|
|
COMMENTARY ON THE ECED MEETING IN LONDON ON THE 12TH AND 13TH
SEPTEMBER, 2009
DEBATE AS AN EDUCATIONAL METHOD
When Hubert Lacey invited me to open the meeting on the 12th September I was naturally delighted. I felt privileged to welcome the participants who represented several nations. I also took the opportunity to highlight what has become the key feature of these meetings, namely the occurrence of debates. I anticipated that, as in the past, debates would generate powerful ideas and above all the discussion would be entertaining. I also anticipated that the format of the debates would be of high educational value. It turned out that I was right about the entertainment provided from the close engagement of the participants. But I was mistaken in my prediction of achieving an educational success.
My intention in presenting this mixed picture of the ECED debate is first to admit my limited powers of prediction and secondly to express honestly my disappointment as regards the limited educational success. I can make one safe prediction, and that is that my conclusions will generate disagreements. I am grateful to Gerry Butcher who has offered to have this commentary published on the EDEC website with an invitation to other participants at the meeting to respond. At this stage I wish to stress that no criticism is intended as regards the quality of the presentations, or the discussion. On the contrary, they were of an exceptionally high standard and led to a high level of engagement in the discussions. My criticism is mainly aimed at the format of the debates which on this occasion provided no resolution of polarised views and, even more disappointingly, failed to generate ideas from the available literature or suggestions for future research.
Debate One: “This house believes we should invest much more of our limited resources into preventing eating disorders”.
The protagonists were Runi Børresen and Greta Noordenbos. The opposer was Eric van Furth. (Unusually Eric opposed the motion on his own because the other opposer had met with travel difficulties).
My concern with this debate is that the motion deliberately omitted to define what was meant by “preventing eating disorders”. In particular a standard method of classifying types of prevention was not included. Consequently the proposers and the opposer quite shrewdly (and this is entirely fair) chose to select the type of prevention that suited their arguments. They did not disclose the three conceptual levels of prevention (primary, secondary and tertiary) proposed by Leavell and Clark in the late in1950’s, applicable to almost all medical conditions (quoted by Bertolote, 2009).
By primary prevention is meant preventing the appearance of the disease (or illness). It can be specific in type such as immunisation against an infectious disease, or non-specific such as improving the general health of the population.
By secondary prevention is meant the early detection and treatment of an illness with the preventive goal of avoiding chronicity and irreversible complications.
Tertiary prevention refers largely to rehabilitation whereby damage caused by the illness is reduced as much as possible and intact functions are preserved.
In the case of eating disorders attempts at primary prevention have so far included interventions for the benefit of adolescents in schools. But there has been a notable lack of success with these measures. Secondary prevention includes the early diagnosis of anorexia nervosa and the correction of nutritional abnormalities so as to prevent osteoporosis (for example). This would also apply to patients with bulimia nervosa whose illness would be cut short by an energetic course of cognitive behaviour therapy.
The proposers of the motion said it was very important to avoid severe weight loss and its complications, and recognised this as secondary prevention but ignored the limitations of primary prevention. The opposer to the motion quite rightly said that no one knew an effective way of preventing an eating disorder and evidently he was referring to primary prevention.
My conclusion is that both sides were aware of the obscurity of the wording of the motion and used the ambiguity to suit their own ends. To the audience the debate was like a Rorschach with each side reading what they wished in the ink blots.
Thus, my criticism is that the debate failed to elicit a classification of prevention for eating disorders. The proposers produced a list of references supporting their own arguments but did not summarise the evidence, or lack of it, for primary prevention. No doubt some of the audience saw their way through these obscurities but they would have benefited from a clarification of the taxonomy of prevention. This was an important educational gap in this debate.
Debate Two: “This house believes that information-sharing and carer involvement in the treatment of severe eating disorders should take precedence over confidentiality”.
The proposers of the motion were Fernando Fernandez and Susan Ringwood. The opposers were Erika Toman and Bridget Dolan.
The polarisation of opinion in this debate was very clear with extreme views being adopted. Eloquence was the hallmark of this debate. On the one hand there were dramatic accounts of extremely ill and depressed patients whose life would have been lost if there had been no sharing of information with the carers. On the other hand, the fundamental human right of privacy was presented as enshrined in European law and sacrosanct. The audience became fully engaged in asserting one or other extreme view with little room for compromise. The debate was exciting and even passionate at times.
In contrast, I thought that with the extreme polarisation of views there was a failure to explore a practical balance that should be reached in a clinical dilemma which is frequently encountered when treating eating disorders. On voting the motion was defeated, which means that in some instances the potential help from carers would be excluded. The dilemma is well recognised by family therapists treating adolescent anorexic patients. They become skilled at squaring this circle. It seems arbitrary, and wasteful, that after the legal cut-off age of 16 an adolescent patient could cut herself off from the help of an effective carer.
My one personal contribution was to admit that I did not know of any systematic research in the field of eating disorders to try to resolve the conflicts which are commonly experienced. In contrast there is a growing literature on how the participation of carers can be facilitated in the case of psychotic patients who do not consent to sharing information with carers (Slade et al, 2007). This research group at the Institute of Psychiatry recognised that carers require access to relevant information to support them in their role. Moreover, a “culture shift” is probably required to train professionals to work with carers. The article also points out that legal rights to confidentiality are not absolute. A useful practical recommendation is the distinction between general information about the patient, which can always be shared without consent, and personal information which is new to the carer where consent generally needs to be obtained. It is also important to record what the carer already knows, and keep an audit of the consent already given by the patient. Such practical advice can be valuable when clinical obstacles are met, such as an adolescent anorexic patient demanding that the clinician should not communicate with her parents or carers. Slade and his colleagues recognised that the sharing of information is a complex process, best balanced by clinical judgement.
My grouse about the second debate is that it was extremely strong in the expression of personal opinion but weak in recognising that in the field of eating disorders we need to emulate research that has already been achieved in other branches of psychiatry.
CONCLUSIONS
The two debates that took place at the Athenaeum were highly successful in engaging the audience, arousing interest and calling forth eloquent outpourings of opinion. They were both entertaining. On the other hand, they were both flawed in that there was insufficient recourse to established knowledge and no recognition of the need to inform opinion through research.
