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On this Memorial Day, we bring you a tribute to a young American soldier, one who sacrificed his life for the cause of freedom on Good Friday of this year.
David Pautsch struggles to read a heartfelt Facebook message from one of his sons to another.
"Hey Jason, this is your brother. You're with the Lord now. We will always remember your sweet smile and personality. I love you so much Jason. You were my hero, and I miss you, and you're in Heaven."
The recipient of the message is David's second oldest son, Army Corporal Jason Pautsch.
At just 20 years old, Jason lost his life in Iraq.
"You find it hard to believe that it could actually be happening, and then it sinks in, and that's when the emotions hit," David said.
Jason and four other soldiers were killed on Good Friday of this year after a suicide bomber detonated a ton of explosives in Mosul.
David strongly believes his son did not die in vain.
"He just despised the gutlessness of some of these politicians who questioned the whole value and the purpose of the war over in Iraq. But he went after it, and he paid the ultimate price," David said.
Jason's midwest community of the Quad Cities recognized his valor, and hundreds lined the streets for his funeral procession, attended his funeral service, and stood watch at his burial.
They were there to welcome their hero home.
"Lead me home, and I will rest in You. He died fighting for his country -- a hero to all, especially his little sister," said Jason's sister, Jenna.
"This final ending or rather a new beginning. I can't say I'm ready, but if God is for us, who can be against us," she said.
Some may ask, "Why must a man be cut down in the prime of his life?"
Perhaps, it's so others will awaken to a new understanding of freedom, a freedom worth dying for.
"I think it's rather fitting in a way that Jason died on Good Friday because I know Someone Else Who lost a Son on Good Friday, and we're talking about Jesus Christ, Himself," David said.
And Jesus, himself, welcomed this hero to his heavenly home.
"He's meeting friends and relatives, and people who also honored the Lord and came to know Him, and learned that the glory of having the blood of Jesus wash your sins away," David said.
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• Fifty consecutive matched patients with benign or malignant biliary tract obstruction were compared to determine the efficacy of preoperative percutaneous biliary drainage (PBD). Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography (PTHC) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5±7.6 mg/dL and 14.9±7.6 mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5±6.2 mg/dL preoperatively in patients having PBD. One week after operation, bilirubin levels were 4.2 ±4.3 mg/dL and 9.0±5.2 mg/dL in the PBD and non-PBD groups, respectively. Major morbidity (sepsis, abscess, renal failure, or bleeding) occurred in two patients (8%) having PBD and in 13 patients (52%) without PBD. One patient (4%) with PBD, and five patients (20%) without PBD, died. The mean hospital stay was shorter for the PBD group. Preoperative PBD reduces operative mortality and morbidity and results in a more rapid resolution of hyperbilirubinemia during the postoperative period.
(Arch Surg 1984;119:703-708)
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Chilean freelance reporter Carlos Hernandez Herrera joined CBN News' Morning program to talk more about the aftermath of Saturday's 8.8 magnitude earthquake.
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Contact & Support
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Edmund Optics Inc. http://www.edmundoptics.com Norman W. Edmund 1942
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Our TECHSPEC® Silver Series Telecentric Measuring Lenses offer superior image quality and less distortion than conventional fixed focal length lenses. This design yields more symmetrical images that are superior for software-integrated measurements. In combination with the high quality optics is a simplified non-focusing mechanical design with adjustable iris control. In addition, the double-telecentric design gives the sharpest image with the lowest amount of errors for the most accurate measurments.
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The Center for Hierarchical Manufacturing is an NSF Nanoscale Science and Engineering Center (NSEC). CHM aims to be a leading research and education center for the development of cost-efficient manufacturing of nanostructured components, devices and systems. The center provides educational programs that reach K-12, community college, undergraduate & graduate students as well as the general public and has a significant industry relations program via MassNanoTech Institute.
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Troubadour of a Troubled Land
The dominant voice in Rian Malan's journalism is his own wonder at the beauty, chaos and paradoxes of South Africa.
In 1990, a South African journalist named Rian Malan published a blood-soaked memoir of his home country, "My Traitor's Heart," that became an instant classic. Published at the height of the anti-apartheid movement, the brutal account of the ways South Africans killed each other briefly made the young Afrikaner with rock-star looks the toast of the American literary scene.
"My Traitor's Heart" wasn't the standard white African confessional. Mr. Malan, descended from a prominent Boer family, worked as a crime reporter in Johannesburg in the 1970s and was appalled by the horrors of apartheid. But he was equally appalled by the lies of those fighting against it. One section of "My Traitor's Heart" related how a Zulu man, Simon Mpungose, orphaned as a child, fell into a life of crime that culminated in a murder spree in which he bludgeoned white people with a hammer. Mr. Malan's account of the court case leaves no doubt as to how the cruelties of apartheid drove the man to his crimes. Most journalists would have stopped there, but Mr. Malan dug deeper. He located the man's rural village—and discovered he wasn't an orphan at all. Rather, he had been cast out of his community as a child over an ancient tribal superstition related to incest. Indeed, the man's father was relieved to hear his son had been executed by the Boers. There are many layers of truth in Africa; Mr. Malan is that rare creature driven to go out and find them.
The fall of apartheid in 1994 didn't make Mr. Malan any less pessimistic about his homeland, and he has spent the years since the success of "My Traitor's Heart" making gloomy prognostications about South Africa's future under what he sees as a corrupt and ideologically toxic African National Congress and railing against the country's stifling political correctness and the supine timidity of white liberals. "The Lion Sleeps Tonight" is a collection of some 20-odd pieces of Mr. Malan's opinion, travel writing and investigative pieces. Exhibiting the same fiercely lyrical voice that made "My Traitor's Heart" so compelling, the book is a beautiful, wry, often angry account of where South Africa has been and where it is going.
The collection's title comes from an epic piece published in Rolling Stone in 2000, about the ditty we know as "The Lion Sleeps Tonight." Originally titled "Mbube" ("The Lion") it was written in 1939 by a Zulu songsmith, Solomon Linda. The tune earned fortunes for the likes of proletarian folk singer Pete Seeger and Disney DIS -0.26 % ; Linda on the other hand died penniless in Johannesburg in 1962. Mr. Malan documents the long tradition of white American songwriters putting their names on "wild horses"—folk songs with no seeming provenance. But Mbube had an author. Without sounding preachy, Mr. Malan goes knocking on Manhattan record-company doors to ask where Mr. Linda's money went.
The Lion Sleeps Tonight
By Rian Malan
(Grove, 317 pages, $25)
The central and most controversial piece—one the author admits "will dog me to my grave"—is an investigation into the AIDS-denialism of Thabo Mbkei, South Africa's president from 1999 to 2008, which appeared in Rolling Stone in 2001. Or, rather, it didn't: What we get here is an astonishing 10,000-word letter Mr. Malan wrote to his editor, explaining how the assignment he had been given had veered wildly off course. What he found was a booming AIDS industry whose funding dwarfs that devoted to equally dire diseases, such as malaria and tuberculosis. Lax testing methods for Africans meant that blood samples from a few HIV-positive pregnant women in, say, Uganda were fed into a computer model in Geneva which extrapolated that "14 million Africans" have died of AIDS.
The letter is riven with Mr. Malan's discomfort at the questions he is raising. The author was branded an AIDS denier in South Africa for his troubles, but it is apparent from the original letter that he never denied the existence or seriousness of the disease—just the predicted scale of it. Perhaps inevitably, the piece Rolling Stone ended up running was so watered down as to be almost unreadable. But Mr. Malan, it turned out, was right. AIDS statistics for Africa have been radically downscaled in the decade since. In "Among the AIDS Fanatics," a more recent piece for the London Spectator, published here with a postscript, he recounts how even U.N. officials have admitted their testing models were seriously flawed and that AIDS infection rates were overestimated by as much as 50%.
Critics often dismiss Mr. Malan as overly bleak, but this is nonsense. The dominant voice in a Malan story is his own wonder at the beauty, chaos and paradoxes of his continent. "The Last Afrikaner" (1994) is a terrific report about an old woman, abandoned by her family in 1960s Tanzania after a youthful dalliance with a black man. Mr. Malan tracks her down to the foot of a volcano where she lives, poor, dressed in rags, yet fiercely proud of her Afrikaner roots, teaching her black grandchildren Boer folk songs. "Over the years I'd sat outside a thousand similar huts. . . . Tannie Katrein was the first African peasant I'd ever met whose every word made sense to me." The hilarious "Those Fabulous Alcock Boys" (2007) introduces two young white men who were raised as Zulus, one now a gun-toting entrepreneur, the other a high-stakes land dispute negotiator, both far more optimistic about the future of the country than Mr. Malan. One gets the feeling the author seeks such people out precisely as a check on his own pessimism. Then there is "The Apocalypse That Wasn't" (2004) a lovely essay—part travelogue, part polemic—in which he admits to being wrong about forecasting the inevitable collapse of South Africa, or at least the timing of it. The piece was quoted extensively by President Mbeki in the opening of parliament—much to the annoyance of Mr. Malan's detractors.
