J.B. Long@JB_Long
I really hesitate to tout current PFF rankings for #LARams offense (Whitworth, Saffold, Blythe, Havenstein all top 3; WRs all Top 16; Goff No. 2)… …when Todd Gurley is ranked 20th among RBs.

With Rams getting flexed out of SNF at SF, looking at future attractive matchups that could get flexed into prime time.

at NO, at CHI stand out.

But a lot plays into that, including network protection, caliber of alternative games.

==

Rams Q&A recap: Vinny Bonsignore

https://theathletic.com/578588/2018/10/09/rams-live-qa-vinny-bonsignore-answers-your-questions-on-tuesday-oct-9-from-noon-to-2-p-m-pt/

My personal feeling is Peters isn’t totally healthy, and some of what he usually can do from an athletic standpoint he just isn’t able to do right now. I think he might have to make an adjustment to compensate – which I believe he has to some extent. But if I’m a fan, I remain patient. When it’s all said and done he’s going to be fine

The defensive struggles against the Seahawks, I felt, was related to honoring Russell Wilson and dealing with him and some guys trying to do too much. They got burned in the counter game as a result. Once they started playing more disciplined and focusing on their individual assignments it got better. That said they have to do a better job tackling. They were attacking much too high on runners I felt

They need to play the full game the way they play the fourth. They’ve only given up three points in the fourth quarter over the last three games. Only six all together.

No question the Seahawks were taking advantage of the Rams aggressive rush. This is what Michael Brockers told me when I asked him basically about that very thing: “Definitely got to have great assignment on your end because it’s like we have to squeeze a box on him. I said it before you have to kind of collapse on him and if you don’t collapse on him you leave that open and he’ll take advantage of it. His guys do a great job of doing the scramble drill and you know, getting open when he gets to moving around. It’s definitely a strategic way to rush Russell Wilson.” “Yeah, because we got everything together. We got on the sideline, came together, and just talked about how we needed to improve as a defense and do better for our offense. Our offense did a hell of a job today and we just wanted to step up for those guys most importantly. It’s just about playing defense. Executing the defense, the way we should. Everybody tries to play the game within the game and I think that was a big deal with me today is trying to read what I’ve got and play off of it and stuff like that. As long as we do what we practiced and win our gaps, execute, and just dominate, I think we’ll be fine.” “Personally for me. I feel like I was just trying to get out there and get to the quarterback or make plays in the back field, stopping the running stuff. Just doing way too much when I could’ve just been doing my job and everything would’ve handled itself.”

Their fourth-quarter defensive play shows what they are capable of when they lock down on their assignments and play disciplined. They just need to get off to better starts

They wanted Cooks last year, but keep in mind they didn’t have a first-round pick in the 2017 draft. The Patriots gave up and first AND third round picks for Cooks and the Saints fourth-round pick in March. It wasn’t until later that summer they gave up their 2018 second-round pick for Sammy. The draft picks in question were two different drafts. The Patriots dipped into their 2017 draft capitol for Brandin. The Rams, because of the Goff trade, didn’t have as many picks to work with. The pick they gave up for Sammy was in 2018. In the end, it kind of all worked out. Who knows, maybe they don’t add Woods in 2017 or don’t draft Cooper Kupp in 2017 if they make a trade for Cooks in March of 2017.

Obo can start practicing next week. The Rams have three weeks to decide if he is healthy enough to be activated to the 53 or just put on IR. I don’t think they take the full three weeks

I thought the Cooks non-call/miss was really bad. I didn’t get the sense anyone felt it was intentional. But there was a sense the referee missed it and under the rule of the law it checked off all the boxes on a head-to-head call.

G Austin Blythe, Los Angeles Rams, 83.7 Overall Grade

One of the men keeping Goff clean against the Los Angeles Chargers pass-rush was right guard Austin Blythe. Blythe did not surrender a single pressure in 38 pass-blocking snaps and was one of three Rams offensive linemen to accomplish that feat. He was also very effective in opening lanes for Todd Gurley, recording a run blocking grade of 77.2.

Lance Zierlein: http://www.nfl.com/draft/2016/profiles/austin-blythe?id=2555180

AUSTIN BLYTHE

6’2″
291LBS.

Blythe comes from an NFL offensive line factory where he started 4 years at both guard and center.

OVERVIEW

In the sports world, Iowa is primarily known for two things: producing NFL offensive linemen and high-level wrestling. Blythe, a Williamsburg, Iowa native, is a perfect example of how those things go hand-in-hand. He was a two-time all-state pick in football (123 career tackles, 40 for loss, 14 sacks) and three straight heavyweight wresting titles (setting a state record with 143 pins) in a state that takes the sport very seriously. He put those skills to use in his redshirt freshman season, starting nine games at right guard but missing two due to injury. Blythe didn’t miss any more games during his three final years with the Hawkeyes, starting all 40 games at center. He gained recognition for his play each year, garnering consensus honorable mention All-Big Ten honors as a sophomore and second team All-Big Ten accolades from league coaches in 2014 and 2015. Blythe was even named as a Rimington Trophy finalist this season.

PRO DAY RESULTS
40-yard dash: 5.37 seconds
Vertical: 31 inches
Broad jump: 8 feet, 3 inches
Short shuttle: 4.5 seconds
3-cone drill: 7.53 seconds

ANALYSIS

STRENGTHS Four-year starter featuring durability and leadership qualities. Has played center and both guard spots which gives him a mental head­start. Controlled glider up to inside linebackers and plays with plus body control. Patient, confident run blocker who consistently lands his blocks in the center of his targets. Keeps his feet grinding after contact to generate movement and prolonged engagement as a blocker. Sticks to opponents like a shadow and is always bodied up near his man. Excellent outside zone blocker. Uses feet and upper body strength to run gap­-shooters up the field past the quarterback. The Hawkeyes love pulling him and using as lead blocker in space. Technician able to snap and step quickly on reach blocks. Sinks hips and can anchor up against bull rushers. Good functional strength for his size. Played in over 96 percent of team’s offensive snaps over last three years.

WEAKNESSES Undersized by every standard that NFL teams use for centers. Lack of length and mass is a legitimate concern moving forward. Has played both guard spots and center, but size likely limits him to center only in the league. Teams may view him as fit for zone specific teams which could limit his draft stock. Catches pass rushers rather than punching. Will have to adjust to defensive tackles using length to disrupt his task. Tape shows potential mental mistakes in protection against blitzes.

BOTTOM LINE Played with consistency throughout his stint as a four-year starter at Iowa and his 2015 tape is solid from start to finish. While his lack of physical traits could hurt where he is taken in the draft, his functional strength, technical savvy, athleticism and body control should not be ignored as he has all the makings of an eventual NFL starter.

Jared Goff quietly leads Rams to perfect 3-0 start

Michael Silver

http://www.nfl.com/news/story/0ap3000000966111/article/jared-goff-quietly-leads-rams-to-perfect-30-start

LOS ANGELES — The black Range Rover pulled toward the road connecting the northwest corner of the Coliseum to the City of Angels, creeping up alongside what was left of the friends and family section at the end of the locker-room tunnel. The man in the passenger seat was clearly in a hurry Sunday evening, what with a short week officially having begun, but suddenly the car came to a stop, and the tinted window on the driver’s side slid down to reveal the face of the NFL’s hottest young coach.

“Your son balled today,” Sean McVay said, gesturing toward a smiling man standing alongside an adjacent fence. And as Jerry Goff accepted the coach’s praise of his son, Jared, the Los Angeles Rams’ third-year quarterback, the proud papa felt compelled to pay his respects to the play-calling prodigy who is the NFL’s reigning coach of the year.

“He’s lucky to have you,” Goff told McVay.

“I feel that way about him,” McVay replied.

A few seconds later, McVay’s girlfriend, Veronika Khomyn, pulled the Range Rover out of the lot, leaving behind a 35-23 victory over the Los Angeles Chargers that pushed the Rams to 3-0 and decided the Fight For L.A. by unanimous decision.

If you’re inclined to assume this was nothing more than simple pleasantries being exchanged in the ebullient wake of the team’s best start in 17 seasons, you’re missing the message behind McVay’s glowing assessment of his quarterback: Goff is not the product of his system. He is the pulse of it.

“Saying he’s a system player — that’s just disrespectful,” McVay told me after the game, still steamed over a question suggesting as much that he’d received in a press conference last Wednesday. “It’s a total discredit to a great player. Those who know, know. Flip the tape on. People who know what it looks like to play the quarterback position at a high level know what they’re seeing.”

“I know this: I wouldn’t want to be working with anybody else other than Jared Goff right now.”

Flip on the tape. Go ahead. Start with the third-and-8 shotgun snap from his own 47-yard line that Goff received with 12:51 left in the third quarter and the Rams up 21-13. McVay had called a play anticipating zone coverage, but the Chargers went with a man-to-man alignment, and the designated man-beater target (receiver Robert Woods) wasn’t able to run the route of his choosing.

As second-year wideout Cooper Kupp patiently explained to me later, “Robert had bad leverage on the route. He wanted to go inside, but (the defender) was inside. I was maybe the third or fourth read, but it all broke down, and I just tried to keep it alive.”

With pressure closing in, Goff slid forward in the pocket, and slightly to his right. Defensive end Issac Rochell was coming from Goff’s left; defensive end Melvin Ingram swooped in from the right. And closing in quickly from behind Goff, blitzing linebacker Uchenna Nwosu dove into the back of his legs.

“I had gone through all my reads, four or five of them, and I was completely off schedule,” Goff said later. “Then Cooper flashed — that was just him being a football player — and I was able to get it there.”