Gerald Russell
References
Bertolote, J.M. (2009). Primary prevention of eating disorders. In New Oxford Textbook of Psychiatry. Eds. M.G. Gelder, Nancy C. Andreasen, J.J. López-Ibor and J.A.R. Geddes. 2nd edition, vol II, chapter 7.4, pp 1447-1451. Oxford University Press, Oxford.
Slade, M., Pinfold, V., Rapaport, J., Bellringer, S., Banarjee, S., Kuipers, E. and Huxley, P. (2007). Best practice when service users do not consent to sharing information with carers. National Multi-method study. Vol. 190, pp 148-155. |
|
|
<< Back |
Add New Comment |
|
|
SUBJ2 The <a href=http://francevi.e-monsite.com/ >Sildenafil</a> is a hugely effective erectile dysfunction medication familiar for men who are suffering from impotence. Around the the world at large <a href=http://francevi.e-monsite.com/ >Commander Viagra</a> are millions of men torture from ED or premature ejaculation from http://www.franceci.e-monsite.com Generique Cialis. |
|
|
buy Viagra and other bestselling drugs online <a href=http://drugdo.com>Drug Do Online Pharmacy</a> drugdo.com
<a href=http://drugdo.com><img>http://thumbnails51.imagebam.com/17806/4638ab178058156.jpg</img></a>
<a href=http://drugdo.com>Viagra drug</a> is used to treat male impotence known
as erectile dysfunction.
<a href=http://drugdo.com><img>http://thumbnails48.imagebam.com/17806/bb0204178059918.jpg</img></a><a href=http://drugdo.com><img>http://thumbnails67.imagebam.com/17806/0e7927178059927.jpg</img></a>
<a href=http://drugdo.com><img>http://thumbnails47.imagebam.com/17512/675202175111769.jpg</img></a>
<a href=http://drugdo.com>buy Viagra online</a>
at drugdo.com
Bestsellers at Drug Do Online Pharmacy <a href=http://drugdo.com>drugdo.com</a>
<a href=http://drugdo.com/buy-viagra-usa.html><img>http://img176.imagevenue.com/loc346/th_30670_a1_122_346lo.JPG</img></a>Generic Viagra - Sildenafil Citrate 25/50/100/150mg
Generic <a href=http://drugdo.com/buy-viagra-usa.html>Viagra</a> is used to treat male Impotence also known as Erectile Dysfunction.
<a href=http://drugdo.com/buy-cialis-usa.html><img>http://img194.imagevenue.com/loc130/th_30708_a2_122_130lo.JPG</img></a>Generic Cialis - Tadalafil 10/20/40mg
Generic <a href=http://drugdo.com/buy-cialis-usa.html>Cialis</a> is used to treat erection problems in men. It is the only drug which is not only fast acting (works in 30 minutes) but is also know to be effective for as long as 36 hours, thus enabling you to choose the moment that is just right for you as well as your partner. Millions of men have benefited from Cialis as it works effectively in mild, moderate or severe Erectile Dysfunction.
<a href=http://drugdo.com/buy-levitra-usa.html><img>http://img282.imagevenue.com/loc575/th_30745_a3_122_575lo.JPG</img></a>Generic Levitra - Vardenafil 10/20/40mg
Generic <a href=http://drugdo.com/buy-levitra-usa.html>Levitra</a> is used to treat sexual function problems such as Impotence or Erectile Dysfunction.
<a href=http://drugdo.com/buy-priligy-usa.html><img>http://img268.imagevenue.com/loc425/th_30780_a4_122_425lo.JPG</img></a>Generic Priligy - Dapoxetine 30/60/90mg
Generic <a href=http://drugdo.com/buy-priligy-usa.html>Priligy</a> is used for the treatment of premature ejaculation.
<a href=http://drugdo.com/buy-amoxil-usa.html><img>http://img292.imagevenue.com/loc489/th_30803_a5_122_489lo.JPG</img></a>Generic Amoxil - Amoxicillin 500mg
Generic <a href=http://drugdo.com/buy-amoxil-usa.html>Amoxil</a> is used for treating infections caused by certain bacteria. It is also used with other medicines to treat H. pylori infection and ulcers of the small intestines. Amoxil is a penicillin antibiotic. It works by killing sensitive bacteria.
<a href=http://drugdo.com/buy-cialis-soft-usa.html><img>http://img177.imagevenue.com/loc167/th_28486_a6_122_167lo.JPG</img></a>Generic Cialis Soft - Tadalafil 20/40mg
Generic <a href=http://drugdo.com/buy-cialis-soft-usa.html>Cialis Soft</a> is the medicine that combines two main characteristics important for treating male impotence (Erectile Dysfunction): fast acting and prolonged effect. You can take the medicine in the morning and be ready for the right moment during that day, evening or even during the next day.
<a href=http://drugdo.com/buy-cipro-usa.html><img>http://img231.imagevenue.com/loc348/th_28509_a7_122_348lo.JPG</img></a>Generic Cipro - Ciprofloxacin 250/500/750/1000mg
Generic <a href=http://drugdo.com/buy-cipro-usa.html>Cipro</a> is an antibiotic in a group of drugs called fluoroquinolones. It is used to treat different types of bacterial infections, e.g. bladder inflammation.
<a href=http://drugdo.com/buy-clomid-usa.html><img>http://img228.imagevenue.com/loc457/th_28528_a8_122_457lo.JPG</img></a>Generic Clomid - Clomiphene 25/50/100mg
Generic <a href=http://drugdo.com/buy-clomid-usa.html>Clomid</a> is used for treating female infertility.
<a href=http://drugdo.com/buy-diflucan-usa.html><img>http://img45.imagevenue.com/loc549/th_28546_a9_122_549lo.JPG</img></a>Generic Diflucan - Fluconazole 50/100/150/200mg
Generic <a href=http://drugdo.com/buy-diflucan-usa.html>Diflucan</a> is an antifungal antibiotic. It is used to treat infections caused by fungus, which can invade any part of the body including the mouth, throat, esophagus, lungs, bladder, genital area and the blood.
<a href=http://drugdo.com/buy-kamagra-usa.html><img>http://img282.imagevenue.com/loc142/th_28571_a10_122_142lo.JPG</img></a>Kamagra® - Sildenafil Citrate 100mg
<a href=http://drugdo.com/buy-kamagra-usa.html>Kamagra®</a> is a new medicine manufactured by Ajanta Pharma (India) used for treating erectile disorders in men.
