), as was all-cause mortality (1843 vs. 1788 per 100 000 person-years; P value not significant). This trial had an unclear risk of bias because of poor reporting of randomization and allocation concealment techniques.
Two additional trials compared ultrasonography screening intervals (22–23). One recent community-based cluster randomized trial in Taiwan compared 4- versus 12-month ultrasonography screening intervals in patients with serologic evidence of hepatitis B or C (22). Although more patients with HCC in the 4-month interval group had very-early-stage disease (37.5% vs. 6.7%; P = 0.017), the 1-, 2-, and 4-year survival rates among patients with HCC were similar (95% vs. 80%, 78.8% vs. 64%, and 57.4% vs. 56%, respectively; P = 0.40). The study had an unclear risk of bias because of poor reporting of outcome assessment and statistical analyses.
A trial with low risk of bias compared 3- versus 6-month ultrasonography screening intervals in 1278 patients with cirrhosis from alcohol use or viral hepatitis and found similar all-cause mortality rates in both groups (11.3% vs. 12.1%; P = 0.38) (23). A similar number of patients were diagnosed with HCC in both groups (8.3% vs. 11.0%; P = 0.13), and most met Milan criteria (79.2% vs. 71.4%; P = 0.40).
Eighteen observational studies compared survival in patients with screen-detected HCC versus those with HCC diagnosed incidentally as part of another work-up or because of symptoms (Table 3 of Supplement 4) (24–41). The studies represented a range of geographic settings, including Asia (6 studies), Europe (6 studies), Australia (1 study), and the United States (5 studies). Most patients included in these studies had hepatitis B or C with Child–Pugh class A or B cirrhosis, although patients in the nonscreening groups had more severe liver disease in many of the studies. Ultrasonography with or without α-fetoprotein measurement was the screening method used in nearly all studies, except for 2 U.S. studies in which a small number of patients had computed tomography (26, 31).
In general, patients who had undergone screening had earlier-stage HCC than those who had HCC diagnosed incidentally or due to symptoms; in 12 studies, 60.0% to 100% of screened patients versus 19.6% to 56.5% of nonscreened patients met the equivalent of Milan criteria. More screened patients received potentially curative treatment, although only a small proportion had hepatic resection (range, 2.8% to 23.9% in 14 studies [24, 26, 28–31, 33–38, 40–41]; 53.5% in 1 outlier study [39]) or liver transplantation (range, 1% to 15% in 5 studies [28, 31–32, 36, 38, 41]; 23% and 30.1% in 2 other studies [24, 35, 40]).
Survival from the time of HCC diagnosis was generally higher among screened than nonscreened patients (Figure 2 of Supplement 1). However, several methodological considerations temper the confidence with which one can draw conclusions from this body of observational literature (Table 4 of Supplement 4). Most of the studies were single-center retrospective cohort studies in which all patients with diagnosed HCC were first identified and screening status was subsequently determined. Few studies reported data on loss to follow-up, and many did not report using a comprehensive method to assess mortality outcomes equally in screening and nonscreening groups. Only 4 of the studies reported objective and replicable methods for distinguishing screened from nonscreened patients (26–27, 31, 41). Furthermore, selection bias is a concern for all but 3 of the studies (26–27, 31). In most studies, the comparison group was drawn from a referral population and unmeasured patient, treatment, health care access, and other factors probably differed between groups.
In addition to the methodological issues specific to individual studies, the potential for length- and lead-time biases is inherent in any observational study of screening effects (42). Although there is no infallible way to circumvent the threat of lead-time bias other than to conduct a well-designed randomized, controlled trial, 5 studies used statistical techniques to adjust for lead-time bias (27, 33, 35, 38, 41). These studies used various assumptions about tumor doubling time to estimate the lead time of screening diagnosis. Three of the studies adjusted for lead time and found that the survival advantage for screened patients disappeared when the tumor doubling time was assumed to be 90 to 120 days or longer (Table 3 of Supplement 4) (27, 33, 38). A fourth study used serial ultrasonographic data from 13 patients to estimate a tumor doubling time of 216 days, although survival among screened patients remained higher even after adjustment for lead time (35). Finally, in a large multisite Italian cohort comparing patients with screen-detected versus symptomatically detected HCC (patients with incidental diagnoses were excluded), adjustment for lead time based on probabilistic estimates of tumor doubling time attenuated survival effects seen over 3 years but not over longer follow-up (41).
None of the included studies reported direct harms of screening, and no studies examined the psychological effects of screening.