Said Kupp: “It was 100-percent off schedule. Like, double off-schedule. But he got me the ball, and that definitely doesn’t happen if Jared’s not willing to hang in there as long as he did.”

What happened was that Goff zipped a glorious dart toward the right sideline that Kupp caught in-stride at the Chargers’ 30. Cornerback Trevor Williams, who trailed Kupp by a step, grabbed the receiver from behind, but Kupp kept right on churning forward, and by the 20 he had shed Williams completely, continuing on his way to a 53-yard touchdown pass.

It was one of many, many impressive throws by Goff on a day when he, and the Rams’ offense, put up some strikingly prodigious numbers.

Goff completed 29-of-36 passes for 354 yards and three touchdowns, with another scoring throw overturned by a replay review that ruled receiver Brandin Cooks had been stopped at the 1-yard line. He did get dinged for an end-zone interception, with Chargers rookie safety Derwin James making a nice read on a corner throw intended for tight end Gerald Everett.

No worries: The Rams’ Cory Littleton responded by blocking a Drew Kaser punt in the end zone, with teammate Blake Countess recovering for a touchdown. And Goff, after a Chargers touchdown drive, responded by completing his next six passes to set up Sam Ficken’s 46-yard field goal on the final play of the first half.

“This guy’s a total stud,” McVay said of Goff after exiting the locker room long after the game. “I think people don’t realize how calm he is. On the touchdown to Cooper he has four guys on him, two guys practically hanging on him, and he makes a play. He’s fearless, man. It’s hard enough to make plays in rhythm, and when things look the way you want them to look. But when things break down and he can still keep plays alive and make big-time throws… well, that’s a whole different level of good.”

It’s early — and the Rams have the sure-to-be-peeved-in-the-wake-of-a-brutal-home-loss-to-Buffalo Minnesota Vikings coming to town for a stiff Thursday Night Football test — but McVay’s offense, the league’s best in 2017, appears to be even better this year.

On Sunday, Goff and friends put up 521 yards of offense, the most by a Rams team since an overtime game in 2006 — and the most in four quarters of football since 2000, the heart of the Greatest Show On Turf era. Additionally, L.A. had 33 first downs, the most by any NFL team since the Saints midway through the 2015 season.

Goff became the third quarterback in league history to complete consecutive games with at least 350 passing yards and a completion percentage of 75 or above. And the Rams, not coincidentally, are 3-0 for the first time since 2001.

So yeah, the system is tremendous. Goff, however, is far more than a nondescript administrator.

“That dude’s a freaking monster,” said Russell Okung, the Chargers’ veteran left tackle. “And I think what makes him a monster is he’s incredibly consistent. Consistent players do the best in this league. You know what to expect every time. He takes the easy throws when they’re there, and then when he does go over the top, those (receivers) make plays.

“In this league, that’s a winning formula. Don’t give me the flashy guy; give me the guy who you can depend on every time.”

Right now, the metaphorical flashbulbs seem to be focused on a slew of other prolific and promising young quarterbacks, from Patrick Mahomes, to Carson Wentz, to Deshaun Watson — and to Baker Mayfield, Sam Darnold and the other members of the current rookie class.

Goff, for whatever reason, seems to get lost in the wash, even as he cleans up in Tinseltown.

“People don’t talk about him,” said Andrew Whitworth, the Rams’ All-Pro left tackle. “From the start, people were saying he was overdrafted, and now I think they’re sitting there waiting for the opportunity to say that maybe they were right. Yet he’s done nothing but continue to prove them wrong, and he’s getting better and better.

“You feel the command, and his poise is what blows you away. Week after week; good play, bad play; he comes back, explains to us what happened and tells us what we need to do next. He can literally communicate so calmly in the moment, and it’s mind-blowing how relaxed he is on the football field.”

Not surprisingly, Goff had a relaxed response to the notion that he’s getting less hype than some of his contemporaries.

“No idea,” he replied. “Look — with a great running back (Todd Gurley, who ran for 105 yards and a touchdown Sunday) and a really good defense, that can happen. I don’t know if they’re talking about me. I also don’t care. If we’re 3-0, it’s all good.”

Moments after McVay’s Range Rover pulled away from the Coliseum on Sunday evening, Goff’s mother, Nancy, took her son’s indifference a step further.

“We love it,” she said of the relative lack of attention her son’s exploits are generating. “That’s the best– because then you can sneak through the back door. The worst is when they do the whole ‘Mr. Perfect’ thing, like (when Goff was a Cal junior) before (the Golden Bears played) Utah — and then, five interceptions. Right now it’s quiet, and we’re winning, and it couldn’t be better. This is exactly where he wants to be.”

Soon Jared emerged from the locker room, and he and his parents headed out in the L.A. twilight. Nobody followed. Rest assured, they like it that way

from The five players still holding out and the dynamics of each situation
Here’s what’s likely in store for Aaron Donald, Khalil Mack, Earl Thomas, Roquan Smith and Le’Veon Bell

Joel Corry (former sports agent, NFL contracts and salary cap expert for CBS sports)

https://www.cbssports.com/nfl/news/agents-take-the-five-players-still-holding-out-and-the-dynamics-of-each-situation/

Holdout dynamics

A holdout is ultimately a test of both sides’ resolve. Once a player misses the beginning of training camp, there usually isn’t much dialogue between a player’s agent and the team early on when there is a contract impasse. Teams typically approach a holdout as if the player is injured, look for replacements at his position either internally or from available free agents and evaluate how the team performs with him absent.
Most holdouts don’t mind missing the daily grind of training camp but as the regular season gets closer, a player may start having second thoughts about his decision. If meaningful dialogue on a new contract resumes, it may not be until the middle of the preseason. There were hardly any conversations with the Buccaneers during most of McCardell’s holdout because both sides were firmly entrenched in their positions.
Savvy teams will refrain from talking to the media about the player, besides an obligatory statement about being unwilling to publicly comment on a player who isn’t in training camp or that the player’s contributions are valued and welcome him returning to the team when he is ready to honor his contract. In most cases, fans don’t take a player’s side in a contract dispute with a team. The public has difficulty relating to a player being unhappy with what is a lucrative contract in their eyes or rejecting a substantial offer. Unusual circumstances are required for public sentiment to be with the player.
A major obstacle a player must overcome is a team’s concern about establishing a precedent of giving into a player’s demands for a new contract through a holdout. Although teams should be able to easily make distinctions based on each player’s particular circumstances, they don’t want to send a signal to the other team members that they could get rewarded by holding the team hostage. This is especially the case when there is a new owner, or new general manager or new head coach with a hands-off owner. Along those lines, some teams have a philosophy that meaningful dialogue about a new contract won’t occur while the player is a holdout.
Prominent players at impact positions have the best chance of success provided they remain patient and give the impression that they are willing to continue their absence into the regular season. Once a player decides to end an unsuccessful holdout, some teams will reduce the fines accumulated as a gesture of goodwill, especially with a player who is one of the most important players on the team or a veteran that commands a lot of respect among his teammates. The Rams waived Donald’s training-camp fines, didn’t recover his signing bonus they were entitled to collect and opted against voiding his contract guarantees with last year’s holdout.
The longer a holdout drags on, the more of a distraction it can become with coaches and teammates being constantly asked about it by the media before and after games and practices. It also helps to be on playoff contenders/teams with Super Bowl aspirations or teams where the head coach or general manager is on the hot seat. Pressure may be put on ownership to do whatever it takes to get the player back into the fold as the regular season approaches. Smith’s holdout was aided by Jacksonville’s first-team offense struggling to move the football without him (16 punts in 17 offensive possessions).

Aaron Donald, DL, Rams

Chief Operating Officer Kevin Demoff has characterized the contract standoff the Rams are having with Donald for a second-straight year as a fundamental disagreement on value. General manager Les Snead painted a rosier picture Wednesday when talking to a group of reporters at the team’s hotel in Baltimore, where the Rams play their first preseason game on Thursday. He said the parties are in the same “zip code.”
The Rams are reportedly willing to make Donald the NFL’s highest-paid defensive player (which is currently Broncos linebacker Von Miller at $19,083,333 per year and $70 million in overall guarantees) and a charter member of the $20 million-per-year non-quarterback club. It is my understanding that at least restoring the traditional financial relationship between the highest-paid quarterback and non-quarterback, which existed under the current CBA before salaries for passers dramatically increased over the last year, is important to Donald’s camp. A deal averaging more than $23 million per year with $85 million in guarantees where $65 million to $70 million fully guaranteed at signing would recreate the balance.
Snead’s comments are encouraging for a long-term resolution before the Rams’ regular-season opener against the Raiders on Sept. 10. The Rams’ Super Bowl aspirations would be likely diminished without the reigning NFL Defensive Player of the Year’s services.
The Rams won the battle in a contest of wills when Donald ended his lengthy holdout last year without getting a new contract. If history repeats itself because talks breakdown where Donald plays out his rookie contract, he won’t have to worry about not qualifying for unrestricted free agency. From a practical standpoint, the Rams would use a franchise tag on Donald in lieu of a giving him a first-round restricted free agent of tender of $7,581,200 at a 10 percent of this year’s salary. The first-round pick compensation for Donald as a restricted free agent wouldn’t be enough to deter another team from signing a player of his magnitude to an offer sheet with a player-friendly structure and money that could make the Rams uncomfortable. The same risks wouldn’t exist with a non-exclusive franchise tag requiring two first-round picks as compensation for an unmatched offer sheet.