In the foreword to "The Lion Sleeps Tonight," Mr. Malan claims, "The only true line I've ever written about South Africa is this one: We yaw between terror and ecstasy. Sometimes we complete the trip in 15 minutes." It is what keeps his traitor's heart true to South Africa. Rian Malan is one of the finest nonfiction writers alive, and American readers should treasure this chance to get to know him again.
Mr. Rogers is the author of "The Last Resort: A Memoir of Mischief and Mayhem on a Family Farm in Africa."


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Injectable drugs referred to as biologic DMARDs (Disease-Modifying Antirheumatic Drugs)-or simply, biologics- are used to treat rheumatoid arthritis, a chronic condition in which the immune system, which normally fights infection, attacks the lining of the joints, causing swelling, stiffness, and pain. If left untreated, it can lead to irreversible joint damage. About 1.3 million adults in the United States suffer from rheumatoid arthritis. It is most common in women, and in people over the age of 40, though it may occur at any age.
The biologics do not cure rheumatoid arthritis, but they do alleviate symptoms and may help prevent further joint damage. However, they can cause serious side effects and should not be used until after you have tried other therapies.
If you have been newly diagnosed with rheumatoid arthritis, studies show that other less costly and safer medications work just as well as biologics, so you should try those first. These include nonbiologic DMARDs, such as hydroxy chloroquine (Plaquenil and generic), sulfasalazine (Azulfidine and generic), minocycline (Dynacin, Minocin, and generic), and methotrexate (Rheumatrex and generic). In addition, your doctor is also likely to recommend pain relievers, such as ibuprofen (Advil, Motrin, and generics) and naproxen (Aleve, Naprosyn, and generics), and corticosteroids, such as prednisone. You should also follow an exercise program because studies show such programs improve function in people with rheumatoid arthritis.
If those therapies fail to provide you with enough symptom relief, then it might be time to try a biologic. Between 30 to 70 percent of people who have not benefitted from other rheumatoid arthritis medications experience some measure of relief from biologics. However, people's responses vary-some people symptoms and function improve, while others may not. Roughly 40 percent of people won't respond to any particular treatment, and will probably need to switch to another biologic.
Nine different biologics are available to treat the symptoms of rheumatoid arthritis, but they are not a cure. They are all very expensive, with some costing more than $5,000 per week. Taking into account the evidence for effectiveness and safety, if you need a biologic drug to treat your rheumatoid arthritis, we have chosen the following as Consumer Reports Best Buy Drugs:
- Abatacept (Orencia)
- Adalimumab (Humira)
- Etanercept (Enbrel)
Studies show that these three medications are as effective as the other biologics for relieving rheumatoid arthritis symptoms, and they also may have lower rates of withdrawal due to adverse effects than some other biologics.
All of the biologics can cause side effects. In studies, people who took a biologic had a higher risk-13% versus 12%-of experiencing a serious life-threatening allergic reaction, infection, lymphoma, or other serious side effect than those who took a placebo. The serious or potentially life-threatening infections include bacterial infections, such as tuberculosis, pneumonia, or staph, and serious fungal infections. Minor side effects, such as abdominal pain, nausea, and injection site reactions, can also occur, but usually do not require stopping or changing drugs.
This report was published in March 2013.
- Section 1: Welcome
- Section 2: What Are Biologics and Who Needs Them?
- Section 3: Choosing a Biologic - Our Best Buy Picks
- Section 4: Overview of Effectiveness and Safety of Biologics
- Section 5: Talking With Your Doctor
- Section 6: How We Picked the Best Buy Drugs
- Section 7: Sharing This Report
- Section 8: About Us
- Section 9: References
About 1.3 million adults suffer from rheumatoid arthritis in the United States, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The disease generally develops in people between 30 and 55 years of age, though it's most common after age 40. For reasons that remain unclear, women develop it more often than men. In some cases, rheumatoid arthritis can also affect children or older adults. If it is not adequately treated, it will often lead to joint destruction, disability, and a reduced quality of life.
This report is based on a comprehensive expert analysis of the medical evidence on biologics to treat rheumatoid arthritis. The biologics are a type of "Disease-modifying Antirheumatic Drug (DMARD)" that not only treat symptoms, but can also reduce joint and bone damage. This report is part of a Consumer Reports project to help you find safe, effective medicines that give you the most value for your health-care dollar. To learn more about the project and other drugs we've evaluated, visit www.CRBestBuyDrugs.org.
The biologics are a relatively new type of medicine for treating rheumatoid arthritis. The first of these biologics, infliximab (Remicade), became available in 1998. The nine biologics we evaluate in this report are:
|Table 1: Generic and brand names of biologics
|Generic Name
|Brand Name
All of them are very expensive. A new biologic, Xeljanz (tofacitinib), that is available as a pill, was approved by the FDA in late 2012 for the treatment of rheumatoid arthritis, but it was not included in the analysis that forms the basis of this report so we don't assess how it compares to the other biologics. Xeljanz is associated with perforations in the stomach and intestines, and elevations in cholesterol levels and liver enzymes, so we recommend avoiding it if possible, until more is known about its effectiveness and safety profile.
Biologics are seen as a significant advancement over other drugs used to treat rheumatoid arthritis - for example, methotrexate (Rheumatrex, Trexall, and generic), leflunomide (Arava and generic), hydroxychloroquine (Plaquenil and generic), and sulfasalazine (Azulfidine and generic) - which are often referred to as conventional or nonbiologic DMARDs. But that said, biologics should only be used if conventional DMARDs do not work well enough for you on their own. Other treatments for rheumatoid arth ritis often used with biologics include pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) - for example, ibuprofen (Advil, Motrin, and generic) and naproxen (Aleve and generic) - and corticosteroids, such as prednisone. This report does not evaluate the conventional DMARDs or other rheumatoid arthritis treatments, or compare them with biologics.
This report focuses specifically on the use of biologics used to treat rheumatoid arthritis, though it is worth noting that some of the biologics have multiple uses and are also approved for treating other diseases, such as ankylosing spondylitis, Crohn's disease, psoriasis, and ulcerative colitis.
What Are Biologics and Who Needs Them?
Biologics work by interfering directly with the human body's immune system, the protective mechanism that fights bacteria and viruses, kills sick cells, and generally helps you stay healthy.
Sometimes, for unknown reasons, the immune system turns against the body and attacks it. This process is called autoimmunity. Rheumatoid arthritis is one of many different autoimmune diseases. In rheumatoid arthritis, the immune system attacks tissue inside the joints, causing inflammation, pain, joint damage, and ultimately joint destruction. By blocking certain components of the immune system, biologics help stop or reduce the inflammation caused by the misdirected attack.
Rheumatoid arthritis is characterized by pain, swelling, and inflammation of the joints. It most commonly starts in the small joints of the hands and feet. Eventually all joints can be affected. Your joints can feel stiff, particularly in the morning. Symptoms often come and go, and are often accompanied by fever or feeling tired or unwell. As the disease progresses, sufferers can experience severe joint damage and fatigue, making it difficult for them to complete everyday tasks. Flare-ups of rheumatoid arthritis are often unpredictable and difficult to manage. Pain, stiffness, and swelling are worse on some days and easier to bear on others.
The exact cause of rheumatoid arthritis is unknown. Some studies show that rheumatoid arthritis may run in families, suggesting a genetic component, yet having a family member who suffers from rheumatoid arthritis does not necessarily mean that you will also develop the disease.
Rheumatoid arthritis can be difficult to diagnose because many other conditions can cause joint stiffness, pain, swelling, and inflammation.
Your doctor will ask you about your symptoms and run a series of tests to confirm the diagnosis. Common blood tests your doctor might run include rheumatoid factor and anti-CCP antibodies. These are antibodies that eight out of 10 people with rheumatoid arthritis carry in their blood. Both rheumatoid factor and anti-CCP antibodies can also be found in one out of 20 people without rheumatoid arthritis, so these tests cannot confirm rheumatoid arthritis. Other tests include the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These can help determine the degree of inflammation in your body. Another common test analyzes X-ray images of your hands to identify joint damage.
The type of medication your doctor will consider depends on the severity of your rheumatoid arthritis, the results of blood tests and X-ray images, the length of time that you have been experiencing symptoms, the rate of progression of your symptoms, and other medical problems that you may have. People who are newly diagnosed with rheumatoid arthritis will most likely be started on a pain reliever, corticosteroid, or conventional DMARD, with biologics reserved for second-line therapy if those treatments are not effective.