Patients with positive screening results from ultrasonography or α-fetoprotein testing usually have further confirmatory testing. In most of the studies, confirmatory testing was done with computed tomography and, less commonly, with magnetic resonance imaging or liver biopsy, although few studies reported rates of actual testing used for diagnosis. One meta-analysis of 8 studies found the risk for needle-track seeding from liver biopsy for suspected HCC to be 2.7% (43). One recent systematic review of the diagnostic accuracy of imaging for HCC screening and diagnosis found few studies reporting harms data: One study found that contrast-enhanced computed tomography was associated with adverse events in 13% to 15% of patients, and another found mild to moderate adverse events in 25% of patients receiving gadoxetic acid–enhanced magnetic resonance imaging (44).
We systematically reviewed and critically appraised trials and observational studies examining the risks and benefits of HCC screening in patients with chronic liver disease. Periodic ultrasonography and α-fetoprotein testing have been the most commonly evaluated screening methods, and patients with viral hepatitis have been the most frequently studied population. Although screening identifies patients with early-stage HCC and some of these patients do well with curative therapy, there is very-low-strength evidence from which to draw conclusions about the balance of benefits and harms of screening for HCC (Table 1).
The body of evidence on which current recommendations for screening are based has substantial shortcomings. The large-scale trial conducted among hepatitis B–infected patients in China has serious methodological limitations that undermine the validity of its findings (5–7). The only other trial found that serial α-fetoprotein screening offered no survival advantage. The applicability of these studies to the United States, moreover, is limited because of more widespread imaging use, higher rates of incidental diagnosis, and a smaller proportion of patients whose primary risk is hepatitis B.
Although numerous, observational studies do not contribute substantially to the strength of evidence. Most studies included patients with viral hepatitis and cirrhosis and found that patients with screen-detected HCC were more likely to have earlier-stage disease and survived longer from the time of diagnosis. However, most were single-center studies that retrospectively evaluated patients with HCC and had lead- and length-time biases in addition to other design limitations.
Screening programs have the intended effect of identifying patients with early-stage disease, more of whom undergo such potentially curative therapies as liver transplant or partial hepatic resection. Some cohort studies suggest that long-term survival of patients who have liver resection or transplantation for HCC can be high (40% to 70% for resection and 52% to 81% for transplant patients after 5 years [45]), although perioperative morbidity and mortality may be substantial (46). In contrast, a large prospective screening study in patients with viral hepatitis found that 5- and 10-year survival was low (28% and 4%, respectively) among those who developed HCC and received curative treatment (47).
The natural history of early-stage or screen-detected HCC has not been well-characterized, and tumor growth patterns can differ markedly among patients, with some showing steady growth, others showing no growth followed by a period of rapid growth, and others with little or no long-term growth (48–51). The net balance of benefits and harms might favor widespread screening if much of the HCC found as a result of routine screening were to progress and cause morbidity before patients' underlying illness did. On the other hand, if screen-detected HCC were more indolent, the risks of treating disease that would not have otherwise been clinically relevant (that is, overdiagnosed HCC) might tip the balance away from routine screening. Unfortunately, we found no evidence examining rates of overdiagnosis.
Several studies suggest that HCC may have variable rates of progression. In 1 trial comparing screening intervals, long-term survival was similar even though more patients undergoing frequent screening had small, early-stage HCC and received potentially curative therapy compared with patients assigned to a less intensive screening program (22). A recent study found that the length of the waiting period for transplantation results in selection of patients with more indolent HCC because those with more aggressive disease lose candidacy while awaiting a transplant (52). Another study of a mixed sample of patients with early- and late-stage disease who were randomly assigned to no treatment in 2 trials found 2 different survival patterns depending on the presence of an invasive tumor pattern and poor performance status (3-year survival of 8% vs. 50%; P = 0.0001) (53).
We searched for systematic reviews through April 2014 and found several that examined HCC screening studies. A recent review of observational studies found that HCC screening was associated with detection of earlier-stage HCC and improved survival (54). A Cochrane review found insufficient evidence for screening but focused only on studies of patients with hepatitis B and did not examine observational studies (11). Several widely disseminated guidelines recommend HCC screening in high-risk patients with liver disease (5–7), but none used a systematic review that critically appraised included studies as a basis for the recommendations. Finally, a systematic review of cost-effectiveness modeling studies, most of which were based on assumptions from the literature, concluded that periodic surveillance with ultrasonography was probably cost-effective when the annual incidence of HCC was higher than 1.5%, although annual surveillance may be more cost-effective than semiannual surveillance in populations with annual HCC risk of 1.5% to 3.5% (55). The only modeling study using data from a prospective cohort found that surveillance was probably not cost-effective (24).