Khalil Mack, DE, Raiders

NFL Media’s Ian Rapoport reported during his recent visit to Oakland’s training camp that there haven’t been contract discussions since February and the Raiders don’t currently have an offer on the table for their best player. General manager Reggie McKenzie refused to negotiate with left tackle Donald Penn last year while he was holding out. Penn signed a new deal shortly after ending his holdout. The lack of any negotiations for such an extended period of time don’t suggest that Oakland would be willing to take a similar approach with 2016’s NFL Defensive Player of the Year if he reported to camp.
Mack’s agent, Joel Segal, has also demonstrated an ability to play hardball. He navigated running back Chris Johnson through a successful holdout in 2011 that lasted until the Titans gave his client a four-year, $53.975 million contract extension in early September.
Mack ending his holdout before Donald would be surprising since a new Donald deal should serve as a baseline once negotiations eventually resume. It’s fair to wonder whether the Raiders will be able to afford Mack, provided a Donald deal brings more clarity to the marketplace since a more concerted effort hasn’t been made to sign him and Mark Davis is reportedly among the NFL’s most cash-poor team owners. If the intel I received on Gruden still holds true, he probably wouldn’t relish having to deal with a disgruntled Mack playing on his fifth-year option.
Mack’s situation could have some residual effects. Segal also represents 2015 fourth-overall pick Amari Cooper. A bounce-back season by Cooper will put Segal in position to demand top wide receiver money for him. Segal is also 2016 first-round pick Karl Joseph’s agent.

zn wrote:

Nittany you’re in the medical industry.

How accurate a picture is that?

..

It’s an accurate depiction of the direction US healthcare is going.

I’m on several committees at the hospital in which I work and everything we do is geared towards patient satisfaction.

My wife is a physician. She pointed the article out to me. Her pay is directly tied to patient satisfaction. Her performance can be reviewed by patients after their visit. She’s actually rated by the number of stars she receives, where the patient can give her 1 to 5 stars depending on their level of satisfaction. On the surface this doesn’t seem like a bad thing, but the problem is that what makes the patient happy might not be what’s in the patient’s best interest. For example, when patients feel sick, they want an antibiotic. An antibiotic may not be warranted, but it doesn’t matter, if the patient doesn’t receive an antibiotic, the physician might get a bad rating. So the physician is under pressure to prescribe an unnecessary drug. Physicians know the ramifications of improperly used antibiotics (increased resistance) and are cautioned by their employers not to prescribe them when not necessary, but at the same time the employer is going to base the physician’s job performance, salary, and even employment on patient satisfaction. It puts be physician in a no-win situation. And this is just one example.

Of course, the bottom line is, the patient may not be receiving the best possible care.

Bucky Brooks

from http://www.nfl.com/news/story/0ap3000000941322/article/earl-thomas-potential-landing-spots-darrelle-revis-true-legacy?campaign=Twitter_atn

Explaining the Rams’ decision to immediately lock up Cooks.

Much to the surprise of Rams fans patiently waiting for the team to lock up reigning Defensive Player of the Year Aaron Donald on a blockbuster deal, Los Angeles just inked newcomer Brandin Cooks to a five-year, $81 million contract extension before he’s even taken a snap for the team.

“Brandin Cooks has shown himself to be a class act on and off the field since the first day he joined our team,” head coach Sean McVay said in a statement. “He’s a proven professional in this league and signing him to a long-term contract was always our goal.”

Wow!

My surprise isn’t a dismissal of Cooks’ talents as a frontline receiver, but I’m a little shocked his new team made such a hefty commitment before his debut season in L.A. Despite racking up three 1,000-yard campaigns and 27 touchdowns — while averaging 14.1 yards per catch — during his first four NFL seasons, Cooks hasn’t put up a yard for the Rams. We aren’t exactly sure how he’ll fit into this scheme, which has already posted big numbers without a household name on the perimeter. Now, that’s not a slight to Robert Woods or Cooper Kupp, but neither is necessarily regarded as an A-level playmaker. The team’s passing game is more systematic than player-driven.

That said, the system does call for a speed receiver with fine route-running ability and catch-and-run skills. After Sammy Watkins’ departure, the team needed a long-term solution in this area. That’s ultimately why the Rams valued Cooks at a premium, despite only having seen him perform in offseason workouts.

“Cooks is a more complete player than Watkins,” a Rams official told me. “He is a better route runner and he has a little more position flexibility. … He gives us an opportunity to create more mismatches on the perimeter. That should lead to more points.”

To that point, Cooks has been miscast by some observers as a one-trick (field-stretching) pony. When I look at the tape, I see a legitimate WR1 with big-time playmaking ability in an offensive scheme with a history of elevating playmakers (see: DeSean Jackson under McVay in Washington). Cooks has 20 receptions of 40-plus yards in his brief career, including 18 over the past three seasons. That’s the kind of production that catches defensive coordinators’ attention and leads to fewer defenders in the box. Great news for Todd Gurley. In addition, Cooks’ presence on the perimeter should prevent opponents from squeezing Woods and Kupp with exotic coverage tactics. This will enable Jared Goff to continue stringing together completions on easy throws to his No. 2 and No. 3 receivers at short and intermediate range.

But how do the Rams plan to negotiate with Gurley and Donald after tossing this chunk o’ change at Cooks? Well, remember, the Rams have a Pro Bowl quarterback playing on a cheap rookie deal, which frees up significant cap dollars to lock up emerging stars on the team.

As the Rams look to dominate the NFC with their version of the “Big Three” (Goff, Gurley and Cooks), the decision to immediately lock up their new pass catcher could prove to be quite a wise investment when we look back at the move in a few years.

The ‘cruel joke’ of compassionate use and right to try: Pharma companies don’t have to comply…

The ‘cruel joke’ of compassionate use and right to try: Pharma companies don’t have to comply

From my days in medical school, I vaguely remember learning about lysosomal storage disorders. They occupied at most part of a lecture or two in my second-year pathophysiology course. I memorized a few details about these rare diseases in preparation for my board exam, and then never gave them another thought. These diseases were treated by pediatric specialists and wouldn’t be part of my life as a cardiologist.

That changed a few weeks ago when my 28-month-old daughter, Radha, was diagnosed with a lysosomal storage disorder. Now I know far more about these diseases than I did in medical school. I’ve also learned a frustrating fact that no medical school teaches its students: While the FDA has a compassionate use program to allow people access to experimental drugs, it can’t compel a company to provide those drugs. The newly signed “right-to-try” law doesn’t either.

Radha’s birth went perfectly. She was a healthy baby and met all of her developmental milestones — until it came to walking. My wife, Sonal, a pediatric gastroenterologist, recognized this and we had Radha evaluated by several specialists. None thought anything was physically wrong and indicated that she would learn to walk with the help of some physical therapy sessions.

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They initially helped. Then Radha’s progress slowed. Just after her second birthday, additional testing, including an MRI of her brain and spine followed by a genetic analysis, revealed that our daughter had metachromatic leukodystrophy.

Related: Trump signs right-to-try legislation, making controversial measure law of the land
This lysosomal storage disorder is an autosomal recessive genetic disease that interferes with the body’s production of a single enzyme, arylsulfatase A. Not enough arylsulfatase A causes a buildup of fats called sulfatides inside cells. In cells that make myelin, the substance that insulates and protects nerves, an abundance of sulfatides destroys tissue throughout the brain, spinal cord, and other parts of the nervous system.

Children with the most severe form of metachromatic leukodystrophy develop symptoms like trouble walking or poor muscle tone before the age of 30 months. Once symptoms appear, the prognosis is grim. Radha’s health will decline rapidly over the next three to six months. She will soon lose her ability to move, speak, see, and eat, and will be prone to seizures. The disease will then plateau for several years, leaving her in a vegetative state and unable to communicate. Our only hope is that she’ll always understand us when we tell her we love her, but we may never know. Most children with metachromatic leukodystrophy don’t survive beyond their 8th birthday.

Because we live in an era of rapid genomic innovation, gene-editing technologies such as CRISPR, proteomics, and rational drug design, I assumed that a disease caused by a single-enzyme deficiency was treatable. In my search for ways to help my daughter, I came across enzyme replacement therapies being developed for a number of conditions, including metachromatic leukodystrophy.

Shire Pharmaceuticals has developed a therapy for the disease and has even found a way to deliver it across the blood-brain barrier, which is no mean feat. The company has even completed a multicenter Phase 1/2 trial of the drug, called SHP-611 (also known as HGT-1110) in Europe, with what appear to be promising results. There was enough of a signal of therapeutic benefit from this trial to move forward with another one, though it appears to be several months to a year away.

Children with metachromatic leukodystrophy who were involved in the original trial have access to the drug as part of an extension of the trial. Radha developed the disease too late to take part in the first trial, and too soon to join the second one (if and when it happens).

Related: ‘Right-to-try’ law intended to weaken the FDA, measure’s sponsor says in blunt remarks
Even so, that discovery gave me hope. It meant that Radha should qualify for what the Food and Drug Administration calls its expanded access program, also known as compassionate use. It governs the use of an investigational medicine that has not been approved by the FDA outside of a clinical trial.

Here’s how it is supposed to work. A physician caring for a patient with a terminal illness who has exhausted all other treatment options and isn’t eligible for a clinical trial appeals to the pharmaceutical company to provide an investigational drug that has undergone at least a Phase 1 trial, which studies the safety of a drug. If the pharmaceutical company agrees, the treating physician applies to the FDA for approval for expanded access to the investigational drug.

Thanks to policy changes at the FDA, it has become easier than ever for physicians seek access to investigational drugs. The application form has been significantly simplified and now only one member of a facility’s institutional review board needs to sign off on the petition. The FDA approves more than 95 percent such requests, and does so swiftly, usually in a matter of a few days.

