Princess Health and You Can Check Out Any Time You Like, But You Can Never Leave - Duke and UNC Allegedly Agreed Not to Hire Each Other's Faculty. Princessiccia

Princess Health and You Can Check Out Any Time You Like, But You Can Never Leave - Duke and UNC Allegedly Agreed Not to Hire Each Other's Faculty. Princessiccia

antitrust corporate physician Duke University economism market fundamentalism medical schools University of North Carolina

Gusty 12:11 Add Comment

We have intermittently discussed the worsening plight of physicians trying to provide clinical care as employees of large organizations.  Such corporate physicians are likely to be squeezed between professional values that put the patient first, and management that puts revenue first.   Physicians employed by large corporations may find their values increasingly at risk as these organizations adapt the tactics of the robber barons.

Now it appears that even ostensibly genteel academic medical institutions may be adapting these tactics.

Allegations of Anti-Competitive Faculty Employment Practices at Duke and University of North Carolina Medical Schools


The story first appeared with little fanfare in the (Duke) Chronicle in June.  An assistant professor at the UNC School of Medicine was interested in a position, also at the assistant professor level, at nearby Duke.

[Dr Danielle] Seaman had been in email communication with UNC�s Chief of Cardiothoracic Imaging beginning in 2011, when she expressed interest in a radiology position at the UNC School of Medicine, and the chief of the division encouraged her to apply, the case file describes. In 2012, Seaman was invited to visit the campus and toured the radiology department at UNC.

However,

When Seaman expressed interest in the assistant professor position again in early 2015, however, the chief responded in an email by saying he had just received confirmation that 'lateral moves of faculty between Duke and UNC are not permitted' as per a 'guideline' set by the schools� deans.

In a later email, the chief also described to Seaman the reason the agreement was created�Duke had tried several years ago to recruit the entire bone marrow transplant team from UNC, and UNC was forced to pay them a large retention package to keep them.

Both emails are included in the filing by Dr Seaman's lawyers.


Imagine the nerve of medical faculty thinking they should be paid more by the current employer because another institution was willling to recruit them and pay them that much.
 
An Agreement Comfortable for the Deans, but Disadvantageous for Their Faculty

An August article in the Chronicle suggested that the top leaders of the two medical schools felt that the "no-poaching" agreement was mutually beneficial. 

According to the case file, Seaman became aware of the policy earlier this year, but the UNC chief of cardiothoracic imaging�who is unnamed in the file�believed the policy had been in place for several years after Duke had previously tried to recruit the entire bone marrow transplant team from UNC.

'The general rule was that we didn�t recruit there and they didn�t recruit at Duke�it certainly was in the years I was in the administration,' said John Burness, former senior vice president for public affairs and government relations from 1991 to 2008. 'I don�t know if it�s ever been a formal agreement, but it�s certainly been a practice over a long period of time.'

Burness�now a visiting professor of the practice in the Sanford School of Public Policy�noted that he could not recall an instance in which a faculty member from UNC was recruited to Duke during Nannerl Keohane�s tenure as president of the University from 1993 to 2004. Keohane also confirmed that during her time as president the University avoided poaching of UNC faculty.

Also,

'The question of whether Duke and UNC [or N.C. State] should attempt to recruit faculty from the other campus was always somewhat delicate,' Keohane, now Laurance S. Rockefeller distinguished visiting professor of public affairs at Princeton University, wrote in an email.

The Chronicle found a Duke Law professor who provided a comfortable rationale for the agreement between the two schools,

Despite the case file�s claims that such a policy is detrimental to faculty from both schools, Clark Havighurst�a former professor in the Duke University School of Law who taught healthcare policy and antitrust law for more than 40 years�also believes that this agreement would be beneficial to both institutions in the long run.

'You�d probably find relatively few instances where Duke and Carolina have poached each other�s faculty,' Havighurst wrote in an email. 'This is probably a matter of mutual restraint as much as explicit agreement, however, as each school or department would hesitate to irritate the faculty at the neighboring institution, thus undermining collegial and personal relations that are undoubtedly beneficial to each.'


What the soothing words about mutual benefit and collegiality leave out is that while the school administrations benefit from less disruption, they also likely benefited by being able to pay their faculty, especially junior faculty less. As Dr Seaman argued in her filing, as per the June Chronicle article,

The suit�filed June 9 in the United States District Court for the Middle District of North Carolina�contends that the no-hire agreement had the �intended and actual effect� of suppressing competition and employee wages, therefore violating federal and state anti-trust laws.

An Aside, the Non-Poaching Agreement Defended by One of the Key Advocates for Market Fundamentalism in Medicine

As an aside, Professor Havinghurst turns out to be one of key architects of the transformation of the US health care from a regulated system emphasizing health care provided by individual professionals and small non-profit institutions to our current laissez faire commercialized system.  It is more than ironic that while Prof Havinghurst now scoffs at applying anti-trust law to alleged collusion by big employers, per M Gregg Bloche in the Stanford Law Review(1),

Since the mid- 1970s, market-oriented scholars have challenged a broad range of legal principles previously assumed to sustain the trustworthiness of physicians and health systems. Doctrines shielding physicians from antitrust law, insulating them from insurers' and hospitals' influence over clinical practice, and reinforcing the precept of undivided clinical loyalty to patients came under attack as protection for the medical profession at consumers' expense. These scholars, including Clark Havighurst, Richard Epstein, and Mark Hall, urge contractual ordering of clinical standards of care; relationships among physicians, hospitals, and health care payers; and physicians' conflicting obligations to patients, payers, and other third parties.

Again, Havinghurst appears to have been one of the principal, if not the principal advocate to use anti-trust law against small groups of physicians, and against the notion that physicians can promulgate their own codes of ethical conduct.  In an introduction to an article by Havinghurst in Health Affairs in 1983.(2)

For a decade or more, Clark Havighurst has been a philosophical thorn in the side of organized medicine, preaching a view of the health sphere that rejects decision making by professional self-regulation in favor of a system based on marketplace principles.

Note that in retrospect, this article seemed to stake out Health Affair's position as an important organ to promote market fundamentalism in health care. 

How convenient that Prof Havinghurst is still affiliated with Duke and in a position to defend his university's treatment of other faculty.


I urge you to scan Health Care Renewal to see how the change from professional self-regulation of ethics to the free rein of the laissez faire marketplace turned out. Look here for our first reporting on the late Dr Arnold Relman's discussion of how medicine was pressured to accept commercialization, and how that acceptance has since decimated our core values.  Look here for our discussion of the fallacy of the perfect market in health care.  Look here for a rebuttal from an authority we do  not often quote of the concept of health care as a commodity versus a calling. 

Summary

Note that the outcome of the lawsuit against Duke and UNC is unknown.  The allegations it makes are not proven.  However, I chose to discuss it because the evidence, particularly the emails reproduced in the court filing, seems pretty strong that the two schools did have an actual agreement not to compete in the hiring of faculty, and the argument that his suppressed faculty wages and opportunity is prety strong and obvious.

Academic physicians, particularly at elite institutions, may feel they are in a rarefied atmosphere separate from the hurley burley or everyday health care.  They may feel they are protected from, and can even ignore the health care dysfunction we discuss on Health Care Renewal.  They certainly may not think of themselves as "wage slaves" from the era of trusts, monopolies, and robber barons.

But this case exhibits that academic medical institutions are getting closer to the ruthless world of poorly regulated, commercialized, market fundamentalist health care.  Talk about collegiality is nice, but it seems pretty clear that the "non-poaching" agreement between Duke and UNC may have reflected collegiality among top medical school leadership, but limited their faculty salaries and individual faculty members' choices and opportunities.  This seems like another example, however soft spoken and genteel, of the leaders of health care organizations putting the interests of their own ingroup ahead of the interests of the larger organizations and the mission they are supposed to serve.

It is time for even academic physicians to realize that they are not protected from the troubles of the larger world.  If they truly believe in their professional values, if they really care about patients' and the public's health, and about medical and health care science and education, they will have to start speaking up, or they will end up wage slaves of the new health care robber barons along with nearly everyone else.   

To lighten things up at the end, the Eagles doing Hotel California live in 1977 -



"We are all prisoners here, of our own device"

References
1.  Bloche MG. Trust and betrayal in the medical marketplace.  Stanford Law Review 2002; 55: 919-954.  Link here.
2.  Havinghurst C. The doctors' trust.  self-regulation and the law.  Health Affairs 1983; 2: 64-76.  Link here.

Princess Health and How Much Does Sugar Contribute to Obesity?. Princessiccia

Princess Health and How Much Does Sugar Contribute to Obesity?. Princessiccia

overweight

Gusty 13:30 Add Comment

Last week, the British Medical Journal published a review article titled "Dietary Sugars and Body Weight", concluding that "free sugars" and sugar-sweetened beverages contribute to weight gain. But what are "free sugars", and why does the scientific literature suggest that the relationship between sugar intake and body weight isn't as straightforward as it may initially appear?

Read more �

Princess Health and The Real Dark Side of Health Care: Health Care Corruption. Princessiccia

Princess Health and The Real Dark Side of Health Care: Health Care Corruption. Princessiccia

anechoic effect Annals of Internal Medicine health care corruption medical journals professionalism

Gusty 14:35 Add Comment

The editors of the prestigious Annals of Internal Medicine just stated they they were shocked, shocked to find out that physicians occasionally express disrespect for patients when the patients cannot hear or see them.  The occasion was an editorial signed by three editors whose title included the phrase, "shining a light on the dark side of health care."(1)  The editorial referred to an anonymous narrative that recounted two incidents from the past.(2)

Two Alleged Incidents of Physicians' Expression of Disrespect for Patients

The first incident, discussed second hand, was of a obstetrician who made a sexist comment about a patient, who was under anesthesia, presumably unconscious, and being prepared for surgery.  The second incident, presumably less recent, was of an obstetric/gynceology resident who, after performing an emergency procedure that saved a woman from potentially fatal acute hemmorhage, performed an impromptu dance routine that appeared to disrespect the patient's ethnicity, until stopped by the anesthesiologist who issued a profance rebuke.