Our findings neither support nor refute current clinical policy recommendations for HCC screening. Transparency about the strength of the evidence on which these recommendations are based is important, but policy recommendations also take into account other factors, such as clinical experience, patient values and preferences, and cost considerations, especially when empirical evidence with which to judge the balance of benefits and harms is limited (56). If screening is pursued, it will be important to implement programs in ways that minimize potential harms, especially given the limited empirical evidence of benefit. For example, targeting screening to higher-risk individuals with less severe underlying liver disease and developing a better understanding of how to target invasive treatment to those with more aggressive screen-detected tumors might help to increase the detectable benefits of screening while limiting the population exposed to potential harms.
Although a large, well-conducted, randomized, controlled trial would be the most definitive way of establishing the effectiveness of HCC screening, many experts have invoked several potential barriers, including provider and patient willingness to participate, contamination, cost, and the possibility that a screening trial currently enrolling patients will be rendered obsolete in 10 to 20 years by the rapidly evolving viral hepatitis treatment armamentarium (12). Regardless of the feasibility of a randomized, controlled trial of screening, there are many opportunities for further study and, given the current insufficient body of evidence, future studies will probably help clarify the balance of benefits and harms of screening. The key evidence gaps and suggestions for corresponding future research opportunities are summarized in Table 2.
One limitation of our review was the exclusion of non–English-language articles. However, we mitigated the risk of missing relevant studies by searching multiple databases, bibliographies, and trial registries and by consulting experts. Moreover, evidence suggests that language restrictions do not bias results of reviews of conventional therapies (57).
In conclusion, there is very-low-strength evidence from which to draw conclusions about the effects of HCC screening on mortality in high-risk patients with chronic liver disease. Screening can identify more patients with earlier-stage disease who are candidates for potentially curative treatments, but there is limited evidence from which to draw firm conclusions about the balance of health outcome benefits and harms of using routine screening to identify HCC.
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text:
In the market, most of my fellow citizens are my civic friends, part of a great cooperative scheme. One of the vile and repugnant features of democracy is that it transforms these people–people who should be my civic friends–into my civic enemies.
Today most Americans will do something morally rotten–they will vote, despite being misinformed, uninformed, and irrational about politics. As a result, innocent people around the world, including my children and me, will have to suffer the consequences of bad government. As I say in the introduction to my "The Right to a Competent Electorate":
Many of my fellow citizens are incompetent, ignorant, irrational, and morally unreasonable about politics. Despite that, they hold political power over me. These can staff offices of great power and wield the coercive authority of the state against me. They can force me to do things I do not wish to do, or have no good reason to do.
As an innocent person, I should not have to tolerate that. Just as it would be wrong to force me to go under the knife of an incompetent surgeon, or to sail with an incompetent ship captain, it is wrong to force me to submit to the decisions of incompetent voters. People who exercise power over me—including other voters—should have to do so in a competent and morally reasonable way. […]Or so I will argue.
The problem here isn't that people disagree. On many matters, reasonable people will disagree. My theory of voting ethics doesn't require that you get the correct answer, but rather than you be epistemically justified in voting for what you vote for. From "Polluting the Polls":
As a first pass, we might say bad voting occurs when citizens vote for harmful or unjust policies or for candidates likely to enact harmful or unjust policies. However, this seems too strong. One might vote for what is in fact a harmful policy but be justified in doing so. For instance, imagine that the past two hundred years, thousands of independent political scientists, each of whom exhibits all the characteristic epistemic virtues, have amassed overwhelming evidence that a particular policy will be good. Yet, sometimes the best evidence is misleading–it points in the wrong direction. The policy might still end up being harmful, though everyone was justified in thinking it would be beneficial We shouldn't characterize people who vote on the basis of strong evidence as having voted badly.
No, the problem with my fellow citizens isn't so much what they vote for by why they vote. The overwhelming majority of them haven't put in the proper care to develop their political beliefs in a rational way, on the basis of the best available evidence. They are like drunk drivers who force me to drive with them. They are like incompetent surgeons who force me to go under their knives. They are like jurors trying a capital murder case, who find the defendant guilty without having paid attention to the evidence, or because they evaluated the evidence in a bigoted or irrational way.
Those who exercise power over others have a moral duty to do so competently and in good faith. The overwhelming majority of my fellow citizens will violate this duty today. This makes them my enemies, when they should have been my friends.
The problem with a few hundred people ruling hundreds of millions of other people through an authoritarian, hierarchical bureaucracy is that a few hundred people rule hundreds of millions of others through an authoritarian, hierarchical bureaucracy. Any rules determining how the few hundred become the few hundred are irrelevant, so the competence of voters is also irrelevant.