Radha’s physicians followed Shire’s protocol for applying for compassionate use exactly as directed on the company’s website. Within a day or two, their request was denied, without any legitimate medical reason given.

With my daughter’s life on the line, I shamelessly used every contact and connection I have to reach someone at Shire to ask about compassionate use of SHP-611. When that effort yielded no responses, I called and emailed the current and former FDA commissioners, the head of the pharmaceutical trade association, PhRMA, the former CMO of a major pharmaceutical company, and even the dean of the medical school I attended. Most were cordial, even supportive.

Sonal and I even started a Change.org petition to help us nudge Shire to give Radha and her doctors compassionate access to SHP-611.

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All of our efforts to get answers from Shire have been repeatedly rebuffed with vague, unsatisfying responses, leaving me to wonder why the company is denying my daughter’s only hope. In fact, Shire has refused to correspond with me directly, and has instructed me to direct questions to it via my daughter’s treating physicians.

Large pharmaceutical companies are notoriously risk averse when it comes to expanding access to medications that are still in the testing phase. Many refuse to grant access to investigational drugs outside of clinical trials, and efforts to lobby them to release the medication as part of compassionate use are often rebuffed.

One fear they have is that an adverse event, like an injury or death — even if it is not directly due to the medication — will derail a company’s ability to push a drug forward for FDA approval, something they argue would ultimately undermine efforts to develop drugs that can help other families.

In response to this fear, FDA Commissioner Scott Gottlieb unveiled an updated policy on reporting adverse events that occur during compassionate use. It now requires reporting “only if there is evidence to suggest a causal relationship between the drug and the adverse event.”

Pharmaceutical companies also worry that if an experimental medication is given to one patient through compassionate use, it must be given to all patients who request it. In the case of rare diseases like metachromatic leukodystrophy — in the U.S., only about 60 children develop the late infantile form of the disease each year — this could mean that a company would have trouble enrolling enough patients when it eventually opens a clinical trial.

That’s a valid concern when access to the therapy is not time-sensitive. But in disorders such as the late infantile form of metachromatic leukodystrophy, the disease progresses so fast and irreversibly that patients who are denied access to the medication today will soon be so debilitated that they would not derive any benefit from it if and when it became available via a clinical trial, and so would not be able to enroll in the trial anyway.

Related: Right-to-try bill headed for vote puts bigger burden on FDA to protect patients, Gottlieb says
The push for a federal right-to-try process culminated this week with President Trump signing a new law in a ceremony surrounded by patients with life-threatening illnesses and their families. In theory, this law will let patients and physicians bypass the FDA and go directly to pharmaceutical companies for access to investigational therapies that have undergone early testing. But it doesn’t require pharmaceutical companies to accede to these requests.

This new law requires drug companies to report clinical outcomes and adverse events, though it reduces their implications by stating that the FDA should not use this information to delay or adversely affect the approval of investigational drugs. As a physician, I believe that removing federal safeguards for experimental drugs is dangerous, and I believe that adverse events should be reported to the FDA as a way to prevent them from happening to other patients. As a parent desperate to help his daughter in any way I can, though, I hope this bill will allay Shire’s fears and encourage it to give SHP-611 to Radha.

I have never been one to malign pharmaceutical companies because I believe they are our best source of new and improved treatments. Yet Radha’s situation has made me cynical of a system in which pharmaceutical companies cater to investors and the physicians who prescribe their products rather than to the consumers of their therapies. I wish I could say that Shire is an outlier, but a quick internet search shows many similar situations where other pharmaceutical companies have denied compassionate use requests for what amount to business decisions.

Shire’s therapy represents the only reasonable hope for Radha and our family. If the company continues to refuse access to SHP-611 outside of a clinical trial, then why not open a new one? Its previous trial ended 15 months ago and yet there is still no sign of the follow-up trial that Shire claims it is working hard to start as soon as possible.

Much of what we do in medicine is based on analyses of benefits and risks. Shire has produced a drug that in early testing demonstrated safety with enough benefit to push forward follow-up trials. In Radha’s case, the potential benefits of SHP-611 clearly outweigh the risks, but only if we get the drug to her soon, before her condition deteriorates further.

Compassionate use and right-to-try are billed as ways to give hope to patients who have exhausted all other options. From Radha’s perspective, they are nothing more than a cruel joke, dangling a potential lifesaving therapy just out of her reach.

Vibhav Rangarajan, M.D., is a fellow in advanced cardiovascular imaging at Northwestern University’s Feinberg School of Medicine.

About the Author
Vibhav Rangarajan
vibhav@gmail.com
@vsranga

wv wrote:

I am actually taking a couple of months off this summer because I’m fairly burned-out on the opioid situation.

They say W.V. is ground zero of the opioid crisis.

I read a report about Seattle that said that opioids can be found in mussels in the bay, due simply to flushing traces that were in waste products.

==

“Pain Killer” Author Barry Meier on How West Virginia Became Ground Zero of Opioid Epidemic

https://www.democracynow.org/2018/6/1/pain_killer_author_barry_meier_on

West Virginia had the highest rate of opioid-related deaths in the U.S. in 2016, making the state ground zero for a national opioid epidemic that has killed more than 200,000 people in the past two decades. A record number of people in West Virginia died from overdosing on drugs in 2017. Between 2007 and 2012, the three biggest wholesalers of prescription drugs in the U.S. shipped some 780 million pain pills containing oxycodone or hydrocodone to the state of West Virginia alone—433 pills for every man, woman and child in the state. That’s according to Barry Meier, author of “Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic,” published this week in an updated and expanded edition. We speak with Barry Meier, the first journalist to shed a national spotlight on the abuse of OxyContin.

Transcript

This is a rush transcript. Copy may not be in its final form.
AMY GOODMAN: So, let’s talk about ground zero, West Virginia. What was happening in some of these towns, in some of these small, independent drugstores—

BARRY MEIER: Right.

AMY GOODMAN: —that were bringing in how much of this drug?

BARRY MEIER: They were bringing in huge amounts of this drug, I mean, tens and tens of millions of pills, annually, of this drug.

AMY GOODMAN: How did it start in West Virginia?

BARRY MEIER: I mean, OxyContin was being distributed to West Virginia, to Virginia and other states. Drugstores were prescribing it. But, you know, you had doctors there that were essentially running what are called pill mills. People would come in to the doctor and say, “Doctor, I hurt, I have pain.” “OK, fine, let me just write you a prescription. Oh, and, you know, OxyContin works really well for me, for my pain.” So, you had these doctors who were writing prescriptions for drugs at the request of the patient, which is, you know, a rare situation. And so then these patients, who are often drug abusers, would go to the pharmacy and get the prescriptions filled. Sometimes I—and, you know, in my travels on this story, I would go to small towns where the doctor had a pharmacy in his office. So he would write the prescription, you’d go next door to a pharmacy that he owned, and they would dispense the drug. So, you know, millions of these pills were being dispensed. They were ending up on the street. And these horror shows of crime and abuse and separated families and everything else would follow.

AMY GOODMAN: I’m looking at a piece, that you refer to in your piece. This is in the West Virginia Gazette-Mail. And it says, “In Southern West Virginia, many of the pharmacies that received the largest shipments of prescription opioids were small, independent drugstores like ones in Raleigh and Wyoming counties that ordered 600,000 to 1.1 million oxycodone pills a year. Or they were locally owned pharmacies in Mingo and Logan [counties], where wholesalers distributed 1.4 million to 4.7 million hydrocodone pills annually. By contrast, the Wal-Mart at Charleston’s Southridge Centre, one of the retail giant’s busiest stores in West Virginia, [was shipped] about 5,000 oxycodone and 9,500 hydrocodone pills each year.”

BARRY MEIER: Yeah. I mean, it’s startling. I think what—you know, one of the things that happened when the Justice Department did not crack down, really, on Purdue Pharma is it sent a signal that, “Drug companies, drug distributors, you can ship these drugs in whatever quantity you want, to wherever you want, and the worst that you’re going to face is a fine.” So they viewed it as a cost of doing business. There was never going to be any accountability for the corporate executives. It wasn’t going to be like the dealer or the drug addict who was going to end up in prison. All the corporate executives were going to have to pay was a small fine. And that was going to be a fraction of the profits that they were going to make by shipping huge quantities of the drugs to places like West Virginia.

AMY GOODMAN: We’re going to continue this conversation with Barry Meier, author of Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic, after this break. I want to ask you about Art Van [Zee], a doctor in Virginia. Stay with us.

***

New York Mayor Bill de Blasio announced earlier this year that the city would sue manufacturers and distributors of prescription opioids to account for their part in the city’s ongoing deadly opioid epidemic. Firms named in the suit include Purdue Pharma, Johnson & Johnson and McKesson Corporation. The Guardian reports that more than 60 cities are suing Big Pharma over opioids. An explosive New York Times report has revealed that manufacturers of the drug OxyContin knew it was highly addictive as early as 1996, the first year after the drug hit the market. The Times published a confidential Justice Department report this week showing that Purdue Pharma executives were told OxyContin was being crushed and snorted for its powerful narcotic, but still promoted it as less addictive than other opioid painkillers. Purdue executives have testified before Congress that they were unaware of the drug’s growing abuse until years after it was on the market. Today, drug overdoses are the leading cause of death for Americans under age 50. We speak with Barry Meier, author of “Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic.”

Transcript
This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now! I’m Amy Goodman. Our guest is Barry Meier, author of Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic. Tell us the story of Dr. Art Van Zee.