The names of the people involved, the hospitals in which these incidents occurred, and even the years when they happened are unknown.  The Annals did not publish anything suggested their veracity was corroborated.

There was no apparent harm to or direct effect on any patient as a result of either incident.  Of course, both alleged incidents suggested very disrespectful expression by the two physicians.  Their actions appeared unprofessional.

The Editorial Reaction

As noted above, the editorial called the incidents examples of medicine's "dark side."  It further said they may make "readers' stomachs churn," referred to "medicine's dark underbelly," and "repugnant behavior," and characterized the narrative as "disgusting and scandalous," and having the potential to "damage the profession's reputation."  The editorial characterized the the behavior of the obstetrician in the first incident as "highly disrespectful," and said it "reeked of misogyny and disrespect," while the second "reeked of all that plus heavy overtones of sexual assault and racism." 

That is certainly extreme language.  The editors appeared shocked, shocked that any physician could ever express disrespect for a patient, even when the patient could not possible be aware of that.  Nonetheless, of course, the behavior alleged to have occurred was certainly inappropriate and unprofesional, and cannot be condoned.

The Media Reaction

The two articles got considerable publicity, and media coverage also made the incidents out to be extremely sordid, using words like,"disturbing," "astonishing," "unsavory," (albeit also "boorish,") (LA Times); "criminal," "vulgarity," (MedPage Today); "appalling," "troubling," (NY Times); and  "misogynistic," "abhorrent," (US News and World Report).  I must note that some of the news coverage did reflect doubts that the two Annals of Internal Medicine articles represented some horrendous catastrophe, raising issues such as the humanness of doctors, so that some may be "prone to sociopathy and criminality;" the stress of some medical emergencies leading to letting off steam, or poor attempts at humor; and doubts about the representativeness and validity of the two alleged anecdotes.

Nonetheless, it seemed to me that the Annals articles and the media coverage did suggest an impending crisis due to the sordid behavior of perhaps numerous doctors, and at least the tone of the media coverage they provoked suggested the need for immediate action.

Was the Outrage Justified?

However, first keep in mind that these two incidents involved two individual doctors, one a trainee.  There are approximately 800,000 physicians in the US.  They are human.  Is it any surprise that some are "bad apples," and that others occasionally behave badly?  There is nothing in the two articles to suggest that these incidents reflected more organized, systemic actions.

Furthermore, the articles seemed to ignore the fact that mechanisms, perhaps not flawless, are already in place to address unprofessional behavior by physicians, even if no one involved in the published narrative may have used them.  In the US, physicians are subject to discipline from state licensing boards.  They may be reported to those boards for unprofessional behavior.  The boards can sanction physicians in a variety of ways, up to and including permanent loss of license.  Both alleged incidents apparently occurred in teaching hospitals.  Attendings and residents at teaching hospital must answer to department chairs, medical school deans and hospital staffs.  So mechanisms for policing such behavior exist, even if they may have not been used in this case.  A look at state medical board websites reveals that that physicians are often sanctioned for bad behavior that disrespects or even endangers patients. 

Finally, the Annals of Internal Medicine used very strong language, involving churning stomachs, reeks of misogyny, sexual assault, and racism, dark underbellies, etc.  Was this a proportionate response to two anonymous cases that did not involve allegations of direct patient harm?

The Real Dark Side

Readers of Health Care Renewal know that we often discuss systemic problems in health care, often involving the leadership of large health care organizations, that may produce real harms to patients' and the public's health, but for which no good policing mechanisms seem to exist.  Worse, these problems seem to be a taboo topic in health care policy discussions, and in medical journals, like the Annals of Internal Medicine.

In my humble opinion, the Annals' editorial outrage would ring less hollowly if it was accompanied by even greater outrage at such more extreme problems. 

Let me start with a recent example.

Example: the Anechoic AllTrials US Launch

Very recently we discussed how the launch of new US AllTrials initiative got almost no notice.  Specifically, even though a sponsor of the initiative is the American College of Physicians, that organization's publication, the Annals of Internal Medicine, did not comment on it.  (A search of the journal using the term AllTrials produced no results.)

However, the AllTrials initiative means to tackle the problem of suppressed clinical research.  We have long discussed how research may be systematically suppressed when its results do not please its commercial sponsors.  Particularly, trials of drugs or devices that do not produce favorable results may be suppressed by their sponsors, usually the companies that make the drugs or devices.  Such suppression breaks trust with and therefore hugely disrespects the patients who volunteered to participate in the trials, who believed they were contributing to science and public health.  Suppressing data that drugs and devices may be ineffective and harmful may endanger patients by letting them be treated by such drugs and devices in the illusory belief that they are safe.  Yet where is the outrage about such dishonest behavior by large and powerful health care organizations that disrespects, and more importantly, endangers patients?

Health Care Corruption

When a pharmaceutical, biotechnology, or device company withholds results of a clinical trial to makes its product look better and enhance its revenue, that is an example of health care corruption.

Transparency International defines corruption as

Abuse of entrusted power for private gain

When health care corporations run clinical trials, we entrust them to do honest research and be worthy of the trust of their research subjects.  Withholding the results to enhance revenue is therefore abuse of that entrusted power for private gain.

Health Care Corruption as a Taboo Topic

This blog focuses on the US, and we  now have in our archives some amazing stories that document various forms of health care corruption in the US, including numerous allegations of misbehavior by large health care organizations ending in legal settlements, and examples of outright fraud, bribery, kickbacks and other crimes.  Some large and profitable health care corporations have made numerous such settlements over recent years.  (For example, see the track record to date of Pfizer Inc here and that of Johnson and Johnson here.)

Much of this bad behavior was meant to sell drugs, devices, or clinical services, often in situations in which their benefits did not outweigh their harms.  For example, we just discussed the latest settlement by Amgen of allegations that it promoted an epoetin (Aranesp) "off-label" for cancer patients not on chemotherapy.  Such "misbranding" was not merely a technical violation, since it has been shown that use of the drug in this situation increases mortality.   Such bad behavior thus likely harmed numerous patients.

Furthermore, efforts to police these kinds of corruption have been weak and scattered.  Most cases have ended with legal settlements that at most involve fines to corporations, yet the fines are rarely big enough to significantly affect their overall revenues.  While the corporations themselves may be thus punished, the people who actually authorized, directed or implemented the bad behavior are usually unscathed.  So as we have discussed frequently, such attempts at justice are unlikely to deter future bad behavior.

In fact, people more distinguished than yours truly have been warning about health care corruption for years. In particular, in 2006, the Transparency International Global Corruption Report focused on health care corruption, and asserted in its executive summary, " the scale of corruption is vast in both rich and poor countries."  It also noted how diverse is health care corruption:

In the health sphere corruption encompasses bribery of regulators and medical professionals, manipulation of information on drug trials, the diversion of medicines and supplies, corruption in procurement, and overbilling of insurance companies. It is not limited to abuse by public officials, because society frequently entrusts private actors in health care with important public roles. When hospital administrators, insurers, physicians or pharmaceutical company executives dishonestly enrich themselves, they are not formally abusing a public office, but they are abusing entrusted power and stealing precious resources needed to improve health.

It further stated how serious the consequences of corruption may be for patients and public health:

Corruption deprives people of access to health care and can lead to the wrong treatments being administered. Corruption in the pharmaceutical chain can prove deadly....

The poor are disproportionately affected by corruption in the health sector, as they are less able to afford small bribes for health services that are supposed to be free, or to pay for private alternatives where corruption has depleted public health services.

Corruption affects health policy and spending priorities.

Occasionally, something is published about health care corruption in the US in the medical literature.

- In 2009, qualitative interviews by Pololi et al in the Journal of General Internal Medicine produced many striking anecdotes suggesting corruption in US academic medicine. Four of the interviews were with faculty whose leaders allegedly used deception for personal and professional gain (i.e., �a situation of major unethical use of funding,� �fraudulently creating data for a research project,� �we�re lying to the people who are doing our school evaluations, we�re putting things on paper that we do that we don�t do,� �that�s what I think he felt he had to do�hide money, lie about money, or at least cook the books a little bit.�)(4)  These results produced few echoes, particularly not any strident editorials about the need to address corruption.
- In 2011, an article in the Lancet suggested that "there is more corruption in the G8 countries than in the whole of Africa," but for any health care professional to acknowledge that would be "professional suicide" (see this post).(3)
- Finally, in 2013, a Transparency International survey showed that 43% of Americans believe their health care system is corrupt.  Yet this received no media attention, and to my knowledge has never been mentioned in a major US medical journal.  (Look here.)

So health care corruption remains a largely taboo topic.  (On Health Care Renewal, we call corruption "anechoic," since evidence of health care corruption produces few echoes.) 

The Annals of Internal Medicine, like most major medical journals, has long avoided discussion of health care corruption, and how systemic corruption harms patients' and the public's health.

Of course, the unwillingness to discuss global health care corruption, health care corruption in the US, and the relationship of health care corruption in the US to corruption in other sectors may arise from the fear, as stated by one person interviewed in Charles Ferguson's documentary Inside Job, that discussion could lead to investigation, and investigation could "find the culprits".

Summary

It is perfectly fitting and proper for the Annals of Internal Medicine to call attention to various kinds of unprofessional behavior by physicians and health care professionals, such as sexist, disrespectful expression, even if such behavior is already subject to sanctions by medical boards, accrediting organizations, etc. In my humble opinion, however, if such disrespectful comments by physicians should generate outrage, corrupt behavior by large health care organizations that may harm patients and the public health, and which often goes largely unchallenged by civil authorities, should deserve more outrage.

Of course, it is one thing to criticize individual physicians, and ask physicians to "call out our colleagues" who behave unacceptably.

It is another to call out large, powerful, wealthy organizations and the executives who have become rich running them.  Such executives command well funded marketing and public relations departments, and corps of attorneys ready to take on perceived critics.

But if we really want better health care and public health, we all have to step up.  In particular, I urge the editors of the Annals of Internal Medicine, and other major health and medical journals to take on health care corruption as vigorously as they would take on physicians' expressions of "misogyny and disrespect."

ADDENDUM (26 August, 2015) - This post was republished on the Naked Capitalism blog. 

