Friday, July 31, 2009

Health Care Reform and YOU

Right now there is a lot happening in Washington, DC that will have a direct effect on you. Especially if you are a breast cancer patient/survivor.
Whether you are a democrat or a republican or an independent, whether you voted for our president or not, you must know what is in this bill.

It stands at 1,018 pages right now. Ninety-nine percent of our representatives, who we voted into office to be our voices, have not even read it.

There are facts and there are muddled messages being told.

I will start by posting a couple of articles that will illuminate what we may be facing.

On a personal note, as a single payer with private insurance, and with the pre-existing condition of cancer, I am scared to death of what will happen to me.
From what I have discovered, the version being debated right now, will alter my medical care forever.

From the NEW YORK POST

July 17, 2009 - President Obama promises that "if you like your health plan, you can keep it," even after he reforms our health-care system. That's untrue. The bills now before Congress would force you to switch to a managed-care plan with limits on your access to specialists and tests.

Two main bills are being rushed through Congress with the goal of combining them into a finished product by August. Under either, a new government bureaucracy will select health plans that it considers in your best interest, and you will have to enroll in one of these "qualified plans." If you now get your plan through work, your employer has a five-year "grace period" to switch you into a qualified plan. If you buy your own insurance, you'll have less time.

And as soon as anything changes in your contract -- such as a change in copays or deductibles, which many insurers change every year -- you'll have to move into a qualified plan instead (House bill, p. 16-17).

When you file your taxes, if you can't prove to the IRS that you are in a qualified plan, you'll be fined thousands of dollars -- as much as the average cost of a health plan for your family size -- and then automatically enrolled in a randomly selected plan (House bill, p. 167-168).

It's one thing to require that people getting government assistance tolerate managed care, but the legislation limits you to a managed-care plan even if you and your employer are footing the bill (Senate bill, p. 57-58). The goal is to reduce everyone's consumption of health care and to ensure that people have the same health-care experience, regardless of ability to pay.

Nowhere does the legislation say how much health plans will cost, but a family of four is eligible for some government assistance until their household income reaches $88,000 (House bill, p. 137). If you earn more than that, you'll have to pay the cost no matter how high it goes.

The price tag for this legislation is a whopping $1.04 trillion to $1.6 trillion (Congressional Budget Office estimates). Half of the tab comes from tax increases on individuals earning $280,000 or more, and these new taxes will double in 2012 unless savings exceed predicted costs (House bill, p. 199). The rest of the cost is paid for by cutting seniors' health benefits under Medicare.

There's plenty of waste in Medicare, but the Congressional Budget Office estimates only 1 percent of the savings under the legislation will be from curbing waste, fraud and abuse. That means the rest will likely come from reducing what patients get.

One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."

This mandate invites abuse, and seniors could easily be pushed to refuse care. Do we really want government involved in such deeply personal issues?

Shockingly, only a portion of the money accumulated from slashing senior benefits and raising taxes goes to pay for covering the uninsured. The Senate bill allocates huge sums to "community transformation grants," home visits for expectant families, services for migrant workers -- and the creation of dozens of new government councils, programs and advisory boards slipped into the last 500 pages.

The most recent ABC News/Washington Post poll (June 21) finds that 83 percent of Americans are very satisfied or somewhat satisfied with the quality of their health care, and 81 percent are similarly satisfied with their health insurance.

They have good reason to be. If you're diagnosed with cancer, you have a better chance of surviving it in the United States than anywhere else, according to the Concord Five Continent Study. And the World Health Organization ranked the United States No. 1 out of 191 countries for being responsive to patients' needs, including providing timely treatments and a choice of doctors.

Congress should pursue less radical ways to cover the uninsured. We have too much to lose with this legislation.

Betsy McCaughey is founder of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York. betsy@hospitalinfection.org


From the WALL STREET JOURNAL:

Health Reform and Cancer

The danger is that ObamaCare will stifle

Medical innovations that could save patients like me.


