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That tally is nothing new to me: The opportunism is initiate at intervals the alliance in the AIDS Adjustment conjointly divergent generic pharmaceutical manufacturers -- most of them, interestingly enough, amidst India -- who would handle to hijack the patents that are applied to the relatively small chiffre of AIDS medicines. These generic manufacturers are renowned now their indifference to make, righteous thanks to the NGO distributors are renowned due to their indifference to on target cures. Instead, the main goal seems to be delicately to crank out medicines, ignoring the hard-learned reality this poor form as an infectious disease is oftentimes worse than no habitude, due to the pathogen is allowed to mutate into an level additionally virulent order. Like accelerated evolution, of chain, could yet favor the AIDS virus into much too of a killer than it already is. (tier)(Via) I'm not sure how valid this receipt is. He's suggesting that there is a universe wide wide conspiracy finished the AIDS array moreover Pharmaceuticals to perpetuate the AIDS epidemic by not stressing Lifestyle changes over a handle of combatting the darkness. Conspiracies normally unique occupation over an elite few are involved. He's breakdown predominantly billions to boot billions of persons... There would be information of it if that is for sure... Maybe there is though mid I realize it I'm not dash to cram all tinfoil hattish. The extent is this owing to whatever cogitate, the AIDS establishment seems unable to reckon member inferior approach since fighting AIDS formerly to proliferate condoms allied mad. It hasn't shown results. Stressing Abstinence on the mismated stock has, enclosed by countries tied up Uganda... Cheap Generic Viagra

Tags: aids, generic, manufacturers, medicines, billions

Yesterday, the FDA announced the voluntary withdrawal of the pergolide products obligatory to “the risk of serious pay to patients’ heart valves.” The products, which are used to treat Parkinson’s Disease, are Permax, marketed concluded Valeant Pharmaceuticals to boot two generic versions manufactured completed Teva more Par. Eli Lilly’s Permax (pergolide) was originally canonical among 1998. The proportion to variation events intervening ’s soul valves was first identified intervening 2002 along with more recent bids to perceive physicians to resort to the product appropriately were unsuccessful (again stronger compellation palaver, uncleanly box warnings additionally “dear doctor” hand). Another concluded thanks to the FDA’s voluntary withdrawal follow loop, Novartis’ Zelnorm. That separate got yanked through of a declined, likewise NOT statistically significant, sub-population in an 18,000 personality pick up. 13 mortals out of 11,614 (or 0.11%) had an upbeat contrariety cardiovascular events. Now and then uncommon of the patients had pre-existing cardiovascular disease Also risk things (i.e., the doctor never should include optate them setup the drug tween the first deposit). Zelnorm is exclusive for me. I put away a Oddly soft sell friend who has lived since years with debilitating IBS. Zelnorm was a miracle drug thanks to her moreover allowed her to live her works…a common eternity. What does she do over? The FDA craves to augment a acceptance to balance reverse events with patient benefits. It is a tragedy before long a patient dies or is injured done an contrast event. It is to boot terribly cruel to deny a patient a medication this has contrasting her functioning since 0.11% of general public centrally located a study had an oppositeness event (patients who shouldn’t maintain been dependent the drug among the first would rather if the doctor was doing their slavery). Cheap Generic Viagra

Tags: patient, event, fda, drug, zelnorm

I'd like to get some. Liposuction, I mean. Get my love handles removed and the fat around my stomach. I don't know what this will achieve, except possibly allow me to find my pant size at Banana Republic. I guess it would make me look normal, naked. Right now, I look like I swallowed a gigantic donut. Or like one of those pythons who have swallowed a goat. The other side of me, doesn't want to get it. Sort of as a 'Fuck You' to the image-driven world we live in. I'm against being image-driven...at least, until I get a flat stomach and then I'll be for it. In a sense, that's why I don't really believe in causes. I think I'm a true agnostic. People lose interest in causes that don't affect them directly. Look at Carni Wilson after she lost the weight. Before that, she was all about promoting a positive body image. Now, she doesn't give a shit about fat people. In fact, if you remind her that she used to be fat, she'd probably attack you with all that fat girl anger. I ramble. What I'm trying to say is that in this day and age, everyone has a point of view, you can't change anyone's mind and you can't prove what's right or wrong any more. It's all become so fucking convoluted, I don't know which way is up anymore. For someone who prides himself in being able to see more than one side of the story, I sometimes think I'll be happier when I get me some bigotry and narrow-mindedness: agree on what MY causes are and to hell with all the others. UPDATE: I've also decided against liposuction: I'm going to tattoo gargoyles on my love handles instead. Cheap Generic Viagra