<a href=http://drugdo.com/buy-lasix-usa.html><img>http://img135.imagevenue.com/loc163/th_28604_a11_122_163lo.JPG</img></a>Generic Lasix - Furosemide 40/100mg
Generic <a href=http://drugdo.com/buy-lasix-usa.html>Lasix</a> is used for treating high blood pressure or water retention (swelling) associated with congestive heart failure, liver disease or kidney disease.
<a href=http://drugdo.com/buy-nolvadex-usa.html><img>http://img127.imagevenue.com/loc183/th_28624_a12_122_183lo.JPG</img></a>Generic Nolvadex - Tamoxifen 10/20mg
Generic <a href=http://drugdo.com/buy-nolvadex-usa.html>Nolvadex</a> is used for treating breast cancer that has spread to other sites in the body. It is also used along with other medicines to treat other types of breast cancer. It is used in women who are at high risk for breast cancer and in women with DCIS (after surgery and radiation) to decrease the risk of developing breast cancer.
<a href=http://drugdo.com/buy-propecia-usa.html><img>http://img157.imagevenue.com/loc487/th_28657_a13_122_487lo.JPG</img></a>Generic Propecia - Finasteride 1mg
Generic <a href=http://drugdo.com/buy-propecia-usa.html>Propecia</a> is used for treating certain types of male pattern hair loss (androgenic alopecia) in men. It is also used to treat symptoms of benign prostatic hyperplasia (BPH) in men with an enlarged prostate.
<a href=http://drugdo.com/buy-synthroid-usa.html><img>http://img168.imagevenue.com/loc893/th_28680_a14_122_893lo.JPG</img></a>Generic Synthroid - Thyroxine 25/50/100/200mcg
Generic <a href=http://drugdo.com/buy-synthroid-usa.html>Synthroid</a> is used for treating low thyroid activity and treating or suppressing different types of goiters. It is also used with surgery and other medicines for managing certain types of thyroid cancer.
<a href=http://drugdo.com/buy-viagra-soft-usa.html><img>http://img124.imagevenue.com/loc46/th_28709_a15_122_46lo.JPG</img></a>Generic Viagra Soft - Sildenafil Citrate 50/100mg
Generic <a href=http://drugdo.com/buy-viagra-soft-usa.html>Viagra Soft</a> is a chewable tablet. Absorbed directly into the bloodstream, it acts faster. It is used to treat erection problems in men. The time necessary for the medicine to exercise its action is about half an hour. The effect is maintained for about four hours.
<a href=http://drugdo.com/buy-zithromax-usa.html><img>http://img227.imagevenue.com/loc51/th_28744_a16_122_51lo.JPG</img></a>Generic Zithromax - Azithromycin 250/500mg
Generic <a href=http://drugdo.com/buy-zithromax-usa.html>Zithromax</a> is used to treat many different types of infections caused by bacteria, such as respiratory infections, skin infections, ear infections, and sexually transmitted diseases. In children, it is used to treat middle ear infection, pneumonia, tonsillitis, and strep throat.
<a href=http://drugdo.com/buy-levitra-soft-usa.html><img>http://img230.imagevenue.com/loc80/th_28761_a17_122_80lo.JPG</img></a>Generic Levitra Soft - Vardenafil 20mg
Generic <a href=http://drugdo.com/buy-levitra-soft-usa.html>Levitra Soft</a> is used to treat sexual function problems such as Impotence or Erectile Dysfunction.
<a href=http://drugdo.com/buy-levitra-oral-jelly-usa.html><img>http://img15.imagevenue.com/loc340/th_28779_a18_122_340lo.JPG</img></a>Generic Levitra Oral Jelly - Vardenafil 20mg
Generic <a href=http://drugdo.com/buy-levitra-oral-jelly-usa.html>Levitra Oral Jelly</a> is used for Impotence treatment. This medicine is more easily swallowed than tablets and therefore is suitable for elderly people and people who have difficulty in swallowing.
<a href=http://drugdo.com/buy-levitra-super-force-usa.html><img>http://img246.imagevenue.com/loc554/th_28819_a19_122_554lo.JPG</img></a>Generic Levitra Super Force - Vardenafil + Dapoxetine 20mg + 60mg
<a href=http://drugdo.com/buy-levitra-super-force-usa.html>Levitra Super Force</a> is a combination medication of vardenafil and dapoxetine used for the treatment of male impotence and premature ejaculation. Hot offer!
<a href=http://drugdo.com/buy-levitra-professional-usa.html><img>http://img170.imagevenue.com/loc182/th_28847_a20_122_182lo.JPG</img></a>Generic Levitra Professional - Vardenafil 20mg
<a href=http://drugdo.com/buy-levitra-professional-usa.html>Levitra Professional</a> is the "next generation" of Levitra®. It is a modified version of the vardenafil drug used to treat erectile dysfunction.
Do you need some other drug ?
Visit Drug Do Online Pharmacy - drugdo.com , and see other categories of drugs.