Some rheumatoid arthritis medications relieve pain, such as ibuprofen (Advil, Motrin, and generics), and naproxen (Aleve, Naprosyn, and generics). Steroids, such as prednisone and methylprednisolone (Medrol), may slow the progression of joint damage, but they do not cure the disease. In addition, your doctor might also prescribe one of the conventional DMARDs, which can help limit joint damage, but also are not a cure. Studies show that for many people, these drugs work just as well as biologics, at a much lower cost.
|Your doctor should not prescribe a biologic if:
|Your doctor may decide not to prescribe a biologic if:
|Table 2: Biologics, mode of administration, and administration intervals
|Generic Name
|Brand Name
|Must be repeated
|Intravenous infusion or subcutaneous injection*
|Intravenous - every 4 weeks Subcutaneous - weekly
|Subcutaneous injection
|Every week or every other week
|Subcutaneous injection
|Subcutaneous injection
|Every other week
|Subcutaneous injection
|Subcutaneous injection
|Once a month
|Intravenous infusion
|Every 4 to 8 weeks
|Intravenous infusion
|Two infusions separated by 2 weeks; repeat treatment after 24 weeks if new symptoms arise
|Intravenous infusion
|Every 4 weeks
* One intravenous dose initially is followed by regular subcutaneous injections.
Subcutaneous injection = injection under the skin.
Intravenous infusion = administered into a vein in arm.
Exercise can also help. Studies show that exercise programs improve the function of people with rheumatoid arthritis. These programs are typically recommended as a complement to, not a replacement for, medications.
If your symptoms continue to progress despite participation in an exercise program and the use of other rheumatoid arthritis medications, such as the conventional DMARDs, or if you experience intolerable side effects from these drugs, your doctor may suggest a biologic. But you should be aware that these can cause rare, but serious side effects, including infections that require a hospital stay, tuberculosis, nonmalignant skin cancer and lymphoma, and allergic reactions following infusion (More about side effects starting on section 3).
The biologics are given by different methods. The nine we evaluate in this report are given by needle (Xeljanz, which was not included in our analysis, is a tablet taken by mouth). Some of them have to be administered slowly into a vein in your arm (intravenously), while others must be injected under the skin (subcutaneously), like insulin injections for diabetes. How often you will have to take a biologic depends on which drug you have been prescribed. You should discuss with your doctor whether or not you feel comfortable injecting yourself or whether you prefer an intravenous infusion at your doctor's office. Table 2, above, summarizes how individual biologics are given and how often.
Choosing a Biologic - Our Best Buy Picks
If other rheumatoid arthritis medications, such as the conventional or nonbiologic DMARDs, have not provided you with sufficient relief from your rheumatoid arthritis symptoms, then you may want to consider trying a biologic. All of the biologics are very expensive. These drugs cannot cure rheumatoid arthritis, but they have been shown to help relieve symptoms in about 30 to 70 percent of people who use them. The available evidence is not good enough to distinguish differences in the effectiveness of the biologics. So the main difference between these medications comes down to their safety profile or the side effects they cause. For example, anakinra (Kineret) has the highest rate of injection site reactions and is less commonly used to treat rheumatoid arthritis. Rituximab (Rituxan) causes more infusion reactions than the other biologics, and certolizumab (Cimzia) might have higher rates of serious infections.
That leaves six remaining biologics. There is more evidence overall on three-adalimumab (Humira), etancercept (Enbrel), and infliximab (Remicade). A large study-known as the DREAM study-used patient records to evaluate these medications in people who were not helped by taking conventional DMARDs. Humira and Enbrel appeared to be equally effective in treating rheumatoid arthritis. Also, similar numbers of people stopped taking each drug due to side effects, suggesting both drugs have similar side effect profiles.
The DREAM study also compared Humira to Remicade. The two drugs were similar in effectiveness, but Humira had a lower rate of people dropping out due to side effects. The DREAM study was not a randomized, controlled clinical trial, since it was based on patient records, so the results are not as robust as they would be if this had been a clinical trial.
Several additional studies suggested Enbrel is more effective than Remicade. An analysis that combined the results of many small trials of all the biologics also suggested that Enbrel is the most effective, but the results of these types of analyses are often not reliable.
|Table 3. Effectiveness and Tolerability of Biologics
|Generic Name
|Brand Name
|Response to Treatment1
|Discontinuation because of side effects2
|Comments / Special Notes
|26% - 40%
|3% - 7%
|Low rate of infusion reactions.
|24% - 97%
|5% - 9%
|19% - 50%
|Not reported
|Highest rate of injection site reactions.
|24% - 41%
|1% - 7%
|Highest rate of serious infections.
|47% - 100%
|3% - 57%
|16% - 40%
|2% - 6%
|27% - 75%
|2% - 20%
|Higher rate of infections than Orencia and Enbrel.
|18% - 49%
|1% - 6%
|Highest rate of infusion reactions.3
|29% - 54%
|4% - 12%
- Response is defined as an at-least 50 percent improvement of rheumatoid arthritis symptoms. Based on multiple studies and combined analysis of studies, or from the drug's product label information. Figures are not meant to imply that drugs were necessarily compared to each other in a study with consistent design.
- Average discontinuation rates due to adverse events seen in studies. Based on multiple studies and combined analysis of studies, or from the drug's product label information. Figures are not meant to imply that drugs were necessarily compared to each other in a study with consistent design.
- 77 percent of people treated with rituximab had a reaction after the first infusion.
One study known as ATTEST found abatacept (Orencia) to be more effective after one year of treatment than infliximab (Remicade) in people who had not gotten adequate symptom relief from methotrexate (Rheumatrex, Trexall, and generic). Orencia also appears to have a lower rate of infections, serious infections, serious adverse events, and infusion reactions than Remicade. In addition, more people in the study discontinued treatment with Remicade. One problem with this study, however, is that the people taking Remicade were not allowed to increase their dose, which is often necessary in a real world setting.
There is no evidence comparing the two remaining biologics-golimumab (Simponi) and tocilizumab (Actemra). There are no trials that have compared them against each other and there are no studies that could be used to compare either of them against the other biologics.
Side effects are an important consideration with this group of biologics. In studies, people who took a biologic had a higher risk-13% versus 12%-of experiencing a serious life-threatening allergic reaction, infection, lymphoma, or other serious side effect than those who took a placebo. The serious or potentially life-threatening infections include bacterial infections, such as tuberculosis, pneumonia, or staph, and serious fungal infections. Minor side effects can also occur, but usually do not require stopping or changing drugs. The mild side effects associated with these medications include:
- Diarrhea
- Headache
- Injection site reactions
- Nausea
- Respiratory infection
- Urinary tract infection
Serious side effects include:
- Allergic reactions
- Liver damage
- Lymphoma
- Serious infections
All of the biologics carry warnings on their labeling about serious side effects, particularly serious infections.
You should not take two or more biologics in combination. Studies show that when two or more biologics are taken at the same time, there is a substantially higher rate of serious adverse events than taking one of the drugs alone. Specific combinations that have been shown to have more adverse events include Kineret with Enbrel, and Orencia with Enbrel.
Rituxan appears to have a higher potential for infusion reactions than other biologics. In addition, it has been linked to an increased risk of a serious viral infection of the brain. The infusion reactions can be severe and even fatal. Because of this, it should only be used as a second-line therapy if other biologics do not provide enough symptom relief.
Remicade has been shown to have a high rate of serious side effects, and is also not one of the top picks. One trial found that, compared to Orencia, Remicade had higher rates of serious adverse events (18.2 percent compared with 9.6 percent), and serious infections (8.5 percent compared with 1.9 percent).
Table 3 is a summary of each drug's effectiveness and the percentage of study participants who stopped taking each biologic due to its side effects. The table also contains comments on noteworthy issues associated with each drug.
The available evidence indicates that Orencia and Kineret have the lowest risk of serious side effects. However, Kineret, which is given as an injection under the skin every day, causes more redness, itching, rash, and pain at the injection site than the other biologics that are given in this way.
In addition to effectiveness and safety, choosing a biologic involves several other factors, including the frequency of use, how the drug is given, and the length of time the treatment is effective. Also, because of the significant cost of these drugs, how much your insurance will provide coverage and how much you will pay out-of-pocket, will all factor into deciding which biologic therapy may be best for your situation.
Taking into account the evidence for effectiveness and safety, as well as cost, if you need a biologic drug to treat your rheumatoid arthritis, we have chosen the following as Consumer Reports Best Buy Drugs:
- Abatacept (Orencia)
- Adalimumab (Humira)
- Etanercept (Enbrel)
Studies show that these three medications are as effective as the other biologics for relieving rheumatoid arthritis symptoms, and they also may have lower rates of withdrawal due to adverse effects than some other biologics.
Overview of Effectiveness and Safety of Biologics
This report is based on an analysis of the clinical evidence on the effectiveness and safety of biologic therapies for rheumatoid arthritis done by the Drug Effectiveness Review Project (DERP). In this analysis, a total of 4,736 studies and research articles dealing with any use of biologic drugs were identified and screened. All were published between 1990 and 2011. As a supplement to the DERP report, we also reviewed additional analyses, including some done by the Cochrane Review, that were published in 2011 and 2012.