References
1.  Laine C, Taichman DB, LaCombe MA. On being a doctor: shining a light on the dark side.  Ann Intern Med 2015; 163: 320.  Link here.
2.  Anonymous.  Our family secrets.  Ann Intern Med 2015; 163: 321.  Link here.
3. Horton R. Offline: ten commandments, G8 corruption, and OBL. Lancet 2011; 377: 1638. Link here.
4. Pololi L, Kern DE, Carr P, Conrad P, Knight S. The culture of academic medicine: faculty perceptions of the lack of alignment between individual and institutional values. J Gen Intern Med. 2009;24:1289�95. Link here.

Princess Health and Once More with Feeling - Amgen Again Settles Allegations of Misbranding, But Why Bother? . Princessiccia

Princess Health and Once More with Feeling - Amgen Again Settles Allegations of Misbranding, But Why Bother? . Princessiccia

Amgen bribery deception kickbacks legal settlements marketing

Gusty 12:21 Add Comment

The Latest Settlement

Biotechnology giant Amgen has just reached another settlement of allegations that it unfairly, deceptively or misleadingly marketed its drug. Per the Los Angeles Times,

Amgen Inc. has agreed to pay $71 million to settle allegations by 48 state attorneys general that it improperly marketed two of its blockbuster drugs.

That is,

The states, including California, alleged that Amgen violated consumer protection laws by promoting the use of its anemia drug Aranesp for longer periods than the Food and Drug Administration had approved and by encouraging its use to treat anemia caused by cancer without FDA approval.

In addition, Amgen was accused of promoting its drug Enbrel as a treatment for mild plaque psoriasis even though it was approved only for severe plaque psoriasis, and for overstating the length of time that Enbrel effectively treats the disease.

This is the second settlement Amgen has made for improper marketing of Aranesp.

Three years ago, Amgen pleaded guilty to a single misdemeanor in federal court in New York for improperly marketing Aranesp. The drugmaker agreed to pay $150 million in criminal penalties and $612 million to resolve broader civil lawsuits, including allegations that Medicare, Medicaid and other government insurance programs were improperly billed.

At the time, federal prosecutors called the settlement 'the single largest criminal and civil False Claims Act settlement involving a biotechnology company in U.S. history.'

Although doctors can prescribe medications for off-label uses, drug companies are banned from promoting uses that aren't approved by the FDA, which has been at odds with some drugmakers over the issue.

This settlement seems to be just the latest in a very long procession of legal settlements  of allegations of apparent misbehavior by large health care organizations.  We have previously discussed many such settlements, how they serve as markers of ethical lapses by leaders of large organizations, and also how the failure of most of these settlements to provide meaningful penalties to those who presided over, directed, or implemented the bad behavior allows continuing impunity and fails to deter future bad behavior.  Many large organizations have made multiple such settlements in recent years, but have these settlements seem to have not promoted honest, transparent, accountable health care.   

Yet continuing government efforts to provide even these weak challenges to continuing bad behavior now appear under threat.

Is Misbranding a Crime?

The fundamental allegations in the original large Aranesp settlement were of misbranding (although the settlements with state government just announced were of violations of state laws prohibiting, as in the case of Connecticut, "unfair, deceptive or misleading" marketing practices.)  Marketing a drug or device for uses other than those approved by the US Food and Drug Administration (FDA) may be called "misbranding."

Whether misbranding should be considered a crime has lately become controversial.   Recently, an appeals court agreed with the notion that such marketing is constitutionally protected speech, as long as it is "truthful." (See discussion by Shannon Brownlee on the Lown Institute blog, and the NY Times news article.)  I am not a lawyer, so I will try not to deal with this constitutional argument at this time.  But most of the public discussion has focused on the narrow issue of whether misbranding is in fact protected free speech.

However, the case of the 'misbranding allegations agains Amgen suggest other issues worthy of consideration.

Promoting a Not Merely Ineffective, but Dangerous Drug

As we discussed here in 2012, Amgen pleaded guilty to one count of illegally marketing Aranesp, and agreed to pay a penalty of $762 million.  As we noted, the misbranding in this case was promotion of Aranesp for patients with cancer who were not receiving chemotherapy.  However, a growing collection of evidence suggested that epoetin drugs, a class in which Aranesp resides, increase the death rate in patients with various kinds of cancer.  On the other hand, Aranesp was never meant as a possible cure for cancer.  At best, its benefit is improvement of anemia, which might, just might improve how some patients feel in the short-term.  So it appears Amgen was promoting a dangerous drug without any evidence that the drug provided benefits that balanced the danger.  This appears very bad for patients.  The misbranding here was not some technical violation, but likely a deceptive effort that could have hurt patients, while profiting Amgen and its top executives.  The ethics here look much worse than the single guilty plea suggested.

Misbranding just refers to promoting a drug or device for uses that the FDA did not approve.  Some cases of misbranding could cause little more than inconvenience and added expense, but others could result in serious harm to patients.  Treating them all as misbranding removes important distinctions.

Allegations of Kickbacks

Furthermore, as discussed here in 2013, the 2012 settlement was not just about misbranding.  It was about kickbacks, that is bribes given to doctors by Amgen to induce them to prescribe a dangerous medication.  The settlement was arranged that Amgen did not admit to the alleged kicbkbacks.  But neither did it deny them, and the company apparently thought it was worth $762 million to avoid further dealing with these accusations, which nonetheless hang in the air.  So the ethics here now look even worse, invovling promoting a dangerous drug allegedly with bribery.


Furthermore, after news of the original Aranesp settlement came out, other stories of other settlements by Amgen appeared.  As we noted here,  in 2013, Amgen settled allegations that it also paid kickbacks to Omnicare and PharMerica to promote Amgen use in nursing homes and hospital.  It also settled charges that it inflated pricing data to obtain larger payments from Medicaid in multiple states for a variety of its drugs, including Aranesp.   Later in 2013, as we noted here, Amgen settled yet more charges that it gave kickbacks to doctors to promote one of its products, this time anti-cancer drug Xgeva.

Organizations accused of misbranding often are also accused of much worse conduct, yet very often, their cases are settled with the emphasis on the misbranding, leaving more serious allegations neither proven nor denied.  Focusing on misbranding may distract from more serious ethical, moral and legal violations.


Discussion

In the case of Amgen, the large 2012 settlement for misbranding resulted in the only guilty plea made and the largest fine paid by the company.  From my informal perusal of legal settlements made by drug, biotechnology and device companies, misbranding seems to be one of the more frequent allegations, and often the only one resulting in admissions of guilt.  It may be that it is easier to prove misbranding than other charges, and companies may admit to misbranding in settlements because the charge is not well understood by the general public and hence may carry less of a stigma than other charges, for example, kickbacks or fraud.

Yet as noted above, while misbranding seems to connote a mere technical violation, in health care misbranding can mean patients hurt by dangerous treatments that did them little if any good.  Furthermore, companies that settle allegations of or even admit to misbranding often have been charged with lots of other bad behavior, but settlements are often set up so none of these other allegations is ever confirmed or refuted.  So settlements that focus on misbranding again may nullify questions about worse ethical problems.

Now whether misbranding is itself really a transgression seems to a legal question.  But perhaps the legal challenges to misbranding as a crime ought to evoke more than just a narrow defense of the legal concept.  Of course, declaring misbranding unconstitutional could result in even weaker enforcement actions against large and powerful health care corporations,  However, maybe the inherent weakness of misbranding charges ought to inspire some rethinking of what bad behavior in health care really deserves attention.

Should not aggressive marketing of a drug as tremendously effective and safe in situations in which the drug is either minimally or not at all effective (especially in terms of improving patient-centered outcomes) or not very safe be considered possible fraud, and prosecuted as such?  Should not alleged kickbacks and bribes given to health professionals and care giving organizations be prosecuted, rather than treated as civil disputes and settled?  Should not the people who actually appeared to have committed fraud, or given bribes be prosecuted, rather than just letting their employers escape with civil monetary penalties?  Should not the leaders of big organizations on whose watches fraud and bribery allegedly occurred be charged as responsible corporate officers (look here )?

If civil authorities were willing to stop regarding big health care organizations and their leaders as "too big to jail,"  maybe less mischief would be going on in health care.  And maybe that would lead to better care for patients and better health for the public. 

ADDENDUM (21 August, 2015) - This post was republished on the Naked Capitalism blog.

Princess Health and More Thoughts on the Recent Low-fat vs. Low-carb Metabolic Ward Study. Princessiccia

Princess Health and More Thoughts on the Recent Low-fat vs. Low-carb Metabolic Ward Study. Princessiccia

low-carb

Gusty 13:53 Add Comment

The recent low-carb vs. low-fat study has provoked criticism from parts of the diet-health community. Let's examine these objections and see how they hold up to scientific scrutiny.
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Princess Health and With 10 Health Care Executives on it Board, US Chamber of Commerce Defends Big Tobacco Abroad. Princessiccia

Princess Health and With 10 Health Care Executives on it Board, US Chamber of Commerce Defends Big Tobacco Abroad. Princessiccia

Abbott Celgene mission-hostile management Pfizer Sanofi-Aventis Steward Health Care tobacco US Chamber of Commerce WellPoint

Gusty 18:47 Add Comment

Tobacco, especially smoked in cigarettes, is generally recognized by health care professionals as having health hazards that greatly outweigh its benefits to society.  Therefore, most health care organizations discourage tobacco use, and many have developed tobacco free policies.

However, the tobacco industry has its powerful supporters.  A recent NY Times investigative report, and a report entitled "Blowing Smoke for Big Tobacco," documented how the US Chamber of Commerce has defended the interests of tobacco companies overseas.  The apparent paradox here is that the leadership of the US Chamber of Commerce includes leaders of large health care organizations.  So far this paradox has not been explained by the parties involved.

How the US Chamber of Commerce Promotes Tobacco Interests Abroad

The NY Times Articles

On June 30, 2015, the NY Times published a wide ranging report on the pro-tobacco activities of the US Chamber of Commerce,

From Ukraine to Uruguay, Moldova to the Philippines, the U.S. Chamber of Commerce and its foreign affiliates have become the hammer for the tobacco industry, engaging in a worldwide effort to fight antismoking laws of all kinds, according to interviews with government ministers, lobbyists, lawmakers and public health groups in Asia, Europe, Latin America and the United States.

