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October 27th, 2014

Explaining the Relevance of Risk Calculation in Choosing a (Chemo)Therapy

Reading Jeff’s explanation of risk calculation below was like taking the Ice Bucket Challenge. My views on that phenomenon are published HERE. This article is very helpful in understanding the nuances and adding perspective to statistical analyses like those published on coffee drinking below. Ultimately one needs to understand the actual biochemical mechanism that explains the benefits of coffee and any other drugs used to treat disease to verify their statistical merits. Until then, I will continue to take my timed-release gram of vitamin C in the morning and pick up a large Dunkin Donuts coffee on my way to work. John Leavitt

From Jeff Gordon, M.D.

Relative Risk is not the same as an actual increase or a decrease in risk.

The Absolute Risk is the risk of developing a disease (such as cancer) over a defined period of time.

The Relative Risk is the risk difference when comparing two groups of people, for example people who smoke cigarettes and people who do not smoke cigarettes. The Hazard Ratio expresses this relative risk difference, but by a different number mechanism.

Let’s say that the risk of developing lung cancer is 80% higher in people who smoke than in people who do not smoke. This means the Relative Risk is an 80% increase. The Hazard Ratio states this as being 1.8. A Hazard Ratio of 1 means the difference between the two groups (smokers and non-smokers) is zero. Numbers higher than 1 mean increased risk. Numbers lower than 1 mean decreased risk. So, 1.8 means the smoking group has an 80% increase of getting lung cancer than does the non-smoking group.

First, this does not mean that the risk of getting lung cancer in the non-smoking group is 0. It just means the risk of getting lung cancer if you smoke is higher than if you do not smoke.

Second, the 80% risk increase may sound like a lot when looking superficially at the number “80%”. But, what is the Absolute Risk increase?

Let’s say the risk in non-smokers of getting lung cancer is 1 in 100,000. For smokers, this risk is increased by 80%, so the risk goes from 1 in 100,000 to 1.8 in 100,000. The absolute difference of 0.8 is very small. If the population were 300 million, then a 1 out of 100,000 risk increasing to a 1.8 out of 100,000 risk would translate into 3,000 cases of lung cancer increasing to 5,400 cases of lung (an increase of just 2,400 cases).

That puts things in perspective.

But, what if the Relative Risk increase is 800%? The Absolute Risk increases from 1 in 100,000 (for non-smokers) to 8 in 100,000 (for smokers). If the population were 300 million, then a 1 out of 100,000 risk increasing to a 8 out of 100,000 risk would translate into 3,000 cases of lung cancer increasing to 24,000 cases of lung (an absolute increase of 21,000 cases).

Even as the Relative Risk goes up, the Absolute Risk increase in this example is not staggeringly high because the baseline risk is not high.

But, what if the risk of getting lung cancer in a non-smoker is 1 out of 100? If the Relative Risk increase is 80% for non-smokers, then given a population of 300 million, as in the example above, then the cases of lung cancer go from 300,000 up to 540,000. This is an absolute increase of 240,000 cases. The increase in total cases goes up more due to the higher baseline Absolute Risk.

If the Relative Risk were 800%, then the number of cases goes from 300,000 to 2,400,000 cases. The increase in total cases is much, much higher because both the baseline Absolute Risk and the Relative Risk are increased.

An example I use daily in my medical practice is explaining the potential risk reduction of dying from a cancer if someone takes a recommended treatment (such as chemo). Look at how the numbers change even if the Relative Risk reduction of dying is the same if the same chemo is used.

· Baseline risk of death is 10%. A 50% Relative Risk reduction by using chemo translates into an Absolute Risk reduction of 5%, so the risk of dying of the breast cancer drops from 10% to 5% after chemo. The risks of having a serious problem from chemo could be 2%, let’s say, so the benefit is larger than the risk of chemo, but not by much.

· Baseline risk of death is 50%. A 50% Relative Risk reduction by using chemo translates into an Absolute Risk reduction of 25%, so the risk of dying of the breast cancer drops from 50% to 25% after chemo. The risks of having a serious problem from chemo could be 2%, let’s say, so the benefit outweighs the risk of chemo.

· Baseline risk of death is 90%. A 50% Relative Risk reduction by using chemo translates into an Absolute Risk reduction of 45%, so the risk of dying of the breast cancer drops from 90% to 45% after chemo. The risks of having a serious problem from chemo could be 2%, let’s say, so the benefit much outweighs the risk of chemo. However, there is still a sizable remaining risk of dying of the cancer even after chemo given the very high baseline risk even with a sizable Relative Risk Reduction.