From these, the analysis focused on 163 studies involving the use of biologics to treat people with rheumatoid arthritis, which included 70 controlled clinical trials, 31 studies that performed an analysis of multiple other studies, 51 observational studies, and 11 studies of other design. An additional 255 articles were reviewed for general background information pertinent to biologic chemistry, biology, and clinical use.
Balancing the effects between benefit and harm is particularly challenging because there is a lack of long-term data on the safety of biologics from controlled trials. There are large registries of patients that are intended to address long-term safety, but they have had conflicting results. They have also focused on biologics vs. DMARDs rather than on comparing different biologics.
How Effective are Biologics?
For many people who have not responded to standard rheumatoid arthritis treatment (conventional DMARDs, for example), the biologics can be effective treatments. However, people's responses vary-some experience a vast improvement in their symptoms and function, while others may experience little or no improvement at all. It is important to note that the studies of biologics have involved people who had failed on other rheumatoid arthritis medications, so we strongly recommend trying conventional DMARDs and other medications first before going to a biologic.
The effectiveness and benefits of biologics are primarily assessed on three criteria:
- People's response to treatment, often characterized by at least 50 percent improvement in rheumatoid arthritis symptoms on a rheumatoid arthritis rating scale.
- Whether there is slowing of the progression of the disease and prevention of joint damage.
- Whether there are improvements in people's quality of life and function.
Response to treatment is based on how people rate their pain, stiffness, and other symptoms. On average, between 25 and 50 percent of people who do not respond to conventional DMARDs and switch to a biologic can expect to experience at least a 50 percent im prove ment in their symptoms as compared to those who continue to take conventional DMARDs. Roughly 40 percent of people will fail to respond to any particular treatment, and will likely require a switch to another biologic. As we have previously noted, however, two biologics should never be taken at the same time, because this significantly increases the chance of ad verse effects, but with little improvement in symptoms.
If you are on Remicade, you may require a dose adjustment after a few months of treatment. Many patients need to adjust their treatment to larger doses to maintain the response. Larger doses for all biologics increase the risk of side effects.
Longer and more extensive studies have been conducted on some of the biologics more than on others. Most trials of biologics are relatively short, lasting between three to 12 months, and only a handful have compared biologics directly to each other in terms of effectiveness and safety. The limited time frame does not allow an assessment of long-term response or safety in a chronic, progressive disease. As mentioned above, biologics cannot cure rheumatoid arthritis, but they may help slow the progression, alleviate the symptoms, and may prevent joint damage.
While television and magazine ads often tout the benefits of starting biologics early during the course of disease, studies in people with early rheumatoid arthritis have not shown any clear benefits of biologics over conventional DMARD treatment when starting treatment for the first time. People responded to both treatments equally well, but conventional DMARDs are vastly cheaper than biologics and should be the first line of treatment in people with newly diagnosed rheumatoid arthritis. Additionally, the bulk of evidence underlying the effectiveness and safety of the biologics is based on studies involving people in whom conventional DMARDs were ineffective. In other words, these drugs should only be used if you do not get adequate symptom relief from other therapies, including exercise, over-the-counter and prescription pain relieving drugs, and conventional DMARDs, like methotrexate (Rheumatrex, Trexall, and generic).
|Important Considerations for Choosing a Biologic
|25 to 50 percent of people who take biologics can expect to experience at least a 50 percent improvement in the number of swollen or tender joints.
|In studies, about 13 percent of people who took a biologic experienced serious or lifethreatening side effects (but many people, about 12 percent, who received a placebo also had serious side effects). Minor side effects, such as abdominal pain, nausea, and injection site reactions, can also occur-but usually do not require-stopping or changing drugs. All biologics carry risk of serious side effects, including infections. Rituximab (Rituxan) and anakinra (Kineret) have higher rates of injection and infusion site reactions, and certolizumab (Cimzia) and infliximab (Remicade) have a higher risk of infections.
|Can cost up to several thousand dollars per month, if paying out-of-pocket.
|Insurance coverage
|Find out if your chosen treatment will be covered by your insurance. The range of coverage, co-pays, and other expenses will likely ultimately determine your biologic choice.
|Availability of product/staff/facilities to administer
|Your health care providers might be more familiar with specific biologics, some products might be more available, and facilities to administer some products might be more easily accessible.
|Need to switch (Failure with another therapy)
|Roughly 40 percent of people are not helped by the first treatment they receive, and might have to be switched to another biologic. How you respond to a first biologic will determine decisions about how to choose the second or third biologic.
|Frequency of administration
|These drugs are given with varying frequencies, such as daily, weekly, monthly, or bimonthly. This may affect your choice of biologic.
|Route of administration
|Self injection, physician injection or intravenous infusion (See Table 2).
|Harm related to route of administration
|Infusion reactions and injection site reactions can be common, but most are mild (headache, dizziness, nausea, itching, chills, fever).
How Safe are the Biologics?
As discussed earlier, studies show that about 13 percent of people who take a biologic experience serious or life-threatening side effects, compared with about 12 percent who receive a placebo. Because biologics target the defense system of your body, minor infections, such as respiratory infections or urinary tract infections, are common. In addition, nausea and joint pain can also occur. Depending on the drug, side effects related to drug administration are common. For biologics that are injected subcutaneously (abatacept, adalimumab, anakinra, certolizumab, etanercept, and golimumab), injection-site reactions, such as rash, itching, and pain, are common. Anakinra appears to cause more injection-site reactions than the other biologics.
Reactions to the intravenous infusion of a biologic (abatacept, infliximab, rituximab, and tocilizumab) are also common. Such infusion reactions include dizziness, chills, itching, headaches, and fever. In about 1 percent of patients, infusion reactions can be severe and can mimic a severe allergic reaction or lead to convulsions. Deaths have also been reported following infusions of biologics. Rituximab appears to have a higher risk for such reactions than other biologic drugs.
Long-term risks of biologics are also a concern. These may include severe infections, particularly tuberculosis and fungal infections. Other infections have been reported, and some have resulted in death. All biologics carry on their labeling warnings about the increased risk of infections.
Biologics are also associated with an increased risk of skin cancers. It was previously thought that the biologics might also increase the risk of cancers involving lymph nodes and bone marrow, but data from multiple studies has not shown this to be the case. However, the FDA continues to warn about this risk (the most recent update was issued in April 2011), and the package insert of biologics still carries a black box warning about lymphoma.
Other adverse effects include worsening or triggering congestive heart failure, liver damage, and neurologic disorders. Long-term adverse effects have yet to be thoroughly studied and identified.
To reduce the risk of side effects, let your doctor know if you have:
- chronic obstructive pulmonary disease (COPD)
- congestive heart failure
- diabetes
- an infection or history of infections
- tuberculosis or a positive skin test for tuberculosis
- viral hepatitis
Also notify your doctor if you have been around an individual with chicken pox, shingles, or tuberculosis, or if you are scheduled to receive a vaccine or have surgery.
The risk of biologics to unborn babies is unknown. Women of child-bearing age should use contraception while on biologics. If you are planning to become pregnant, talk with your doctor about when to stop using contraception and biologics. The labeling of biologics advises these medications not be used by pregnant women unless necessary.
Drug Interactions
Biologics are often prescribed together with other medications, such as methotrexate, pain medications, or corticosteroids, and do not seem to interact with most drugs. But it's important to note that there is little research on how the biologics interact with other drugs. Biologics, however, should never be taken together with other biologics, as this can increase the risk of severe adverse effects.
Because biologics affect your immune system, it is recommended that you should not be immunized with 'live' vaccines, such as the yellow fever vaccine, while you are on biologic therapy. In certain situations, however, a live vaccine may be necessary (for example, rubella immunization in women of childbearing age). You should discuss the possible risks and benefits of immunizations with your doctor. Other vaccines, such as flu vaccines (but not the nasal flu vaccine, FluMist, which contains live virus), are safe, and can be administered with biologic medications. But read the package insert of the biologic you are taking, and also discuss with your doctor any vaccines you plan to take.
Age, Race, and Gender Differences
People older than 65 and various ethnic groups have been under-represented in most studies of biologics. Still, the existing evidence does not indicate that any biologic is more or less effective in older patients, people of any particular race or gender, or in patients who have other diseases.
Talking With Your Doctor
It's important for you to know that the information we present here is not meant to substitute for a doctor's judgment. But we hope it will help you and your doctor arrive at a decision about which biologic therapy and dose is best for you, if one is warranted at all, and which gives you the most value for your health-care dollar.
Bear in mind that people are often reluctant to discuss the cost of medicine with their doctor, and studies have found that doctors do not routinely take price into account when prescribing medicine. Unless you bring it up, your doctors might assume that cost is not a factor for you.