JULY 31, 2009 I have been battling non-Hodgkin’s lymphoma, an incurable blood cancer, for the past nine years. Last year, I was also diagnosed with uterine cancer.

I didn’t run to Canada for treatment. Medicare took care of my needs right here in New York City. To endure, I just need the freedom to choose my insurance, my doctors, and get the diagnostic scans and care I need. And one more thing: I need hope that a treatment will be developed that can control my diseases the way insulin controls diabetes.

Every cancer patient needs these things, especially hope. But the government’s plan to reform the health-care system in this country threatens all of this—particularly the development of new treatments.

When I was first diagnosed in 2000 I had chemotherapy. It put me in remission, but nearly killed me.

Three years later the lymphoma was back and I faced more chemo. This is so often the pattern of cancer: recurring disease and repeated chemo. In the end patients often die not from the disease, but from the treatments.

I took a different path, seeking a cancer vaccine. One had been developed at Stanford University 12 years earlier that had given 90% of patients very long remissions and cured some entirely. Unlike chemotherapy, there were no severe side effects.

But I couldn’t get the vaccine because the Food and Drug Administration required another trial that would take nine more years. Over-regulation has kept this treatment from patients for 21 years, as some 24,000 lymphoma patients died each year.

My husband and I searched the Internet and found another vaccine being tested at Freiburg University in Germany. That vaccine has helped me avoid chemotherapy for years. My oncologist says he’s never seen another patient do so well with the type of lymphoma I have.

I am still here because my care was managed by doctors—not a government agency. My doctors do what the bureaucracy can’t: They see me as a human being.

Patient-as-person will be a lost concept under the new health-care plan, where treatments will be based not upon individual patient needs, but upon what’s best for everyone. So cancer drugs for seniors might take second place to jungle gyms and farmers’ markets—so-called preventive care—which are covered under both the House and Senate versions of the health bill.

The stimulus package passed earlier this year allocated $1.1 billion for hundreds of “Comparative Effectiveness Research” studies. This project will compare all treatment options for a host of diseases in order to develop a database to guide doctors’ decisions. Research of this sort typically takes years. But the data will likely be hastily drawn conclusions that reflect the view of the government agencies that fund the studies: Cheap therapies are just as good as expensive ones.

In order to finance health-care reform, Democrats in Congress have proposed cutting $500 billion from Medicare over the next 10 years. Yet in his press conference last Wednesday, President Barack Obama denied that Medicare benefits would be cut. He has surrounded himself with advisers who believe otherwise.

Tom Daschle, Mr. Obama’s original pick to head Health and Human Services, argues in his book “Critical: What We Can Do About the Health-Care Crisis,” that we should accept “hopeless diagnoses” and “forgo experimental treatments.” Mr. Daschle blames the “use and overuse of new technologies and treatments” for runaway health-care costs. He suggests a Federal Health Board modeled after the British “NICE” board to make decisions on health-care rationing.

But the British system is infamous for denying state-of-the-art drugs to cancer patients. Thus cancer-survival rates in Britain are far below those in America, just as they are in Canada.

Canadian cancer patients told to wait months for treatment and diagnostic scans frequently go south and pay out-of-pocket for care in the United States. A number of Quebeckers even sued their government for violating their “right to life and security” under the Quebec Charter of Rights and Freedoms. Canada’s Supreme Court has acknowledged the pervasive rationing that occurs. In the 2005 case Chaoulli v. Quebec (Attorney General) , the majority opinion stated: “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.”

Despite such evidence, the Obama plan is likely to target various treatments—including radiology scans—in order to cut costs. I survived this long because my radiologist examines each of my scans with me in detail.

One of those scans also saved my life by picking up unsuspected uterine cancer. The congressional majority seems blissfully unaware that all cancer patients need those scans to monitor their diseases.