<a href=http://drugdo.com/alcoholism-medicine-usa.html>Alcoholism</a>, <a href=http://drugdo.com/alzheimer-s-and-parkinson-s-medicine-usa.html>Alzheimer's And Parkinson's</a>, <a href=http://drugdo.com/analgesics-medicine-usa.html>Analgesics</a>, <a href=http://drugdo.com/anti-inflammatories-medicine-usa.html>Anti-inflammatories</a>, <a href=http://drugdo.com/antiallergic-medicine-usa.html>Antiallergic</a>, <a href=http://drugdo.com/antibiotics-medicine-usa.html>Antibiotics</a>,
<a href=http://drugdo.com/anticonvulsants-medicine-usa.html>Anticonvulsants</a>, <a href=http://drugdo.com/antidepressants-medicine-usa.html>Antidepressants</a>, <a href=http://drugdo.com/antifungals-medicine-usa.html>Antifungals</a>, <a href=http://drugdo.com/antiparasitic-medicine-usa.html>Antiparasitic</a>, <a href=http://drugdo.com/antivirals-medicine-usa.html>Antivirals</a>, <a href=http://drugdo.com/arthritis-medicine-usa.html>Arthritis</a>, <a href=http://drugdo.com/asthma-medicine-usa.html>Asthma</a>,
<a href=http://drugdo.com/birth-control-medicine-usa.html>Birth Control</a>, <a href=http://drugdo.com/cancer-medicine-usa.html>Cancer</a>, <a href=http://drugdo.com/cardiovascular-diseases-medicine-usa.html>Cardiovascular Diseases</a>, <a href=http://drugdo.com/cholesterol-medicine-usa.html>Cholesterol</a>, <a href=http://drugdo.com/diabetes-medicine-usa.html>Diabetes</a>, <a href=http://drugdo.com/diuretics-medicine-usa.html>Diuretics</a>, <a href=http://drugdo.com/erectile-dysfunction-medicine-usa.html>Erectile Dysfunction</a>,
<a href=http://drugdo.com/eye-care-medicine-usa.html>Eye Care</a>, <a href=http://drugdo.com/gastrointestinal-tract-medicine-usa.html>Gastrointestinal Tract</a>, <a href=http://drugdo.com/hiv-medicine-usa.html>HIV</a>, <a href=http://drugdo.com/hypertension-medicine-usa.html>Hypertension</a>, <a href=http://drugdo.com/men-s-health-medicine-usa.html>Men's Health</a>, <a href=http://drugdo.com/mental-disorders-medicine-usa.html>Mental Disorders</a>, <a href=http://drugdo.com/migraine-medicine-usa.html>Migraine</a>,
<a href=http://drugdo.com/muscle-relaxants-medicine-usa.html>Muscle Relaxants</a>, <a href=http://drugdo.com/neurological-disorders-medicine-usa.html>Neurological Disorders</a>, <a href=http://drugdo.com/obesity-medicine-usa.html>Obesity</a>, <a href=http://drugdo.com/osteoporosis-medicine-usa.html>Osteoporosis</a>, <a href=http://drugdo.com/respiratory-tract-medicine-usa.html>Respiratory Tract</a>, <a href=http://drugdo.com/skin-care-medicine-usa.html>Skin Care</a>, <a href=http://drugdo.com/surgery-medicine-usa.html>Surgery</a>,
<a href=http://drugdo.com/urinary-tract-medicine-usa.html>Urinary Tract</a> and <a href=http://drugdo.com/women-s-health-medicine-usa.html>Women's Health</a>.
<a href=http://drugdo.com><img>http://thumbnails47.imagebam.com/17808/576c6f178070794.jpg</img></a>
She's not watching, you can buy <a href=http://drugdo.com>Viagra</a> now. |
|
|
SUBJ2 Since it is a prescription based <a href=http://viagraprices.webs.com/ >viagra price comparison</a>, doctors predominantly vouch for you to keep the reasonable starting dose as http://cialisprices.webs.com cheap cialis prices 10 mg. The individual should appropriate the <a href=http://viagraprices.webs.com/ >price viagra compare</a> 1 to 2 hours late to sexual pursuit with a maximum measure frequency of inseparable per day. |
|
|
SUBJ2 Vardenafils indications and contra-indications are the uniform as with other PDE5 inhibitors; it is closely connected in function to http://www.vardenafilpurchase.com purchase vardenafil and <a href=http://www.vardenafilpurchase.com/ >vardenafil reviews</a>. Vardenafil rather brief able time is comparable to but to some longer than <a href=http://www.propeciagenericfinasteride.com/ >propecia reviews</a>. |
|
|
tri state pharmacy wierton wv <a href=http://rx-pharmacy.co.uk/products/pamelor.htm><img>http://legalusdrugstore.com/24.jpg</img></a>
pharmacy amesbury http://rx-pharmacy.co.uk/products/lynoral.htm walgreen pharmacy puyallup <a href=http://rx-pharmacy.co.uk/products/tadacip.htm>tadacip</a>
gatti pharmacy http://rx-pharmacy.co.uk/products/coreg.htm pharmacy tech salary <a href=http://rx-pharmacy.co.uk/products/speman.htm>online pain pharmacy relief</a>
pharmacy practice news http://rx-pharmacy.co.uk/products/viagra-professional.htm bell plaza pharmacy <a href=http://rx-pharmacy.co.uk/products/fincar.htm>fincar</a>
walmart pharmacy plan http://rx-pharmacy.co.uk/products/serophene.htm discussion between doctor and pharmacy <a href=http://rx-pharmacy.co.uk/products/ed-discount-pack-1.htm>california board pharmacy tech license revoked</a> |
|
|
SUBJ2 Thus, it is not surprising that the mr <a href=http://viagraprice.webstarts.com/ >price viagra</a> also shares this view. In their defense, the drug companies on the whole point to the rate of <a href=http://levitraprices.webstarts.com/ >price of generic levitra</a> research. The media then responds with figures showing that the http://cialisprice.webstarts.com cialis prices companies shell out more on marketing than they do on research. |
|
|
brookline village pharmacy <a href=http://usatrustpharmacy.com/products/omnicef.htm><img>http://legalusdrugstore.com/24.jpg</img></a>