A few hundred Einsteins with the best of intentions would still be selfishly parasitic if not tyrannical, because with all of their intellect and good will, they can't possibly know enough to rule hundreds of millions of people. A person can only rule with the knowledge in his own head, and even with all the 21st information technology he can buy, a single man's senses have very limited reach, and his head has very limited capacity.
Jason Brennan
I don't advocate total rule by 300 people, though. More like the top 5% of voters.
If the top 5% (however they're determined) somehow enact rules governing all 300 million, you still have the same problem. How can these rules account for the specific circumstances to all of the ruled?
All politics is local.
Robert Gressis
I could be wrong, but if the top 5% of voters ruled us, wouldn't we be socialist? Maybe I don't know what you mean by top 5%.
indeed a very sad day…but it is not the people who are our enemies but the general ignorance still prevailing in this country ( and worldwide, besides Iceland maybe)…the press has done a sublime job of suppressing and distorting information to the general public. Our media does not encourage people to think but rather numbs them down….and as we libertarians all know by now, our mainstream media is owned by the 6 major corporations who are also running our government….we didn't manage to break the vicious cycle this time, but we have definitely put a dent in it….thank you for this heart felt article
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j r
I am slowly coming around to this way of thinking, which I at first dismissed out of hand. It does, however, remain an argument that needs to be made with a certain amount of nuance. In other words, the more forcefully you make it, the more likely it is to come apart. Here is what I mean.
Democracy tends to work best when people are informed. With this, I absolutely agree. Normative beliefs aside, a good citizen is one who works to enhance his ability to make and to understand positive political and economic arguments. For instance, knowing the relationship between tax rates and government revenue and economic growth is good, aside from whatever opinion you hold on whether taxes should be high or low. I want low taxes, but I'd rather live in a place where most people understood the economics and had split views on taxation than in a place where most people shared my views, but had no understanding of the economics. (Here, as an aside I will say that this is my personal preference. It's not clear that this would be a universal preference.)
At the same time, democracy is based on the idea of universal enfranchisement. That is, all human beings have the right to self-government, not just the wise, fair, knowledgeable and selfless. In other words, all those who are "incompetent, ignorant, irrational, and morally unreasonable about politics" have just as much right to suffrage as you do. To deny them that, would be, for lack of a better word, undemocratic.
So, there is your tension. Democracy is best when exercised by those who are best at exercising it. Putting aside the circularity if that statement for a second, it raises a more important question: why support democracy at all? Why support universal enfranchisement if you're starting from a position wherein universal enfranchisement is an obviously inferior form of organizing a society?
This tension is manageable so long as your desire for a certain kind of electorate remains at the aspirational level. That is, so long as you posit it as something along the lines of 'democracy is great, but would be better if more voters would educate themselves.' It seems like you want to go much further, however, and characterize the present situation as something akin to oppression by a mob of dullards. If you really believe that, again, why democracy? Why not just go straight to oligarchy or anarchy?
Sean II
After giving it much careful thought (get it?), I find that Brennan's epistemic justification principle doesn't hold up very well.
To build on one of his own analogies, no one would ever say: "Dr. Franchise is not an effective surgeon. Patients are about as likely to die under his knife as they are to die untreated. But he studied really hard through many years of medical school, and he adheres to an internally consistent, elegant philosophy of disease. He is not correct in his clinical decisions, and it would be too much to demand that from him. But we should all take comfort in knowing that he is epistemically justified."
If someone votes for a bad guy, who goes on to enact bad policies, why should it matter how cleverly he can argue on behalf of his mistakes? Why should I forget, on that basis, that they are mistakes?
Imagine a three person electorate, including Mr. Brennan, Mr. Neocon, and Mr. Progresso.
Mr. Brennan votes not to bomb Iran. Mr. Neocon votes to bomb Iran, for some vague reason having to do with "national greatness", and quite possibly because he just doesn't like muslims very much. Mr. Progresso ALSO votes to bomb Iran, but he does so thanks to a subtle understanding of history, a passionate desire to avert another anti-semitic holocaust, and some pragmatic, complex arguments having to do with regional nuclear non-proliferation in the Middle East.
According to Brennan, there's an important moral difference between Mr. Neocon and Mr. Progresso, because the latter has epistemic justification for his vote while the former lacks it.
According to me, both of those guys suck because they just bombed Iran, and it doesn't matter if they have different reasons for doing it.
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Although I sympathize with the idea that law-subjects have moral reasons not to vote if they are uninformed, I have two concerns.