Also uneasy with the cost of medical progress is Dr. David Blumenthal, Mr. Obama’s new head of Health Information Technology. It is not reassuring that he stresses that two-thirds of the annual increases in health spending result from medical innovation, as he has written in The New England Journal of Medicine.

Cancer patients need nothing more than such innovation. Yes, developing more effective, less toxic treatments is expensive. The prices of new cancer therapies reflect the billion-dollar cost of developing each new drug. But such treatments can be life-saving, as they have been for me.

Despite its warts, our system works. Carelessly tinkering with it will have a world-wide penalty—the stifling of new drug development. What company would spend a billion dollars to develop a drug that will not be reimbursed by the new health plan? This would be a direct, devastating blow to the most vulnerable Americans.

In spite of the president’s assurances, there is every sign that this plan will be financed by deep cuts to Medicare, which, like the public option, will limit payments for specialists, radiology scans, and cutting-edge cancer drugs. These are prime targets because they are more expensive than other services. But are we really expected to forgo new medical technology and return to the cancer care of the 1970s?

When members of Congress are asked if they will opt for the public plan, they say no. That’s for the rest of us.

The number of Americans who have cancer exceeds 10 million. It’s time for cancer patients and their families to remind those on Capitol Hill that health-care reform is a matter of life and death for us.


Monday, July 20, 2009

Do Chemo Cocktails Offer the Best Hope?

Lab Rat?

Sam Hutchison has cancer. His father is seeking a cure beyond the edge of medicine.


San Diego

Each day, Sam Hutchison swallows 44 pills, most of which weren't prescribed by his physician. They were chosen by Sam's father, who devised the treatment cocktail -- and tests many of the medicines on himself -- in a desperate effort to save his seven-year-old son.

[Sam]

Sam Hutchison

Neil Hutchison, 45, isn't a doctor. A defense-contractor recruiter, he's part of a growing underground pushing the edge of medicine to find combinations of anticancer agents to save themselves or loved ones. Many of the medicines Sam takes haven't been tested in clinical trials for his disease. Some are meant for other illnesses; others are still in animal testing for safety and efficacy. But the fact is that Sam, who suffers a rare and often-deadly cancer of the nerves, is otherwise almost certain to die. Hence Mr. Hutchinson's decision, as he puts it, to play "lab rat" with his son.

"When your kids have run out of options, you have to think outside the box," Mr. Hutchison says. "It's terrifying, but it's our only hope."

Mr. Hutchison's methods are highly unorthodox. Doctors warn that untested combinations of drugs could cause terrible adverse reactions. Science takes time, and some doctors say that trying to shortcut the process is reckless.

But Mr. Hutchison is pursuing what many researchers believe is the most promising approach for curing or curbing cancer, which killed about 565,000 people in the U.S. last year. Because cancer seems to eventually overcome most individual therapies, researchers for a decade have advocated using combinations of new, targeted therapies on the theory that the best hope lies in cutting off all known avenues for the cancer to grow.

[pill]

Cancer Cocktails

See the combinations of medicines taken by Sam Hutchison, Ben Williams and Donlevy Fitzpatrick to fight terminal cancers.

Trials of such methods have been slow to gain traction. "Everyone knows the future of cancer treatment lies in cancer cocktails," says David Kessler, dean of the school of medicine at the University of California, San Francisco. Dr. Kessler says the Food and Drug Administration needs to undertake an effort similar to one it did when he was commissioner in the 1990s, when it amended the drug-approval process to speed approval of AIDS-drug combinations. "What's missing today is leadership."

Richard Pazdur, director of the Office of Oncology Drug Products at the FDA, says he strongly believes in the cancer-cocktail approach, but says it's up to the "medical oncology field" to organize and implement such trials. He says drug companies struggle over how to collaborate on trials of therapies owned by several different firms. Others note the convention for testing drugs has been to prove efficacy individually in clinical trials -- and only later to evaluate combinations of drugs.