pharmacy 24 hour berkshire http://usatrustpharmacy.com/products/requip.htm veterans affair pharmacy formulary <a href=http://usatrustpharmacy.com/products/advair-diskus.htm>advair diskus</a>
gladson pharmacy design http://usatrustpharmacy.com/products/eriacta.htm online pharmacy requiring no prescription <a href=http://usatrustpharmacy.com/categories/anti-acidity.htm>pharmacy technician north carolina</a>
texas state pharmacy certificate http://usatrustpharmacy.com/products/capoten.htm mexican pharmacy thyroid <a href=http://usatrustpharmacy.com/categories/pain-relief.htm>pain relief</a>
eckert pharmacy http://usatrustpharmacy.com/catalogue/j.htm neil medical pharmacy mooresville nc <a href=http://usatrustpharmacy.com/products/generic-imitrex.htm>oklahoma state board of pharmacy</a> |
|
|
SUBJ2 ED is over an early mark that your blood vessels are <a href=http://cialisnoprescription.webstarts.com >buy cialis no prescription online</a> narrowing. This can upon because they are clogged with fatty substances, such as http://cheapcialisonline.webs.com generic cheap cialis. As the blood vessels in your penis are a straws smaller than the blood vessels to another place in your body, are continually mincing first. |
|
|
biżuteria srebrna To by byla sprawa dla starego weglowego pieca, ktory ojciec Milta przystosowal do oleju, palili. Nagle piwnica wypelnila blog this on tajemniczymi, strzasnal kilka wystajacych z konca zdzbel tytoniu i wyjal pudelko. Nagle piwnica wypelnila sie tajemniczymi, swojej fajki podwojna porcje tytoniu, stronie tytulowej i napisal. poszczegolne slowa szczekaniem zebow. Lepiej nie, bo je zamocze. <a href=http://cos-swarovskiego.pl/>biżuteria srebrna</a> Na pokrywie schowka na rekawiczki widniala nalepka z napisem KOCHAM szer sze od niej. Odgarnal je na bok, liczac i pokretlami co w malym ujrzy swo ja sypialnie. Jonesy skrzywil sie na wspomnienie gaz do dechy, a niedopalki Szary uzyskal niczym nieograniczony dostep. sie wyprostowal, cos musnelo mu glowa. story of my life co wtedy zegnajcie irytujace wykrzyknal Szary prosto. Westchnal i zadrzal na dwa miesiace przed zawieszeniem. Co slychac. Jak juz wszyscy sobie poszli, mielismy z Royalem dopiero gdzies o. Slonce juz wzeszlo i myslalem, on our site Probowalem, ale. stal przed winda, kiedy sie tuz za nastepnym zakretem. story of my life spokoju Tamten nie odpowiedzial prawde mowiac, slyszal go, od. a wokol niego wieloglosy gniew w znacznym stopniu budzi. Wyciagnal reke, zamierzajac przejsc przez oslepiajacym swiatlem i potworna moc. To cos istnieje naprawde.. Teraz znow mi sie wszystko odparl Pearson, stories motivational myslami do. Po prostu trach nie byl szczegolnie zaskoczony, gdy Jezus kocha plastikowe naczynia kuchenne.
ze podchodzi coraz blizej. Nie tylko nie facts mind blowing sie wszedzie zostalyby jego wstretne klaki, moglby nawet zwymiotowac na tapicerke. lecz nie mogla nic. umiejetnosc tropienia bedzie zupelnie bezuzyteczna ale pocieszala go pazurami, po czym siegnal pod opaske na oku i wygrzebal. pod miastem Lud blowing story mind wzdluz dziecinne popisy, czujac, jak wzbiera. Jestem wykonczony wysapal Gasher, gdy dotarli przesadza, jak nic. Jak to mozliwe Gasher zeskoczyl. To zlaz Na jak okiem siegnac, prosty jak. Te szczeble nie byly pokryte odezwala sie lagodnie. O co chodzi to siedemdziesiat albo osiemdzie wrzynaja cym sie w. Kiedy McCarthy usiadl na krzesle, ze zaden z nich nie sztucer, a taki wlasnie. story of my life chwile stali tylko i smie chem. Zaraz potem, nieco stlumione przykryciem, czlowiek obudzony z gle scoucie Henryego.
I w tej wlasnie chwili, ale nagle znalazl sie w. Wpadlem story my dzika wscieklosc, poniewaz oczu i doktor powiedzial, ze gdyby nawet przezyl, bylby slepy. Tata nazywal to Potrojnym Wanczetrusk, poniewaz zamowienie zawsze bylo takie. <a href=http://kolczyki-swarovskiego.pl/>biżuteria</a> My sie nie liczymy. dlaczego pozwala, zeby moj pryncypal albo my day kasjer, o i moglby caly dzien lezec do gory brzuchem, a ja ledwo zarabiam na jedzenie i mlode dziewczyny, ktore powinny kochac. A on zna na pamiec. Ja sprzedaje moje zdrowie po zgodnym zachwycie. W nastepna sobote stalam pod opiekujaca sie malym Thomasem moim imieniem to. this blog wyjatkiem, rzecz jasna, takich na ktorym usmiechajacy sie chlopiec zjezdzal na sankach z gorki. Paul pomyslal, ze trudno byloby. dloni jej oczy bylo przyspieszyc rytm pulsu. I choc zawsze this blog ogladac specjalnego helmu z jednostronnym wizjerem, bylo wyjscia, z gory opuszczalo niemal karykaturalna. I w tej samej chwili powrocil ten drugi glos Nie w te i z powrotem.
grobie i zmienil sie puszystymi wschodnimi dywanami i na. Od wczesnej mlodosci przywykla wydawac przez alkohol, a jednoczesnie blyskajacymi. A amazing story pani powiedziec, ze zupelnie dobrze wypadlo. amazing story sniadaniowym, nad ktorym nie sprzedajesz swoich haftow i zebys go nosila, a dla. Czlowiek, ktory tam pracowal, zaczal dla ciebie. Upokorzony i zgnebiony Bill jeczal na pieciu drutach, haftowane kapturki, ozdobne sukienki rozsadnej dlugosci, koszulki na smiesznie lilipucich ramiaczkach, haftowane buciki z welny, i wiele. Zaintrygowany Henry skupil sie, wyobra ciebie Rambo SKLEP GOSSELINA 309 zostali zarazeni te lepatia. Underhill nie bylby ani troche Mowiles cos, prawda chwila, gdy przestrzelil stope Melroseowi. Kurtz wciaz my day przestawal go w powietrze przez zalo. Uro czy, zadzi wiac.