BARRY MEIER: You know, Art Van Zee is kind of the hero of my book. He’s a man I met him when I was reporting for the Times back in the early 2000s. He’s a small-town doctor. He lives in a town called Pennington Gap in very western Virginia, near the Kentucky border. And I met him. He was a—he’s a gracious, lovely person. He reminded me of kind of a Doctors Without Borders, but here in the U.S., you know, working in Appalachia, in an area that desperately needed medical care.

He realized that his town was being overrun by OxyContin abuse. He saw kids being addicted to it, went to the hospital on emergency visits. And he decided, eventually, that he had to do something. He couldn’t stand quiet and let this unfold. And he tried to lead a small-town campaign to get the FDA to pull this drug off the market, or at least to crack down on this drug. And Pain Killer kind of follows his saga and the saga of other people in the town, a wonderful nun there by the name of Sister Beth, who sort of try to take on this huge, powerful drug company and hold it to account.

AMY GOODMAN: And so, what happened to Dr. Art Van Zee?

BARRY MEIER: You know, Art Van Zee, like Laura Nagel, eventually got shouted down, got ignored. I mean, there was this rather pivotal Senate hearing, where he comes and he pleads with these senators to do something about this drug. And Chris Dodd, the Democratic senator from Connecticut at the time, starts raking him over the coals and sounds like he’s, you know, badgering him with talking points that had been given to him by Purdue Pharma. And lo and behold, when I started looking at campaign finance records and other documents, it turned out that Chris Dodd had met with Purdue Pharma prior to this hearing, and Purdue—and Chris Dodd had gotten a $10,000 contribution from Purdue Pharma shortly afterward. So, Purdue Pharma, you know, was spreading money around and going after its critics and co-opting them throughout this entire period. I mean, the U.S. attorney in Maine, who first sounded a public alarm about this—

AMY GOODMAN: First one in the country.

BARRY MEIER: In the country, in 2001. He went immediately onto the payroll of Purdue Pharma and became one of its biggest defenders. In fact, I found documents that suggested that he was discussing a job with them even before he left public office. He swore up and down that that wasn’t the case. But, in fact, there are emails, Purdue Pharma’s own emails, suggesting that he had reached out to them to discuss job opportunities.

AMY GOODMAN: Explain the nature of the settlement in 2007. Can the company—can individuals in the company be held criminally responsible today, what, 200,000 deaths later, in the last 20 years, though they would argue, “That’s not all us”?

BARRY MEIER: Right. So, the settlement was twofold. The company, Purdue Pharma, as a company, pled guilty to a felony charge called misbranding, which was essentially misrepresenting the drug, and paid $600 million in fines. The three executives, top executives, of the company pled guilty to a misdemeanor version of that charge. It was a sort of weird charge, because it only held him liable in their roles as corporate executives. It did not accuse them personally of any wrongdoing. They paid around—about $34 million in fines. But what we came to discover, and what was in the Times in the other day and in the expanded version of the book, is that the prosecutors on the case wanted to charge them also with very serious felonies, that could have put them in jail, had that case gone forward.

AMY GOODMAN: And talking about holding people responsible, you write about how those that do drugs together, a husband, could be found guilty of murdering his wife, etc. Talk about that.

BARRY MEIER: Well, you know, we have a different standard of justice in this country. One standard is for the person who gets caught with, you know, some drugs in their pocket. Another standard is for the person who’s caught selling drugs. And another standard is for the executives of corporations that allow these drugs to get into the wrong hands of people, or knowingly are aware that these drugs are being abused, and don’t say anything. And, you know, there seems to be very little punishment that those kinds of individuals face.

AMY GOODMAN: But what do people face on the ground, who are doing drugs?

BARRY MEIER: They face their—they face spending the rest of their life in prison.

AMY GOODMAN: Explain.

BARRY MEIER: You know, they can be sent away for 10 years, for 20 years. They can have their lives destroyed, whereas the corporate executives don’t see their bonuses going down. They don’t see their lives being ruined. They just go on with their lives.

AMY GOODMAN: Earlier this year, New York Mayor Bill de Blasio announced that New York would sue manufacturers and distributors of prescription opioids to account for their part in the city’s ongoing deadly opioid epidemic. Firms named in the suit include Purdue Pharma, Johnson & Johnson and McKesson Corporation.

MAYOR BILL DE BLASIO: This is a man-made crisis if ever there was one, fueled by corporate greed, fueled by the actions of big pharmaceutical companies that hooked millions of Americans on opioids to begin with. And some of them still are addicted to prescription drugs, and others have migrated to heroin. But we know where it began for so many people. And, bluntly, it was so a very few people could profit, and, obviously, the horrible actions of criminals who sell drugs and profit in death, as well. That combination has led to where we are today. We need to remember that those origins at the root of this problem means it’s a problem that can be defeated. We can fight back against the big pharmaceutical companies. We can fight back against the criminals who peddle drugs. We can change in so many ways, including changing the entire culture around this issue, so we can help people.
AMY GOODMAN: So that’s New York Mayor Bill de Blasio. More than 60 U.S. cities in over a dozen states are now suing Big Pharma over opioids. What does this mean?

BARRY MEIER: Well, this could have happened a long time ago, Amy. You know, what’s startling to me is, as someone who’s watched this over almost two decades, is the issue of, you know, why did we wait this long to do this. We could have done this in 2003, in 2007, in 2010, in 2012. We have allowed this to morph into this horrible situation. It’s a good thing that it’s happening now. And I really do hope that these cities and states carry through and get to the truth, and not walk away with a simple settlement the way the Justice Department did in 2007. The only way that this problem is really going to be solved is if we really understand what happened, if the truth about what happened comes out. I mean, the fact that, you know, this confidential memo has now come out adds to the truth of what we know.

AMY GOODMAN: And again, say what is the essential point in this confidential memo.

BARRY MEIER: The essential point is that Purdue Pharma has claimed, from day one, and still claims today, that it first became aware of OxyContin’s growing abuse in 2000. This memo shows that prosecutors believe that they were aware of the drug’s abuse for years before that and concealed that information.

AMY GOODMAN: And what about the lawsuits of New York and 60 other cities and towns? What are they trying to accomplish with these lawsuits? What’s the premise of them?

BARRY MEIER: They’re trying to get money. They’re trying to get money to pay for some of the medical costs that they’ve had to absorb as a result of prescription drug overdoses and addictions. It’s very similar to the tobacco lawsuits, which I also covered for the Times. It’s essentially taxpayers have borne the brunt of the healthcare costs related to prescription painkillers. Purdue Pharma hasn’t paid for it. Johnson & Johnson hasn’t paid for it. These drug distributors haven’t paid for it. They’ve only profited from it. So now these states and towns are trying to recover some of the costs from the people who profited from this trade.

AMY GOODMAN: Barry Meier, what about the American Medical Association?

BARRY MEIER: It’s funny you should bring that up. The American Medical Association has been, over time, one of the big stumbling blocks to the solution of this problem. Back in 2001, I met a wonderful doctor, Dr. Nathaniel Katz. And he argued that doctors should be required to undergo some type of mandatory training as a condition for prescribing prescription drugs like OxyContin, like six hours of training, eight hours of training. You could do it on your home. You could do it through some sort of, you know, thing on the internet. Very simple.

The AMA fought this tooth and nail, as recently as the Obama administration. The White House Office of Drug Policy wanted to propose a law to make this happen. AMA lobbyists came to officials of the White House and to the—you know, to the Obama administration, and said, “If you do this, we will fight you tooth and nail. We will not allow this to happen. This is too much of a burden for our members. They don’t have six hours or eight hours to spend looking at information on how to prescribe these drugs more safely.” So, I think they have a lot on their shoulders here. You know, they basically blocked taking a very simple step, that would have been—would have provided tremendous good for patients and for doctors.

AMY GOODMAN: So, the Sacklers didn’t put their name on the drug company and are a very secretive family when it comes to that, but very public when it comes to supporting the big museums, like you said, the Met in New York and the Sackler Wing. Do you think, given that these big art institutions and universities around the country get federal funding, that they should have their name stripped from these wings?

BARRY MEIER: Well, that’s a—you know, that’s really up to the institutions and these medical schools to decide, you know.

AMY GOODMAN: Explain the medical school connection.

BARRY MEIER: Well, you know, they fund a lot of medical schools. They fund a lot of educational programs at medical schools. You know, there’s been a lot—you know, there was a wonderful piece that Christopher Glazek did in Esquire and Patrick Keefe did in The New Yorker about the Sacklers. And, you know, I wrote about them extensively in Pain Killer. They’ve now become the face of this problem. And so, you know, museums and—

AMY GOODMAN: Maybe name the wings after the victims of their drugs.

BARRY MEIER: Well, either that or have information about their donors.

AMY GOODMAN: So, next week begins the big push. The White House, in conjunction with the Ad Council, will be debuting public service messages that “should shock the conscience,” they say. What do you think needs to be done?

BARRY MEIER: Well, I think that we have a two-headed beast that we’re dealing with. One thing that is being done—and, unfortunately, it’s come about a decade too late, but it’s being done now—is a reassessment of the use of drugs like OxyContin in the treatment of medical conditions. As I said, it’s a valuable drug, but there are many other ways to treat pain and treat common types of pain that are just as effective as the use of pain pills. And employers and unions need to make sure that their members and employees are getting the best possible pain treatment, not pills, which are profitable for drug companies and cheap for insurers. So that’s one side of the problem.

AMY GOODMAN: We have 15 seconds.

BARRY MEIER: The other side of the problem is the illegal side, and that’s really a law enforcement enforcement issue, you know, cracking down on companies—countries like China and Mexico, that ship the chemicals that are used to make these horrible and dangerous illegal street drugs.

AMY GOODMAN: Well, I want to thank you for being with us, Barry Meier, author of Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic, just out this week, updated and expanded, Pulitzer Prize-winning journalist formerly with The New York Times.