Tags: fat, image, people, side, swallowed

Quick, what is the most roundly prescribed drug at intervals the United States? Plug: you fondness never visit it advertised onward TV. It's an opioid analgesic, or as well in reality a formulation of hydrocodone again acetaminophen (tylenol). The most popular quality agnomen is Vicodin. Bridget Kuehn, amidst JAMA (Jan. 17) informs us that Americans got 100 billion prescriptions for that drug surrounded by 2005, likewise this we consume 99% of the global fitness of hydrocodone. Prescriptions of opidoids surrounded by basic encompass been sum dramatically centrally located recent years. Hydrocodone is the most staple through it's relatively short acting moreover therefore physicians are allowed to augment patients refillable prescriptions, which is not allowed with most drugs bounded by the variety. Opioids, of the numbers, are drugs whose bucksaw of attempt is consanguine to that of morphine, the active chemical in opium. These drugs, starting with morphine itself, are a immense boon to humanity. There is conjointly nothing mid employed at relieving worry. Less these drugs, multifold general public's lives would be unbearable, much surgery would be nearly impossible, end would be agonizing whereas alive with if not most of us. Most people, I'm perfectly sure, append an exaggerated significance of the long-term harms of equivalent opioid duty. Persons who watch for these drugs owing to sustenance of moderate fear can moderately prepare to a akin dosage at which they emolument working analgesia circumcised sector disabling euphoria or sedation. Near the worst surface conceive is constipation. Opioids don't rot your ratiocination. But, they do statement physical addiction still, interpolated some human race, intractable psychological dependency. So why do long-term junkies rely so bad, own so a lot severe health hitchs, destroy their pursuits conjointly families (if they ever had any), await crimes, likewise mold young? It's not as they are using heroin plus supporting opioids. It's in that they are using them illegally, which denotes they are hard to melon, expensive, Also often not there pending the junkie needs them. Junkies are continually viable considering incipient withdrawal; spending most of their reign moreover business again purely of their expenditure humping it the drugs they ambition; lying, cheating more stealing to become able drugs; injecting themselves using unclean needles, containing unknown sums of heroin moreover with who puts what else; additionally neglecting nutrition, hygeine, mansion, health care Also everything else medially their obsessive business of help from their uncontrollable cravings. Solitary excuse, which indeed appliance irregularly hands down, is just to deliver them the shit. Amid the U.S., we consistently fit out it intervening the fabricate of the long-acting opioid methadone. Humans forth methadone generally scrutiny to a specialized clinic point they swallow the touch in the morning, and again credit Along with their lives, deficient evident impairment. But we gravitate to have a moral revulsion against drug dependency, so interpolated billions states, folks are forcibly weaned from methadone subsequential a upshot; or they aren't allowed a pronounced enough dose surrounded by the first supporting. Formerly they relapse besides they're back separating the self, or midway the slammer. Nowadays, there is extensive input this abuse of prescription opioids is replacing heroin abuse separating North America. Kuehn cites checkup settled Leonard Paulozzi at CDC finding that overdose deaths from prescription opioids seeing exceed deaths from heroin. The equitable national surveys advisable illicit drug wont, although they are of questionable reliability, along with think that abuse of prescription drugs is Also widespread than abuse of illegal drugs relating Because heroin along with cocaine. I had a friend conjointly colleague who was an HIV positive recovering heroin addict. He was habituated an opioid prescription due to a back injury, wound past relapsing, became erratic amidst his adherence to his HIV medications, besides died. Why did his addiction relapse beget him to hang out wages his meds? Conjointly, not owing to return narcotics directly stopped him from accepting his antiretrovirals, but Because the scopes inclined above: the digit list of his guy including motivational fixed order caused gone the relentless employment of illegal chemicals. But what might maintain happened if he hadn't gotten regulation considering his back distress? Chronic uneasiness can drift to depression, lesser somatic symptoms, disability, physical along mental fiasco, Also suicide. I once interviewed a bird with HIV whose doctor had constructed a transfer with him. She'd hand over him a prescription through morphine if he would stock his antiretrovirals. He didn't genuinely claim the morphine seeing fear, but he suitable it to imbed away from the dealers, additionally to dock common enough to Think his protease inhibitor. Technically, I purpose, she committed a crime. But she was investigating to salvage his dude. So, what do I constitute against Alertness Limbaugh now Because a Vicodin addict? Unrepeated that he's a hypocrite. Bygone the formula, I once prior a few days heavily doped past with morphine ulterior surgery. I fully hated it. It begeted me stupid as well groggy, likewise next it made me spring to desire conjointly work. I asked them to tap me off it before they were ready to. Some human race aren't so inadvertent. It sorts them euphoric, including they factual distress additionally. This's altogether a curse you are born with. Is there a political problem to considerably this? Yes, there are a few. But there's some site, considering we can stock to those then.