Many people (including physicians) think that newer drugs are better. While that's a natural assumption to make, it's not necessarily true. Studies consistently find that many older medicines are as good as - and in some cases better than - newer medicines. Think of older drugs as "tried and true," particularly when it comes to their safety record. Newer drugs have not yet met the test of time, and unexpected problems can and do crop up once they hit the market.
Of course, some newer prescription drugs are indeed more effective and safer. Talk with your doctor about the pluses and minuses of newer vs. older medicines.
Another important issue to discuss with your doctor is keeping a record of the drugs you are taking. There are several reasons for this:
- First, if you see several doctors, each may not be aware of medicines the others have prescribed.
- Second, since people differ in their response to medications, it is very common for doctors today to prescribe several medicines before finding one that works well or best.
- Third, many people take several prescription medications, nonprescription drugs, and dietary supplements at the same time. They can interact in ways that can reduce the benefit you get from one or more of the drugs, and in ways that may be dangerous.
- Fourth, the names of prescription drugs-both generic and brand-are often hard to pronounce and remember.
For all these reasons, it's important to keep a written list of all the drugs and supplements you are taking, and to periodically review this list with your doctors.
Additionally, it is important to always be sure that you understand the dose of the medicine being prescribed for you. Your doctor should tell you this information. When you fill a prescription at the pharmacy, or if you receive it by mail, you should check that the dose on the labeling or package matches the amounts recommended by your physician.
How We Picked the Best Buy Drugs
Our evaluation is based in part on an independent scientific review of the studies and research literature on biologic therapies conducted by a team of physicians and researchers at the Oregon Health & Science University Evidence-Based Practice Center. This analysis reviewed more than 163 studies, that included 70 controlled clinical trials, 31 studies that performed a cross-cutting analysis of multiple other studies, 51 observational studies, and 11 studies of other design. This effort was conducted as part of the Drug Effectiveness Review Project, or DERP. DERP is a first-of-its-kind, multistate initiative created to evaluate the comparative effectiveness and safety of hundreds of prescription drugs.
A synopsis of DERP's analysis of the biologic drugs forms the basis for this report. A consultant to Consumer Reports Best Buy Drugs is also a member of the Oregon-based research team, which has no financial interest in any pharmaceutical company or product. The full DERP review of the biologic drugs to treat rheumatoid arthritis is available at http://derp.ohsu.edu/about/final-documentdisplay.cfm. (Note that this is a long and technical document written for physicians and other medical researchers.)
The monthly costs we cite were obtained from Symphony Health Solutions, a health-care information company that tracks the sales of prescription drugs in the U.S. Prices for a drug can vary quite widely. All the prices in this report are national averages based on sales in retail stores only. They reflect the cash price paid for a month's supply of each drug in December 2012.
Consumer Reports selected the Best Buy Drugs using the following criteria. The drug had to:
- Be approved by the FDA to treat rheumatoid arthritis.
- Be as effective as or more effective than other biologics when prescribed appropriately according to FDA guidelines based on published randomized controlled trials.
- Have a safety record equal to or better than other biologics medicines when prescribed appropriately.
The Consumers Reports Best Buy Drugs methodology is described in more detail in the Methods section at www.CRBestBuyDrugs.org.
Sharing This Report
This copyrighted report can be freely downloaded, reprinted, and disseminated for individual noncommercial use without permission from Consumer Reports as long as it is clearly attributed to Consumer Reports Best Buy Drugs™. We encourage its wide dissemination as well for the purpose of informing consumers. But Consumer Reports does not authorize the use of its name or materials for commercial, marketing, or promotional purposes. Any organization interested in broader distribution of this report should email firstname.lastname@example.com. Consumer Reports Best Buy Drugs™ is a trademarked property of Consumers Union. All quotes from the material should cite Consumer Reports Best Buy Drugs™ as the source.
©2013 Consumers Union of U.S., Inc.
About Us
Consumers Union, publisher of Consumer Reports® magazine, is an independent and nonprofit organization whose mission since 1936 has been to provide consumers with unbiased information on goods and services and to create a fair marketplace. Its Web site is www.consumerreports.org.
These materials are made possible by a grant from the states Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin.
The Engelberg Foundation provided a major grant to fund the creation of the project from 2004 to 2007. Additional initial funding came from the National Library of Medicine, part of the National Institutes of Health. A more detailed explanation of the project is available at www.CRBestBuyDrugs.org.
We followed a rigorous editorial process to ensure that the information in this report and on the Consumer Reports Best Buy Drugs Web site is accurate and describes generally accepted clinical practices. If we find, or are alerted to, an error, we will correct it as quickly as possible. But Consumer Reports and its authors, editors, publishers, licensers, and any suppliers cannot be responsible for medical errors or omissions, or any consequences from the use of the information on this site. Please refer to our user agreement at www.CRBestBuyDrugs.org for further information.
Consumer Reports Best Buy Drugs should not be viewed as a substitute for a consultation with a medical or health professional. This report and the information on www.CRBestBuyDrugs.org are provided to enhance your communication with your doctor rather than to replace it.
- Alonso-Ruiz, A., J. I. Pijoan, et al. (2008). "Tumor necrosis factor alpha drugs in rheumatoid arthritis: systematic review and metaanalysis of efficacy and safety." BMC Musculoskelet Disord 9: 52.
- Askling, J., C. M. Fored, et al. (2007). "Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists." Annals of the Rheumatic Diseases 66(10): 1339-1344.
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- Blumenauer, B., A. Burls, et al. (2002). "Infliximab for the treatment of rheumatoid arthritis." The Cochrane Database of Systematic Reviews(3).
- Bongartz, T., A. J. Sutton, et al. (2006). "Anti-TNF Antibody Therapy in Rheumatoid Arthritis and the Risk of Serious Infections and Malignancies: Systematic Review and Meta-analysis of Rare Harmful Effects in Randomized Controlled Trials." JAMA 295(19): 2275-2285.
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- Breedveld, F. C., M. H. Weisman, et al. (2006). "The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment." Arthritis Rheum 54(1): 26-37.
- Clark, W., P. Jobanputra, et al. (2004). "The clinical and cost-effectiveness of anakinra for the treatment of rheumatoid arthritis in adults: a systematic review and economic analysis." Health Technol Assess 8(18): iii-iv, ix-x, 1-105.
- Cohen, S. B., P. Emery, et al. (2006). "Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks." Arthritis and Rheumatism 54(9): 2793-2806.
- Emery, P., R. Fleischmann, et al. (2006). "The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: Results of a phase IIB randomized, double-blind, placebo-controlled, dose-ranging trial." Arthritis Rheum 54(5): 1390-400.
- Gartlehner, G., R. A. Hansen, et al. (2006). "The comparative efficacy and safety of biologics for the treatment of rheumatoid arthritis: a systematic review and metaanalysis." J Rheumatol 33(12): 2398-408.
- Geborek, P., M. Crnkic, et al. (2002). "Etanercept, infliximab, and leflunomide in established rheumatoid arthritis: clinical experience using a structured follow up programme in southern Sweden." Ann Rheum Dis 61(9): 793-8.
- Genovese, M. C., S. Cohen, et al. (2004). "Combination therapy with etanercept and anakinra in the treatment of patients with rheumatoid arthritis who have been treated unsuccessfully with methotrexate." Arthritis Rheum 50(5): 1412-9.
- Hochberg, M. C., J. K. Tracy, et al. (2003). "Comparison of the efficacy of the tumour necrosis factor alpha blocking agents adalimumab, etanercept, and infliximab when added to methotrexate in patients with active rheumatoid arthritis." Ann Rheum Dis 62 Suppl 2: ii13-6.
- Keystone, E., P. Emery, et al. (2009). "Rituximab inhibits structural joint damage in patients with rheumatoid arthritis with an inadequate response to tumour necrosis factor inhibitor therapies." Ann Rheum Dis 68(2): 216-21.
- Kievit, W., E. M. Adang, et al. (2008). "The effectiveness and medication costs of three antitumour necrosis factor alpha agents in the treatment of rheumatoid arthritis from prospective clinical practice data." Ann Rheum Dis 67(9): 1229-34.
- Kristensen, L. E., T. Saxne, et al. (2006). "The LUNDEX, a new index of drug efficacy in clinical practice: results of a five-year observational study of treatment with infliximab and etanercept among rheumatoid arthritis patients in southern Sweden." Arthritis Rheum 54(2): 600-6.
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- Schiff, M., M. Keiserman, et al. (2008). "Efficacy and safety of abatacept or infliximab vs placebo in ATTEST: a phase III, multi-centre, randomised, double-blind, placebo-controlled study in patients with rheumatoid arthritis and an inadequate response to methotrexate." Ann Rheum Dis 67(8): 1096-103.
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- Singh J.A., R. Christensen R, et al. (2009). "Biologics for rheumatoid arthritis: an overview of Cochrane reviews." The Cochrane Database of Systematic Reviews(4).
- Singh JA, Beg S, et al. (2010). Tocilizumab for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD008331. DOI: 10.1002/14651858.CD008331.pub2.