There are many ways to try to explain this.

Another number worthy of knowing is the Number Needed To Treat (NNT).

Let’s say that chemotherapy has a 50% Relative Risk reduction in the risk of dying of breast cancer. If the Absolute Risk of dying of breast cancer without chemo is 10%, then the Number Needed To Treat with chemo to benefit one person is 20. That means 20 people get chemo so that one person can get the actual benefit. A lot of people would be getting chemo without benefit because the baseline Absolute Risk of death from the breast cancer is low and the Absolute Risk Reduction is low.

But, if the same 50% Relative Risk reduction from chemo is applied to a baseline Absolute Risk of 90% of dying without chemo, then the NNT is 2.2, which means that 2.2 people get treatment so 1 can benefit (which is the same as 22 people getting treatment so 10 can benefit).

Of course, nowadays, we are much better with individualized benefit and risk assessments of breast cancer to minimize people getting treatment that won’t benefit them, thereby focusing on giving treatment to the people who could benefit the most from it.

So, the next time you read a news story trying to wow you with statistics about how great something is, keep these questions in mind:

What is the baseline Absolute Risk of the disease?
What is the Absolute Risk Reduction of a treatment for the disease?
What are the risks of side effects of the treatment?
How many people need to be treated for one person to get benefit?
What is the cost for treating an individual and what are the costs for treating a whole population?

October 25th, 2014

Is Coffee Good or Bad for You?

From John

These are the findings of very recent major meta-analyses of multiple clinical trials, some of which examined >100,000 to >1,000,000 subjects. The arrows point to the data of completely separated studies. I’ve included some tea drinkers and studies on caffeine drinkers, as well. The “relative risk” (risk ratio) is the key measurement. If you are in a group that has a relative risk of 0.80 then you have a 20% lower chance of developing the disease being examined. Likewise if you are in a group with a relative risk of 0.60, 0.40, 0.20, then you have a 40%, 60%, or 80% lower chance of getting the disease being examined, respectively. Over the years I have looked at past meta-analyses and they tell the same story. Rarely has a negative relationship between coffee or tea drinking been found.

Click to enlarge the actual data and its source:

October 21st, 2014

Woodstock Registered Voters Can’t Hide and the Ballot for November 4th

From John

Voter registration lists have always been available. Now CT’s registered voters can be searched by zip code and name (use the Find option when in the list of registered voters for a specific zip code). I looked at my home town of Rowayton and Woodstock. By doing this I can find out who is living in my past houses in my youth right down to their names and phone numbers. For a particular address you might see who lived there in the past also. For example, Andy Rooney’s wife Marge, who passed away a decade ago, is still listed at their former residence in Rowayton. She’s listed as inactive at that address. My sister Phoebe lived with Otis L in Rowayton for several years and voted  from there. Even though she has lived elsewhere for the last seven years, she’s still listed as active. Becki and I are listed in Woodstock. You can hyperlink to a second page which discloses your registered party affiliation and when you voted from 2000 on including referendums. See Connvoters.com for all zips in CT and see the Woodstock CT registered voters. Again, this information has always been available for the savvy.



October 17th, 2014

The Ebolavirus Infectious Process of a Liver Cell

From John

In August of 2013, Gordian Schudt and colleagues at The University of Marburg (Germany) published a study of live-cell imaging of the Ebolavirus infectious process in human hepatocytes. I will try to summarize their observations here.

They re-assembled Ebola nucleocapids (viral particles empty of the RNA genome) in a human hepatocyte cell line and then examined the trafficking of the these viral particles from the site of cellular entry across the cell cytoplasm to an exit door where the viral particles are secreted from the cell.

This table on the left gives us a handle on the relative sizes of this virus and the cells that they infect. The Ebolavirus particle is a cylinder with a diameter of about 80 nanometers (nm) and length of about 800 nm (an unusual shape for a virus); most human/animal cells have a diameter of about 30 micrometers or 30,000 nanometers. Simple math tells us that the Ebolavirus diameter is about 1/380th the diameter of a cell.