The U.S. Chamber�s work in support of the tobacco industry in recent years has emerged as a priority at the same time the industry has faced one of the most serious threats in its history. A global treaty, negotiated through the World Health Organization, mandates anti-smoking measures and also seeks to curb the influence of the tobacco industry in policy making. The treaty, which took effect in 2005, has been ratified by 179 countries; holdouts include Cuba, Haiti and the United States.

Facing a wave of new legislation around the world, the tobacco lobby has turned for help to the U.S. Chamber of Commerce, with the weight of American business behind it. While the chamber�s global tobacco lobbying has been largely hidden from public view, its influence has been widely felt.

Letters, emails and other documents from foreign governments, the chamber�s affiliates and antismoking groups, which were reviewed by The New York Times, show how the chamber has embraced the challenge, undertaking a three-pronged strategy in its global campaign to advance the interests of the tobacco industry.

In the capitals of far-flung nations, the chamber lobbies alongside its foreign affiliates to beat back antismoking laws.

In trade forums, the chamber pits countries against one another. The Ukrainian prime minister, Arseniy Yatsenyuk, recently revealed that his country�s case against Australia was prompted by a complaint from the U.S. Chamber.

And in Washington, Thomas J. Donohue, the chief executive of the chamber, has personally taken part in lobbying to defend the ability of the tobacco industry to sue under future international treaties, notably the Trans-Pacific Partnership, a trade agreement being negotiated between the United States and several Pacific Rim nations.

'They represent the interests of the tobacco industry,' said Dr. Vera Luiza da Costa e Silva, the head of the Secretariat that oversees the W.H.O treaty,...

The NYT asked the Chamber of Commerce for a response, and got only

The U.S. Chamber issued brief statements in response to inquiries. 'The Chamber regularly reaches out to governments around the world to urge them to avoid measures that discriminate against particular companies or industries, undermine their trademarks or brands, or destroy their intellectual property,' the statement said, adding, 'we�ve worked with a broad array of business organizations at home and abroad to defend these principles.'

The chamber declined to say if it supported any measures to curb smoking.

"Blowing Smoke for Big Tobacco"

Two weeks after the first NY Times article, a group of nine organizations including Campaign for Tobacco Free Kids, Corporate Accountability International, and Public Citizen released a report on the US Chamber of Commerce pro-tobacco actions. A summary article in the Huffington Post written by representatives of the latter two organizations included,

Our report and a two-part New York Times investigation shows that, while the Chamber throws its weight around in many Global South countries to protect its corporate members' interests, Big Tobacco has also pushed it to adopt particularly aggressive and radical positions in order to undermine the cascade of public health laws being passed as a result of the success of the global tobacco treaty.

In particular,

For tobacco control advocates familiar with this deadly industry's tactics, the Chamber's work in this space comes as no surprise. Internal documents tell us that as the tobacco industry lost its public credibility, it began to use third parties to advocate on its behalf.

Case studies in our report, from Africa to Latin America, make it clear that Big Tobacco is doggedly pursuing this strategy with the U.S. Chamber and its affiliates in Global South countries. In countries the tobacco industry has targeted around the world, the Chamber is delivering threatening letters that cast doubt on the science behind tobacco control, exaggerating exaggerate the economic impacts repercussions of proven measures like tobacco taxation and crying wolf about explosions in illicit trade. In pursuing these actions, the Chamber and its AmCham affiliates are exporting well-documented tobacco industry tactics to block health laws around the globe.

And as the New York Times points out in its investigation, (and then advocates that countries resist in their recent editorial: Tarred by Tobacco), these tactics are in some cases drafted by Big Tobacco executives themselves.

Who Runs the US Chamber of Commerce?

A 2010 MotherJones article noted that the US Chamber of Commerce as having a "name that evokes Main Street and Little League teams," and its history of "taking a moderate, nonpartisan approach."  So who is responsible for the US Chamber of Commerce becoming a tobacco advocate, at least outside of the US?

First, the Chamber has become more the creature of the biggest corporations than small businesses.  The MotherJones article noted that recently

The Chamber's politics became synonymous with its biggest corporate donors.  [Chamber President Tom] Donohue established special accounts for companies that feared taking controversial public stands, allowing them to anonymously funnel money to the Chamber, which advocated on their behalf.

Furthermore,

The Chamber claims that 96 percent of its members are small businesses, yet its self-seleted board includes just 6 representatives from small businesses, 1 from a local chamber, and 111 from large corporations.

Among these large corporations, tobacco corporations seem to be particularly influential.  The NY Times article noted,

The increasing global advocacy highlights the chamber�s enduring ties to the tobacco industry, which in years past centered on American regulation of cigarettes. A top executive at the tobacco giant Altria Group serves on the chamber�s board. Philip Morris International plays a leading role in the global campaign; one executive drafted a position paper used by a chamber affiliate in Brussels, while another accompanied a chamber executive to a meeting with the Philippine ambassador in Washington to lobby against a cigarette-tax increase. The cigarette makers� payments to the chamber are not disclosed.

Yet the Chamber's governance also ostensibly includes health care viewpoints.  Its current board includes 10 member who are executives of large health care organizations:

- Richard Bagger Senior Vice President, Corporate Affairs & Strategic Market Access, Celgene Corporation, [biopharmaceutical company] Summit, NJ
- John Cannon Executive Vice President & Chief Administrative Officer, Health Care Service Corporation, [health insurance company] Chicago, IL
- Ken W. Cole Senior Vice President, Government Relations, Pfizer, Inc., [pharmaceutical company] Washington, DC
- Wayne S. DeVeydt Executive Vice President and Chief Financial Officer, Anthem, Inc., [health insurance company, formerly Wellpoint] Indianapolis, IN
- Ralph de la Torre, MD Chairman and CEO, Steward Health Care System LLC, [for-profit hospital system, owned by Cerberus Capital Management] Boston, MA
- Fuad El-Hibri Executive Chairman, Emergent BioSolutions Inc. [biopharmaceutical company] Gaithersburg, MD
- Daniel F. Evans, Jr. President & Chief Executive Officer, Indiana University Health, [non-profit hospital system] Indianapolis, IN
- Gregory Irace President and Chief Executive Officer, Sanofi US Services Inc., [US subsidiary of French pharmaceutical company] Bridgewater, NJ
- Paul J. Klaassen Founder, Sunrise Senior Living, Inc., [for-profit provider of nursing care, hospice care, etc] Arlington, VA
- Elaine R. Leavenworth Senior Vice President, Chief Marketing and External Affairs Officer, Abbott Laboratories, [pharmaceutical and device company] Abbott Park, IL

These organizations ostensibly are all about promoting or sustaining individual or population health.  Executives of these organizations serving on the board of the US Chamber of Commerce are responsible for the governance and stewardship of the Chamber.  How could they square the missions of the organizations which the lead, and their responsibility for the Chamber's pro-tobacco stance?

The Health Care Organizations Dodge the Question

The answer to that question is elusive.

The NY Times article stated,

It is not clear how the chamber�s campaign reflects the interests of its broader membership, which includes technology companies like Google, pharmaceutical giants like Pfizer and health insurers like Anthem.

An accompanying NY Times editorial added,

Health insurance and hospital companies that are members of the U.S. Chamber of Commerce find themselves in an uncomfortable situation. Publicly, these companies support policies designed to reduce smoking, but the chamber, as Danny Hakim recently reported, has opposed anti-smoking measures around the world.

The controversy appears to have surprised health-related businesses like Anthem, one of the nation�s biggest health insurers, and Steward Health Care Systems of Boston, which have executives on the board of the chamber. 'If the chamber is in fact advocating for increased smoking, we do not agree with them on this public health issue,' a spokeswoman for Steward said in a statement to The Times.

In an article in the Indianapolis Business Journal, J K Wall recounted how he tried to get a substantive response to the NY Times article from Indiana University Health, whose President is on the Chamber board,

Indiana University Health CEO Dan Evans is one of the most anti-smoking health care executives I know.

Just a few months after I started covering health care for IBJ in 2007, Evans told me in an interview that Indiana employees 'should snatch the cigarettes out of their co-workers mouths and say, �Hey, you�re costing me money!�'

However, Evans was not available, and the only response was this statement from a spokesperson

We are proud of the many programs we have in place for smoking prevention and cessation, as well as health promotion and screenings for our team members, patients and members of the community. IU Health has been and will continue to be a leader in Indiana to prevent and curtail the use of tobacco products.

IU Health is a member of many diverse state and national organizations to support our public policy goals including the U.S. Chamber of Commerce and the Indiana State Chamber of Commerce. We are talking with U.S. Chamber leadership about the facts surrounding recent stories in the NY Times and will strongly encourage the U.S. Chamber to review its international programs to ensure they are consistent with its own stated policy to oppose smoking and promote wellness.

Similarly, a follow up story in the New York Times documented this response from Anthem, (formerly Wellpoint), whose Executive Vice President and CFO is on the Chamber board,

Anthem said it was 'dedicated to helping people quit smoking and has led the charge to end tobacco use.'

'Anthem has shared its strong, longstanding position with the chamber and will continue to address our concerns with the chamber directly,' the statement said.

Likewise, the Times noted this response from

Greg Thompson, a spokesman for the Health Care Service Corporation, said in a statement last week: 'We are convinced that ending smoking may help people live longer, enjoy a better quality of life and reduce costs in our health care system.'

'This is a point of view we have advocated for decades and made clear to organizations that we support.'

Those seem to be the only public responses from companies whose leadership is represented on the Chamber of Commerce board. They all ignored the main issue.  None of them seemed informed by the role their companies' executives on the Chamber of Commerce board play.  None of the executives or the companies for whom they worked acknowledged any accountability for the Board's vigorous foreign campaign of pro-tobacco activities.

The Times did note that Chamber of Commerce member CVS, which is not specifically represented on the Chamber board, and which recently stopped selling tobacco products, withdrew from Chamber membership. But as a simply a member of the Chamber, it had little direct responsibility for the Chamber's actions.