- Singh JA, Furst DE, et al. (2012) 2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis. Arthritis Care & Research, Vol 64, No. 5, May 2012, pp 625-639.
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Biologics Cost Comparison
Note: If the price box contains a , that indicates the dose of that drug is likely available for a low monthly cost through discount programs offered by large chain stores. For example, Kroger, Sam's Club, Target, and Walmart offer a month's supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.
Narrow your list
Best Buy
|Generic Name and Strength
|Brand Name
|Frequency of Use
|Average Monthly CostA
|Abatacept 125 mg/mLB
|Every 4 weeks for intravenous injection
|Once a week for subcutaneous injection
|Adalimumab 40 mg, injectable kit
|Every week or every other week
|Given every other week: $2,632
|Given every week: $5,264
|Adalimumab 40 mg, pen injector
|Every week or every other week
|Given every other week: $2,654
|Given every week: $5,308
|Anakinra 100 mg, disposable syringes
|Certolizumab 400 mg, injectable kit
|Every other week
|Etanercept 25 mg, prefilled syringe
|Once a week
|Etanercept 50 mg, prefilled syringe
|Once a week
|Etanercept 50 mg, pen injector
|Once a week
|Golimumab 50 mg, prefilled syringe
|Every 4 weeks
|Golimumab 50 mg, pen injector
|Every 4 weeks
|Infliximab 100 mgB
|Every 4 to 8 weeksC
|Given every 8 weeks: $2,296D
|Given every 4 weeks: $4,592D
|Rituximab 10 mg/mL
|Every 24 weeksC
|Tocilizumab 200 mg/10 mL
|Every 4 weeks
|Tocilizumab 400 mg/20 mL
|Every 4 weeks
- Prices are derived from national average retail costs for December 2012, rounded to the nearest dollar. Information is derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations. The price listed is for the medication only and does not include administration or other fees that could be incurred.
- Calculated price is based on an assumed body weight of 75 kg (165 pounds) and a dose of 6.5 mg/kg.
- Refers to an average interval; number of infusions required varies among people.
- A typical course requires closer intervals in the beginning. Average costs during the first year of treatment, therefore, may be substantially higher.
- Price might be unreliable because it is based on less than 20 prescriptions.


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text: Machinists Union Machinists At Boeing Supplier In Spokane Prepare To Go On Strike By Ashley Gross • May 10, 2016 Elaine Thompson / AP Photo Listen Listening... / 1:26 About 400 union machinists at Triumph Composite Systems, an aerospace supplier in Spokane, are preparing to go on strike tonight after their contract expires. Lynne Warne, a spokeswoman for Triumph, said the facility will keep operating by using a combination of salaried employees and contractors. Boeing Begins Process Of Building Its 777X Composite Wing Plant In Everett By Ashley Gross • Aug 13, 2014 Ashley Gross Everett is a step closer to becoming the home of Boeing's next wide-body jet assembly. The company has started demolition work on three buildings that will be torn down to make way for the new 777X composite wing center. Machinists Union Leaders Keep Their Posts After Rare Contested Election By Ashley Gross • May 9, 2014 Ted S. Warren / AP Photo After a rare contested election, the incumbents have retained their posts at the top of the International Association of Machinists and Aerospace Workers. International President Tom Buffenbarger kept the position he's held since 1997 by a margin of two-to-one, according to preliminary results. About 23,500 members voted for Buffenbarger, and about 11,200 voted for IAM Reform candidate, Jay Cronk. Longtime Union Organizer Says Machinists' Reform Push Is A Hopeful Sign For Labor By Ashley Gross • May 2, 2014 Elaine Thompson/AP Photo Machinists Union Reform Candidates Explain Why They're Running By Ashley Gross • Apr 3, 2014 Ashley Gross / KPLU Editor's Note: The International Association of Machinists and Aerospace Workers, a union of about 333,000 dues-paying members across the country, has not had a contested election for its top posts since 1961. People have tried to get through the nomination and endorsement process in the past to challenge the union's leadership, but they haven't succeeded, until now. Machinists are voting throughout the month of April, and the results will be known next month. Boeing Contract Fight Fuels Effort To Oust Top Leaders Of The Machinists Union By Ashley Gross • Apr 3, 2014 Elaine Thompson / AP Photo Boeing machinists in the Puget Sound region have a rare chance to head to the polls Thursday and vote on who should run their union's national headquarters. It's the first contested election for the top leadership posts in more than 50 years, and lingering anger over the recent Boeing contract extension vote is fueling an effort to oust the union leaders. Machinists Union President Buffenbarger On Boeing, Reformers' Challenge By Ashley Gross • Apr 3, 2014 Ted S. Warren / AP Photo Editor's Note: Tom Buffenbarger has held the top job of the International Association of Machinists and Aerospace Workers since 1997. He's been in the public eye in the Pacific Northwest ever since the contentious Boeing contract-extension votes that took place last November and in January. Boeing Shifts 26,000 Non-Union Workers In The Seattle Region Away From A Pension By Ashley Gross • Mar 6, 2014 Boeing plans to shift its non-union employees away from a defined benefit pension plan, including about 26,000 workers in the Puget Sound region. In January, machinists here narrowly accepted a similar pension freeze to win the 777X production line. Now, Boeing's including non-union employees in the retirement plan change because the company says its pension obligation is unsustainable. Volkswagen Vote Won't Stop Machinists From Continuing Boeing South Carolina Effort By Ashley Gross • Feb 20, 2014 Bruce Smith / AP Photo Listen Listening... / 1:40 The vote by Volkswagen workers in Tennessee to reject the United Auto Workers union has sent shock waves throughout the world of organized labor. And that setback is an example of why the International Association of Machinists and Aerospace Workers faces an uphill battle organizing Boeing workers in South Carolina. Boeing CEO Says It's Time To Rebuild Relationship With Machinists By Ashley Gross • Jan 29, 2014 AP Photo Listen Listening... / 1:23 (Corrects to clarify that the agreement the machinists passed phases out the pension over time and replaces it with a company-funded 401(k) retirement plan.) Boeing's Chief Executive Jim McNerney says he's looking forward to the prospect of no strikes for the next decade by Washington state machinists. McNerney told Wall Street analysts it made the most sense to build the next version of the 777 jet in the Puget Sound region, as long as the workers accepted the company's contract extension offer. Machinists narrowly approved the deal that preserves job security but phases out their pension and replaces it with a 401(k) retirement plan. McNerney says his deputy, Ray Conner, is now trying to improve morale in the wake of the vote. Reform Candidates Try To Dislodge Top Leaders Of The Machinists Union By Ashley Gross • Jan 23, 2014 Ashley Gross / KPLU Listen Listening... / 1:17 The contentious Boeing contract extension offer that machinists narrowly passed earlier this month left many workers unhappy with their union leaders. This Saturday, they'll have a chance to nominate new candidates for top positions in the union's national headquarters. But the reform candidates face an uphill battle in their effort to dislodge the top leaders. The International Association of Machinists and Aerospace Workers hasn't had a contested election for its highest jobs in more than half a century. NLRB Once Again Caught In The Middle Of A Thorny Boeing-Machinists Dispute By Ashley Gross • Jan 21, 2014 Elaine Thompson / AP Photo Listen Listening... / 2:01 The National Labor Relations Board once again is being called into the middle of a thorny dispute between machinists and the Boeing Company. Could the agency find itself in as much political hot water this time as three years ago? 2011 is the year the NLRB exploded onto the national consciousness, all because the agency's general counsel filed a complaint against Boeing over its decision to build a Dreamliner plant in South Carolina. That drew heated responses from many political conservatives. Boeing Machinists' Plight Marks Changing Times For Labor By Ashley Gross • Jan 15, 2014 The mood at the Seattle union hall was quiet, almost funereal on the night Boeing workers narrowly approved an offer to build the company's new airliner, the 777X. Members of the International Association of Machinists and Aerospace Workers who had gathered had wanted to reject the offer. But they were in a tight spot. They risked losing the bid to one of the 21 states hoping to step in. Embattled Local Leader Of The Machinists Union Announces Resignation By Ashley Gross • Jan 14, 2014 Elaine Thompson / AP Photo Citing health concerns and two hospital stays brought on by stress connected to the Boeing 777x contract extension proposal, the embattled local leader of the machinists' union says he'll resign at the end of the month. Tom Wroblewski, 59, has been president of District Lodge 751 of the machinists' union since 2007. Prior to the post, he served as a grievance coordinator as well as a business representative for the union, with assignments throughout the Puget Sound region. The experience of the 777X contract proposal "changed my perspective on work-life balance," Wroblewski said in a statement. "Your job should not destroy your health." Local Machinists Narrowly Approve Boeing's Best And Final Offer For 777X Work By Ashley Gross • Jan 3, 2014 Ted S. Warren / AP Photo Local machinists narrowly approved Boeing's "best and final" offer that guarantees assembly of the next 777 wide-body