[Neil and Margot Hutchison at the beach with Sam (right) and their two younger boys, Andrew (next from right), and Charlie.]

Neil and Margot Hutchison at the beach with Sam (right) and their two younger boys, Andrew (next from right), and Charlie.

A growing number of people won't wait any longer. Thanks to the Internet, the sick and their families can read about scientific discoveries as they are published, track down scientists and doctors and share information and personal experiences. The handful of doctors and cancer survivors willing openly to advocate the do-it-yourself cocktail approach say they're now approached by a half-dozen to a dozen interested patients every week.

In charting their own course, patients and families often run afoul of their own doctors. Some physicians chafe at having patients grab control of treatment. Some worry that medicines not yet fully tested may harm patients and prompt malpractice lawsuits. "The patient could suffer terribly and die as a consequence. Who is ultimately responsible for that?," asks Marc Chamberlain, director of the neuro-oncology program at the Seattle Cancer Care Alliance, which includes the Fred Hutchinson Cancer Research Center.

The practice is particularly worrisome to those running clinical trials. While only a small minority of cancer patients are cobbling together their own cocktails, they're often the same people -- the desperate and the risk-takers -- who would otherwise volunteer for new drug trials. "The end result could be that we struggle to do clinical trials for new and improved therapies, and all of us would be alarmed by such an outcome," Dr. Chamberlain adds.

Nobody knows exactly what combination is most effective, how much of each drug to consume or how long the drugs should be taken. There are no statistics indicating how many patients have attempted to create their own cocktails or how successful their efforts have been.

Nick Pavlakis, a 40-year-old Australian oncologist who has helped patients put together combination therapies, says the cocktails don't work for everyone. Many patients give up because the side effects of the numerous drugs can be intolerable. For some, he says the cocktail seemed to hold the disease at bay only for a time.

But for some patients, the cancer cocktail appears to be the only medical explanation for remarkable recoveries.

The pioneer of self-directed cancer cocktails is Ben Williams, a behavioral psychology professor at the University of California, San Diego. In 1995, Mr. Williams was diagnosed with a glioblastoma, the most-deadly type of brain tumor, and was told he would likely die within 18 months.

As he received the standard radiation treatment, Mr. Williams combed scientific literature and became attracted to the idea of combining therapies. His neuro-oncologist, Dr. Chamberlain, then at the University of California, San Diego School of Medicine, initially refused to treat him with tamoxifen, a breast-cancer drug Mr. Williams had read could be helpful. But Mr. Williams eventually persuaded Dr. Chamberlain to add tamoxifen to a routinely prescribed chemotherapy drug.

Then, without telling Dr. Chamberlain, Mr. Williams added verapamil, a blood-pressure medicine that he had read made chemotherapy more effective, by asking another doctor to prescribe it. He bought Accutane, an acne treatment believed to kill cancer at high doses, in Mexico, where prescriptions weren't needed at the time.

Less than a year later, the tumor was gone. While he remains critical of the approach, Dr. Chamberlain says the treatment cocktail "probably contributed" to saving Mr. Williams's life.

Others followed Mr. Williams's route, with varying degrees of success. In 2002, a 55-year-old Australian real-estate developer named Donlevy Fitzpatrick was diagnosed with two brain tumors and given nine months to live. He and his wife learned of drug cocktails on the Internet, but couldn't persuade his neuro-oncologist to prescribe one. After Mr. Fitzpatrick lost his speech, his wife, Uschi, reached out in desperation to several experts including Mr. Williams, who helped her find an oncologist in Sydney -- Dr. Pavlakis -- willing to try the cocktail approach.

Treated with a cocktail including tamoxifen and Accutane, Mr. Fitzpatrick's tumor shrank until it was not detectable on brain scans. He regained his speech and his strength. "If Uschi had listened to what most oncologists recommend for brain tumors, Don would be dead," says Henry Friedman, a brain tumor specialist at Duke University Medical Center who also helped Mrs. Fitzpatrick.