Discussion

US health care is increasingly dominated by large organizations.  Most of these organizations like to portray themselves as warm and fuzzy supporters of individual and population health.  For example, Pfizer has a statement of responsibility which begins

As a member of today�s rapidly changing global community, we are striving to adapt to the evolving needs of society and contribute to the overall health and wellness of our world.

Anthem's statement includes

Anthem is dedicated to delivering better care to our members, providing greater value to our customers and helping improve the health of our communities.

Yet on Health Care Renewal, we have documented actions by leaders of health care organizations that directly contradict their lofty mission statements, and may have threatened patients' or the public's health.

In its aggressive international promotion of tobacco interests, the US Chamber of Commerce appears to be promoting the use of products that directly threaten individual's and the public's health.  Even though the Chamber protested that it was merely reaching out

to governments around the world to urge them to avoid measures that discriminate against particular companies or industries, undermine their trademarks or brands...

their protestation ignored how tobacco is a different product than that of nearly all industries.  It seems inherently dangerous to patient's the and public's health even when used as intended, and has no known health or societal benefits that even partially compensate for its risks.  Therefore, what is the argument not to discriminate those who make and promote such an inherently dangerous product from those who make products that do not threaten health, or provide obvious benefits that may compensate for their risks?

It is obvious why tobacco companies might want the Chamber's support.  What, however, could be the rationale for executives of corporations pledge to promote health to preside over the international promotion of tobacco?

The executives on the Chamber board, and their companies have not as yet even tried to provide an answer.

Thus, in the absence of better responses, in my humble opinion the presence of health care executives on the US Chamber of Commerce board is another example - an important one - of mission-hostile actions by top leaders of US health care organizations.

As we have said far too many times - without much impact so far, unfortunately - true health care reform would put in place leadership that understands the health care context, upholds health care professionals' values, and puts patients' and the public's health ahead of extraneous, particularly short-term financial concerns. We need health care governance that holds health care leaders accountable, and ensures their transparency, integrity and honesty.

Princess Health and A New Human Trial Undermines the Carbohydrate-insulin Hypothesis of Obesity, Again. Princessiccia

Princess Health and A New Human Trial Undermines the Carbohydrate-insulin Hypothesis of Obesity, Again. Princessiccia

low-carb overweight

Gusty 17:41 Add Comment

The carbohydrate-insulin hypothesis of obesity states that carbohydrates (particularly refined carbohydrates and sugar) are the primary cause of obesity due to their ability to increase circulating insulin, and that the solution to obesity is to restrict carbohydrate intake. Numerous studies have tested this hypothesis, more or less directly, in animals and humans. Despite the fact that many of these studies undermine the hypothesis, it remains extremely popular, both in the popular media and to a lesser extent among researchers. A new human trial by Kevin Hall's research team at the US National Institutes of Health offers very strong evidence that the carbohydrate-insulin hypothesis of obesity is incorrect. At the same time, it offers surprising and provocative results that challenge prevailing ideas about diet and weight loss.

Read more �

Princess Health and The Latest Example of the Anechoic Effect - AllTrials US Initiative Launches to Deafening Media Silence. Princessiccia

Princess Health and The Latest Example of the Anechoic Effect - AllTrials US Initiative Launches to Deafening Media Silence. Princessiccia

AllTrials anechoic effect suppression of medical research

Gusty 13:12 Add Comment

Every now and then, someone tries to persuade me how much more open discussion of various kinds of recent unpleasantness in health care has become in the US. I admit there has been more media attention to certain issues, but unfortunately must maintain that the issues most likely to be make those who profit the most from our current health care system uncomfortable remains anechoic. Now I have my latest example

AllTrials

AllTrials is a UK based organization that advocates for registration and public reporting of all clinical trials.  AllTrials explains the reasons for this simply:

Clinical trials are the best way we have of testing whether a medicine is safe and effective. They can involve thousands of people, patients and healthy volunteers, and take years to complete.

Results from around half of all clinical trials remain hidden

Trials with negative results are twice as likely to remain unreported as those with positive results. This means that people who make decisions about medicines don�t have full information about the benefits and risks of treatments we use every day. Read our 8 page briefing note on missing trials here.

Thousands of clinical trials have never been publicly registered

There is no complete list of all clinical trials, so we don�t even know that some trials have taken place, never mind what was found in them.

The contributions of hundreds of thousands of patients are unused and unusable

Patients volunteer for clinical trials because they expect that what was found in the trial will be of use to doctors who make decisions about treatments and to researchers who are studying the condition. Trial participants have told us that the culture of secrecy around clinical trial reporting is a betrayal of their trust. Read their words here.

AllTrials has garnered considerable support in the UK.

On Health Care Renewal, we have been discussing the problem of suppressed clinical research for a long time, and have made similar arguments.  Up to now, I have chosen not to post a lot about AllTrials because as a UK based movement, it was getting considerable press coverage in the UK, and garnering considerable support there.  I did not think the movement needed what meager help a Health Care Renewal post would provide.

The Anechoic AllTrials USA Launch

But now, AllTrials has come to America.  And it perhaps should not be a surprise that its advent on this side of the pond generated essentially no notice, particularly, no notice in the US mainstream media or in US scholarly health care and medical journals.  

The announcement of the AllTrials US initiative appeared on the organization's website, and on the Biomed Central blog..  A press release appeared on the PRNewswire.  The American Academy of Family Practice (AAFP) announced its participation on its website.   The move received support from a post on the PLoS Public Health Perspectives blog, and perhaps surprisingly, from the UK based Financial Times.

Otherwise, at least according to my web searching efforts, there has been silence.  I found nothing in major media outlets, nothing in medical journals, and even nothing on the websites of the few US professional societies other than the AAFP that are listed as AllTrials USA supporters (that is, the American College of Obstetricians and Gynecologists, American College of Physicians and the American College of Chest Physicians). 

The Anechoic Effect Continues

We have frequently discussed the anechoic effect, the phenomenon that information or discussion that could challenge or discomfit the powers that be in the US health care often generates no echoes.  In effect, suppression of clinical research in itself is an example of the anechoic effect.

Why might even discussion that allows that clinical research might be suppressed invoke the cone of silence?

Looking at AllTrials literature may not be too helpful in providing an answer to this question.  The AllTrials organization is adept at discussing the reasons that clinical trials should not be suppressed, but has been very diplomatic about why they actually are suppressed.

On the other hand, its seems logical that when clinical trials are sponsored by organizations, such as pharmaceutical, biotechnology and device companies, to assess their own products, company management might get strong incentives to ensure that such research ends up making their products look good.  Sponsored research could be manipulated (in terms of the formal hypotheses it tests, its design, implmentation, and analysis) to increase the likelihood that the results would favor the sponsor.  When all else fails, the sponsor could suppress research that fails to make its products look good.  There is at least suggestive evidence that this occurs.  For example, see the now classic study by Turner et al that showed that clinical research sponsored by pharmaceutical companies to assess their own antidepressants were much more likely to be published if the results favored their own products.

So I suspect that the management of many health care organizations, particularly but not exclusively pharmaceutical, biotechnology, and device companies may not be very comfortable discussing the problem of suppressed research, or with measures designed to uncover such research.  Further, as we have discussed frequently, such companies have financial arrangements with individual health care professionals, health care academics, academic health care organizations, and a variety of other organizations such as medical societies and patient-advocacy groups.  These arrangements can constitute individual and institutional conflicts of interest.  It is not impossible that such financial relationships might influence such individuals and groups to want to avoid the topic of research suppression.

Yet it is striking that the important AllTrials USA initiative, an offshoot of an organization that has certainly got some attention in another English speaking country, has generated NO media or medical/ health care journal coverage in the US so far.

We cannot expect any real improvement in the dysfunctional US health care system while it still appears to be taboo to discuss many of its most dysfunctional aspects.  True health care reform requires open and honest discussion of these issues, that is, we need real free speech and a real free press in health care.  

ADDENDUM (21 August, 2015) - This post was republished on the Naked Capitalism blog. 

Princess Health and H+P at the 2015 ENDURrun.Princessiccia

Princess Health and H+P at the 2015 ENDURrun.Princessiccia

Gusty 10:19 Add Comment

WELCOME to the Health and Performance 2015 ENDURrun blog.  Throughout the week, we will be updating this post on a DAILY basis with the most up-to-date results along with a preview of upcoming stages.

Our 7 Teams

Click on each team to view the full roster, learn about each runner, and check out the team goals for the week:

Men's A1

Men's A2

Women's  Team vs. Men's Masters Team

Team Sam vs. Team Laura

Mixed Team

Stay on top of all the team battles on our stats page here:

• H+P Men's A1 vs 2014 H+P Men's A1
• H+P Men's A2 vs 2014 H+P Men's A2
• H+P Women's A vs H+P Masters Men
• H+P Women's A vs 2014 H+P Women's Team
• H+P Team Sam vs H+P Team Laura
• H+P Mixed vs 2014 H+P Mixed

Our 8 Ultimates

Follow their full results here on our stats page.

Dave Rutherford- Val Hobson- Derek Hergott- Vicki Zandbergen -Howie O'Krafka- Manny Jones- Jeff Martin - RunnerRob

Our ultimates have some individual battles to follow:

• Howie vs Manny
• Dave Rutherford vs 2012
• Jeff Martin vs 2013
• Vicki Zandbergen vs 2014

Daily Recaps

Stage 1: Half Marathon

Preview:

• Men's A1 team: Ahmed is up.  After a tough month away during ramadan, he is looking to run low-1:20, put the team in first place.  He wants to keep the men's A1 team in striking distance of the record and close to the 2014 team which started with a 1:16.
• Men's A2: Mailman is looking to run a solid 1:25-26-ish which would give them over a 10-minute advantage over the 2014 A2 team.  He is also looking to solidify the team's position in 2nd OA.
• Women's A: Kailey is up, and is looking to post a massive PB and break 1:30.  She should give the women's team a slight advantage in their competition vs. the men's masters team.
• Men's Masters: Don up and is looking to PB and to keep their team within striking distance of the women's team- anything less than 5 minutes!
• Team Sam: The team captain, Sam is up first.  He is expected to lose some time to his competitor on team Laura, but is aiming to PB and keep his team close enough to strike back on stages where they have the advantage. 
• Team Laura: Lucas is up, and is looking to post a massive PB, and create a significant gap between himself and Sam LaLonde. 
• Mixed Team:  Tammy is up.  She is looking to get the team off to a solid start, and maybe even take down Derek Hergott in the process! 