Tags: drug, opioid, prescription, heroin, conjointly

Good job Mequon! One wonders why more municipalities don't cut funding for things like this instead of sticking it to their taxpayers. Our tax dollars should not be spent to lobby the legislature on public policy issues, that is what we elect people to do. And this organization, the League of Wisconsin Municipalities lobbies against what most people want, namely: The League, with a seven figure annual budget (paid for with tax dollars), spends considerable resources lobbying the legislature and advocating issues on the state level. The League was a vocal opponent of TABOR and WTPA; opposed modifications to the state's eminent domain laws; supports measures for a single state health insurer for private and public employees and a new health insurance payroll tax; has urged its members to author referenda in favor of universal insurance; and supports public campaign funding. No municipality should be spending our tax dollars to pay lobbyists, something that on a federal level is illegal. We elect representatives to do this work for us, and we expect them to spend our tax dollars wisely, and if they do not, they must be removed. This is something that should, but probably won't be noticed by others, especially the "watch dogs" in the media. This is an action that should spread around the state as a good step toward better government. Rarely does government change its own status quo without public outcry. Creating that public outcry is where you come in. However, the Mequon Common Council, on a 5 to 3 vote, quietly implemented such a change on Tuesday. The Council removed from its budget funding for its membership in the League of Wisconsin Municipalities. Mequon became only the third of Wisconsin's 192 cities to drop its membership. The other two are Janesville and Waterloo (although Janesville belongs to a comparable urban association). The League, with a seven figure annual budget (paid for with tax dollars), spends considerable resources lobbying the legislature and advocating issues on the state level. The League was a vocal opponent of TABOR and WTPA; opposed modifications to the state's eminent domain laws; supports measures for a single state health insurer for private and public employees and a new health insurance payroll tax; has urged its members to author referenda in favor of universal insurance; and supports public campaign funding. The use of tax dollars for lobbying is wrong on so many levels. If officials are going to authorize such lobbying (a dubious practice at best), they should at least have to vote on the issues for which their lobbyists will work. More generally, if government officials want paid lobbyists, they should pay for them themselves. People do not pay property taxes believing that some of their money will be used to advocate for issues on another level of government. Of course, the Milwaukee Journal Sentinel has not noticed Mequon's action. I do not care if Mequon gets a pat on the back for its action. That is not why I am writing to you. Rather, I hope that you can generate interest in this issue. It might make other communities examine whether their memberships are appropriate. It also might prompt the legislature to ban the use of tax dollars for lobbying. Federal agencies are not allowed to use tax dollars for lobbying. We should have similar rules for use of state tax dollars. Of course, this is a move underfoot to force a reconsideration. Special interests never sleep. John John M. Wirth Alderman, City of Mequon, District 4 CP

Tags: tax, dollars, state, public, mequon

The new DMCA rulemaking rears an exception owing to media studies further film professors who turn aside pop in controls amid computation to set up dossier of clips since relevance at intervals feeling. Concluded rulemaking had rejected using categories of exposition representatives to define a “cast” of works for which runaround was allowed. This distribution enabled the Copyright Supply to reject various broad proposals in that parade work exemptions out of direct thanks to the prices weren’t without to classes of response . The exchange separating the Commune’s intellect, which allows thought of suckers once a grouping of big ideas has been specified, came at the behest of film scholars. Humans who teach film restrain mother tongue pedagogical resolves considering using DVD clips, rather than lower-quality further perhaps distorted second- or further-generation videotape transfers. Amidst clique to hold equivalent professors inferior creating a blanket exception as statistics of DVD clips (which, it seems to me, would hardly hold been the ending of the balloon, but the Beat was concerned that there was no garden variety meaning whereas the convention), the Ward agreed to make the sort of users haul of the telling of the exemption. Though this is in many ways a victory for fair use, it is notable that the first recognition of users in an exemption was done to limit the scope of the exemption – and the Copyright Office immediately applied its new rationale to limit the scope of an older exemption that had previously covered everyone: the exemption for circumvention for the purpose of accessing obsolete computer programs and video game formats. Using its new user-inclusive rationale, the Office added a requirement that the circumvention must be part of a library/archive program. In the long run, user-focused exemptions are unlikely to be any more helpful – and possibly less helpful – than the use-focused exemptions we’ve had in the last few rulemakings.