The investigators recorded live-cell time-lapse images using a high-powered Leica microscope to follow the fate of the viral particles from entry to exit from the cell. They could track this fate because the viral particles were re-assembled with fluorescent molecular tags that allowed them to see the particles as they moved through the live cell cytoplasm. They were trying to determine how the particles were transported through the cell and secreted with the hope that if the transport process was discovered, this knowledge might suggest a target of the transport process that could be used therapeutically.

The Ebolavirus enters the cell by attaching to a cell surface receptor followed by endocytosis (engulfment by the cell plasma membrane). The negative stranded RNA genome is unwrapped and translated into seven viral proteins using the human cell’s protein synthetic machinery. The viral RNA is replicated by its own RNA polymerase. Multiple viral particles are re-assembled into infectious viruses by this process. This is where we start Gordian Shudt’s study of the transport of the re-assembled particles to a cellular site where they can be released to infect other cells.

Viruses have been known to be transported along the architectural filamentous structures of mammalian cells. There are three filamentous networks in the cytoplasm of human and other animal cells – microtubules, intermediate sized filaments, and the most abundant microfilament network. The investigators found that it was the microfilament network that trafficked the newly assembled viruses to the exit door. The photo on the left shows how the microfilament network is organized in a human cell. These fibers are composed primarily of polymerized actin  – the most abundant and most highly conserved protein of human and all other eukaryotic cells (cells with a nucleus) [Human actin was first sequenced and cloned by yours truly.]

The investigators clocked the movement of the transported viral particles at three different transport velocities of about 100, 200, or 400 nanometers per second which could be caused by three different sets of actin-based motors (the width of a actin microfilament is about 8 nanometers) which catalyze the movement of a myosin motor protein along a microfilament. At 200 nm/sec the viral particle might reach the exit door fully assembled in about 105 seconds after the basic core of the particle had been assembled in the cytoplasm. The illustration below shows what this transport process looks like at the macromolecular level – the particle with myosin legs actually walks on an actin filament to the exit door.

The strand along the bottom is the actin filament with a motor protein (myosin) transporting the particle across the cell cytoplasm – energy is produced for this transport process by removal of phosphate groups from ATP.

Where is the exit door? It’s in the filopodia which are long cellular projections at the cell surface. The viral particle is transported into filopodia on its actin filament track where it then buds from the cell through the plasma membrane of the filopodia. It’s this site of budding that gives the Ebolavirus some protection from its victim’s immune system because filopodia attach to neighboring cells permitting direct cell-to-cell transmission of the virus.

October 16th, 2014

Some Basic Facts About Ebola Pathology

From John

Ebola is potentially the most debilitating infectious disease known to mankind; it rapidly ravages many organs of the human body such that it is the most highly fatal acute disease on record.

Regarding host range, Ebolaviruses cause often fatal, hemorrhagic fever in several species of simian primates. While fruit bats are considered a natural reservoir, the involvement of other species in the virus transmission cycle is unclear, especially for domesticated animals. Dogs and pigs are, so far, the only domestic animals identified as species that can be infected with Ebolavirus. In 2009 the Reston-Ebolavirus was the first Ebolavirus to infect swine followed by transmission to humans in the Philippines. A survey in Gabon found over 30% seroprevalence in dogs (production of anti-Ebola antibodies due to infection) during the Ebola outbreak in 2001-2002. Infections in dogs, as in bats, appears to be asymptomatic, while pigs experimentally infected with Ebolavirus can develop clinical disease, depending on the virus strain and possibly the age of the infected animals (Weingartl  et al, 2013; from the Canadian Science Centre for Human and Animal Health, Winnipeg, Canada)

Regarding transmission to humans, introduction from the wild into humans most likely occurs through direct contact with bats or their excretions or secretions or through contact with other end hosts such as monkeys and possibly dogs and pigs. Human-to-human transmission leads to ‘outbreaks’, which are often started by a single introduction from the wildlife or domesticated animal reservoir. Ebolavirus variants exhibit little genetic diversity, as in the current outbreak in West Africa ( Feldmann, Oct 9, 2014; from the Rocky Mountain Laboratories of the National Institute of Allergy and Infectious Diseases, NIAID). The current Ebolavirus genome has been sequence although as of yet the role of genetic variations does not explain the aggressiveness of this particular outbreak.

