Pharmaceutical Corruption Media ArticlesExcerpts of Key Pharmaceutical Corruption Media Articles in Major Media
Note: Explore our full index to revealing excerpts of key major media news articles on several dozen engaging topics. And don't miss amazing excerpts from 20 of the most revealing news articles ever published.
Thinking about going through your medicine cabinet and throwing out all your expired prescriptions? That might not be necessary, according to a UCSF-led study. Researchers analyzed eight prescription drugs with 15 active ingredients that expired between 28 and 40 years ago and found that most remained just as potent as they were on the day they were made. In 12 of the 14 drug compounds, or 86 percent of the time, the amount of active ingredient present in the drugs was at least 90 percent of the amount indicated on the label. That's well within the "reasonable variation" allowed by the U.S. Food and Drug Administration of 90 percent to 110 percent. Only two compounds - aspirin and the stimulant amphetamine - fell below the 90 percent threshold. Another medication, the painkiller phenacetin, fell below the threshold in one sample but was found in levels greater than 90 percent in another. The study was published online last week in the Archives of Internal Medicine.
Note: A drug listed expired as 40 years ago is still just as potent as the day it was made. Could short expiration dates be an example of drug companies finding a way to make more money through unnecessary disposal of older medications?
When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall. The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools. “I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.” Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance. It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.
Note: For deeply revealing reports from reliable major media sources on pharmaceutical corruption, click here.
Mexico on [October 3] launched a massive program to vaccinate fifth-grade girls against human papillomavirus, making it one of the few nations in the world with a universal campaign against the sexually transmitted virus. One million schoolgirls ages 11 or 12 will receive the HPV vaccination this week, Mexican President Felipe Calderon said. Another 200,000 girls who aren’t in school also will be given the vaccine. Mexico becomes one of the few countries in the world to follow in the footsteps of Greece, which in 2007 made the HPV vaccination mandatory for girls entering seventh grade. All fifth-grade girls will be given an initial shot, then a second shot six months later. A third and final dose will be given to girls in ninth grade. Mexico began an obligatory vaccination program of schoolchildren and pregnant women in 1991, and currently [administers] 14 types of vaccines, Health Secretary Salomon Chertorivski said. During weeklong periods three times a year, thousands of doctors and nurses spread across the country to schools and rural clinics to administer the free vaccinations.
Note: Once again the pharmaceutical companies are persuading governments to force the public to take their questionable vaccines. For an excellent report endorsed by dozens of respected doctors and nurses on the serious risks and dangers of vaccines, click here. Read about a key scientific study which showed that monkeys given standard human vaccines developed autism symptoms, at this link. For powerful evidence presented in major media articles that some vaccines are much more dangerous than the health industry will acknowledge, click here.
Dr. Ben Goldacre is no slouch when it comes to rooting out the flaws in scientific studies, analyzing clinical trial data and recognizing when it's been manipulated or fudged. But even Goldacre has been fooled by bad science. In ... his forthcoming book, Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients, ... Goldacre describes how he ended up prescribing the antidepressant reboxetine to his patients based on insufficient data. The research overwhelmingly finds the drug to be ineffective, but it was still approved in the U.K. In order to get approval of the drug in Europe, the manufacturer had simply not published its negative data. Seven trials had been conducted comparing reboxetine against a placebo. Only one, conducted in 254 patients, had a neat, positive result, and that one was published in an academic journal, for doctors and researchers to read. But six more trials were conducted, in almost 10 times as many patients. All of them showed that reboxetine was no better than a dummy sugar pill. None of these trials was published. I had no idea they existed. It got worse. The trials comparing reboxetine against other drugs showed exactly the same picture: three small studies, 507 patients in total, showed that reboxetine was just as good as any other drug. They were all published. But 1,657 patients' worth of data was left unpublished, and this unpublished data showed that patients on reboxetine did worse than those on other drugs.
Note: For deeply revealing reports from reliable major media sources on pharmaceutical corruption, click here.
The doctors prescribing ... drugs don't know they don't do what they're meant to. Nor do their patients. The manufacturers know full well, but they're not telling. Negative data goes missing, for all treatments, in all areas of science. The regulators and professional bodies we would reasonably expect to stamp out such practices have failed us. Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don't like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug's true effects. This distorted evidence is then communicated and applied in a distorted fashion. In their 40 years of practice after leaving medical school, doctors hear about what works ad hoc, from sales reps, colleagues and journals. But those colleagues can be in the pay of drug companies â€“ often undisclosed â€“ and the journals are, too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are owned outright by one drug company.
Note: This is an edited extract from Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients, by Ben Goldacre, published next week by Fourth Estate. For deeply revealing reports from reliable major media sources on pharmaceutical corruption, click here.