jet and the fabrication of the plane's carbon-fiber wing for the Puget Sound region. Some 30,000 local machinists accepted the deal with a 51-percent vote, said International Association of Machinists and Aerospace Workers spokesman Jim Bearden late Friday. Boeing Says Union Vote Will Decide Fate Of Jobs In Puget Sound Area By The Associated Press • Dec 30, 2013 Elaine Thompson / AP Photo Boeing has told local political leaders that this week's vote by Machinists will determine the fate of some jobs on the new 777X airplane. In a press conference Monday morning, local politicians gathered in Everett to discuss the importance of approving the contract. They said Boeing executive Ray Conner told them in a meeting that the union vote will decide whether the new 777X composite wing is built in the region. Union Chief Says Boeing's Latest Offer A $1 Billion Gain By Mike Baker • Dec 27, 2013 AP Photo The international president of the machinists union says Boeing's revised contract offer is an improvement of more than $1 billion. In a letter to union members, Tom Buffenbarger said the offer that workers will consider next week is a significant improvement over a contract the union rejected last month. Nader Says Boeing Pressure On Machinists Union 'Unseemly' By The Associated Press • Dec 26, 2013 Jacquelyn Martin / AP Photo Consumer activist and failed presidential candidate Ralph Nader has some words for Boeing. In an open letter to Boeing CEO Jim McNerney on Thursday, Nader said the company's effort to squeeze worker pensions and pay is "unseemly." He cited McNerney's salary as one reason and the tax advantages the company is receiving as another. Boeing Machinists Will Vote On Company's Contract Offer By Ashley Gross • Dec 21, 2013 Ashley Gross / KPLU Editor's Note: An earlier version of this story stated voting will take place on Jan. 3. However, according to a spokesman for the union's international headquarters, the exact date is still being finalized. Local Boeing machinists will have a chance to vote on the company's "best and final" offer, the acceptance of which would guarantee assembly of the next 777 wide-body jet and the fabrication of the plane's carbon-fiber wing for the Puget Sound region. Shouting Machinists Disagree Over Whether To Vote on Boeing's Latest Offer By Ashley Gross • Dec 18, 2013 Ashley Gross Tempers are running high among Boeing machinists as the company evaluates potential sites to build the next 777 jet. That became evident at a small rally outside the machinists' union hall in Everett Wednesday. Machinists who want to push their union leaders to let them vote on the company's last contract offer organized the rally and said about 80 people would show up. But they only drew about 40. That group marched to the union hall from the company's Everett factory chanting "Give us a voice!" About a dozen counter-protesters arrived, yelling, "We already voted!" The rally turned into a shouting match, with the two sides arguing about things like whether a 401(k) is a good retirement plan. One shouted that he suspected voter fraud in the union's November vote over Boeing's labor proposal. Local Boeing Worker Files Unfair Labor Practice Charge Against Union By Ashley Gross • Dec 17, 2013 Ted S. Warren / AP Photo A Boeing worker in Renton has filed an unfair labor practice charge against the machinists union. Timothy Limestall says local leaders of the International Association of Machinists and Aerospace Workers failed to provide enough information about Boeing's contract extension offer that members voted on last month. Boeing Machinists Say They'll Ask NLRB To Help Force A Vote By Ashley Gross • Dec 15, 2013 Ashley Gross / KPLU Some Boeing machinists angry at their union leaders plan to ask for help from the National Labor Relations Board. They're upset that local leaders from the International Association of Machinists and Aerospace Workers turned down Boeing's best and final offer without putting it to members for a vote. The offer would have secured assembly of the next 777 jet in Washington state along with the carbon-fiber wing fabrication. Schism In Machinists' Union Leaves Boeing Offer Up In The Air By Ashley Gross • Dec 13, 2013 Listen Listening... / 1:08 Boeing machinists in Washington state are trying to figure out whether they'll have a chance to vote on an offer the company made Thursday that would guarantee production of the 777X wide-body jet in the Puget Sound region. Union Leaders: Machinists Make Labor Proposal to Boeing By Ashley Gross • Dec 11, 2013 Ashley Gross / KPLU Listen Listening... / 1:24 The machinists' union has presented a labor proposal to the Boeing Company, local union leaders said late Wednesday afternoon. The details of the proposal have not been released. The union made the announcement after an hours-long meeting with Boeing Commercial Airplanes Chief Executive Ray Conner and other company executives Wednesday, raising hopes that the two sides may strike an agreement to build the next 777 wide-body jet in the Puget Sound region. "We tried to craft a proposal that would meet the needs of our members, while also ensuring the long-term success of the Boeing Co. in Washington state," said Tom Wroblewski, the president of Machinists Union District Lodge 751, in a statement. The union said it expects a response from Boeing by Thursday. St. Louis Machinists President: Keep 777X in Washington By Austin Jenkins • Dec 5, 2013 Listen Listening... / 0:59 The president of the machinists union in St. Louis says Boeing should build the 777X in Washington. And he's angrily denying reports that his members would accept the Boeing contract recently rejected by Northwest machinists. Local Machinist Leader Says There's No New Offer from Boeing By Ashley Gross • Nov 27, 2013 Ashley Gross / KPLU Contrary to rumors that have been circulating among Boeing machinists in Washington state, there's been no new contract offer from the company, according to Tom Wroblewski, president of Local 751 of the International Association of Machinists and Aerospace Workers. Wroblewski, in a post published on the local's website, wrote he's had routine meetings with his counterparts at the company, but hasn't been involved in any talks that would lead to a new offer. He said he has also met with Gov. Jay Inslee and other elected officials. Labor Groups Rally to Support Machinists' Crucial Boeing Vote By Ashley Gross • Nov 18, 2013 Ashley Gross / KPLU Listen Listening... / 1:13 Ever since Boeing machinists voted last week to reject the company's contract extension offer, people in the Puget Sound region have been trying to imagine a future without the aerospace giant here. But against the backdrop of those fears, labor supporters rallied Monday to show they think the machinists did the right thing. Boeing Reaches Out to Utah about 777x Production By The Associated Press • Nov 14, 2013 Ashley Gross / KPLU Boeing Co. leaders have reached out to Utah Gov. Gary Herbert about the state's interest in bringing the production line of 777X airplanes to the state. Michael Sullivan, a spokesman for the Governor's Office of Economic Development, says Herbert received the call Thursday afternoon and has begun preliminary discussions with Boeing leaders. Boeing: 'No Plans to Re-Engage' Machinists until Contract Expires By Ashley Gross • Nov 14, 2013 Ashley Gross / KPLU Listen Listening... / 1:20 Boeing shot down hopes that a sweetened offer might clinch a deal with its 31,000 machinists in the Seattle area to build its next 777 wide-body jet in Washington state. "The contract expires in September 2016. There are no plans to re-engage with the union regarding contract negotiations until prior to contract expiration," Boeing said in a question-and-answer section on its website regarding the contract extension offer it unveiled last week. Boeing Machinists Reject Offer, But Inslee Says 777X Not Lost Yet By Ashley Gross • Nov 13, 2013 Ashley Gross / KPLU Listen Listening... / 0:45 With 67 percent of the votes, Boeing machinists rejected an eight-year contract proposal that would have ensured the assembly of Boeing's 777X and carbon-fiber wing in Washington state. Machinists booed union officials off the stage as they prepared to announce the decision made by the 31,000 members of the International Association of Machinists and Aerospace Workers Local 751 Wednesday night. Local 751 District President Tom Wroblewski later released a statement with the decision. "We preserved something sacred by rejecting the Boeing proposal. We've held onto our pensions, and that's big," the statement said. Pages1 2 next › last »


text:
No reason given for director general's departure
MONTREAL — Radio-Canada Television director general Mario Clement has quit the French-language pubcaster and no reason has been given for the sudden departure.
The laconic press release only stated that the decision was taken by mutual consent of both parties.
Clement started at Radio-Canada as head of programming in 2003 and he became head in November 2006.
Under his tenure, the pubcaster snared a number of hit local shows and shook-up the Sunday night TV scene in French Canada thanks to the popular talk show "Tout le monde en parle," a show that Clement helped get on air.
But he was also a controversial figure. Clement made headlines by publicly attacking the Radio-Canada series "Felix Leclerc," on the iconic Quebec singer-songwriter, while the show was still airing. The producers sued Clement and the network for C$4.3 million ($4.2 million), a case which is still before the Quebec courts.
Radio-Canada's executive VP Sylvain Lafrance will take over Clement's job until a replacement is found.


text:
[[folder: Series-wide ]]
* Any time Tayledras mating circles are mentioned.
** "How many Hawkbrothers does it take for a mating circle?"
*** "Only one, but he has to be flexible!"
* Companions insisting they're not horses.