In spite of the fact that >5000 Africans have died from Ebola, few detailed autopsies have been reported. From the little that has been done, it appears that the pathogenesis of Ebolavirus infections is complex and involves a systemic cytokine storm during which circulating white blood phagocytic cells (macrophages, etc.) are activated resulting in release of proinflammatory cytokines, chemokines and growth factors which cause direct organ and endothelial damage and extensive (blood) coagulopathy ( Martines et al, Oct 9, 2014; from the CDC in Atlanta, GE). Elevated levels of proinflammatory cytokines by our inflammatory immune system, particularly IL-6, trigger the coagulation cascade. Vascular endothelial impairment is caused by an indirect immune-mediated mechanism, e.g. the cytokine storm. This systemic storm of immune inflammatory mediators such as nitric oxide, prostacyclin, interferons, interleukins and chemokines modifies vascular tone and causes hemorrhagic permeability, thrombosis, and inflammation. The massive release of these proinflammatory mediators and vasoactive substances promotes systemic inflammation and coagulation, but renders the adaptive immune system (antibody production) unable to effectively prevent systemic spread of the virus. In the lungs, for example, Ebola cases show congestion, focal alveolar edema, and hemorrhage. Tissue histology shows viral antigens in alveolar macrophages, endothelial cells, fibroblasts, and others interstitial cells within the lungs. In the liver, for example, hepatocyte necrosis ranges from focal to widespread and hepatocytes show characteristic intracellular oval virus inclusions. Ultrastructurally, these hepatocyte inclusions are composed of aggregates of viral particles.

A thorough description of the science of Ebola disease transmission can be found in a recent paper by Olival and Hayman, Apr 2014; from EcoHealth Alliance and Colorado State University, respectively.

October 15th, 2014

Ebola Talking Heads Are Not Addressing the Most Frightening Scenario

The problem with Ebola lies in Africa, not the USA

If the epidemic can spread to the USA why not throughout sub-Saharan Africa. Africa has a population of >1 billion. If Ebola spreads throughout Africa, then this increases the possibility that it will spread to India and southeast Asia as far east as the Philippines by migration of fruit bats, and possibly Australia. If that scenario occurs, then the likelihood of the virus reaching the USA is far greater.

October 14th, 2014

Ebola Update

From John

I constructed this graph from the announcement from the World Health Organization that is now projecting 10,000 new cases of Ebola PER WEEK by the end of December. In the last week the number have cases has risen by 1000. WHO is also projecting a 70% death rate. If the new cases rise to 10,000 per week by the end of the year, the projected number of cases in the graph will be closer to 50,000. So I asked the CDC why the difference between this outbreak and previous outbreaks. The CDC has not gotten back to me. See the article in the NYtimes

In this rapidly evolving story, the TV news media is either acting stupid and/or being manipulated. This started to get out of control when Charlie Rose asked Dr. LaPook, “What’s the worst scenario?” LaPook responded, “You journalists!” It’s kind of comical. Yesterday WHO started to answer Charlie’s question after the heads of the CDC and NIAID (NIH Inst. of Allergy and Infectious Disease) had tried to avoid hysteria by reassuring the public that things were understood and completely under control. Yesterday Chris Matthews berated Fauci (NIAID) because there was no “Ebola Czar” or Surgeon General. I read the expression on Fauci’s face to reflect the insulting behavior by Matthews. He was probably thinking ‘I am the Czar and there is no need for other Czars.’ This morning it was reported that nurses at the Dallas Hospital had contacted a national nurses union and reported that there “was no protocol” at the hospital to deal with dying Duncan. Days earlier Fauci and the head of the CDC, as well as Dallas judge, had tried to persuade the TV media that the first nurse infected by Duncan was due to a “breach of protocol” putting the onus on the nurses. But if there was no protocol, how could there be a breach of protocol? Then at 4 AM this morning a second nurse was diagnosed with Ebola because of breach of a fictitious protocol.

October 13th, 2014

African Fruit Bat – Likely Reservoir for Ebolavirus – 5-9 inch wing span

There are a gazillion of these migratory bats in sub-Saharan Africa. Transmission may result from contact with guano and eating these bats.

October 10th, 2014

Basic Information On Ebola and Ebolavirus

From John

These are the eight largest outbreaks of Ebola since the first significant outbreak in 1976 (data from the World Health organization, WHO). You don’t have to be a mathematician to see the difference in the current outbreak which is still growing. A representative of the CDC said yesterday that this epidemic reminiscent of the emergence of the HIV epidemic in 1981. That comparison while dramatic does not shed light on the lethality of Ebola. The problem with HIV is that the carriers were asymptomatic and they spread the virus without knowing it initially. HIV and Ebola work very differently.