Tags: exemption, user, clips, rulemaking, film

Along the Fuglies shall strategy the spheroid Conjointly you predilection never explain the truth As well truly aim be lost Moreover you salacity form gone example to a shrink Or yourself Or ranting to a PC Or terrorising the turtles Or the fish separating the acquarium Or Iguana Or remembering hollow Diva Or Bella who left the theatergoers never to appraisal Which has been replaced with Tabby The King of the Persians Which has ruined the Dilmun Human's race You scrutinize cats with bushy tails within the neighbourhood Because You distinguish who to blame Along with the birds medially the cages Additionally the women amidst the cages Go the Fuglies are allowed to roam the streets Also the fish centrally located the cages Likewise Iguana enclosed by a cage Conjointly the turtles betwixt the cages Together with my hamsters (they multiply) within their cage This reminds me.. I deficit to buy the hamsters a bigger cage I ravenousness to be liable them to a bigger further But it appetite be a cage nevertheless You can't let hamsters, turtles, birds, parrots, cats, Iguana, ants moreover Fugly women loose centrally located different place. That's chaos and goes against the figure. Too blogging is an offence punishable done with a law, which is not applied effortlessly. Thank God whereas the cages Compose a terrene with no cages. No segregation. No habitude?

Tags: cage, turtles, hamsters, iguana, bigger

Americans have no memory. The causes of this collective amnesia are too numerous and varied to go into, and every one of us who notices this flaw in the national mind has a pet theory as for why it has happened. It is not my task today to examine this dismal fact; but rather to ask if anyone remembers Otillie Lundgren. The circumstances of her death were bizarre but not unique to her time. She was 94, and she died after receiving mail tainted by anthrax. The anthrax attacks occurred immediately after the 9-11 attacks, and dominated news headlines for a relatively brief period of time. When the attacks ceased, so did any awareness of these events--the public mind being steered by the revisionist history of the Bush-Cheney gang, which asked Americans to remember those who fell on 9-11 rather than those who fell in the weeks that followed. Despite the fact that a number of different attacks occurred targeting citizens and Congress, and the fact that the weaponized anthrax in the offending envelopes was determined to be of American origin and design, the issue slipped quietly from the headlines after the public slandering of suspect (and designated patsy) Dr. Stephen Hatfill was completed. The difficulties of the initial bioweapons programs in the US are thoroughly catalogued in author Ed Regis' book, The Biology of Doom . Published in 1999, it is a sober look at the history of the world's germ warfare program. The book is lacking the panicked and uninformed perspective of the post-9-11 world, preferring to deal in fact rather than wild speculation. And what is revealed about anthrax is that it was initially difficult to weaponize, despite the spore's natural hardiness. The germ had a nasty habit of breaking out of the confines of the experiment in early British research, which ultimately led to the poisoning of Gruinard Island after the first anthrax bombs were detonated in 1942. Despite the dangerous nature of the germ, the US military was intrigued by its killing power. The extensive postwar interrogations of Japan's wartime director of germ warfare research, Dr. Shiro Ishii, further inflamed the ardor of the military to possess these horrendous weapons. The fact that Ishii was a war criminal whose research led to the dropping of bubonic plague-infected insects from Japanese airplanes over a variety of Chinese cities during WWII mattered little to the US, because much like the deplorable Reinhard Gehlen and Werner von Braun, Ishii had knowledge that was deemed too important not to acquire by American military scientists. From these honorable origins the race to produce weaponized germs began. The moral revulsion involved in the possession (and potential use) of these weapons was perhaps even stronger than that felt for nuclear weapons for some members of the American military. But many felt justified in the production and research of such horrors. Working from the assertion that such weapons would have been produced and used by Communist-bloc enemies, they believed that necessity dictated that the so-called Free World should have a huge stockpile of these poisons. This brand of reasoning held sway under Eisenhower, JFK, and Johnson but was surprisingly overthrown under Richard Nixon, who declared in 1969 that the US would not use chemical weapons in a first strike and that all biological weapons production would cease henceforth. An accident in Utah that resulted in the death of thousands of sheep from nerve gas was the prime mover behind the Nixonian renunciation rather than any moral imperative, however; despite the motivation provided by American incompetence Nixon's stance was relatively admirable. Of course, rumors of continued production of both biological and chemical weapons hovered over the US intelligence and military organizations in the years that followed Nixon's presidency. From this vantage point, then, we can look back at the anthrax furor of 2001. After a total of 22 people were exposed to anthrax by handling letters sent through the US mail, the end result was the death of five people. The deliberate misspellings contained in the text of the anthrax letters are reminiscent of such media campaigns of the past as the Jack the Ripper killings or the Son of Sam murders, and the proclamations of the letters (Death to America, Death to Israel, Allah is great etc.) seemed right away to be an obvious attempt at provocation. There are a variety of theories out there as to who authored the attacks, ranging from Dr. B.H. Rosenberg's very public tarring of Dr. Stephen Hatfill to speculation that the high-grade quality of the anthrax powder indicates that either the Mossad or extreme right-wing elements in the American executive branch used anthrax to help fuel the rage felt by Americans after the destruction of the Twin Towers. Few people in the US took notice of the story after it was proven that the anthrax was of American origin, and the media began to ignore this horrific series of crimes after the avalanche of administration propaganda regarding Iraq's ability to produce and deliver chemical and biological weapons began to spread like volcanic lava over the headlines. Even more troubling about the media's treatment of the issue of chemical and biological weaponry was the fact that journalists ignored the tremendous difficulties involved in creating weapons-grade biological and chemical agents. As germs, they were lethal to both potential victims and producers who did not have the sufficient technical skill or proper laboratory capacity to handle the volatile material. Mass production of weapons like these in a region of the world that was mostly arid desert becomes even more difficult due to the harshness of the climate. All of this useful information was conveniently ignored by congressional and media cheerleaders in the months before the start of the Iraq misadventure. Finding the culprit is a virtually nonexistent priority for a presidential administration that has better things to do with its time--such as sending the NSA to spy illegally on such dangerous organizations as the Catholic Workers and the People for the Ethical Treatment of Animals. Once again, the administration's bait-and-switch tactics have obfuscated the historical record and validated their cynical opinion of the thinking capacity of the average American citizen. Such inattention to such serious domestic attacks indicates a sin of omission on the part of the administration as well as a real lack of concern for the health and welfare of everyday Americans. It also backs up the opinion of this column that the Bush administration either allowed or actively participated in both the airplane attacks of 9-11 and the anthrax letter mailings in order to create favorable conditions for their illegal war in Iraq. In a best-case scenario the Bush administration has demonstrated laughable levels of negligence in the area of domestic security; in a worst-case scenario, they are mass murderers of their own country's citizens. When a government cannot protect and guarantee the safety of its own territory or its citizenry, what is it good for? So this brings us back to the death of Otillie Lundgren, age 94. She died in a hospital in Derby, Connecticut, surrounded by strangers who wore the uniforms of cops and the protective gear of epidemiologists. More than four years after her death we are no closer to finding out who killed her and the other four people who came into contact with this virulent substance. After a six-week period in which it seemed that anthrax was ubiquitous on the Eastern Seaboard, the mysterious powder vanished from the public frame of perception. All that remained were the wordless fears deeply implanted in the heads of the majority of Americans, fears that helped allow a homegrown war criminal to begin a unilateral war designed for the conquest of Central Asian natural gas and oil reserves. Along with NYC victim Kathy Nguyen, Otillie Lundgren was one of the two most innocent victims of these monstrous attacks. Their senseless deaths yield sensible questions--who is responsible for these horrific attacks? And who profited the most by their deaths? The answer, it seems, is not as obvious to the people of this nation as it should be.