The global pharmaceutical industry has racked up fines of more than $11bn in the past three years for criminal wrongdoing, including withholding safety data and promoting drugs for use beyond their licensed conditions. In all, 26 companies, including eight of the 10 top players in the global industry, have been found to be acting dishonestly. The scale of the wrongdoing, revealed for the first time, has undermined public and professional trust in the industry and is holding back clinical progress, according to two papers published in today's New England Journal of Medicine. Leading lawyers have warned that the multibillion-dollar fines are not enough to change the industry's behaviour. The 26 firms are under "corporate integrity agreements", which are imposed in the US when healthcare wrongdoing is detected, and place the companies on notice for good behaviour for up to five years. The largest fine of $3bn, imposed on the UK-based company GlaxoSmith-Kline in July after it admitted three counts of criminal behaviour in the US courts, was the largest ever. But GSK is not alone â€“ nine other companies have had fines imposed, ranging from $420m on Novartis to $2.3bn on Pfizer since 2009, totalling over $11bn. Kevin Outterson, a lawyer at Boston University, says that despite the eye watering size of the fines they amount to a small proportion of the companies' total revenues and may be regarded as a "cost of doing business".
Note: For deeply revealing reports from reliable major media sources on pharmaceutical corruption, click here.
One of [the big drug companies'] bright spots has been emerging markets where in recent years percentage growth in sales has caught up to and in many instances galloped ahead of other regions. But with pharmaceutical companies continuing to pay record civil and criminal fines in the U.S. for illegal marketing practices, recent scrutiny of similar practices abroad raises questions as to whether pharma has simply exported its fraudulent marketing playbook to Europe, Asia, the Middle East and elsewhere. Those sales and marketing tactics are bad news for patients around the world, as financial inducements and bribes should not be permitted to corrupt medical treatment decisions. The good news is that the Securities and Exchange Commission (SEC) whistleblower program will undoubtedly accelerate exposure of corrupt practices overseas and bring greater transparency into pharma’s business practices generally. Pharma companies already are being investigated for U.S. Foreign Corrupt Practices Act (FCPA) violations. The FCPA makes it illegal to bribe foreign officials to win business. Pfizer, the world’s largest drugmaker, paid $60.2 million last month to the U.S. to settle charges that the company bribed government officials – including hospital administrators, government doctors and members of regulatory and purchasing committees — in China, Russia, Italy, Bulgaria, Croatia, Serbia and Kazakhstan to approve and prescribe Pfizer products. Other pharma companies are under scrutiny by the U.S. for their practices elsewhere.
Note: For deeply revealing reports from reliable major media sources on pharmaceutical industry corruption, click here.
The U.S. health care system squanders $750 billion a year — roughly 30 cents of every medical dollar — through unneeded care, byzantine paperwork, fraud and other waste, the influential Institute of Medicine [said] in a report. President Barack Obama and Republican Mitt Romney are accusing each other of trying to slash Medicare and put seniors at risk. But the counter-intuitive finding from the report is that deep cuts are possible without rationing, and a leaner system may even produce better quality. More than 18 months in the making, the report identified six major areas of waste: unnecessary services ($210 billion annually); inefficient delivery of care ($130 billion); excess administrative costs ($190 billion); inflated prices ($105 billion); prevention failures ($55 billion), and fraud ($75 billion). Adjusting for some overlap among the categories, the panel settled on an estimate of $750 billion. The report makes ten recommendations, including payment reforms to reward quality results instead of reimbursing for each procedure, improving coordination among different kinds of service providers, leveraging technology to reinforce sound clinical decisions and educating patients to become more savvy consumers. The report’s main message for government is to accelerate payment reforms, said panel chair Dr. Mark Smith, president of the California HealthCare Foundation, a research group. For employers, it’s to move beyond cost shifts to workers and start demanding accountability from hospitals and major medical groups. For doctors, it means getting beyond the bubble of solo practice and collaborating with peers and other clinicians.
Note: The US spends far more on health care than most other developed countries which provide health care to all of their citizens. The US system is driven by profits. For more on this, click here.