The map below shows the locations of these eight outbreaks. Thus far Ebola infections have been confined to central Africa. The only infections outside of Africa have been carried by travelers from Africa.

October 7th, 2014

Ebola: “What’s the Worst Scenario?”

from John

This morning, October 7th, I was amused to hear Charlie Rose (CBS Morning News) ask Medical Advisor, Jon LaPook MD, “What’s the Worst Scenario?” regarding the Ebola outbreak. This question produced a rare moment in national news coverage when LaPook blurted out “You reporters!” which left a stunned expression on Charlie’s face (check tomorrow to see if LaPook or Charlie is still with CBS). Becki (my wife), immediately answered Charlie’s question with raised voice by answering factiously, “The virus will spread to wipe out the human race!” Charlie asked a question that put LaPook on the spot because if he had speculated and answered the question the way Becki did, CBS might have become the cause of worldwide mass hysteria.

If LaPook had had time to think and had read Becky Ryznar’s article (find on Google by searching Ryznar+Nerac+Ebola; must create a log in) on Ebola, he would have been able to say as Becky states, “it is plausible that a variant (virus) with an extremely high mutation rate and one that is replicating enough times throughout the population, could potentially mutate to become airborne. Can we rule out the possible Ebola viral evolutionary path to airborne transmission? The possibility of the virus mutating such that it would be highly transmissible in the air is a scary thought …” This is a plausible scenario because of the size of the outbreak in West Africa – it’s interesting that this scenario has never been raised by LaPook or any of the news media.

Let’s imagine that Ebola became airborne and spread around the world over a few months. The human race would not be wiped out because at worst only 45% of the population would die and the remaining 55% would develop immunity from the virus unless it mutated to produce a new serotype. Wandering further astray I am still immune to polio from the infection I got in 1949; my high titer of anti-polio antibodies was confirmed at the FDA in 1978 before I started growing poliovirus in the lab.

So if the worst scenario comes about, rent the movie Omega Man, starring Charlton Heston, to learn the end to this scenario.

October 7th, 2014

Bungay Firehouse Addition Nearly Completed

This addition was funded by a bequest. The top picture is the new meeting room on the second story of the new addition.

September 27th, 2014

Woodstock Academy Centaur Football Gets Its First Win in 2.5 Years – 35-14 Over St. Bernard/Norwich Tech

Woodstock Academy lost to Montville 40-0 on October 3rd following this win. On October 11 New London came out and scored 38 first-half points and rolled to a 51-6 win over the Centaurs at the Bentley Athletic Complex.

Read more: http://www.norwichbulletin.com/article/20141011/Sports/141019924#ixzz3FvqCIQWS

from John

Holden Cote (27 carries, 192 yards and 4 touchdowns) and Dan Templeton (defense) were the most valuable players. See the Norwich Bull article.

September 25th, 2014

Bungay Fire Department Needs to Sell a Lot of Chicken

Becki and I visited the Bungay Firehouse to pick up our chicken yesterday and Rich Dempsey gave us a nice tour of the new still unfinished fire house. The money to pay for this improvement came from a bequest of $479,000 from two elderly deceased who lived on Bungay Lake who appreciated the help of the fire crew in their final stages of life. What a nice story. There will be a large meeting room for locals on the second floor of the new addition. Needless to say, the other two fire houses in town are jealous.

September 21st, 2014

Woodstock Academy Continues Its Remarkable Streak Losing 7 to 52 to Bacon Academy Who Lost Badly Last Week

From John

The bright spot was that the Centaurs (0-2) did get a few more yards (234) than they did in their season-opening loss to Stonington. They also scored when quarterback Trent Appleton (9-for-18 passing, 134 yards) found Kyle Prouty for a 19-yard score. However, Woodstock could do little defensively.

See the article in the Norwich Bull.

September 19th, 2014

Rowland Convicted on All Seven Counts – Now a Two-Time Loser to Be Sentenced in December

from John

During my drive home from work during the years that John G. Rowland conducted his political talk show on WTIC between 3PM and 6PM (July 2010 to early April 2014), I would tune in to hear his biased rant against all things Malloy and Obama. I was often disgusted by his twisted point of view. So when President Obama won re-election in November 2012, I made a special point of tuning in to hear him whine. In his commentary about state Republican campaigns – who was good and who was not so good – Rowland never disclosed that he was a paid consultant for one of those campaigns. A second Republican candidate, MG (Mark Greenberg), wisely brushed off his solicitations.