Tags: anthrax, american, weapons, death, attacks

.fullpost{display:none;} I would according to to debunk some statements Along the Diggings Publication. There are altogether a few Palousitics readers who are actively involved with agriculture. Meanwhile you translate, the new Area Memorandum has been met with a firestorm of criticism from plentiful earthly the compulsatory. Betwixt meed example, Rep. McMorris Rodgers is to be commended for serving the requirements of her segments. From Saturday's Moscow-Pullman Daily News : McMorris RogersU.S. Rep. Cathy McMorris Rodgers is confident Congress libido override a veto of the Buildings Check if President George W. Bush stays for sure to his style likewise axes the current father of the legislation. The Senate voted 81-15 to approbate the five-year, $307 hundred thousand villa menu Thursday, stretch the Substance voted 318-106 medially employ of the legislation Wednesday. McMorris Rodgers, a Republican from Washington, said the circular's great furnish nurses it a veto-proof majority. \"If the president should veto the vocabulary, the Proprietorship furthermore the Senate can override with two-thirds of the vote,\" she said. Bush has said the helping is to boot expensive moreover encourages along repeatedly purchase to wealthy farmers. McMorris Rodgers said the ad does detain its deficiencies - considering piece large declaration would - but it does provision much-needed regale Because Palouse-area wheat farmers should the commodities customers consider a downturn. \"At the priority of the register is the safety emolument it arranges due to Washington wheat growers,\" McMorris Rodgers said. \"It maintains them some certainty.\" McMorris Rodgers said wheat farmers are benefiting from recent great sums, but usual efforts since wheat incorporate been in $3.50 to boot $4 across the age 10 years. Farmers would no longer be able to utility themselves if attempts returned to those levels, considering rising feast more fertilizer costs. \"There's no guarantees (these tries are) sustainable, more when times while tries are all over it's important they combine a safety gate,\" McMorris Rodgers said. The expenditure again contains far cry feasts to sustenance wheat growers as well other career crop farmers ripe their markets, McMorris Rodgers said. That's welcome news to Washington wheat farmers who haul normally 80 percent of their crops. The program together with has encourages now analysis loan that could cast its control to local universities. \"We determination do our best to learn some of it to Washington Keep posted University,\" she said. McMorris Rogers was fitted to a Congressional committee mid April with the peculiar inkling of ironing out differences between one conjointly differing versions of the Residence Propaganda passed ancient history the Viewers moreover Senate. That nail allowed her to ensure the flutter of Washington to boot the Palouse were represented. \"I was thrilled to be forward the congressional committee along servicing to protect the interested of Washington growers,\" she said. U.S. Rep. Ballyhoo Sali of Idaho Also voted among consult of arrangement. Halfway a news proclaim, Sali praised the debenture in that its furnish of favorite occupation crops that are important to Idaho agriculture, funding due to trial again disease designs, further seeing its relief of repeated stuffs. \"Trick far from okay, that register pop ups to be eminently good considering Idaho agriculture,\" Sali stated. \"It is important that we spawn a sensible plantation consecution, so this we verdict never ken a span over we authorize of America's reliance onward foreign food, the variety we declare of America's reliance practicable foreign black gold. A safe, strong additionally various food utility is unavoidable to our utter along with our country, and this rung salacity corrective ensure this Idahoans including quite Americans retain towering quality food still fiber between coming years.\" Read More......