[[folder: Exiles ]]
* How Herald Alberich (with some help from Kantor) deters a pursuer (who happens to be a popular stage actor). He ducks into an inn, finds out there is a group of young women and chaperones who are major fans, and innocently directs them to outside, where the actor is lurking about. Then he nearly flattens himself against the nearby wall before he gets stampeded by fangirls who practically chase the actor down the street.
* Also, Alberich's first scenes with Herald-Chronicler Myste, where it talks about just how ''unsuited'' to combat she is, being clusmy with coke bottle glasses. Being [[SupremeBadass Alberich]], he immediately comes up with alternative training designed to all but weaponize ScrewThisImOuttaHere.
[[folder: Arrows Trilogy ]]
* The minor sub-plot/ RunningGag in the first book about Talia and Skif repeatedly trying to have sex and failing because one of them keeps ''falling asleep'' due to their crazy schedules.
[[folder: Last Herald-Mage ]]
* More darkly humorous than anything else... Bard Stefan complains to Vanyel's nephew Medren that he's done nearly everything to try to seduce Vanyel and is seriously considering just ambushing the man. Medren quickly advises him not to take that approach, given Vanyel does not react to... surprises well, and mulls to himself about a time when some poor idiot barged in on Vanyel taking a bath. Said thoughts go along the lines of "Grandfather did say he wanted to rebuild the bathhouse. I don't think he meant for it to happen ''that'' way."
* Starwind and Moondance become the first Tayledras to make their presence known to multiple Valdemarans with they visit Forst Reach. Savil warns them about the particularities of the Ashkevrons and Starwind airily waves off her concern. The next chapter, the two of them are desperately trying to maintain polite calm when chattered at by one of the many teenage girls of the main family. Once they are able to elude her, a bewildered Starwind says that the Ashkevrons aren't a family but an army, noting that k'Vala is bigger but that's an entire Clan, not the descent of a single set of parents (Three generations, with the oldest members of the third getting ready to be married themselves, all in ''one'' household)!
[[folder: Mage Winds ]]
* After finding and rescuing Hyllarr, an injured hawkeagle bondbird, Darkwind hits on the idea of having his father Starblade care for him, as Starblade is himself slowly recovering after being freed from the villain's control and having someone to take care of might help both of them heal. Since most bondbirds have very limited ability to grasp complex ideas or abstract concepts, Darkwind is prepared to face some difficulty in explaining his plan to Hyllarr - and is completely floored to discover that Hyllarr not only gets it immediately, but is fully capable of shamelessly hamming up the pain of his hurt wing to play to Starblade's sympathy, complete with little chirps of distress.
-->The bird roused again with satisfaction. '':Hyllarr plays hurt-wing-eyas, Starblade feels good, Hyllarr gets many good eatings, tender eatings, tasty prey, make Hyllarr better. All good.:''\\
"You," [Darkwind] said, shaking an admonitory finger at the bird, "are going to wind up too fat to fly."


text:
Apply directly to the forehead.
Well do you?
Everything in this signature except for this text was made by Wiired, he is my creator and almighty.
This is useless, but it's 2:30 in the morning.
I hate your commercial, and because of it, I don't know your product.
I like how there are 2000 different "ons" though.
This will be gone tomorrow morning.
Even cartoon network made fun of this commercial.
Nothing compares to the original though.


text:
Ready to start her Christmas shopping, Reese Witherspoon says she's going to set limits on the presents for her kids.
"I'm a little strict about that kind of stuff," Witherspoon, 32, the mother of Ava, 9, and Deacon, 5, tells the BBC. "I think kids do best when they only have a couple of things that they really enjoy. I try and stay away from the gluttony of things. They don't appreciate it as much. When they only get one or two things they really like it."
Busy promoting Four Christmases with Vince Vaughn, Witherspoon says she's "just not getting into the spirit" of Christmas – an ironic issue she'll soon remedy.
"I'm going to definitely start doing the Christmas shopping, the whole thing," she says.
Christmas will have her doing the cooking – "I really enjoy that part of it," she says – and a holiday tradition that only an Academy Award-winning actress could have: the children dressing up her Oscar.
"At Christmas time they put a little hat on him and a little scarf," she says, "so he doesn't get cold."
Reese Witherspoon a 'Little Strict' About Kids' Xmas Presents
Charley Gallay/Getty


text:
Web posted Friday, August 28, 1998 5:10 a.m. CT
Editorial: County offers logical choice to fire volunteers
Where there's smoke, there's fire - and there was certainly a heated debate between members of the Potter County Volunteer Fire Department and Potter County commissioners Wednesday during a budget hearing.
Approximately 20 members of the Potter County Volunteer Fire Department were in attendance to voice their concerns over the proposed $25,659,481 budget.
The volunteers - who all stood in unison during their hour-long discussion with county commissioners and County Judge Arthur Ware - expressed their displeasure with inadequate fire trucks and equipment.
Ware, along with commissioners Manny Perez, Strick Watkins and John Stradley, suggested a logical compromise.
However, members of the volunteer group, along with Potter County Fire Chief Jack Bivens, failed to decide on the compromise
Ware's compromise boiled down to a choice - the volunteers can use unused funds for a new fire station at Givens and Broadway from the previous budget for new trucks and equipment or continue to pursue a new fire station.
The county's proposed budget cannot adequately afford both options, Ware said.
Commissioners once again failed to pass the proposed budget, deadlocking at 2-2 for the second time in two days.
Another budget hearing is scheduled for 9 a.m. today.
John Price, River Road Fire Chief and Potter County Volunteer Fire Department President, said Wed-nesday afternoon the group will present a proposal at this morning's meeting.
The Potter County Volunteer Fire Department is an asset, saving the county $1,277 per call, according to figures presented by Price.
Members of the volunteer group are not paid, which saves taxpayers money and prevents the county from having to use possible alternative methods, such as contracting with the city of Amarillo.
A logical compromise was offered Wednesday.
There is only so much available taxpayer money, and a compromise from both sides is the most appropriate solution.
We'd love to hear your feedback. © 1998 Amarillo Globe-NewsWebmaster
_uacct = "UA-2472207-1";
© 2016. All Rights Reserved. | Contact Us


text: public Property propX; public Property propY; protected void registerProperties( int code ) { super.registerProperties( code ); propX = registerProperty( code, "propX", TYPE_INT ); propY = registerProperty( code, "propY", TYPE_INT ); }} PropertyContainer?'s constructor would call the registerProperties() method with one code, and its clone method would call it with another code. The registerProperty() method could tell by the code whether it needed to construct a new property, or clone an existing one. In a simple case like the one above, a PropertyContainer? subclass didn't need to declare a constructor or a clone method -- it just needed a registerProperties() method. (PropertyContainer? was also capable of detecting when a registerProperties() method failed to super). This whole scheme was only possible because Java calls the most derived method from a constructor. --CurtisBartley I have since seen the idiom of calling methods in the derived class from the base class constructor used in the Swing library. The JFrame class has a protected createContentPane method that is used to create the panel that contains the contents of the window. Derived classes can override the method to create panels that are different from the default type. The semantics of Java constructors are really only a problem for those of us who are used to C++ or are converting code from C++ to Java. --NatPryce


text:
There is a widespread belief that the fats of lipomas are not available to the host as a source of reserve food-supply. This is based on certain reputed instances in which the bearer of a lipoma is said to have become greatly emaciated from some intercurrent disease, notwithstanding which the lipoma has either remained its original size or has even continued to grow. Specific cases in which such occurrences have been accurately observed and reported are, however, difficult to find.
Shattock,1 in an interesting discussion of "Localized Fatty Deposits," has commented on this paucity of evidence. He himself knew of but two such reputed cases, and reinvestigation of some of the supposed lipomas in one of these cases showed them to be caseous lymph-nodes. Furthermore, he mentions a third case in which a subcutaneous lipoma did decrease in size during the emaciation of the patient. A diligent search of
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text:
Bill Murray Ended Up In This Couple's Engagement Photos For Some Reason
I mean, why not?
1. On Wednesday, Ashley Donald and Erik Rogers were shooting their engagement photos in downtown Charleston, S.C.
2. According to Raheel Gauba, the photographer, people were shouting all kinds of nice things at the couple as they posed around town.
3. During one shot, though, the photographer turned around to see Bill Murray with his shirt pulled up, hitting his belly, trying to make the posing couple laugh. They invited Murray to pose with him and he agreed.
4. So, the lesson here is, if you ask him, Bill Murray will probably pose in a photo with you. As for the couple, hopefully Ashley and Erik are Murray happy together and always have a clean Bill of health.
5. Sorry…
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text:
Create fabulous spa party favors with Water Lily Spa Party Sticker Decals!
The Water Lily Spa Party Sticker Decals feature a water lily resting on a calm body of water. Each Personalized Water Lily Spa Party Sticker is printed on a white sticker material that is available in 2 inch, 4 inch and 8 inch and can be personalized with your message. Use the Water Lily Spa Party Sticker Decals to personalize plain glassware, favor bags, invitations and much more!
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