Brian Foley and Lisa Wilson Foley pled guilty in a plea deal which imposed one-year in jail for each and substantial fines. Their acceptance of these sentences speaks strongly to the guilt of John G. Rowland in his political fraud. His trial starts in September down in New Haven. As a two-time loser, he will get jail time for sure.

Election Law
The Federal Election Campaign Act of 1971 limited financial influence in the election of candidates for federal office, including the office of United States Representative. The Election Act is enforced by the Federal Election Commission and the United States Department of Justice. It provides for public disclosure of certain contributions to and expenditures by federal election campaigns:

The Election Act limits the amount and source of money that may be contributed to a federal candidate or the candidate’s campaign committee; and In 2011 and 2012, the Election Act limited convention, primary and general election campaign contributions to $2,500 each for a total of $7,500, from any individual to any one candidate.

The Federal Election Commission (“FEC”) is an agency and department of the United States with jurisdiction to enforce the limits and prohibitions of the Election Act, and to compile and publicly report accurate information about the source and amount of contributions to federal campaigns. Federal candidates were required to file periodic reports with the FEC detailing, among other things, contributions made to their campaigns and expenditures made on the campaign’s behalf. In these reports, the campaign committees are required to identify each person who, during the relevant reporting period, contributed more than $200 to the committee, together with the date and the amount of any such contribution. These reports are made available to the public.

The Campaign Committee is required to and did file these periodic reports with the FEC.

COUNT ONE (Falsification of Records in a Federal Investigation)
Beginning in approximately October 2009, ROWLAND devised a scheme to work for the Congressional campaign of MG (referred to as “Candidate 2” in the indictment; identified in many media releases), and to conceal from the FEC and the public the fact that he would be paid to perform that work. To conceal the payments to ROWLAND, which MG’s campaign would otherwise be required to report to the FEC, ROWLAND proposed to be paid through a separate corporate entity, that is, the Animal Center. Further, to make the illegal arrangement appear legitimate, ROWLAND drafted and proposed to enter into a sham consulting contract with MG, pursuant to which ROWLAND would purportedly perform work for the Animal Center. By proposing to run the campaign related payments to ROWLAND through the Animal Center, ROWLAND sought to prevent actual campaign contributions and expenditures from being reported to the FEC and the public.

MG “Candidate 2” was a candidate for election to the U.S. House of Representatives from Connecticut’s Fifth Congressional District during the 2009-2010 and 2011-2012 election cycles, and competed in a primary campaign for the nomination of the Repubiican Party during each of those cycles. Candidate 2 was also the owner of an animal rescue and adoption center, located in Bloomfield, Corurecticut (the “Animal Center”).

On or about October 18, 2009, ROWLAND emailed an attomey: “attached is a contract that I have put together I hope you will be impressed, then I thought I better run it by you.” Attached to the email was a document titled, “MG contract.docx.” The attached document was a contract to be signed by ROWLAND and MG that outlined fictitious duties that ROWLAND would perform for the Animal Center.

On or around October 23, 2009, ROWLAND met with MG at the Animal Center. At the meeting, ROWLAND provided MG with the fictitious contract, purporting to establish a paid consulting relationship between ROWLAND and the Animal Center. In fact, ROWLAND was proposing to perform paid campaign work for MG’s Congressional campaign.

On or about October 23, 2009, ROWLAND emailed MG with the subject line “working together.” ROWLAND wrote: “Let me know if you want to put your own proposal together. Unfortunately, it was very diffrcult to get into a long discussion this week in Bloomfield. Your wife was very patient with us and I didn’t want to push it. Let me know. Have a great weekend. Love, the Gov.”

On or about November 2, 2009, in furtherance of his scheme. ROWLAND emailed MG: “Do you want to meet again?”

On or about November 3,2009, Greenberg responded via email: “I always enjoy your company.” ROWLAND replied: “I appreciate that you enjoy my company, but do you want to negotiate a contract? By the way, there will be another Republican candidate or two after today’s election. Let me know, thanks.”