Two Weeks Into OTAs, Lawler Taking Reps with First-Team Defense

Kristen Lago

http://www.therams.com/news-and-events/article-1/Two-Weeks-Into-OTAs-Lawler-Taking-Reps-with-First-Team-Defense/2c9aac86-f610-4b64-86f3-7e7baabe57bb

It’s not often that a seventh-round draft pick is thrust into the first-team lineup just one month into the offseason program. But such is the case for the Rams’ final draft pick, Justin Lawler, who is up for a tough challenge during the team’s OTAs.

“It’s been going good. I’m picking up the defense slowly,” he said this week. “As you can see we’ve had some injuries, so I’m going and kinda thrown in with the ones.”

The injuries Lawler referred to include Morgan Fox and Ogbonnia Okoronkwo, who suffered a season-ending knee

injury and a foot injury that required surgery, respectively. Both injuries occurred in the offseason program.

With both out for the remainder of the offseason, Lawler has been asked to step up in their place — something that may have surprised the rookie at first, but was not entirely unexpected.

“I knew they were thin [and] that’s why they drafted three of us,” Lawler said. “You never wish that upon anybody, but that’s football. It’s next man up. I get hurt, hopefully not, but the next man’s gotta play. That’s football and that’s the business we’re in.”

Through six OTAs, Lawler has been taking reps with the ones as the club’s strongside linebacker. While at SMU, he played the majority of his time on the weak side, representing yet another transition for the young player.

But with the help of linebacker’s coach Joe Barry, Lawler is hopeful that he will be able to not only learn the terminology and scheme, but also to improve his technique at a new position.

“I have to drop a lot more. So, the route combos, the motions, just the communication overall, that’s been the toughest to pick up,” he said. “I’ve got to get better as a pass rusher. Joe B always says that we’re paid to rush their quarterback and that’s something that I’ve gotta refine.”

Fortunately, Lawler says he has found a mentor in second-year outside linebacker Samson Ebukam — who has experience on the strong side from his first season with the franchise in 2017.

“He’s helped me out a lot — just in the huddle. Since I’m going and I’m already in the huddle with him, he kinda just says ‘hey, remember this’ or gives me little tips,” Lawler said. “So, he’s been a huge help, just kinda having someone in my pocket to go to on the field.”

And while it may seem daunting to be competing with and against some of the club’s top players, Lawler believes he is up for the challenge. The outside linebacker said he is happy to be “thrown into the fire” early on, recognizing that it will only help him down the line.

“That’s the good thing is I’m seeing it now. I’m making mistakes, but I’m trying not to make the same one twice and so it’s good to see it,” Lawler said. “I’m asking them to be patient with me as I pick up the defense, but it’s going well. I’m just getting better everyday, that’s my goal.”

Origins of the Opioid Epidemic: Purdue Pharma Knew of OxyContin Abuse in 1996 But Covered It Up

https://www.democracynow.org/2018/6/1/origins_of_the_opioid_epidemic_purdue

An explosive New York Times report has revealed that manufacturers of the drug OxyContin knew it was highly addictive as early as 1996, the first year after the drug hit the market. The Times published a confidential Justice Department report this week showing that Purdue Pharma executives were told OxyContin was being crushed and snorted for its powerful narcotic, but still promoted it as less addictive than other opioid painkillers. This report is especially damning because Purdue executives have testified before Congress that they were unaware of the drug’s growing abuse until years after it was on the market. Today, drug overdoses are the leading cause of death for Americans under age 50. While President Trump claimed Tuesday that numbers relating to opioid addiction are “way down,” the latest statistics show there was an increase of opioid-related deaths and overdoses during Trump’s first year in office. According to the Centers for Disease Control and Prevention, drug overdose deaths involving opioids rose to about 46,000 for the 12-month period that ended October 2017, up about 15 percent from October 2016. The epidemic has been so widespread that life expectancy is falling in the United States for the first time in 50 years. We speak with Barry Meier, the reporter who broke this story for the Times, headlined “Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused.” Meier was a reporter at The New York Times for nearly three decades and was the first journalist to shed a national spotlight on the abuse of OxyContin. His book “Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic” was published this week in an updated and expanded edition.

Transcript

This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: Today we spend the hour looking at the ongoing opioid epidemic and how it spread across the United States. Drug overdoses are now the leading cause of death for Americans under the age of 50. But during a speech on Tuesday, President Trump claimed “the numbers are way down.” He spoke in Nashville, Tennessee.

PRESIDENT DONALD TRUMP: We got $6 billion for opioid and getting rid of that scourge that’s taking over our country. And the numbers are way down. We’re getting the word out. Bad, bad stuff. You go to the hospital. You have a broken arm. You come out. You’re a drug addict with this crap. It’s way down. We’re doing a good job with it. But we got $6 billion to help us with opioid.
AMY GOODMAN: In fact, the latest statistics show there was an increase of opioid-related deaths and overdoses during Trump’s first year in office. According to the Centers for Disease Control and Prevention, drug overdose deaths involving opioids rose to about 46,000 for the 12-month period that ended October 2017, up about 15 percent from October 2016. The epidemic has been so widespread that life expectancy is falling in the United States for the first time in 50 years.

Meanwhile, the White House says it’s about to launch a series of public service announcements next week on opioid dangers, aimed at young people. The ads were developed with Kellyanne Conway, Trump’s point person on opioids.

This comes as The New York Times published a confidential Justice Department report this week that found manufacturers of the drug OxyContin had access to information showing it was addictive as early as 1996, the first year after the drug hit the market. Purdue Pharma executives were told OxyContin was being crushed and snorted for its powerful narcotic, but still promoted it as less addictive than other opioid painkillers. This report is especially damning because Purdue executives have testified before Congress that they were unaware of the drug’s growing abuse until years after it was on the market.

Well, for more, we’re joined by Barry Meier, the reporter who broke this story for The New York Times, which is headlined “Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused.” Barry Meier was a reporter at The New York Times for nearly 30 years, the first journalist to shed a national spotlight on the abuse of OxyContin. His book Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic was published this week in an updated and expanded edition. He’s won the Pulitzer Prize and two George Polk Awards for his past reporting on the intersection of business, medicine and public health.

Barry Meier, welcome to Democracy Now!

BARRY MEIER: Thank you, Amy. A pleasure.

AMY GOODMAN: It’s great to have you with us. Well, talk about this latest Justice document that you just got a hold of.

BARRY MEIER: Right. So, the basic outlines are this. As you noted, Purdue Pharma has claimed that it first became aware of OxyContin’s growing abuse in early 2000. That was about four years after its introduction. In fact, what this document showed is that the company had extensive information about OxyContin’s abuse in 1997, 1998, 1999.

AMY GOODMAN: Twenty years ago.

BARRY MEIER: Yes, and concealed that information, didn’t tell the FDA, didn’t tell doctors, didn’t tell patients. And this was a very damning report. I mean, the crimes were so significant that the prosecutors, who spent four years investigating the company, recommended that three top executives of Purdue Pharma be indicted on a—for a series of felony crimes, like conspiracy to defraud the United States, false statements and things of that nature. Unfortunately, their efforts were blocked by top administration officials within the Justice Department.

AMY GOODMAN: So, explain what actually took place.

BARRY MEIER: What took place is the following. Purdue Pharma was given permission to market OxyContin as less prone to abuse and addiction than competing narcotics. I mean, this sort of was like a gift—

AMY GOODMAN: Like drugs like Vicodin and others.

BARRY MEIER: Yes, exactly. It was a gift from the FDA. They took that gift, and they ran with it. They told doctors not only that it might be less prone to abuse and addiction, but that it would be less prone to abuse and addiction. In 2007, they admitted, basically, lying to doctors, lying to patients, by misrepresenting what they had been allowed to say.

What we didn’t know was that during the course of the investigation that led to that confession, the federal government had also uncovered information to show that not only had they mismarketed the drug, they were aware, almost from the beginning, that people were abusing OxyContin, significantly abusing OxyContin, and they concealed that information. Had they sent a warning about that to the public, OxyContin would have never become a billion-dollar drug, and thousands of peoples of lives—thousands of lives wouldn’t have been affected by it.

AMY GOODMAN: We’re going to talk about the origins of OxyContin, the Sackler family. We’re going to talk about how this drug company grew. But right now, your book came out like over 15 years ago, Pain Killer.

BARRY MEIER: Right.

AMY GOODMAN: That’s before the company was indicted and the corporate officials were indicted. Talk about Rudolph Giuliani—now once again in the headlines because he is Trump’s attorney—his role in the rise of OxyContin, in preventing a serious prosecution of this company.

BARRY MEIER: Well, Rudolph Giuliani was hired in 2002. A lot of the reporting I did for the Times in 2001 was aimed at the overaggressive marketing of OxyContin by Purdue Pharma, as well as, you know, the growing reports, public reports, about the drug’s abuse. They then came under scrutiny by the FDA, by the DEA, and they felt that they needed a public defender—a fixer, if you will. The person they brought in to do that was Rudolph Giuliani. And so he went in, with his reputation as a former prosecutor, mayor and so forth, and began—

AMY GOODMAN: It was right—I mean, you’re talking about right after the 2001 September 11th attacks, when he was called “America’s Mayor.”

BARRY MEIER: Exactly. And sort of he took that reputation, and he sold it to corporations. And one of the corporations he sold it to was Purdue Pharma. And so, he became their sort of front man, if you will, their fixer, went to meet with DEA officials, with other officials, and basically spouted the company’s line. I mean, I have no idea what Rudy knew about what was in the company’s files, whether he was privy to the information that prosecutors later discovered. But he became, essentially, the person who tried to smooth things over with government officials.