Recap:

Full results HERE.

Women

• Val Hobson posted a stellar new PB of 1:34, and now sits in 4th place OA!
• Manny had an outstanding race, beat Howie in the #MannyVsHowie challenge for the first time this year with a 1:46 clocking.  She sits in 7th OA.
• Vicki ran a very solid 1:46 despite a foot injury, and now sits in 8th place.  She is still within striking distance of her EB from 2014.

Ultimate Men

• RunnerRob got off to a great start, coming in with a time of 1:17:39, putting him in 1st place OA for the ultimates.
• Fighting a cold, Dave still salvaged a very strong run.  He ran 1:27, and now sits 8th.  He is about 1 minute off his EB from 2012 at this point!
• Jeff Martin had an outstanding half marathon, posting a 1:33, good enough to put him in 10th place OA.  This also places him 1 minute ahead of his previous EB from 2013.
• Howie had a solid race, but dropped the fist match up against Manny with a time of 1:53!
• Derek Hergott got off to a very solid start an an ER rookie, coming in with a 2:11 clocking.

Relay

• Men's A1 team: Ahmed posted a 1:23:59, which puts the team in 1st place OA.  They are now about 7 minutes off of last year's pace, but still on track with their current plan to set a new ER relay record. 
• Men's A2:  Aaron Mailman battles his post-honeymoon fitness loss to put in a very solid 1:28, placing the team in 2nd OA.  This also gives the team almost a 10 minute lead over last year's A2 team.
• Women's A:  Kailey did not run exactly how she wanted, but still posted an outstanding time of 1:34:10!  This is good enough to put the team in 4th place OA, and to give them a lead over the men's masters team!
• Men's Masters: Don had an outstanding race.  Running 5 minutes faster than expected, he posted a massive new PB of 1:34:38, which means the gap to the women's team sits at a mere 28s!
• Team Laura: Lucas got the team off to an outstanding start.  He ran a very solid 1:37 to set a new PB and to give team Laura the required commanding lead they will need to win the #SamVsLaura challenge.
• Team Sam: Sam posted a very solid 1:44 for the team, keeping his team within striking distance of Team Laura.  #TeamSam now sits in 7th place OA.
• Mixed Team: Tammy has an outstanding start for the team.  Running with Derek for most of the race, she posted a very solid 2:11!

Stage 2: 15K TT

Preview:

• Men's A1 team: Adam is up for the men's team.  He is looking to post a massive 15K split and single-handedly put the team ahead of last year's pace.  He's looking to run 50-51min.
• Men's A2:  Mike is up!  This is his 3rd year in a row tackling this course and is looking to post a massive PB, to better his 67min time from last year, and to strengthen the A2's position in 2nd OA.  
• Women's A: Coach Gillian is up for the Women's A team.  With a slim lead of 28s and a strong competitor in Holger on the Masters team, she is hoping to run at her best to keep the women within striking distance of the Masters team.  Anything in the 62-63 range would put them in a position to do this.
• Men's Masters: Holger, the mileage man himself is up!  He's chasing a PB close to the 1:01 range, and is seeking to bump the team up to 3rd place ahead of the women's team and RC team.
• Team Sam: Cari, one of Laura's most notorious rivals is up in the 15K to race head-to-head with Laura.  She is hoping to close some of that 7 minute gap to Team Laura, and bring her team back into contention in the #SamVsLaura challenge!
• Team Laura: Laura, the captain is up to face Cari!  She is hoping to maintain as much of that time gap that Lucas produced as possible!
• Mixed Team:  Nicole Green is back in action after some time away from running.

Recap:

Full results HERE.

Ultimate Women

• Val Hobson posted yet another PB 1:03:56, finishing 3rd on the stage.  She now sits 4th, but only 2 minutes off the podium with a lot of miles still to run!
• Vicki had a better day with her foot, and managed a new PB of 1:09:47.  She now sits in 7th OA.
• Manny ran a very solid 1:13:19, and now sits 8th OA.  She just barely lost the stage to Howie in the #howievsmanny challenge.  The stage tally is 1-1, but Manny still has a lead of 6:12 OA.

Ultimate Men

• RunnerRob had another great performance, running a best time among the ultimates of 53:41.  His OA lead is now 5:57 after 2 stages.
• Dave had a good bounce-back stage, running 59:09.  This brought him up one spot past last year's second place finisher.  He now sits 7th OA, but less than 2:30 off the podium.
• Jeff Martin ran a strong 1:06, and now sits 11th OA.
• Howie ran a very solid 1:12, good enough take the second stage of the #HowieVsManny challenge.  He is now 6:12 behind Manny OA, and sits 22nd OA.
• Derek Hergott ran through a very tough injury to finish with a strong 1:24. 

Relay

• Men's A1 team: Adam ran an unbelievable and numerically easy to remember time of 48:49.  He was the fastest of the day and set a new CR. This was a huge performance, and not one we expected with an average pace of 3:15/K.  This padded the A1's lead to now 17 minutes over the A2 team.  More importantly, it puts the team 5:41 ahead of last year's pace, and on a trajectory to beat the course relay record. 
• Men's A2:  Mike posted an extremely solid PB of 61:12.  This was the second fastest relay time of the day, and padded the team's position in 2nd OA.  
• Women's A: Coach Gillian ran an outstanding time of 1:03:44.  This was fast enough to put the women's team 4:20 ahead of last year's pace to break the women's team record.  It was also a mere 2s slower than Holger, and fast enough to overtake the RC team, pumping them up to 3rd place OA.
• Men's Masters: Holger posted a strong 15K of 1:03:42.  This time brought them within striking distance of the women's team for 3rd place OA (26s back).  It also brought them to within 18s of 4th place behind the RC team!  Will there be a podium sweep for H+P?
• Team Sam: Cari ran an outstanding PB of 1:26:22.  This kept team Sam very close to Team Laura in the #SamVsLaura challenge.  #TeamSam now sits in 8th place and 7:05 back of #TeamLaura.
• Team Laura: Laura posted an unbelievable and unexpected PB of 1:25:35!  This grew her team's lead over Team Sam, and was enough to maintain their position over the 2nd RC team.  They now sit in 6th OA!
• Mixed Team:  Nicole Green had a great return to running after a long time away.  She ran 1:26 for the 15K, and the team sits in 9th place.

Stage 3: 30K Cross-Country

Preview:

• Men's A1 team: Luke is up for the men's team.  His only goal is to run as fast as possible to chase the relay course record- a 2:10 would be a complete success and within his ability, but how will his legs respond less than 2 weeks removed from IM Canada?
• Men's A2:   Jan is up for the A2 team.  Originally on the masters team, he has really stepped up to replace Ahmed/Luke who had moved up to replace Brendan on the A1 team.  Jan is looking to battle hard to maintain the team's position in 2nd OA.
• Women's A: Helen is up for the women's team.  The women's team is expecting to lose some time on this stage as Helen is matched up with the very speedy Holger.  She is looking to beat her time of 3:02 from last year and keep the team on pace to breaking the women's relay CR.
• Men's Masters: Holger is back in action once again.  Stepping in as a last minute addition to fill an empty spot, he is looking to run under 2:30, which should give the team a boost from it's 5th place position- will the men's Masters team sit on the podium after the 30K?
• Team Sam: With a 7:04 gap to Team Laura, Team Sam has work to do!  Justin Buis is up, but is facing off with a runner of very similar ability on paper- that 7:05 gap will most likely not change very much, but who knows what can happen on race day!
• Team Laura: Eric Hunsberger is up for Team Laura.  He is looking to battle with Justin of #TeamSam, and fight to maintain if not grow upon their 7:04 lead.  He is also looking to maintain or perhaps even improve upon the team's 6th place OA standing.  
• Mixed Team:  Charlotte is up for the mixed team.  The 6-day Canadian record holder will be using this stage to train and have some fun along the way!

Recap:

Full results HERE.

Ultimate Women

• Val Hobson had an outstanding performance.  Running 2:31 for the 30K, she was able to put about a 1 minute dent into the 3rd place athlete.  She now sits a mere 28s off the podium! 
• Vicki ran a very solid 2:42 which bumped her up yet ANOTHER position to 6th OA!
• Manny ran a solid 2:59, and now sits in 9th OA.  This time was enough to take another stage from Howie in the #HowieVsManny challenge.  The race is now 2-1 in Manny's favour!  She also holds about a 15minute lead over Howie OA.

Ultimate Men

• RunnerRob ran the fastest time of the day, finishing in 2:01:57.  He now carries a 17:31 gap to his nearest competitor.   
• Dave ran a very solid 2:15 and continues to rebound from his cold.  This bumps him up to 6th place OA and a mere 38s out of 5th!
• Jeff Martin had another great day at the office finishing in 2:30, and still sits in 11th.  
• Howie battled hard to run 3:07.  Manny took this round, and he is now down 1-2 in the week long #MannVsHowie series.
• Derek Hergott announced with a heavy heart that he will be dropping out due to injury.  This is GOOD news for the rest of H+P though, because they just picked up the best cheer-squad leader of all time!  We all hope you recover quickly D!