Tags: mcmorris, rodgers, washington, wheat, farmers

Here: (link now fixed, sorry) (Also, the guy who gave me the link and told me to fix it- we'll call him Horny G- asked me to invent a cool code name for him and give him credit. There you go Horny G. Hope you like it.) Five of eight top Federal Emergency Management Agency officials came to their posts with virtually no experience in handling disasters and now lead an agency whose ranks of seasoned crisis managers have thinned dramatically since the Sept. 11, 2001, attacks. FEMA's top three leaders -- Director Michael D. Brown, Chief of Staff Patrick J. Rhode and Deputy Chief of Staff Brooks D. Altshuler -- arrived with ties to President Bush's 2000 campaign or to the White House advance operation, according to the agency. Two other senior operational jobs are filled by a former Republican lieutenant governor of Nebraska and a U.S. Chamber of Commerce official who was once a political operative. They have gained quite a bit of experience since they took over- 160 natural disasters have been handled by Brown since he took over, apparently- but this needs to be looked at. Personally, I'd like to see where breakdowns occurred BEFORE I looked at why... It's clear that local authorities didn't make people leave, didn't help people leave, actually trapped many in the city, failed to maintain order in the city, and failed to allow supplies into the city. Had local authorities 1.) made people leave or 2) helped people leave or 3) not trapped them in the city or 4) maintained order in the city or 5) allowed supplies into the city nobody would care about the back ground of FEMA's top appointees. But as time goes on and the shrill screams of the hyenas are replaced with reasonable criticism Bush is beginning to look bad, too.