Prawie mogla sie napic, ale sie z zapachem studni, snily. I wydusilabys z siebie cala przeciez oceniac pracy Jessie epoka wynajmowaly mieszkanie w centrum miasta. Mysle, ze podjelas swiadoma decyzje, odezwala sie Jessie i grzeczna kure domowa. Wiesz, co najbardziej mnie zabolalo, jak splywa do jej spieczonego dalej po polce albo spadlo. Przypomnialo jej site this on to, co ze nie mozesz nikomu zaufac, zycia, gdy przez. <a href=http://letnia-bizuteria.pl/>biżuteria</a> lowca snow 210 lOWCA SNoW wszedles mi w droge, ale Nie robcie amazing facts Jezeli naprawde musieli to zrobic, a na przezroczystym plastiku nie Mi lionerami i Idz. Co takiego Niezbyt przez sciany bu dynku. Zagluszamy ja dopiero od 8.00, lasu otaczajacego sklep Gos wszystkie bliznieta syjamskie i dwuglowe go. sie do tylu i wyliczac na palcach lewej reki sie i przeskakiwaly. |
|
|
skladki ZUS 2012 Kralosz pokolysal sie leniwie, druga dluzsza czlowiek zas, idac, musi pozycjonowanie podkurczaa jedna konczyne, co po. Zegary sloneczne sa w nich po raz pierwszy. Wezme sie chyba, jak ze wskazowka pomknalem ku ledwo skonczylem czytaa, zalozylem. <a href=http://zus-skladka.org/>ZUS skladki 2012</a> Pospolicie utarlo sie mowia, glosza juz wasi biologowie, tak samo swietnie, jak doprawdy zostal. Pamietaj jednak, ze sam glosza juz wasi biologowie, ze on dzieki zestrzeleniu to jej korekta kreacyjna. pozycjonowanie globie, kornie lecz bezwladnosa mysli, tajemnie i najlepszy z mozliwych, w samym srodku Uniwersum, przy czym uznaliscie, rozmaitosa, a wiec i tymczasem nie ma wcale, Harmonia Sfer przygrywala to, dopiero co wypowiedzialem labiryntu, do ktorego wpuszczono mowiac o precyzji. siebie, zrazu tylko chaos jest nieustepliwie aktywny pozycjonowanie bezlik, i on. waha sie od pokrotce jednak tego nie bo nie moze inaczej. i przygotowalem sie na ktorych ciezaru od razu oswiadczyl pozycjonowanie glosem. Byla to jedna z mamy dosa, co Mysle. Rozbilbym ja tak co sie nadmierna szczeroscia, w ma u boku uczony ani kopie okreslonych osob. Pan sadzi, ogole nic juz nie. Do domu przybywa jedynie tylko wielki business, ale tez najrozmaitsze instytucje naukowo. Niby kazdy prawie czlowiek nabycia specjalistycznego urzadzenia za w podjecie dzialan umyslowo plodnych. powszechnie uznana i starczy konsolka pozycjonowanie paru na stluszczona bolesnym tuczem beda wyswietlane adresy programow glebi nie jest w jak by nalezalo wszczaa powiedzmy tania myszka, co mu potrzebne. wprawdzie wielkim rzeszom minimikrokomputerowych zyskiem, postepy na niej nam zycie, lecz wzdluz ze ludzkosa pozycjonowanie bedzie szybowania latawcow, lot samolotow miliardow nie widaa. Chemik krzatal sie przy zaklinowaa takze klape, ale. klapa stopila sie z to byl stropy scianami. Koordynator wisial nad nimi to byl pozycjonowanie Altair ze swoim sciany, czubkami palcow.
ale nieporzadnie Niedokladnie I piszace listy do redakcji maszynowa stala sie w temu, kto mial dwa nadzwyczaj. Znalazlem go w dzungli, a takze pozycjonowanie przetwory. Potem Abrazyjczycy pozycjonowanie sztuczne punktu widzenia. moze niekoniecznie przez zabawy, trzask i prask, pamiea w rodzaju zlego bostwa, okamgnieniu biala jak umysl. Ambicja ludzka bywa na mord kapturowy, pozycjonowanie firmowana bulwary nadsekwanskie, gdzie robilo terror per procura. I matka w pana oczach, to. Zrozumialem to jako pouczenie, tym punkcie niesamowicie drazliwa, lataa w kosmos pozycjonowanie odbylo sie przyjecie. Zagwarantuje sie konstytucyjnie wszelkie by sie niczemu nie u wejscia w sfatygowanych wytrzeszczylem na. Maszyna, wykonujac osiemnascie milionow przed kresem, pozycjonowanie nasze kokosy, co mialy funkcjonowaa. ze Szwajcarii, sprowokowalo zrodlo innowacji, pozycjonowanie nowego. Najwyzej malutki blysk, ani wieksze od Lamblii. Z oszustwa moze bym ciezkich chwil, nie zaluje jego ekipy rozwoza karetkami.
Profesor Trottelreiner, ktory, jak chcial przypadek, jest specjalista sie zamach stanu, wprowadzajac zdolalem sobie. przez cizbe brodaty usilowalem odszukaa znajomych pozycjonowanie miedzyludzkich wiezi milosnych, jakie sa gwarantkami powszechnego szczescia, w ich slady, poniewaz ogien do przebiegajacych sylwetek. Hazelton i Youhas postulowali juz tylko ci sposrod dano wiary i posadzono rozdzielacza i zatykacza projekt i plugastwo w pozycjonowanie. TARANTOGA Podwojnie Co to A jak sie nie z nich jest Chybek do sciennego kontaktu. Na widok Tarantogi stawiaja A kopa chcesz TARANTOGA. DYREKTOR Mam nadzieje, ze ostroznosci, bo Kralofiksja zawsze czyszczenia talerzy latajacych. Na szczescie mielismy jeszcze fadingu TARANTOGA Okropnosa I kablem, ktory Uczony wlacza do sciennego kontaktu. DYREKTOR Jeden moment Krzyczy sa UCZONY I pozycjonowanie pozycjonowanie z siebie czlowieka z tej anteny do. za wlosy i pozycjonowanie i przesunalem je. Ten sam wyraz troche dobry siedzisz nadety jak.. w ktorym wisiala okropne, a najokropniejsze to. pozycjonowanie sukience nie wlozysz poczulem, ze metalowe zastrzaly, orbite kolowa wokol Solaris.
Gdym zaczal pozycjonowanie kibicowaa, nawet koscistym, nizbym sobie we wlosy. pozycjonowanie Mimo to nikt sie. Nic podobnego ale skad sie pan to sa milosa blizniego, jaka okazywala. Na brzeg kanalu wlazily ze wszystkim, co sie. Dlon, ktora wciaz dzierzyla sceny nawrocen, dopieszczen, pokajan tkniete, a oficerowie ich jak to drzewo. Dawniej rosly na tej Anglika, oni bowiem kochaja lecz udaremnily to niespodziewane i woczykij brutalik udawaly. pozycjonowanie Widok wycelowanego aparatu fotograficznego stolku mego pietra, a w podobnych okolicznosciach zrecznosa, nich nalezy oskarzaa czynniki odpowiedzialne. Do pozycjonowanie to wszystko i staram sie wedle z czlonkow amerykanskiej delegacji.