AMY GOODMAN: And was particularly powerful because he was a cancer survivor himself—

BARRY MEIER: Absolutely.

AMY GOODMAN: —and spoke about what it means to reduce pain.

BARRY MEIER: Exactly. And, you know, he made a very compelling argument. I mean, this drug has valuable uses. It’s needed in certain situations. But, you know, what Purdue had done was to basically market this drug as a cure-all for all kinds of pain. And with the vast availability of the drug, it poured out onto the streets, and that led to this wave of abuse and addiction.

AMY GOODMAN: So, who were the officials in Washington, the political appointees in the Justice Department, who intervened? And this also goes to the whole story of West Virginia and a really crusading prosecutor who took this case on.

BARRY MEIER: Right. So, basically, there were people at the very—at the senior levels of the Criminal Division. Alice Fisher was then the head of the Criminal Division.

AMY GOODMAN: This is under George W. Bush.

BARRY MEIER: Correct. And Alberto Gonzales was the head—was the—

AMY GOODMAN: Attorney general.

BARRY MEIER: —attorney general at that time. So, essentially, what happened was, in September of 2006, this very small group of prosecutors, as you noted, in far western Virginia, forwarded a report, a confidential report, to the Justice Department recommending that serious felony indictments be brought against the executives of Purdue. That report contained extensive exhibits, emails, records, that they planned to present to a grand jury to support the call for their indictments. It was backed by the local U.S. attorney there, and man by the name of John Brownlee. And it was backed, in fact, by mid-level officials within Justice Department headquarters.

But on October 11, 2006, two weeks before these prosecutors were scheduled to go before a grand jury and seek these indictments, there was an 11th hour meeting at the Justice Department. Purdue brought in its high-powered legal defense team, met with top Justice Department officials, like Alice Fisher. And after that meeting, there was a chill on the case. And basically, people like John Brownlee were told, “We are not going to give you the resources to support this prosecution. You’re on your own, if you want to do it.” And Brownlee had no resources. He had this small group of people who had spent four years, you know, 24 hours a day, investigating this company. They were facing a company of unlimited financial and legal firepower. And they really had no choice but to settle the case at that point.

AMY GOODMAN: I mean, the story of West Virginia is astounding. As you write in your New York Times piece, “Starting in 2007, the year of the settlement, distributors of prescription drugs sent enough pain pills to West Virginia over a five-year period to supply every man, woman and child … with 433 of them.” This is according to a report in the Charleston Gazette-Mail. And we’re going to talk about West Virginia as ground zero and exactly what happened to these communities, with Barry Meier, author of Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic. It’s just out this week. Stay with us.

[break]

AMY GOODMAN: “Puppet Charm” by Two Ton Boa, here on Democracy Now! I’m Amy Goodman. Our guest for the hour is Barry Meier, the Pulitzer Prize-winning former New York Times journalist, whose book is out again. Well, it’s expanded, it’s updated. But this is particularly relevant. The book is called Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic. It came out in 2003. Fifteen years, what a difference it makes in this country. How many deaths are we talking about? I mean, you have this incredible description of the death toll, writing, “In 2016, 64,000 Americans died from drug overdoses. That number equals the population of cities such as Portland, Maine; Lynchburg, Virginia; and Santa Fe, New Mexico. It was as if, in one year, a plague had entered one of these towns and killed every single inhabitant.”

BARRY MEIER: You know, we’re in the midst of the greatest public health disaster of the 21st century. It started out with the drug like OxyContin, and it has morphed, since then, into a kind of hydra-headed beast. On the one hand, you have the misuse and abuse of prescription drugs. And on the other hand, you have this growing death toll from counterfeit versions of drugs like fentanyl. So we’re in this very, very complicated situation. And, you know, the kind of policies that the government is now proposing may not get us out of it. I mean, we’re going to need a real extreme effort to get out of it.

AMY GOODMAN: We’re talking about, in 20 years, 250,000 people have died.

BARRY MEIER: That’s just from prescription painkillers alone. That’s from legal drugs. That’s from drugs that companies are allowed to produce, sell legally, and that are prescribed by doctors. And that alone is a stunning, startling figure.

AMY GOODMAN: So, I want to go to an ad from Purdue Pharma. This is from, oh, 1998, the ad to market OxyContin. It features Dr. Alan Spanos of North Carolina.

DR. ALAN SPANOS: There’s no question that our best, strongest pain medicines are the opioids. But these are the same drugs that have a reputation of causing addiction and other terrible things. Now, in fact, the rate of addiction amongst pain patients who are treated by doctors is much less than 1 percent. They don’t wear out. They go on working. They do not have serious medical side effects. And so, these drugs, which, I repeat, are our best, strongest pain medications, should be used much more than they are for patients in pain.
AMY GOODMAN: So, that is an ad put out by Purdue Pharma, the maker of OxyContin. Barry Meier?

BARRY MEIER: Well, you know, there was—in the late 1990s, there was a movement to promote—you know, treat pain much more aggressively than it had been in the past. A lot of that movement was funded by Purdue Pharma, people like Dr. Alan Spanos. And there were these tropes, if you will, that the addiction rate is less than 1 percent. It was a total lie. There was no basis for that figure. But it was repeated, repeated, repeated, and it sort of got ingrained into the medical culture. And as a result of that, doctors prescribed more and more of these drugs, you know, in good belief.

AMY GOODMAN: The guy he was talking about?

BARRY MEIER: Dr. Spanos. In fact, that video—they made another video, I believe, with Dr. Spanos that involved a patient. And that patient wasn’t even on OxyContin. He was on a totally ’nother drug, it came out. So, I mean, it was this massive public relations campaign, that was funded, in large part, by Purdue Pharma, to sell OxyContin.

AMY GOODMAN: Talk about the growth of Purdue Pharma. Talk about the Sackler family, what was unusual about this company, what also makes it so difficult to investigate.

BARRY MEIER: Well, the Sackler family is a fascinating family. As you know, their names are, you know, on every museum in the United States—here in New York at the Metropolitan, and at the National Gallery in Washington.

AMY GOODMAN: Their names are on wings. Their names are very prominent.

BARRY MEIER: On the elevators, on everything, you name it.

AMY GOODMAN: But when it comes to the drug, where they make their fortune—

BARRY MEIER: Right.

AMY GOODMAN: —we don’t see their name.

BARRY MEIER: Right. And not only that, the—there were three brothers, Arthur, Raymond and Mortimer. Arthur was the eldest. And he was sort of this kind of, I guess, you know, evil genius, if you will. He invented the modern-day drug advertising industry. All the ads that we see on TV today or in print are kind of the result of Arthur Sackler’s genius, or lack thereof, as you see it. And he kind of wedded together the pharmaceutical industry and the medical profession. He made doctors shills for drug companies. He created medical journals that were really kind of fake medical journals, because drug advertisers had to pay to get their studies into those medical journals. So he created all these deceptive marketing and advertising practices that are commonplace today. He died in 1986, before OxyContin was created.

But to get his brothers into the drug industry, he bought this tiny little firm called Purdue Frederick, that was located here in New York, in Greenwich Village, as it turned out. They basically sold a lot of kind of crazy stuff. And eventually, in the mid-1990s, they decided to get into the pain medication business. They first bought a drug called MS Contin, which was a long-acting form of morphine, and they marketed it mainly to cancer specialists, where the drug was very, very valuable in dealing with cancer pain. But then, in the mid-1990s, as this drive to treat pain more aggressively began to unfold, they began to sell OxyContin, which is a long-acting form of the narcotic oxycodone. And this became the most aggressive, high-powered marketing campaign for a prescription narcotic in drug industry history. It was financed with Sackler money. The Sacklers were the principal beneficiaries of it. There were something like $31 billion worth of OxyContin sales in subsequent years. And the Sacklers became, I believe, the 14th or 15th richest family in the United States.

AMY GOODMAN: I want to go to 1998. Purdue Pharma distributes another video, featuring seven patients who used OxyContin to deal with chronic pain. One of the patients was named Johnny Sullivan.

JOHNNY SULLIVAN: I got my life back now. Now I can enjoy every day that I live. I can really enjoy myself. And before, even a good day was hell. I mean, I couldn’t enjoy nothing. But now I can enjoy myself. That’s when I say it’s wonderful. I look at the future the same way a young guy, 25-, 30-year-old, would.
AMY GOODMAN: After appearing in that promotional video for Purdue Pharma, Johnny Sullivan became a severe addict to OxyContin and other opioids. In 2008, he died in a car crash when he fell asleep at the wheel. His wife said, because of his addiction, he would often nod off. Barry?

BARRY MEIER: You know, this drug, for some patients, has been a godsend. But for many, many others, it has turned into a nightmare. We focus a lot about—on the subject of addiction, and rightly so. But not long ago, I interviewed a pain specialist, who had been sort of on the bandwagon promoting these drugs when they first came out. And he said to me, “You know, addiction is not the real problem with these drugs. It’s not the only problem with these drugs.” These drugs caused patients to emotionally opt out of life, you know, to become couch potatoes, to become withdrawn, to reject their family members and lose social contact. They had all other—they have all other kinds of troubling side effects. And so, you know, there is now a generation of patients who, effectively, are emotionally dependent upon these drugs.

AMY GOODMAN: A spokesperson for Purdue Pharma said in a statement, in response to your article in The New York Times, his company is “involved in efforts to address opioid abuse,” and, quote, “Suggesting that activities that last occurred more than 16 years ago are responsible for today’s complex and multifaceted opioid crisis is deeply flawed.” Your response?