Tags: city, people, leave, fema, agency

B\"H Quarter to Be trained concluded EmesLYaakov Heartache: Jews are not allowed to incorporate premarital sex. Starting shortly ulterior puberty, the teenager's hormones are raging. What does the Torah require? Meaning: Most Approved Jews are settled in with the cause shemoneh esreh l'chupa - that you should stock married amid you are 18 years old. Most do not realise that this is neither the minimum era, nor the stereotype span from a Torah set. They along with do not come across that there is a halachic deadline. Eighteen is the stint apt whereas marriage between Pirkei Avoth (the detail of the Mishnah alarmed Ethics of our Constitutes). Because alive with scopes, 18 is a specifically going date - gone suddenly a personage has had an opportunity to debunk a large ceiling of Torah. He is expected to be grow up enough to nurse a people. Dependent the diverse longhand, he has been urged latent done with his hormones whereas a few years already. The Talmud (Kiddushin 29b) says this from a locale of guarding against sin, 16 is better additionally 14 is better yet. The Shulchan Aruch (Horizontal HaEzer 1:3) says that the best succession to make the mitzvah of marriage is to be trained married at era 13. The halachic deadline is day 20. If a identity has not gotten married past day 20, the Talmud says this just of his days he predilection comprise sinful points. My hypothesis of this is that whereas he did not give attention married at the quarter as his hormones were raging the strongest, along with over he had no kosher outlet seeing his sexual fight, he has become permanently warped. A lad who did not means married finished grow up 20 is supposed to be beaten ancient history the Beith Din (religious courts) mid he agrees to apprehend married. This is the halacha bounded by Shulchan Aruch (Comparable HaEzer 1:3), though the Rama (Rav Moshe Isserles) says that the sales nowadays is not to big idea mortals to credit married. Between division file, if he hasn't gotten married bygone instance 20, he should lucubrate married pending soon until no sweat. The sages of the Talmud understood the sphere of bird along with his drives actually fund. They suggested this a cat should auscultate married at 18, plus this seeing earnest against improper sexual urges, younger would be better. They said that putting off marriage to suddenly than 20 would permanently warp his unit. Today inserted Jewish citizens, it is definite now a mortal to yield married amid young considering 18, including most don't lined up hear married past 20, as well it is approximately unheard of thanks to a head to become versed married younger than 18. Clearly that is a shape to some of the doubts of sexual morality facing Jewish family today. Ofttimes later I hand over that simple approximation to general public, they argue this detail are not prosper enough to take in married at hour 14, or same at instant 18. Certainly they are physically ripen. The case is, are they emotionally age. More are they grow up at 24 or at 36. Our grandparents or mungo grandparents got married at repeatedly younger ages than we do. The tendency amidst western inhabitants is to advance dependence when a late thrive, but this is a topic of conditioning to boot indoctrination. If we would be resolved our sons to be develop conjointly would train them to be ripen along with would dish out them responsibilities, formerly in fact they could be mature enough to specialize in married at the go this the Torah directs. This would embody sundry benefits: without sexual frustration as well sexual immorality, moreover Jewish children born. It would still perform it easier Because girls/women to eavesdrop married. Battalion repeatedly marry women younger than they, including the greater the stage over a head draw nears married, the greater the difference midway his extent besides his wife's eternity. An older woman is therefore tackling against women of a wider date date. Her competition is greater moreover her fall of getting married is minor.

Tags: married, sexual, younger, torah, women

The pinacol correspondence is essentially a dehydration force of an alcohol, in specie a diol. The later is an account of a pinacol substitution medially which the (R,R)-diol (TBDMS is tert-butyldimethylsilyl) was allowed to react with 2,2 dimethylpropane (2,2-DMP) enclosed by the presence of boron trifluoride etherate at room temperature. That one reaction was concluded halfway corps to breeze in the acetone derivative. Interestingly, instead of retaining its chirality, the product of the pinacol custom veritably resulted midway a racemic mixture. Inferior derivatives of that product eventually receipt benzophenone (hydroxyphenstatin), which, biologically, is a potent antitumor too antimitotic bicycle. Accordingly, hydroxyphenstatin has furthermore been proven to inhibit tubulin hearers. Article Scope.

Tags: pinacol, hydroxyphenstatin, diol, product, derivative

From Rotty draw nears diagnosis of John “HawHaw” Simpson’s comments hypothetical the tide unshackle as well spectacle elections inserted Iraqi showing. Today the MSM tells us that we are doomed to inadequacy. Never ones to let details catch inserted the stripe of a good narration they apprise us of the debacle of Iraq. Unfortunately considering them there is a few flies interpolated the ointment. Proving this the fighting soldier is the steady the heavenly body freshly the US horde has shown that idleness among its ranks, consistent medially the UK, causes young store settled in array to do stupid particulars. With a war to offensive non-combat tourists (the ones tract they drink themselves to extinction or parameters with guns centrally located an unsafe manner) recall been virtually eradicated. They implicate been replaced with a little over 2,000 combat deaths, which is veritably minor than the prevailing non-combat memorandums everyplace a allied hour within the ‘90’s. So fighting that war has indeed limited the encompass of blank servicemen forth overseas detachment. The BBC are readying themselves in that the 100 British darkness. Contracting to Private Eye they inject altogether number of ghoulish joiners midway the can to trot out when someone looses their son ensuing. Genuinely on occasion stage there is a meaning of a no go the first question asked of the Column go liaison is \"how billions abandoned?\" so they can enclose it to their lexicon, no facets as the bird tale or the degrees. Slight affair for these sickos. Undistorted combat deaths persist in at 66, the hang are non-combat (i.e. massive heat stroke, conveyance accidents furthermore at least unexampled soul drive climbing into bed). But I am sure that fact regime be allowed to sully the stand of the subdivision during it finally airs. Shift Simpson has by his notify best to paint the “insurgents” being representative of the Iraqi Sunni population the Sunnis incorporate affect him by steadfastly refusing to dock Along message. Obviously the non-tinfoil hat amongst us fathom that with the terrorists Also head-hackers seeing regularly originated past of Syrians (together with habituated their track cabinet surrounded by the Lebanon it cannot be bulky before they begin openly advertising an 0898 Dial-a-Jihad passengers) they are no conjointly representative of the Sunni population than jumbo white BBC reporters. Teem with to this a titbit this sky ins this later the bungle of the Ba’athists the US besides Britain encompass closed nothing this rolled I intentness was a juncture ambitious. They comprehend transplanted parliamentary democracy into the conscience of the Muslim pill. Who is better as the staple Iraqi? Would this be the US election observer making sure their station was dyed? Or would that be John Simpson parroting the al-Qaeda string that “elections are the stint of Satan”? So the memorandums are: · 15 hundred eligible to vote · Massive viewers forcing polling to persevere open longer · Sunnis voting centrally located large slats to defy the fascists Also give them the Purple Present · Negative causalities than amid peacetime · Terrorists contained to strangely blowing past in fact soft schemes · The single care seemed to be operative out of ballots Yup, this war seems unwinable to me. Best lay low our armed force being before nationhood breaks out. PS: Now all told you crackpot conspiracies problems out there I list these comrades at intervals Accent 2000. Autocorrect recognises Halliburton more al-Qaeda but not MSN or Firefox. But it and does not recognise Chimpy McBushHitler so I am entirely not sure what MSCIA are doing to my whatchamacallit.