On or about December 16,2009, ROWLAND emailed a political consultant: “I have talked with MG about helping him, his little non-political friends tell him I would hurt him [maybe in the htfd. courant readership] but I don’t think in the 5th (district), and actually no one knows MG. I told his people that most political types would be more curious that I was helping MG and would be a help to his fledging campaign …. if MG is willing to spend his own $$ and raise some he could win.”

On or about May 23, 2010, ROWLAND emailed MG : “I’m unpopular as your campaign manager would lead you to believe !! especiaily , [sic] in the 5th district. I can get you elected …. If you are interested.”

On or about June 1, 2010, ROWLAND wrote to GM that other political consultants “can not get [sic] you elected .. none of them will want me involved for obvious financial self interests [sic] . .. I give you the only chance of winning and that is still going to be hard. [by the way what you don't understand is .. if I go with you I am going against alot [sic] of friends from 25 yrs ,, [sic] not easy for me to do[.]] Sorry about today , [sic] I thought I was coming over , for you to give me a pitch , not that I was supposed to sell myself to you, I tried that already.”

In July 2010, Rowland started hosting his political talk show in the WTIC 3PM to 6PM time slot. WTIC is the major radio station in CT but the show quickly became strictly focused on promoting right-wing Republicanism and trashing everything Malloy and Obama to an extreme and often citing opinions of “Rush” (Limbaugh).

On or about October 18, 2009, in the District of Connecticut, ROWLAND, in relation to and in contemplation of a matter within the jurisdiction of the FEC and the United States Department of Justice, did knowingly falsify and make material false entries in a document with the intent to impede, obstruct, and influence the investigation and proper administration of that matter, that is, ROWLAND falsified and made material false entries in a
contract for services between ROWLAND and MG inorder to conceal from the FEC and the United States Department of Justice that payments made pursuant to the fictitious contract would, in fact, be in consideration for work performed by ROWLAND on behalf of MG’s campaign for election to the U.S. House of Representatives.

All in violation of Title 18, United States Code, Section 1519.

COUNT TWO – (Conspiracy)
Brian Foley (“Foley”), a co-conspirator who has been charged and sentenced separately, is the owner of a Connecticut nursing home company (the “Nursing Home Company”). Foley also owns a number of other related companies, including a real estate company (the “Real Estate Company”). Foley is the husband of Lisa Wilson-Foley.

Lisa Wilson-Foley (“Wilson-Foley”), a co-conspirator who has been charged and sentenced separately, was a candidate for election to the U.S. House of Representatives from Connecticut’s Fifth Congressional District in 2011 and 2012, and competed in a primary campaign for the nomination of the Republican Party.

Background of the Conspiracy
On or about September 5, 2011, ROWLAND (while hosting his 3-6PM political radio talk show) emailed (Brian) Foley and Wilson-Foley: “I have an idea to run by you, what days are good?”

On or about September 12, 2011, ROWLAND, Foley and Wilson-Foley met to discuss ROWLAND’s idea. At the meeting, ROWLAND recommended to Foley and Wilson-Foley that they hire him to work on Wilson-Foley’s campaign. ROWLAND suggested that he could replace Wilson-Foley’s campaign consultant, who was based in Washington, D.C., and perform a variety of services for the campaign.

On or about September 14, 2011, ROWLAND emailed Foley: “I had a brief chat with Lisa” I get it, Let’s you and I meet.”

On or about September 16, 2011, ROWLAND met with Foley. At the beginning of the meeting, ROWLAND falsely stated that MG (Candidate 2) had offered ROWLAND a position on his Congressional campaign, but that ROWLAND would prefer to work for Wilson-Foley. In fact, MG had made no such offer.

The Conspiracy
From on or about September 16, 2011 to in or about April 2012 – the exact dates being unknown to the Grand Jury, in the District of Connecticut and elsewhere – ROWLAND, together with Foley and Wilson-Foley, who have been charged separately, and others known and unknown to the Grand Jury, did unlawfully, knowingly and intentionally conspire, combine, confederate and agree with each other to:

a. knowingly falsify and make false entries in a document in relation to and in contemplation of a matter within the jurisdiction of the FEC (Federal Election Commission) and the United States Department of Justice with the intent to impede, obstruct, and influence the investigation and proper administration of that matter, in violation of Title 18, United States Code, Section 1519;