I remember the moment my son's teacher told us, "Just a little medication could really turn things around for Will." We stared at her as if she were speaking Greek. "Are you talking about Ritalin?" my husband asked. Will was in third grade, and his school wanted him to settle down in order to focus on math worksheets and geography lessons and social studies. The children were expected to line up quietly and "transition" between classes without goofing around. Will did not bounce off walls. He wasn't particularly antsy. He didn't exhibit any behaviors I'd associated with attention deficit or hyperactivity. He was an 8-year-old boy with normal 8-year-old boy energy - at least that's what I'd deduced from scrutinizing his friends. "He doesn't have attention deficit," I said. "We're not going to medicate him." Once you start looking for a problem, someone's going to find one, and attention deficit has become the go-to diagnosis, increasing by an average of 5.5 percent a year between 2003 and 2007, according to the Centers for Disease Control and Prevention. As of 2010, according to the National Health Interview Survey, 8.4 percent, or 5.2 million children, between the ages of 3 and 17 had been given diagnoses of attention deficit hyperactivity disorder. There's no clinical test for it: doctors make diagnoses based on subjective impressions from a series of interviews and questionnaires. I understand why the statistics are so high. In many cases, I discovered, diagnoses hinge on the teachers' [information].
Note: For deeply revealing reports from reliable major media sources on corruption in the medical-pharmaceutical complex, click here.
The U.S. Department of Justice has reached a settlement in the largest health care fraud case in U.S. history. The ruling, which included accusations of false advertising, forced the once widely respected British drugmaker, GlaxoSmithKline ... to pay a record-shattering $3 billion to various plaintiffs and the Department of Justice. Despite this $3 billion settlement, advertising fraud is on the rise in the United States. Expert public relations teams are called in to spin stories and confuse consumers. It is clear there is not enough being done to prevent, stop or resolve matters of false advertising in this country. The effect of the GlaxoSmithKline case has yet to be fully seen. If GlaxoSmithKline is [creative and deceptive] then we might see it roll out ads that skew the $3 billion loss in its favor - blatantly distorting the ruling as an endorsement of its products. At this point, even as regulators secure record-breaking settlements, the American people are losing, and the corporate spin teams are winning, the fight. Record settlements mean little if the deception continues. While winning lawsuits is a first step, what really matters is changing corporate behavior.
Note: For lots more from reliable sources on corporate corruption, click here.
Dr. David Healy is an internationally renowned psychiatrist, psychopharmacologist, scientist, and author. He was responsible for submitting the key document that led to New York State's successful fraud action against GlaxoSmithKline. [Q.] You’ve written at your blog that “evidence-based medicine and RCTs [random controlled trials] are ... simply not the answer to determining cause and effect,” [because] they’re “quite likely to hide rather than reveal a problem like antidepressant induced suicidality.” How in fact do RCTs hide such information? [Dr. Healy:] There are ... specific problems like miscoding, where suicidality becomes “nausea” or “emotional lability” or even “treatment non-responsiveness.” There is also the problem of mislocation – patients on placebo end up being given problems they never had – and of nonexistent patients, who don’t of course have adverse events. Beyond that, there are more sophisticated tricks that companies can and do play – such as claiming that increased rates of a problem on a drug are not really evidence of an increase in rates if the data are not statistically significant. In this way, companies have hidden many more heart attacks on Vioxx and Avandia or suicidal acts on SSRIs than have been hidden by miscoding or mislocation. When it comes to adverse events, trials almost never get the right answer. The deeper problem ... is the combination of product patents, prescription-only status, and the use of clinical trials as a means of determining efficacy – in particular, when the data from those trials are not made available. This creates a perfect product ... which industry can manipulate to mean whatever they want them to mean.
Note: Dr. Healy is the author of more than 150 peer-reviewed articles and 20 books. For an excellent article going further into Dr. Healy's amazing work, click here. For deeply revealing reports from reliable major media sources on health corruption and manipulations, click here.
Drug maker Novartis is taking legal action in Britain to make state-run hospitals use an eye drug that costs about 700 pounds ($1,130) per shot instead of a cheaper one that costs 60 pounds ($97). In a statement, Novartis said it was calling for a judicial review “as a last resort” because it believed patient safety was being potentially compromised. According to the U.K.’s health watchdog, Novartis’ Lucentis is the only drug recommended to treat the eye problem macular degeneration in the country’s state-run National Health Service hospitals. However, several NHS hospitals have been prescribing the much cheaper Avastin, a cancer drug made by Genentech Inc., a subsidiary of Roche, for the same problem even though it has not been officially approved. A study published in the New England Journal of Medicine last year showed Avastin worked just as well as Lucentis for treating the eye disorder. Lucentis and Avastin act on the same biological protein in the body to spur blood vessel growth. In the U.S., eye doctors have often used tiny amounts of Avastin and billed the government for the cost, rather than buying Lucentis. Patient groups called for an independent analysis to determine which drug should be used.
Note: For lots more from reliable sources on corporate corruption, click here.