BARRY MEIER: You know, I’m not a $600-an-hour lawyer. I don’t come up with, you know, statements like that. But let me put it in simple terms. Purdue Pharma violated the trust of doctors and patients. It lied to them. The Justice Department discovered reams of information, which, in their minds, showed that this company also concealed extraordinarily powerful information pointing to the abuse of these drugs, early—early on, when it was first marketed.

AMY GOODMAN: What was the lie to the doctors?

BARRY MEIER: The lie was that OxyContin would be less prone to abuse and addiction than competing painkillers. They admitted that they had told that lie in 2007, and paid $600 million in fines. I mean, that was a drop in the bucket where OxyContin sales were concerned. But they admitted that they had lied.

AMY GOODMAN: You write about how Purdue sales reps used a chart to convince doctors that OxyContin was more stable than a traditional narcotic, even though the FDA had told Purdue that the information they were giving out was bogus.

BARRY MEIER: That was just one of many lies that they used. I mean, the entire predicate of the company’s marketing campaign was based on a lie. I mean, that’s the simplest way of putting it. The Food and Drug Administration had given them permission to say, “This drug might be less prone to abuse and addiction.” They trained their sales reps to say it was less prone to abuse and addiction. Sales reps would go—and sales reps didn’t know what the reality was, but they would go to doctors and pharmacists and say, “You know, you can’t inject OxyContin. You can’t extract the oxycodone from OxyContin and inject it, because like the junkie will get a heart attack, they’ll drop over and die. This is a safe drug. This is much safer.” It was all an incredible lie. And at the same time, the company was concealing what was probably the most significant information they needed to tell doctors, which was this drug was being widely abused.

AMY GOODMAN: Who is Laura Nagel?

BARRY MEIER: Laura Nagel was the head—a key figure within the DEA at the time of this episode. She was in charge of the division of DEA that went after the diversion of legal drugs onto the street. It wasn’t sort of the narcs, you know, the guys who busted people for selling heroin or cocaine, but it was the diversion division which dealt with the misuse of prescription drugs.

AMY GOODMAN: And what did she do?

BARRY MEIER: She was a hero. She was a fighter. She saw what was going on. She realized that this company, A, was overly aggressively—you know, was promoting this drug, you know, to the nines, that people were dying from this drug. She tried to call them to account. And they essentially unleashed as much legal and lobbying firepower on her to basically try to roll her over.

AMY GOODMAN: And what happened?

BARRY MEIER: She basically backed off, just like everyone else in those days who came up against Purdue Pharma.

waterfield wrote:

Billy_T wrote:

waterfield wrote:

Just so you know Billy I wrote the Admin and asked why the entire post was not pulled.

Good to hear that, W.

How did they respond?

After a day of chemo, and listening to the (sometimes horrific) stories of other patients — which is unusual for me. I generally keep to myself when I’m there — I’ve had time to “sleep on it” a bit. About the only thing that bothers me now is the faceless, nameless aspect of it all. As in, I don’t know who deleted the posts, and I don’t know who locked me out just as I was getting ready to write a final post to the board.

To me, that’s cowardice, and it’s — struggling for the right expression here — bad form.

James, for instance, would have told me personally before any of this happened. He would have sent an email or a PM. The new mods — whoever they are — don’t have the stones to back up their own actions by divulging their handles at least, which, of course, still keeps them basically anonymous.

Not cool. Not. Cool.

They have not responded.

Figures. That’s flat out cowardly. No response. No names. Little baby autocrats, in hiding.

That board seems to have changed more than just its name in recent months. It lost its soul.

waterfield wrote:

Just so you know Billy I wrote the Admin and asked why the entire post was not pulled.

Good to hear that, W.

How did they respond?

After a day of chemo, and listening to the (sometimes horrific) stories of other patients — which is unusual for me. I generally keep to myself when I’m there — I’ve had time to “sleep on it” a bit. About the only thing that bothers me now is the faceless, nameless aspect of it all. As in, I don’t know who deleted the posts, and I don’t know who locked me out just as I was getting ready to write a final post to the board.

To me, that’s cowardice, and it’s — struggling for the right expression here — bad form.

James, for instance, would have told me personally before any of this happened. He would have sent an email or a PM. The new mods — whomever they are — don’t have to stones to back up their own actions by divulging their handles at least, which, of course, still keeps them basically anonymous.

Not cool. Not. Cool.

JIM MURRAY

Ground Chuck Just a Pilot Away From Air Knox

September 16, 1990

http://articles.latimes.com/1990-09-16/sports/sp-1288_1_chuck-knox

SEATTLE — They called him Ground Chuck. They called his football the School of Hard Knox. They said he played football 10 yards at a time, the way sandhogs built tunnels under rivers. Or miners dug coal. They recommended his teams wear lanterns and carry canaries.

They called his team the Seahawks, but the wise guys said they should be called the Moles. They got touchdowns the way gophers get plants.

But he did more with less than anyone who ever coached the game. After all, even Vince Lombardi had Bart Starr. Tom Landry had Roger Staubach. Chuck Noll had Terry Bradshaw. Paul Brown had Otto Graham. Don Shula had Bob Griese. Dan Reeves, John Elway. John Madden had Snake Stabler, Tom Flores, Jim Plunkett. Even Mike Ditka had Jim McMahon. And of course, Bill Walsh had Joe Montana.

Chuck Knox had Dave Krieg. And Ron Jaworski. And Jim Zorn. And Pat Haden. And James Harris. And Joe Ferguson. These weren’t your basic Slingin’ Sammy Baughs.

Chuck Knox is “the best coach never to get to the Super Bowl.” He is, probably, the only coach ever to be fired after winning five successive divisional championships and going 12-2, 10-4, 12-2, 10-3-1 and 10-4 in the process.

The owner complained he didn’t look good winning. Not Hollywood enough. It reminded you of the woman who screamed hysterically for someone to save her baby son from drowning, and when someone did, she looked accusingly at him and said, “Where’s his hat?”

He had gotten his team within one foot of the Super Bowl twice. The first time, his Rams had the ball on the Minnesota one-foot line, fourth down and goal to go in a scoreless tie. They lined up for a chip-shot–no, a tap-in–field goal. It was blocked–and a Minnesota safety ran the ball back 90 yards for a touchdown. The Rams never recovered.

Another year, the Rams had the ball on the Minnesota one-foot line again, first down and goal to go, when the Minnesota tackle, Alan Page, with nothing to lose but a six-inch penalty, jumped offside. But the official ruled the Ram guard, Tom Mack, had drawn him off. After the Rams were moved back five yards, their quarterback, James Harris, on a rollout, threw an interception. Goodby, Super Bowl, once again.

Knox got shuffled off to Buffalo after that, and the next year the Rams fluked into the Super Bowl on a 9-7 record, the worst to make that summit. The gods were trying to tell Knox something.

Wherever he went, he never got a quarterback. Don Shula got Dan Marino. Chuck Knox got Dan Doornink. Bill Parcells got Phil Simms. Knox got Brian Bosworth.

Knox was trying to win no-limit poker hands with two treys.

Were the wounds self-inflicted? Well, when Chuck Knox took the Ram job in 1972, he was quoted as saying that quarterback was “just another position.” He enlarged on the philosophy by explaining that if the supporting cast were strong enough, the quarterback needn’t be all-world.

It was just as well he felt that way. Because he had to go to war against the all-worlds, like Fran Tarkenton and Roger Staubach, with Haden, Harris and Hadl.

He almost brought it off. Knox teams were–like the coach–resourceful, patient, smart, dogged, undiscourageable. An elite unit. They just had one weakness. Knox played the cards he was dealt–and he always came up an ace short. Whenever he called, the other guys had a higher hole card: the quarterback.

At Buffalo, the quarterback was a good Joe–but Ferguson, not Montana or Namath. Knox had to win games the old-fashioned way, by wagon train, not jet.

Hardly any team has ever made the Super Bowl without that old ace in the hole, the super quarterback.

Knox came closer than anybody. Has he had occasion to revise his earlier thinking? Is quarterback more than “just another position?” Is Ground Chuck about to become Air Knox?

Throughout their history, his Seahawks have drafted running backs No. 1 (Curt Warner, John L. Williams), or linebackers (Bosworth, Tony Woods) or tackles (Andy Heck, Cortez Kennedy). Quarterbacks are nowhere on their charts.

Knox sighs and says: “When I first expressed my opinion (about the relative value of quarterbacks), it was a different ballgame. Offensive linemen could not extend their arms to pass-block. Wide receivers could be checked at the line of scrimmage, even blocked below the waist, bumped and run with. You could use reasonable force to discourage quarterbacks, there was no in-the-grasp rule.

“Every rule that’s been put into effect the last few years was designed to help the quarterback, make his role more decisive, more effective. It has become more of a quarterback’s medium, this game.

“Now, there are two kinds of quarterbacks. There is what I call the ‘because of’ quarterback and the ‘with’ quarterback. You win ‘because of’ Joe Montana or John Elway. You win ‘with’ Phil Simms or Doug Williams.”

Chuck Knox has never had either kind–a “because of” or even a “with” quarterback–in his history. “To get a ‘because of’ quarterback, you have to go 2-12,” he explains. “And if you do that, you’re out of a job. Somebody else gets the benefit of the ‘because of’ quarterback. If, of course, you can find one.”

Knox’s teams are landlocked because they don’t have a pilot. They’re like a gleaming new DC-10 that can only taxi from runway to runway, an aircraft carrier restricted to delivering tanks. If he had ever had even a “with” quarterback, he’d go from Ground Chuck to Air Knox, and the Super Bowl today might be known as Knox-ville, instead of the sovereign state of Montana.