Relay

• Men's A1 team: Luke proved his recovery went smoothly from IM Canada and showed why he is a sure thing when it comes to endurance events.  He ran an outstanding 2:11, giving the team a 41minute lead over 2nd, and an 18 minute lead over last year's A1 team- the course record is in sight! 
• Men's Masters: Holger put his mileage on display today!  He ran a new PB of 2:27 which was the second fastest relay time of the day and took the men's Masters team way up in the standings from 5th all the way to second OA!  They now have a 22:44 lead on the women's team.
• Men's A2:   Jan ran an outstanding performance of 2:39 which was enough to keep the A2 team on the podium in 3rd, and a mere 9 minutes back of last year's A2 team.
• Women's A: Helen had a massive PB of over 10 minutes, coming in with a time of 2:51.  The women's team now sits 22:44 back of the masters team and 15 minutes ahead of women's team record pace!  They now sit in 5th OA, but only 1 minute out of 4th!
• Team Sam: Justin Buis was up and knew #TeamSam needed a boost.  He went out hard, and felt it during the second half of the race.  He finished with a 3:02, and Team Sam now sits 28 minutes back of Team Laura.  They are less than 1 minute out of 7th place!
• Team Laura: Eric Hunsberger had a very strong run of 2:41 for Team Laura.  This gives his team a massive lead of 28 minutes which is a gap they will need as they approach stages where Team Sam has the advantage!
• Mixed Team:  Charlotte put in another consistent and solid effort.  She ran 4 minutes faster than last year with a time of 3:00:29!  This shrinks the gap to last year's mixed team to 40 minutes.

Stage 4: 10-Mile Hill Run

Preview:

• Men's A1 team: Coach Sean is up for the men's A1 team.  He is hoping to improve upon last year's team time of 1:03 and to keep the team on pace to break the course record.  Even though A1 is 18 minutes ahead of last year's pace, and 7 minutes ahead of the course record pace, Rob's 2:41 marathon will not be matched this year.  We will want to give him at least a 10 minute buffer to make this record attempt realistic!
• Men's Masters: Speedy is up!  He is hoping to battle to maintain the team's position in 2nd, but is in tough against Dave Haiser of  the 3rd place A2 team with ~2 minutes separating the two teams.  
• Men's A2:   Dave Haiser is up, and is looking to chase down Speedy to pump the team back up to 2nd place OA.  The gap is about 2 minutes!
• Women's A: Andrea is scheduled to race.  She is looking to improve on the team's lead in breaking the women's relay record- anything faster than 1:35 will do this!  She is also hoping to close the gap on the A2 and men's masters team to bring the team back into contention for the podium.  The team also sits a mere 1 minute out of 4th place behind the 1st RC team- will she be able to move them up a position?
• Team Sam: Kristin is up and is matched up with a runner of very similar ability from Team Laura!  She hoping to maintain or even put small dent into Team Laura 28 minute lead.  This will give Team Sam a fighting chance in the final 2 stages!
• Team Laura: Kim will be running for Team Laura.  She is looking to battle hard to keep as much of that 28 minute lead as possible.  The team also sits in 6th ahead of the 2nd RC team, and is looking to maintain that position.
• Mixed Team:  Mountain man is BACK IN ACTION!  Craig Kingston, coming back from being hit by a car, is looking to put in a solid performance and test the legs and lungs out on the slopes of Wilmot line!

Recap:

Full results HERE

Ultimate Women

• Val Hobson had a solid performance of 1:14:46, and now sits a mere 3 minutes out of 3rd.
• Vicki battled with her foot again, yet still was able to tough out a 1:21:41 which keeps her comfortably in 6th place OA.  She is 2:47 back of a PB with lots of racing still to come!
• Manny ran a very strong 1:25:51 and still sits in 9th place OA.  Howie took this round with a 1:23, and the #HowieVsManny series now sits 2-2!  Manny still holds a 12minute lead OA for the entire week!

Ultimate Men

• RunnerRob ran the fastest time of the day, finishing in 58:16.  He now holds an overall lead of 21:57!
• Dave is starting to show signs that he is coming back to life as the effects of his cold subsides.  He ran the 3rd fastest ultimate time of the day with a 1:06:24 clocking.  He now sits in 5th place OA, and 3:35 off his 2012 PB pace!
• Jeff Martin ran a solid 1:13:46 and still sits very safely in 11th OA.  With this outstanding new course PB, Jeff is a mere 5s off his ENDURrun PB pace!

Relay

• Men's A1 team: Coach Sean ran 1:02:00, and the team now is now 20 minutes ahead of club record pace and about 9 minutes ahead of course record pace.  They have a 53 minute lead over 2nd place. 
• Men's A2:   Dave Haiser had a very solid performance of 1:11:52.  This was enough to bump the men's A2 team up to 2nd OA and they now carry a ~6.5 minute lead over the 3rd place masters team.  A2 now sits 16 minutes off of the 2014 A2 team, but with some of their strongest runners still to come.
• Men's Masters: Speedy ran a very strong 1:20:05.  This kept the men's masters team on the podium in 3rd place, and also maintained 14 minutes of their lead over the women's A team.
• Women's A: Andrea, who was only beaten by Sean in the relay, posted an outstanding 1:11:23.  This bumped the women's team back up to 4th place OA with now a 1.5minute lead over the 1st place RC team who now sits in 5th.  She also gave the team an increasing lead over the female course record pace of over 39 minutes!  They now sit 14 minutes back of the masters team.
• Team Sam: Kristin battled hard to run a very strong 1:25:22.  This kept the gap close to #TeamLaura, as they now sit 29:59 back in the #SamVsLaura challenge.  Team Sam is less than 2 minutes behind the 2nd RC team for 7th OA.
• Team Laura: Kim was able to put even more of a dent into #TeamSam with a time of 1:24:20.  This gives them a massive 29:59 lead over #TeamSam which will be much needed with some of their fastest runners still to come!  They sit comfortably in 6th OA.
• Mixed Team:  Mountain Man had a much faster than expected return to action with a strong 1:16 finish, and was the 5th fastest relay time of the day!

Stage 5: 25.6K Alpine Run

Preview:

• Men's A1 team: Coach Dyce is up for the men's team.  His 3rd year in a row doing this stage, he is looking to better his 2014 PB of 2:12:34.  With a 20 minute lead over club record pace, and a 9 minute lead over course record pace, Greg is hoping to battle hard to give Rob a few extra buffer minutes in the marathon!
• Men's A2:    Adam Dixon is up for the men's A2 team.  He is going try to put his 70.3 fitness to work and maintain the team's position in 2nd OA.  He is in a tough spot up against a very solid runner from the men's masters team.
• Men's Masters: Jon Fugelsang is up, and is looking to fight to maintain the team's position in 3rd, and perhaps even put a dent into the Men's A2 6.5 minute lead for 2nd place.  He is also looking to maintain or even fight to grow upon their 14 minute lead vs. the women's team.
• Women's A: Coach Emily is up for the women's team.  Her main goal is to beat her 2:34 PB from 2014 and grow on the team's 39minute lead over record relay pace.  She is also hoping to put a dent into the men's masters lead of 14 minutes, and put the team in a position to make a run at 3rd place. 
• Team Sam: Steve Parke is up and is looking for vengeance!  Less than a week removed from his sub-17 hour 100M race, he is looking to put a massive dent into that 29:59 lead that #TeamLaura has in that #SamVsLaura challenge.  He is also hoping to make inroads on the 7th place RC team to bump the team up a spot. 
• Team Laura: Linda is up for #TeamLaura.  She is not expecting to beat Steve, but is looking to push her limits as she fights to maintain as much of that 29minute lead as possible.  She is also striving to keep the team safely in 6th place OA.
• Mixed Team:  Chris Philips is up.  With zero training other than the 2.2K TT a few weeks back, Chris is praying that he finishes the race before the race finishes him.  This..will..be..FUN!

Recap:

Full results HERE

Ultimate Women

• Val Hobson ran a great race!  After taking it a little easy during the 10-miler, Val crushed an outstanding 2:35.  Coming into this race she was 3 minutes out of 3rd.  With this performance, she has jumped up to 3rd place with over a 10 minute lead on her next closest competitor.   
• Vicki battled with her foot once again, but still managed to grind out the race and maintain her very solid 6th place position.
• Manny pushed hard, and ran a 3:31.  Howie took this stage, so the stage tally is now in his favour 3-2, but Manny still holds the OA lead by just over 2 minutes going into the final 2 stages.

Ultimate Men

• RunnerRob ran a stage winning 2:03 to lengthen his lead in the OA standings to 30:12.  He also has launched himself into being on pace to post the 3rd fastest winning time in ENDURrun history.  This puts him ahead of the pace set by Rich Tremain back in the inaugural event in 2003.  To put this in perspective, Rich has since gone on to a number of amazing running accomplishments, including setting the Canadian Masters Mile record of 3:54 in 2011.
• Dave ran a very solid 2:28 which keeps him in 5th place OA, with the 6th place hot on his heels only 1 minute back.  
• Jeff Martin ran 2:38 which was more than enough to keep him in 11th OA!
• Howie beat Manny in this one, and now leads the stage tally 3-2.  Manny still has an overall lead of 1:56.

Relay

• Men's A1 team: Coach Dyce posted the fastest relay time of the day with a 2:19:37.  This was a hard fought time that keeps the team in first with a 1 hour 13 min lead over 2nd place.  This was a 7:03 slower than his time from last year, and leaves the team 13 minutes ahead of team record pace, but just under 2 minutes ahead of course record pace.  The record will be tough to take down this time around!
• Men's A2:    Adam Dixon ran a strong 2:39.  This was enough to keep the team in 2nd place OA, and they now sit 42 minutes back of last year's A2 team.  
• Men's Masters: Jon Fugelsang started fast and battled to the bitter end!  He ran a strong 2:41 which now leaves the team 2:12 ahead of the women's team who is in direct competition with them for the podium.  They are also only about 7 minutes out of 2nd!
• Women's A: Coach Emily had quite possibly the BEST race she's ever had with H+P.  She managed to post the second fastest relay time of the day, and 2nd fastest female time of the day: 2:29:11.  This gave the women's team a massive 11:50 cut into the men's masters team as they now sit 2:12 behind them for 3rd OA.  This also put them even further ahead of women's relay record pace which now sits at 44:25.
• Team Sam: Steve Parke came through and made things interesting!  Just 6 days removed from his 100M race, he still ran a solid 2:32.  This closed over 25 minutes on Team Laura, and they now sit a mere 4:34 back.  this also bumped the team up a position to 7th OA. 
• Team Laura: Linda had an oustanding race.  She ran completely to her max with a solid and consistent time of 2:57.  This was enough to maintain Team Laura as the leader in the #SamVsLaura challenge with a gap of 4:34.  They still sit in 6th OA.
• Mixed Team:  Chris Philips showed why he doesn't train...because apparently he doesn't have to!  With one run in the last month, he still finished this insanely tough 25.6K course in a solid 3:32!