Why is a me-too drug for which there are much cheaper alternatives the second-best selling medicine in the United States? Today, IMS Health released its annual look at the sales of prescription drugs in America. It is the first year in which all of the top ten medicines in America are generics. This year, cancer drugs passed antipsychotic medicines as the top revenue generators. The biggest surprise ... is in the second-place spot: Nexium, ... from AstraZeneca, which generated $6.3 billion in sales. Abilify, from Otsuka and Bristol-Myers Squibb, passed Seroquel from Astra as the top-selling antipsychotic drug for disease like schizophrenia, bipolar disorder, and depression. Crestor, AstraZeneca’s cholesterol drug, has delivered a pretty stunning 5-year sales increase of 190%, apparently grabbing patients for whom Lipitor, from Pfizer, is not powerful enough. Sales do not equal popularity. Only three of these drugs (Lipitor, Plavix, and Singulair) rank among the top 25 most popular medicines. Price is often as big a component in making money as volume.
A study in Finland has found that children vaccinated against the H1N1 swine flu virus with Pandemrix were more likely to develop the sleep disorder narcolepsy. The condition causes excessive daytime sleepiness and sufferers can fall asleep suddenly and unintentionally. The researchers found that between 2002 and 2009, before the swine flu pandemic struck, the rate of narcolepsy in children under the age of 17 was 0.31 per 100,000. In 2010 this was about 17 times higher at 5.3 per 100,000 while the narcolepsy rate remained the same in adults. Markku Partinen of the Helsinki Sleep Clinic and Hanna Nohynek of the National Institute for Health and Welfare in Finland, also collected vaccination and childhood narcolepsy data for children born between January 1991 and December 2005. They found that in those who were vaccinated the rate of narcolepsy was nine per 100,000 compared to 0.7 per 100,000 unvaccinated children, or 13 times lower. Pandemrix was the main vaccine used in Britain against the swine flu epidemic in which six million people were vaccinated. It was formulated specifically for the swine flu pandemic virus and is no longer in use.
Note: The WHO stated "more than 12 countries reported cases of narcolepsy in children and adolescents using GlaxoSmithKline's swine flu vaccine." For powerful media reports suggesting that both the Avian Flu and Swine Flu were incredibly manipulated to promote fear and boost pharmaceutical sales, click here. For many news articles showing that vaccines are not tested adequately for safety and are at times politically and financially motivated, click here. For lots more from reliable sources on pharmaceutical corruption, click here.
Dr. Arnold S. Relman [is] 88; Dr. Marcia Angell, 72. But their voices are as strong as ever. Colleagues for decades, late-life romantic partners, the pair has occasionally, wistfully, been called American medicine’s royal couple. In fact, controversy and some considerably less complimentary labels have dogged them as well. From 1977 to 2000, one or both of them filled top editorial slots at The New England Journal of Medicine as it grew into perhaps the most influential medical publication in the world, with a voice echoing to Wall Street, Washington and beyond. Many of the urgent questions in the accelerating turmoil surrounding health care today were first articulated during their tenure. Or, as Dr. Relman summarized one recent afternoon ..., Dr. Angell nodding in agreement by his side: “I told you so.” Their joint crusade ... is against for-profit medicine, especially its ancillary profit centers of commercial insurance and drug manufacture — in Dr. Relman’s words, “the people who are making a zillion bucks out of the commercial exploitation of medicine.” Some have dismissed the pair as medical Don Quixotes, comically deluded figures tilting at benign features of the landscape. Others consider them first responders in what has become a battle for the soul of American medicine.
Note: For a powerful summary of Dr. Marcia Angell's critique of corruption in the medical industry, click here.
There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. Americans don’t see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, actually. We spend less time in the hospital than Germans and see the doctor less often than the Canadians. The International Federation of Health Plans ... surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor’s visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we’re paying quite a bit more. In America, ... it’s a free-for-all. Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured.
Note: And why are the prices higher in the U.S.? Could it be that the U.S. is the only developed nation that doesn't have nationalized health care, so that profit is no longer a motive in caring for people's health? For deeply revealing reports from reliable major media sources on corruption in the medical industry, click here.
One brief message at a time, Lancet editor Richard Horton is tweeting his dark view of the contemporary medical establishment. If you have any interest at all in peeking behind the curtain to see what really goes on behind the scenes of top medical organizations then you need to follow Richard Horton’s Twitter feed. In sudden bursts of candor, humor, and cynicism, Horton has been tweeting thoughts that don’t often see the light of day. Here’s his unvarnished opinion of the World Health Organization, for instance: "WHO is no longer a science-based organisation. WHO believes that scientists within the agency should be anonymous bureaucrats." The thread of tweets that prompted this post [is] about an ongoing editorial battle with authors and another highly respected journal. The significance of these remarks is considerable. As Horton remarks at the end, the episode appears to lend evidence to the manipulation of journals by industry: "The mother of all authorship disputes has broken out. When papers get salami sliced and divided between NEJM and us, it gets complicated. And sometimes nasty. And today, even threatening. From Principal Investigator: “Approval [of the drug in question] has already occurred in the US, yet private insurers are slow to place it on their formulary. A major publication is typically how this occurs in the US, and it is important to be in a journal typically recognised by US-based companies. This publication is critical to (company A's) ability to “market” their product. Lancet ... will aid (company Y) quite nicely.”