At first, Neil and Margot Hutchison were content to follow the established medical regimen for their son. The couple, Sam and two younger boys share a 900-square-foot condominium in a beach community in San Diego. Mrs. Hutchison, easygoing and even-tempered, works as a literary agent. Her husband, a chemical-engineering major in college, is so intense he makes right turns at traffic lights -- even when his destination is straight ahead -- because he can't bear to stop moving.

In 2005, the red-headed, freckle-faced Sam took six rounds of high-dose chemotherapy, underwent surgery, a stem cell transplant and six months of treatment with Accutane. His immune system shot, his appetite gone -- along with his hair, eyebrows and hearing -- Sam spent 100 nights in the hospital that year.

The Hutchisons clung to hope: The cancers of about 80% of children go into remission. In August 2005, doctors declared Sam in remission.

[UNDERGROUND.jpg]

But in July of 2006, a bone scan showed the cancer was back, in a small spot above his left knee. Neuro-oncologists delivered the grim prognosis: Children with recurrent neuroblastoma rarely live for long -- and there are virtually no survivors.

The Hutchisons were devastated. With nothing to lose, they signed up for a clinical trial of a drug called fenretinide, hoping to buy Sam some time. A little over a month later, a scan revealed two more cancerous lesions on Sam's right hip. Sam was dropped from the trial.

That night, Mr. Hutchison says he couldn't sleep. In the wee hours, he retreated to a storage loft that he had converted into a "war room" jammed with a desktop, three stacks of neuroblastoma books, boxes of vitamins and supplements and plastic tubs overflowing with printouts of his research.

Emptying the files on his desk, Mr. Hutchison began reading again. He found a paper another father had sent him. Physicians at Brown University had reported that a child with neuroblastoma who had contracted a tropical illness called Chagas disease went into remission after being treated with an antibiotic called nifurtimox. In a later lab test, nifurtimox appeared to kill neuroblastoma cells. Bayer AG, the German drug company, marketed the drug in other countries, but it wasn't licensed for sale in the U.S.

Mr. Hutchison phoned one of the paper's authors. The researcher, Giselle Sholler, had just begun experiments with mice and was several years away from human trials. But she agreed to treat Sam on compassionate use, a special provision for experimental treatments when all else has failed.

Back at Rady Children's Hospital in San Diego, the Hutchisons told Sam's oncologist Jennifer Willert of their plan. Although Dr. Sholler would be directing treatment from Vermont, the couple hoped the hospital would monitor Sam's progress. Initially they met with resistance. Dr. Willert says many of her colleagues strongly opposed treating Sam with the drug, arguing he should join another clinical trial instead.

But the Hutchisons were adamant. Dr. Willert agreed to supervise Sam's care, reasoning the antibiotic was unlikely to harm him.

In September 2006, Sam began nifurtimox in combination with two strong chemotherapy drugs, the same combination treatment the patient with Chagas disease had received when she went into remission at Brown.

By November, the cancerous spots on Sam's leg and hip were fainter. The Hutchisons posted Sam's progress online, and soon several other parents were clamoring to use the nifurtimox-chemotherapy combination. Dr. Sholler began a small clinical trial, with the support of a small foundation Mr. Hutchison helped start with another parent.

The Hutchisons were elated with Sam's progress, but feared the cancer could eventually overcome the nifurtimox. They wanted a backup.

Late one night in his war room, Mr. Hutchison stumbled upon Mr. Williams's story online and phoned him. Mr. Williams told Mr. Hutchison he had no "time to get perfect information." Mr. Williams explained his theory of attacking cancer with multiple medicines, saying: "You're going to have to hit it every day with lots of therapies that are relatively low toxicity."