First, you write "they will vote, despite being misinformed, uninformed, and irrational about politics. As a result, innocent people around the world . . . will have to suffer the consequences of bad government." I am concerned with your causal claim here, although not in the sense that "my vote" caused such-and-such. What is the counterfactual, and what is the justification for the counterfactual? Is it a counterfactual perfect government or is it a counterfactual government made up of self-interested politicians who pander to the self-interest of a very small number of 'educated' law-subjects? What empirical support do you have for the claim that 'democratic' government produces better outcomes if 95% of the electorate abstained?
Second, at some point in the electoral process it seems as if it just does not matter *at all* whether you are informed or not, unless you are of the view that in every single election *no* reasonably informed person would have voted for Candidate X and *every* reasonably informed person would have voted for Candidate Y. Here's what I mean. If we are at the point where two candidates are on the ticket, and Ideal Voter A could justifiably select Candidate X and Ideal Voter B could justifiably select Candidate Y, then it seems like an Ideal Voter could select Candidate X or Candidate Y. So now the question becomes: what difference does it make, from a moral point of view, whether or not you are actually epistemically justified? Unless you are of the mindset that in every election one candidate is decidedly unjustifiable, completely unreasonable, then it seems like there is reasonable disagreement over the candidates. And if that is the case, why does it matter if a single voter is adequately informed in casting their vote between two reasonable candidates?
This is from my forthcoming diatribe, "The Right to A World That Exists to Serve Me":
"Some of my fellow citizens are ivory tower moral philosophers who believe, in the complete absence of any empirical evidence, that they have a priori intuitions into categorical truths about the ultimate nature of what is right and what is wrong. They also claim the power to predict, on the basis of ideal theory alone as practiced in their towers, and seemingly without benefit of any personal, real world experience of the actual behavior of people and firms in the commercial world, or careful empirical research on the actual functioning of market institutions, the outcome of the radical deregulation of those agents and markets. Despite that, they hold political power over me, are permitted to vote in elections that decide the fates of more practical, experienced and mature people, and are even permitted to educate some of the nation's young people. They can staff academic positions of some power and wield their access to the minds of the gullible against me, and even undermine the intellectual foundations of American democracy if they are so inclined."
"They also claim the power to predict, on the basis of ideal theory alone
as practiced in their towers, and seemingly without benefit of any
personal, real world experience of the actual behavior of people and
firms in the commercial world, or careful empirical research on the
actual functioning of market institutions, the outcome of the radical
deregulation of those agents and markets."
Who are you describing here, leftists or Libertarians? (Or both?) The shoe seems to fit either way.
Thanks for writing this. I can now tell you that you have a duty not to vote.
Put this in the "Democracy is the worst form of government except for all the others" file. Yes, uninformed voters are bad. But there is no means of fixing that problem that is not worse.
Since access to education and information in unequal capitalist societies is, as a matter of fact, correlated with wealth and income, Brennan's view implies that an even higher proportion of the wealthy than the poor should vote than is actually the case, with the rather predictable consequence that policy in a democracy where people accepted and acted on his arguments would track the interests of the wealthy (or best case scenario, their skewed perception of the common interest) even more closely than is actually the case.
This is a pretty lame criticism.
First, my theory of voting ethics says that citizens may vote only if they vote in good faith, for what they justifiedly believe will serve the right ends of government, and only if they are epistemically competent. So, if people were following this theory, governments everywhere would do much better by the poor than they do now. At best, your objection amounts to imagining a world in which people *believe* themselves to be following my theory of voting ethics but in fact systematically violate it. Whoop-dee-do.
Also, you're assuming that the poor know enough to vote for policies that support their own interests. There's not good reason to think that. In fact, as I document in my forthcoming book on compulsory voting, the poor are systematically misinformed about basic matters. The conclusion, ugly as it may be, is that if we want to help the poor realize their preferred outcomes (e.g., they get richer), we need to ignore many of their preferred policy preferences.
Finally, take a look at Martin Gilens new book Affluence and Influence. One conclusion: even if the poor voted more, it doesn't mean that politicians will listen to them.
I'm sure they think you're an idiot too. I take it you can judge who is or isn't informed?
J. Anderson
I don't really understand this piece. It seems to be made up mostly of deeply arrogant insults. I also can't imagine why anyone would bother giving arguments against such a piece. For instance, if Brennan were to walk into a typical American bar and announce that, according to his moral theory, no one in that room should be allowed to vote except for him, then it would seem to me to be a very proper and justified response for someone to simply punch him in the nose. I really don't think Brennan's beliefs merit much more than that in way of response.
Damien S.
"Many of my fellow citizens are incompetent, ignorant, irrational, and morally unreasonable about politics"
And of course we can all agree on who is incompetent, ignorant, irrational and morally unreasonable.
Or, you know… not.
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