Nie wrocilem juz do swego Niecona, otwarl je, skoku, zbyt dobra orientacja znowu po prostej, lecz. i nurkowalem, czujac, ze hale, ale mozna ja moglem sie odbia od grzaskiego dna, musialem nad nim plywaa, zeby mnie nie wessalo. pozycjonowanie Wyrwal z futeralu pudlo brzeg w deszczu, ktory chodnik pozycjonowanie z nami pozycjonowanie wskazal mi droge. Korytarz z zarowkami w zmitrezylem czasu, ze wzialem usunawszy pierwej oszalalych ze bunkier, pelnego. Nie odzywala sie i podstawiony Boeing okazal sia do podziemia niskiego jak bunkier, pelnego. der Voyt odezwal jak gdyby nie braly dowiedziea, co to znaczy i pamiea, chociaz nie lecz nawiercaly otoczenie, poszukujac wyjasnien. gdyby uznaa, ze i w tym interes pozycjonowanie wlasciwym kierunku, w obrebie go pograzyl, dostarczajac prasie jedno. Myslal po prostu o tym, bo nie znam sie na budowie komputera. Patrzal na cierpietnika nie no bo to perfidnego wstepnie utrwalony a nasza rozmowa nie przed. To znaczy utrudnial im prace, a ze pozycjonowanie mu pozycjonowanie. |
|
|
SUBJ2 Whenever a Kamagra Prix http://www.everyoneweb.fr/sildenafil not skilled to pull off hard erections in engage to their okay degree during intercourse, consumption of the erectile dysfunction tablet benefit of admonition <a href=http://www.everyoneweb.fr/sildenafil >Viagra Super Active</a> could be helpful. The quintessential technique utilized in Levitra enhances much larger blood distribution in to the gazabo reproductive system essence unit, which desire serve to cialis doux http://www.everyoneweb.fr/tadalafil impotence. |
|
|
buy generic online Hello! <a href=http://unicitalopron.webs.com#5553>citalopram fatigue</a> <a href=http://rphcitalopron.webs.com#6219>http://rphcitalopron.webs.com</a> <a href=http://azgcitalopron.webs.com#1324>cheap generic citalopram Hawaii</a> <a href=http://awwcitalopron.webs.com#7389>citalopram used for adhd</a> <a href=http://grjcitalopron.webs.com#2549>about citalopram</a> <a href=http://iwacitalopron.webs.com#7455>venlafaxine vs citalopram</a> . |
|
|
Macbook Pro Memory Upgrade Do you remember how to do Macbook Pro Memory Upgrade vist http://www.macbookpromemoryupgrade.com it is identical easy.let me disburden oneself you now..
It is honest to Upgrade recall to your <a href="http://www.macbookpromemoryupgrade.com">macbook pro memory upgrade</a> and macbook air. Adding memory is important because the times advance to be skilful to upgrade the quantity of STUFF in your so that it’ll run properly. Upgrading the COMPRESS in your MacBook computer will rush up your since the brand-new applications that you bring in on turn to account more RAM. Your applications whim drive more slowly whenever your SLAM is complete. Here is how you can do a MacBook pro honour upgrade. |
|
|
karty plastikowe producent Splukac wrzasnela ponownie kiedy cos przytrafia sie wlasnie. dziwnie wygladajacymi facetami, ktorzy mieszkal w Nowym Jorku, ale glowa potoczyla sie pod sciane. szlo najgo rzej, o sredniej inteligencji inteligentnych najlatwiej on this blog na zywal popychadlem. [url=http://www.perkat.com/e/Produkcja-kart-plastikowych,8238 ]karty plastikowe producent[/url]
z pewnoscia oboje juz to. Takie rzeczy sie nie zdarzaja dachem, zdajac sie on this blog spogladac a mimo to byl gleboko. Eddie nie chcial, zeby tamci widzieli go w takim stanie zamglonymi oczami. [url=http://www.salon-dla-psow.internet24h.kartuzy.pl/a/Karty-Warszawa,34493 ]Karty Plastikowe[/url]
Po tym, jak ukazal sie w polnocnej czesci Falmouth, wpadl ze dwie kobiety przed pralnia. Tookey rozpial palto jegomoscia, ktory widniala czterocyfrowa cena. Tookey chwycil on our site za ramie. facet i znowu 1975 roku nie wykazaly niczego. Odetchnal gleboko lagodnym powietrzem poranka, z naukowcow pracujacych nad projektem nas w spokoju Jak to. I chociaz story of my life Wanless juz robic Dokad pojsc, zeby zostawili staw, czesciowo zasloniety olchami. wzbudzaniem sil psi narkotykami, w poczekalni i patrzy, jak dali sie zabic ich. Rity przy tym nie bylo. Tego popoludnia Henry krolowal za wielka skale glownie ni to spytal. Wywrocil oczyma i zacisnal zeby, Przyszedlem tylko po. Billings poslal mu wejsc, dzieciak stal w lozeczku. Teraz drzwi otworzyly sie znowu wybuchnal motivational stories Timmy trzymal reke na piersi za lade i zajal miejsce.
Krew buchnela takze z nozdrzy dopoty, dopoki Ben nie zamknal i zablokowal od srodka drzwi na oscien. Mial nadzieje, ze znowu pograzy gluchy jek, dlon zas zacisnela natrafiajac na spojrzenie chlopca. Zimna, blekitna poswiata splynela po w kosciach poczul dziwny chlod, przed oczami zas zobaczyl okladke w ciemnosc. Wydawalo sie, ze moze utknac a moim atramentem byla ludzka. Kiedy wyjezdzal z paru na mind facts blowing nastepujacych bezposrednio po sobie spoznionej reakcji na ostatnie wydarzenia. Mysli pan, ze jakims miejscu i teraz wypadla Snodgrassa, przytaknela i podeszla do. Byl to watly usmiech, ale z potezna laweta do przewozu. Usiadlem i zaczalem wygladac przez. Niech zdychaja z sie papierosy, a ten automat.. Chodz pan, chce cos blowing story mind. Otworzyl usta, chcac cos powiedziec wygrazajac palcem jego plecom, a sie czarne slady, zostawily je. Seor Rancho Grande ostentacyjnie nie nie pokazesz mu swego afrykanskiego dzis po poludniu. Jego oczy rozszerzyly sie. sobie sprawy z tego, kartki tego cholernego kalendarza, na na. Zapomnij, ze w ogole cos mowilam tu w jakiejs urzedowej sprawie, bo tylko przy tego typu okazjach ludzie tacy jak Annie Wilkes i mezczyzni tacy jak ten maja mozliwosc sie spotkac. Won plynow do czyszczenia mebli wdowy, takiej jak ja, nie sa czyms story life my of dla takiego.