Stage 6: 10K TT

Preview:

Some interesting points going into Stage 6:

Through 107.8K of racing...

- Only 1s/K separates the women's team and masters team!
- Only 2s/K separates team Sam and team Laura
- Only 1s/K separates Manny and Howie in the ?#?MannyVsHowie? challenge 
- Only 1s/K separates Valery and Jeff who will be anchoring the women's team and men's masters team respectively.
- The men's A team is only 1s/K ahead of course relay record pace

• Men's A1 team: Jordan is up for the men's team.  Being only a few minutes ahead of record pace, he is hoping to better his 35:49 time from last year and keep the team alive in their chase for the course record.  
• Men's A2:    Alex Dos Antos is up for the A2 team, and is hoping to add a small advantage on their 7 minute lead over the 3rd place masters team and solidify their 2nd place podium position.
• Men's Masters: Steve Schmidt it up for the masters team.  His goal is simple: hammer as hard as he can, and try to build the team's 2:12 lead on the 4th place women's team.  
• Women's A: Payton is up.  She is not expecting to beat Steve, but is looking to run as hard as possible to try to maintain as much of that 2:12 gap as possible.  This will give Val a fighting chance in the marathon to pass the masters team.
• Team Sam: Tracy Urquhart is up.  Just one week removed from her awesome 70.3 performance in Michigan, she is looking to fight to maintain as much of that 4:34 gap to Team Laura as possible.
• Team Laura: Val T is up running in her first race for H+P since her marathon record breaking season in 2013.  She wants to do everything she can to grow upon that 4:34 lead over Team Sam.
• Mixed Team:  Tracey Kuchma is up for the the mixed team.  She will be chasing a new PB on this flat and fast TT course!

Recap:

Full results HERE

Ultimate Women

• Val Hobson ran well yet again.  She was able to run a very strong 43:37, which maintains her 3rd place position OA.  
• Vicki put in a very solid effort to come in with a time of 47:37.  This was more than enough to keep her in 6th place OA.
• Manny ran a 50:56 and still sits in 11th OA.  More importantly, this was enough to keep her in the lead of the Manny vs Howie challenge..but by only TWO SECONDS!  It will all come down to the marathon for these friendly competitors. 

Ultimate Men

• RunnerRob ran an outstanding 10K just off of his PB.  33:21 was fast enough to win the stage OA, and to build upon his massive lead in this year's race.  This time also grows upon the 4th place all-time performance by Rich Tremain, which makes it look very possible that Rob will post the 3rd fastest ENDURrun finish time ever, and be the 2nd fastest ultimate (Charles Bedley holds the #1 and #2 best times ever).
• Dave, while still struggling with feeling under the weather, still managed to hammer home a respectable 41:24.  He has had a great attitude and been a positive force all week despite this disappointing and ill-timed cold.  Dave now sits 6th OA, an outstanding position despite not being at his best. 
• Jeff Martin came home with a 46:03 10K, another strong showing that keeps him in 11th OA.  He now sits 6 minutes off his ENDURrun PB with 42.2K to go...will he be able to take his 2013 ultimate time down?
• Howie..well this is just crazy.  After 6 stages, the gap between him and Manny is TWO SECONDS.  This is even more impressive since they barely ran together all week.  It has been a lot of back and forth to say the least.  Howie took the 10K with a time of 48:58 which puts the stage tally to 4-2 in his favour.

Relay

• Men's A1 team: Jordan ran the 2nd fastest relay time of the day to come in with a strong 36:55.  This was not exactly what he was looking for, but still an excellent result that keeps the team about 12 minutes ahead of team record pace.  This now sets up Rob for the relay record.  He will have to run 2:42 to set the team record- which seems like too much to ask after a week of racing- but you never know with how he has been looking!
• Men's A2:    Alex Dos Antos came in with an outstanding and surprising personal best of 36:31.  This solidifies the team's position in 2nd OA with a 12 minute gap.
• Men's Masters: Steve Schmidt had a great debut in the 10K for the masters team.  He ran 40:52, which increased the team's lead in 3rd place OA.  In the masters vs. women's team challenge, the men now carry a 7minute buffer, which as we all know, can disappear quickly in the marathon.
• Women's A: Payton ran a strong 45minute 10K, which was enough to keep the women's team on pace to break the women's team relay record by over 41 minutes!  It also keeps the team within striking distance of the masters team as the gap now sits at 7:14.
• Team Sam: Tracy Urquhart, just one week removed from her IM 70.3, still pushed a strong 47minute 10K for team Sam.  This keeps the team within striking distance in the marathon with a 9:03 deficit behind Team Laura. The team still sits strong in 7th OA. 
• Team Laura: Val was able to achieve a very successful return to H+P racing with a strong 42:36.  This increased team Laura's lead over team Sam by just under 5 minutes on the stage to give them a 9:03 lead OA.  They still hold a strong 6th place OA position.
• Mixed Team:  Tracey Kuchma ran an amazing new PB of 49:46!  This is over 3 minutes better than her pervious mark, nice work Tracey!

Stage 7: Marathon

Preview:

• Men's A1 team: RunnerRob is up for the men's A1 team.  While the team has a solid 11:54 lead over team record pace, the chance of taking down the event relay record will be tough.  He will have to run a 2:42 or faster to make this happen.  
• Men's A2:    Chris is up for the men's A2 team.  He is looking to run a fast enough time to maintain the team's position in 2nd OA.  The current gap to the 3rd place team is about 12 minutes.
• Men's Masters: Jeff Martin is up for the masters team.  After a week of beating up his legs doing the ultimate, he says he still wants to chase a PB!  He hopes to hold onto the team's 3rd place position, but is up against a fast runner on the women's team who are 7:14 back, and a great runner from the RC team who only sit 10 minutes back.
• Women's A: Val Hobson is racing for the women's team.  Like Jeff, she too has crushed her legs all week.  She is just going to run her race and see what happens!
• Team Sam: Colin is lacing up and ready to run a hard marathon for Team Sam.  There is a 9minute gap between the two teams in the #SamVsLaura challenge, but he is facing off against a runner of very similar ability to him...at least on paper!
• Team Laura: Nick is up for #TeamLaura.  He is attempting to put together a successful marathon debut while also trying to maintain or even grow upon that 9 minute lead over Colin and team Sam.  Who will win this #SamVsLaura challenge??  It's definitely too close to call going into the 7th and final stage.
• Mixed Team:  Vicki Z is up for the mixed team!  She is looking to finish her injury-plagued week off on a positive note with a strong marathon for herself and for the team!

Recap:

Well the marathon was HOT, HUMID and therefore a sufferfest for many.  What a challenging and soul-crushing way to finish off this week.  That being said, many of our athletes still conquered and ran great times.  Here are the results.

Ultimate Women

• Val Hobson ran a very strong and evenly paced marathon in this brutal heat.  She came in with a time of 3:28, and a final OA time of 3:11:56.  This gave the ENDURrun rookie a 4th place finish OA!
• Vicki Z decided enough was enough, and wanted to enjoy the day after a week of foot troubles slowed her down.  She cruised the marathon in 4:30, and still finished in a very solid 8th place OA!
• Manny never gave up, and at somewhere in between 25-30K was close to taking down Howie!  Yet today was not her day, and Howie was able to edge her out on this very close #MannyVsHowie battle.  That being said, she posted a solid time good enough to keep in her 11th place OA!

Ultimate Men

• RunnerRob ran 2:51, which was the fastest time of the day.  This brings him with the OA win with the 3rd best time ever- 10:40:18!
• Dave just couldn't shake the bug that has been crushing his energy levels throughout the ENDURrun.  Despite being beat down all week, he refused to quit, and even refused to give up on trying to go fast.  In the end, the cold hurt him in the marathon as he ran a 3:32- a great time, but not representative of his current fitness.  This lands him in 8th OA for the week.
• Jeff Martin was completely beat down after a week of hammering, but like Dave, he too fought hard not to quit.  He ended up running a 4:14 which brought his final time to 14:03 and 13th OA.
• Howie pushed his limits, and at one point was on the verge of being taken down by Manny.  He hung in there for a 4:08 marathon and a 15:55 final time.  This was enough to give him the victory in the #MannyVsHowie challenge! 

Relay

• Men's A1 team: RunnerRob ran an outstanding time of 2:51 which was enough to give the team the 4th fastest time ever, and a club record of 11:15:01.  The team is happy with this..but is STILL very hungry for that 11:05 record..onwards to 2016!
• Men's A2:    Chris came in with very limited training, but showed some outstanding mental toughness.  He was able to run 3:20:35, and keep the team in 2nd place OA.  
• Women's A: Val Hobson battled strong in the heat and ran an excellent 3:28.  This brought the women's team final time to 13:23- a new ENDURrun and H+P record.   This also gave them the win in the women's team/ masters team challenge! The RC team ended up using a very speedy ultimate as their marathoner in Stefan, so the women landed just off the podium in 4th place.
• Men's Masters: Jeff Martin, who had been hammering all week as an ultimate with lots of successful racing finally got the message from his body that enough was enough.  He still stayed tough and ran a 4:14, good enough to keep the men in 5th place OA, making them the 4th H+P team in the top 5.
• Team Laura: Nick had an amazing marathon debut for #TeamLaura.  Just 6 weeks of training for this, and he still managed a 3:16 which solidified Team Laura as the victors in the #SamVsLaura challenge.  In fact the time was so good, the team was only a couple minutes outside of the top 5 when all was said and done!
• Team Sam: Colin ran his marathon on no training.  Apparently this makes life tough on race day!  He still got the job done in 4:27 which was actually more than enough to keep the team in 7th OA.
• Mixed Team:  Vicki Z was hampered with foot issues all week, but still had fun and got the marathon done!  She was not in this one to push herself but to enjoy the day.  She finished in 4:30 and the mixed time had a final time of 16:46.

Well, thanks for everything ENDURrun!  It's hard to believe the 2015 edition has come and gone already.  We shall be back for more in less than 1 year with more athletes, and faster teams!

#cantwontstop