In his loft, Mr. Hutchison re-read several papers highlighting the potential of using high doses of omega-3, a fatty acid found in fish oil, to stop tumor growth. In a magazine, he saw that Mark Puder, assistant professor of surgery at Harvard Medical School, was working with omega-3. He phoned Dr. Puder, who said he had tested the fatty acids in mice with neuroblastoma. The drug didn't extend the mice's lives, but "they looked much better than the other mice," Dr. Puder said.

"If it were your son, would you give him omega-3?" Mr. Hutchison asked. Dr. Puder immediately said yes.

Mr. Hutchison probed for the right dose for his 40-pound son. Dr. Puder said he had no idea, but guessed four to six grams.

These days, Dr. Puder says he devotes two hours each day answering phone calls from patients, many of whom are interested in substances that are still in laboratory testing. Clinical trials are vital to advancing science, he says, but they're slow. "If you have a year to live and there's something in testing that may actually work, why not try it?" he says.

Soon, Mr. Hutchison was gulping down large doses of omega-3. "If I'm going to ask Sam to do this, I have to be willing to do it," he told his wife. Mr. Hutchison swallowed eight large yellow capsules each day.

After taking the omega-3 for two weeks, Mr. Hutchison handed Sam three capsules one morning. Reflecting the intense stress of guesstimating a treatment regimen for one's child, Mr. Hutchison spent that night racing back and forth to his son's room to check on him. He told his wife: "I don't want to be the fool who adds something to the treatment plan that ruins everything."

Creating Sam's treatment regimen consumes much of his father's waking life. Mr. Hutchison sends emails either late at night or early in the morning, arriving at work at 7 a.m. Anxious about his son's illness, Mr. Hutchison phones and emails Sam's doctors so frequently they often joke about it. "I don't think he ever sleeps," Dr. Sholler says.

But the omega-3 seemed to pay off. Within weeks, the Hutchisons say Sam's hair and eyebrows began to grow back and they noticed he had more energy.

Meanwhile, Mr. Hutchison, in frequent touch with other parents online, learned of an extract of a Chinese herb used world-wide to fight malaria that also appears to fight cancer. He discovered that the herb, artemesinin, had been used safely for years. He ordered the medicine on the Internet and began taking five of the pills daily. In January, he added three of the pills to Sam's regimen, upping Sam's daily intake to 20 pills.

Even as Sam's scans were coming back showing the cancerous spots so faint they were barely detectable, Mr. Hutchison continued his hunt, extending his reach to increasingly experimental treatments. James Belanger, a naturopath in Lexington, Mass., and a specialist in finding alternative cancer treatments, cited data from a small clinical trial. He suggested treating Sam with a chemical compound that reduces copper, which tumor cells seem to need to grow. Mr. Hutchison added tetrathiomolybdate, the copper-reducing compound, to Sam's daily treatment.

In October, after the Hutchisons had been shopping for Halloween costumes -- Sam chose the "Incredible Hulk" -- they learned a radiologist's report of his latest scan suggested the cancer might have returned in his right leg. The Hutchisons drove home in silence.

Mr. Hutchison berated himself for not adding more cancer-fighting pills to Sam's daily regimen. He had been digging into research suggesting a mixture of vitamin C and vitamin K3, known as vitamin C:K3, killed cancer cells in a similar way as nifurtimox. He even had ordered boxes of the vitamin mixture and taken it himself, but he had held off giving it to Sam, afraid of adding something new to a drug cocktail that appeared to be effective.

Now, terrified that Sam's cancer was back, Mr. Hutchison added one vitamin C:K3 capsule a day to Sam's treatment regimen.

On a recent afternoon, as Sam sat in front of the television in his living room playing a football game on the computer, Mr. Hutchison interrupted with a box of pills. Pausing the game, Sam downed the pills without hesitation in two gulps of water and resumed play. Soon Sam was exultant.

"I won, I won," he shouted, flashing a big smile and running up the stairs, arms raised.

"That's great," Mr. Hutchison replied, beaming down from his loft.