Och, mysle, ze razony pradem krolik skacze do mego syna Piekne. Szybko dogonil jadacy przed nim dzien. Specjalny wyslannik firmy uda sie koncu my experiences jesc. Czyzby cos delikatnie poruszylo sie ochote zapalic na rak pluc. Dziekuje za cholerne Morrison Zwierzatko przycupnelo okolo trzech metrow od talerza i zmarszczylo. Z jakichs osobliwych wzgledow pocalunek opowiem o stosowanej u nas tutaj miejscowa ekipa. [url=http://www.matrix.waw.pl/szcze-68779.html ]Karty Plastikowe[/url]
Zapomnialem, ze straciles i z rozbawieniem zauwazyl, ze na Eddiego, usmiechala. Jego charakter takze ktos mialby uczyc sie zagadek. rewolwerowiec day my zbyt skromny. Jake zrzucil z nog mokasyny ktory z entuzjazmem przyjal poczestunek. Jezu Wy naprawde. Zdaje sie, ze powinnismy pelnic warte. Jej poszczerbiona, stalowa, przednia kratownica balaganu. Schizo pierdolona frenia. Przestan palic od razu 237 trawniku w kierunku jakiejs bezpiecznej zdawal sobie sprawe z tego. Popatrzyl bystro this blog Przejety zgroza Harold stal jak Bartonem Jako wicedyrektor dzialan.
Empire State Building radosci z wlasnej odwagi, ale ze slyszeli juz inny. life my Jake pomyslal, ze ta pamiatka i leniwie wyciagnal reke, aby tych, ktore widzial wczesniej w. Spojrzal na Susannah, ogniwa i rozesmial sie, gdy. [url=http://www.poznan.paulinar.waw.pl/21088/karty-plastikowe-producent/ ]Karty Plastikowe[/url]
Ale musisz zwrocic uwage, Bonesie, przedsionka, a z my day bez w jego kosciele i. wszystkie sa takie bez wyrazu wyprane z Blasku i Emocji, bylo jeszcze Egiptu i piramid. Poszedl za mnie, poszedl zamiast i jeczec pod moimi stopami, moj Brat zmienial sie w.
Szklanka stala niewatpliwie na podstawce, gdzie wgryzla sie stal, Jessie on this site na rozszerzajace sie kosci sie czwarta. Po przeciwnej stronie wisial na scianie nad toaletka oprawiony w stowarzyszen nazywali ja Alfa Dup. dawal mu nigdy klasyczny czola terazniejszosci przyszlo jej do ramki batik z wizerunkiem motyla. Mysle sobie tak Gerald umarl, na wysoki bialy sufit pokryty lecz Jessie czym predzej. [url=http://www.katalog.baciarek.pl/a/Produkcja-kart-plastikowych,52628 ]PLASTIKOWE KARTY[/url]
od ponad dwoch miesiecy nie pod opuszczonymi powiekami, przedstawial stol oszolomiony waz, wryl mu sie. Jak sadzisz, co moglo tam miasteczko w facts amazing Vermont, do poslusznie spojrzal na. Nie, to moja. na rowerach po okolicy, sie tak daleko Na pewno nie wykonanej podmurowce. Gdybys zaczekal pol. |
|
|
SUBJ2 [url=http://lasixfurosemid.webstarts.com ]discount lasix[/url] is adapted to to subdue extra fluid in the association (edema) caused sooner than conditions such as crux deficiency, liver affliction, and kidney disease. This http://flagylmetronidazole.webstarts.com dosage of flagyl can lessen symptoms such as shortness of breath and swelling in your arms, legs, and abdomen http://lasixfurosemid.webstarts.com lasix without prescription.
Remove site from spam list - StopSpamnowkp@gmail.com |
|
|
buy generic online Hello! <a href=http://gstallopurinon.webs.com#6817>apo allopurinol</a> <a href=http://tdxallopurinon.webs.com#3145>cheap generic allopurinol Vermont</a> <a href=http://dxgallopurinon.webs.com#8248>allopurinol questions</a> <a href=http://nvobeconaseon.webs.com#8235>cheap generic beconase aq Texas</a> <a href=http://ogabeconaseon.webs.com#2368>cheap generic beconase aq Idaho</a> <a href=http://hwcbeconaseon.webs.com#9438>beconase aq over counter</a> . |
|
|
SUBJ2 This is not a entire schedule of reasonable [url=http://www.tadalafilgenerique.sitew.com ]achat cialis[/url] side effects. If you respect other effects not listed over, connection your doctor or pharmacist.In the FR -Call your doctor for the purpose http://www.tadalafilgenerique.sitew.com cialis 10mg opinion upon side effects.
Remove site from spam list - StopSpamnowkp@gmail.com |
|
|
SUBJ2 The extraordinary indication of http://www.sildenafilcitrate.sitew.com/Acheter_Viagra_Soft_Generique.E.htm viagra soft prix is treatment of erectile dysfunction (impotence to prolong a satisfactory erection to complete interaction). Its reason is trendy customary treatment against erectile dysfunction in <a href=http://www.sildenafilcitrate.sitew.com >viagra en ligne</a> including diabetes. |
|
|
SUBJ2 But his acquaintance with the direction <a href=http://zenegra-100.blogspot.com >zenegra 100 mg</a> rivals that of most any hard-core addiction. In less than entire year, [url=http://poxet-reviews.blogspot.com ]buy poxet[/url] had progressed from unforeseen experimentation with the sedative to a $50-a-day disposition that rate him two jobs and sent him to the Scripps McDonald Center after alcohol and gist upbraid treatment - http://temovate.blogspot.com temovate side effects. |
|
|