Note: The Lancet is considered by many to be the most prestigious medical journal in the world. If the editor-in-chief of the Lancet readily admits to for-profit collusion between medical journals, insurers and big pharma, who can we trust for accurate health information? To learn more, read a powerfully revealing essay by former editor-in-chief of the New England Journal of Medicine Marcia Angell on how the drug companies blatantly manipulate science for profit.
Johnson & Johnson will pay more than $1 billion to the U.S. and most states to resolve a civil investigation into marketing of the antipsychotic Risperdal. Negotiations over a possible criminal plea are still under way. The U.S. government has been investigating Risperdal sales practices since 2004, including allegations the company marketed the drug for unapproved uses. J&J, the world’s largest health products company ... disclosed in August that it reached an agreement to settle a misdemeanor criminal charge related to Risperdal marketing. The company is discussing paying about $400 million more to settle that portion of the investigation. Risperdal, once J&J’s best-selling drug, generated worldwide sales of $24.2 billion from 2003 to 2010, reaching $4.5 billion in 2007. After that, J&J lost patent protection and sales declined. The settlement represents ... about 5.6 percent of the drug’s cumulative sales since 2003. The Food and Drug Administration approved Risperdal in 1993 for psychotic disorders including schizophrenia. That market is limited, and J&J’s Janssen unit sought to sell Risperdal for bipolar disorder, dementia, mood and anxiety disorders and other unapproved uses.
Note: For highly-illuminating reports from reliable sources on the corruption in the pharmaceutical industry, click here.
In 2006 ... the Centers for Disease Control and Prevention in Atlanta and the World Health Organization in Geneva warned of the imminent onset of an avian flu "pandemic" of lethal proportions. The pandemic never occurred. After reviewing studies of Tamiflu during the avian flu scare, Dr. Tom Jefferson ... had concluded in a 2006 report that the drug was effective. "But," said the article, "several years later, another physician challenged that conclusion because 8 of 10 studies in a meta-analysis — a review of studies — that Jefferson relied on had never been published." That prompted Jefferson to seek the raw data. "He was stymied when several authors and the manufacturer gave one excuse after another for why it couldn't supply the actual data. Jefferson's concern turned to outrage when two employees of a communications company … [revealed] they had been paid to ghostwrite some of the Tamiflu studies [and] had been given explicit instructions to ensure that a key message was embedded in the articles: Flu is a threat, and Tamiflu is the answer. "After reanalyzing the raw data finally made available (they still don't have it all), Jefferson and his colleagues published their review [in December 2009], saying that once the unpublished studies were excluded, there was no proof that Tamiflu reduced serious flu complications like pneumonia or death." In short, it appears the pharmaceutical companies had been as cunning in conning the public on matters of health as Wall Street had been on matters of wealth.
Note: For powerful media reports suggesting that both the Avian Flu and Swine Flu were incredibly manipulated to promote fear and boost pharmaceutical sales, click here. For lots more from reliable sources on pharmaceutical corruption, click here.
Insurance companies spent millions of dollars trying to defeat the U.S. health care overhaul, saying it would raise costs and disrupt coverage. Instead, profit margins at the companies widened to levels not seen since before the recession, a Bloomberg Government study shows. Insurers led by WellPoint ... recorded their highest combined quarterly net income of the past decade after the law was signed in 2010, said Peter Gosselin, the study author. "The industry that was the loudest, most persistent critic of this law, the industry whose analysts and executives predicted it would suffer immensely because of the law, has thrived," Gosselin said. Health insurers contributed $86.2 million to the U.S. Chamber of Commerce to oppose the law after Obama administration officials criticized the [corporations'] plans for enriching themselves by raising customer premiums. Companies are changing their business focus to gain from provisions in the law that will expand the size of Medicaid, the $401 billion government health plan for the poor.
Note: Is it surprising that health insurance companies are raking in big profits from the new health care legislation?
Important Note: Explore our full index to revealing excerpts of key major media news articles on several dozen engaging topics. And don't miss amazing excerpts from 20 of the most revealing news articles ever published.