b. falsify, conceal, and cover up by trick, scheme, and device a material fact in a matter within the jurisdiction of the executive branch of the United States Govemment by, among other things, causing the campaign Committee to create and file false and misleading campaign finance reports with the FEC, in violation of Title 18, United States Code, Sections I 001(aX1) and 2;

c. make contributions and cause contributions to be made by Foley through the Real Estate Company to the Campaign Committee, which aggregated $2,000 or more (but less than $25,000) during a calendar year, in excess of the limits of the Election Act, in violation of Title 2, United States Code, Sections a41a(a)(1)(A), 44ra(f) md 437g(dxlxA)(ii), and title 18, United States Code, Section 2;

d. defraud the united States by impairing, impeding, obstructing, and defeating, through deceitful and dishonest means, the lawful govemment functions of the FEC, in violation of Title 18, United States Code, Section 37.

Purpose of the Conspiracy
The purpose of the conspiracy was to conceal from the FEC and the public that ROWLAND was paid money in exchange for services he provided to Wilson-Foley’s campaign for election to the U.S. House of Representatives.

Manner and Means of the Conspiracy
The manner and means by which ROWLAND, Foley, Wilson-Foley and others, both known and unknown to the Grand Jury, sought to accomplish the objects of the conspiracy included the following:

a. It was part of the conspiracy that ROWLAND, Foley and others created and executed a fictitious contract outlining an agreement purportedly for
consulting services between ROWLAND at the law offces of Attomey 1. It was part of the conspiracy that Foley made payments to ROWLAND for
his work on behalf of Wilson-Foley’s campaign in excess of the legal contribution iimits, and routed those payments from the Real Estate Company through the law offices of Attomey 1 and on to ROWLAND.

b. It was part of the conspiracy that ROWLAND provided nominal services to the Nursing Home company in order to create a “cover” or pretext that
he was being paid for providing consulting services to the Nursing Home Company, when, in fact, he was being paid for his work on behalf of
Wilson-Foley’s campaign.

c. It was part of the conspiracy that Wilson-Foley, ROWLAND and others concealed from the FEC and the public Folev’s unlawfull contributions to the Campaign Committee and the payments to ROWLAND, by causing the Campaign Committee to file with the FEC false and misleading campaign finance reports that failed to disclose these illegal contributions.

Overt Acts
In furtherance of the conspiracy and to accomplish its purpose and objects, ROWLAND, Foley, Wilson-Foley and others, both known and unknown to the Grand Jury, committed and caused others to commit at least one of the following overt acts, among others, in the District of Connecticut and elsewhere:

On or about September 27, 2011, ROWLAND emailed Wilson-Foley: “Does [campaign staffer] know I am ‘helping’ … should I work with him on delegate ideas/strategyl”

In or about October 2011, ROWLAND began working regularly on Wilson-Foley’s campaign.

On or about October 11, 2011, Attorney 1 emailed Foley: “[Executive 1] asked me to construct a consulting agreement between [the Nursing Home
Companyl and John Rowland. I would recommend that due to me [sic] Rowland’s background and the compliance issue that creates and links to
Lisa’s campaign that the contract be between my Law office and Mr [sic] Rowland – that way there is no connections.”

On or about October 12, 2011, Attorney 1 emailed Foley and attached a document titled, “Rowlandconsult.doc.” The email stated, “Attached is a
draft agreement b/t Rowland and my law firm. I have discussed with [Executive I and Executive 2] – please let me know if you have any revisions.” The attached draft contract referred to ROWLAND as ..the consultant.” ln a section titled “Duties,” the draft contract stated, “The consultant shall provide the following services (‘services’): a) provide education, opinions and information on the State of Connecticut and federal government’s election process; b) Assistance with the campaign of any candidate that the Nursing Home Company or its member(s) become engaged with.” A section titled “Restricted Activities” provided that, “During the Term and for a period of one (1) year after termination of this Agreement, consultant will not directly or indirectly: (i) Assist, become employed, consult or contract with any other candidate for federal or State of Connecticut office in which the [Nursing Home company] or its Managing Member is not engaged in.”

In or about the week beginning October 9, 2011, Wilson-Foley advised Campaign Worker 1 that paying ROWLAND through Foley was
advantageous to Wilson-Foley’ s campaign.

On or about October 13, 2011, Attorney 1 emailed Foley: “I spoke with [Executive 1] on the Rowland [sic] and your VM (voicemail). I’ll make the
Changes.” Read the rest of this entry »

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