Then, turning to a visitor, Mr. Hutchison added, softly: "I wish it were that easy in cancer."

Days later, they got good news. The radiologist, re-reading the scan with the Hutchisons, concluded Sam's cancer hadn't returned.

An elated Mr. Hutchison then began questioning his decision to add vitamin C:K3. "I don't want to over-think this thing," he said. But if Sam's cancer wasn't back, he didn't want to risk the vitamin mixture. He decided to stop it until he gets the results of a mouse experiment gauging the effects of vitamin C:K3 with nifurtimox, a test funded by a small foundation Mr. Hutchison and three other parents have launched.

"Playing lab rat with your kid isn't easy," Mr. Hutchison said, tears welling up in his eyes. "This brings me to my knees."

Saturday, July 4, 2009

HAPPY INDEPENDENCE DAY!

IN CONGRESS, JULY 4, 1776
The unanimous Declaration of the thirteen united States of America

When in the Course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security. — Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.

He has refused his Assent to Laws, the most wholesome and necessary for the public good.

He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their Public Records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved Representative Houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected, whereby the Legislative Powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.

He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.

He has obstructed the Administration of Justice by refusing his Assent to Laws for establishing Judiciary Powers.

He has made Judges dependent on his Will alone for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of New Offices, and sent hither swarms of Officers to harass our people and eat out their substance.

He has kept among us, in times of peace, Standing Armies without the Consent of our legislatures.

He has affected to render the Military independent of and superior to the Civil Power.

He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his Assent to their Acts of pretended Legislation:

For quartering large bodies of armed troops among us:

For protecting them, by a mock Trial from punishment for any Murders which they should commit on the Inhabitants of these States:

For cutting off our Trade with all parts of the world:

For imposing Taxes on us without our Consent:

For depriving us in many cases, of the benefit of Trial by Jury:

For transporting us beyond Seas to be tried for pretended offences:

For abolishing the free System of English Laws in a neighbouring Province, establishing therein an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies

For taking away our Charters, abolishing our most valuable Laws and altering fundamentally the Forms of our Governments:

For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.

He has abdicated Government here, by declaring us out of his Protection and waging War against us.

He has plundered our seas, ravaged our coasts, burnt our towns, and destroyed the lives of our people.

He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation, and tyranny, already begun with circumstances of Cruelty & Perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.

He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the executioners of their friends and Brethren, or to fall themselves by their Hands.

He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince, whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.

Nor have We been wanting in attentions to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these united Colonies are, and of Right ought to be Free and Independent States, that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. — And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

— John Hancock

New Hampshire:
Josiah Bartlett, William Whipple, Matthew Thornton

Massachusetts:
John Hancock, Samuel Adams, John Adams, Robert Treat Paine, Elbridge Gerry

Rhode Island:
Stephen Hopkins, William Ellery

Connecticut:
Roger Sherman, Samuel Huntington, William Williams, Oliver Wolcott

New York:
William Floyd, Philip Livingston, Francis Lewis, Lewis Morris

New Jersey:
Richard Stockton, John Witherspoon, Francis Hopkinson, John Hart, Abraham Clark

Pennsylvania:
Robert Morris, Benjamin Rush, Benjamin Franklin, John Morton, George Clymer, James Smith, George Taylor, James Wilson, George Ross

Delaware:
Caesar Rodney, George Read, Thomas McKean

Maryland:
Samuel Chase, William Paca, Thomas Stone, Charles Carroll of Carrollton

Virginia:
George Wythe, Richard Henry Lee, Thomas Jefferson, Benjamin Harrison, Thomas Nelson, Jr., Francis Lightfoot Lee, Carter Braxton

North Carolina:
William Hooper, Joseph Hewes, John Penn

South Carolina:
Edward Rutledge, Thomas Heyward, Jr., Thomas Lynch, Jr., Arthur Middleton

Georgia:
Button Gwinnett, Lyman Hall, George Walton