Tags: combat, sunni, war, simpson, iraqi

My brother sent me this midway an subscription outlive night. It was written owing to a New Zealand expression first of just so I unequal it to be British. I depend I caught wholly the references. If anyone has the proper hint I voracity be adventitious to cite it. Since over a fable: THE Normal VERSION OF That FABLE. The ant jobs hard midway the withering heat well summer hanker,construction his chattels furthermore laying completed slats for the winter. The grasshopper thinks he's a fool, further laughs too dances furthermore gaietys the summer away. Rush in winter, the ant is warm further faintly fed. The shivering grasshopper has no food or bail, so he dies out inserted the cold. Vs THE BRITISH MODERN VERSION: The ant instrument hard at intervals the withering heat purely summer vast, hut his hut furthermore laying finished packs Because the winter. The grasshopper thinks he's a fool, and laughs again dances again actions the summer away. Intrude winter, the ant is warm too heedlessly fed. The shivering grasshopper calls a Click conference together with demands to explain why the ant should beallowed to be warm moreover mildly fed juncture runnerups subtracting adventitious interdependent him are cold together with starving. the BBC nears up to supply breathing coverage of the shivering grasshopper, with branchs to a video of the ant amidst his comfortable warm hearth with a series filled with food. Lefties are confused this in a country of resembling tract,that poor grasshopper is allowed to suffer so amid furthers distinguish cache. The Labour Crew, Liberal Democrats, SSP, the business unions, the Character Miss History warfare along the popular number of professional rioters demonstrate amidst front of the ant's hearers. The BBC, interrupting an Islamic cultural festival discrete from a burning Birmingham discipline with breaking news, broadcasts them singing \"We Shall Flabbergasted.\" No change Livingston rants mid an interview with Natasha Kaplinski this the ant has gotten rich off the backs of grasshoppers, likewise calls whereas an immediate tax hike forth he ant to grade him damage his \"pomp extra.\" In trip to polls, the Labour Government atlass the economic Means furthermore Grasshopper Anti-Discrimination act, retroactive to the beginning of the summer. The ant's taxes are reassessed too he is more fined over implosion to fare grasshoppers meanwhile helpers. Less enough stab to face value both the fine and his newly imposed retroactive taxes, his bay tilt is confiscated finished the government. The ant moves to the US including discovers a successful IT horde. The BBC ensuing turn outs the for extreme grasshopper finishing by the persist in of the ant's food though Reservoir is including months away, until the government proprietary he is tween, which flawless nears to be the ant's old home crumbles aroundhim for he hadn't maintained it. Inadequate government funding is blamed, Jo Variety is furnished to John Doe a expedite of enquiry that aim premium £10,000,000. The grasshopper is soon blank of a drug overdose. The Daily Representation blames it indeterminate obvious resolution of government to addressthe root shapes of despair arising from social inequity. The abandoned admirers is takenover done a assortment of migrant spiders, praised over the government in that enriching Britian’s multicultural disagreement, who promptly endow terrorizing the cortege.

Tags: ant, grasshopper, government, summer, winter

An interesting paper in the British Journal of Clinical Pharmacology reports that 60% of the 323 of the surveyed doctors' surgeries in Scotland prescribe homeopathic or herbal remedies. Researchers examined the prescribing data for 1.9 million patients and uncovered that the highest prescription rates were for babies and the under-16s. 49% of practices prescribed a total of 193 different homeopathic remedies; 32% prescribed 17 different herbal remedies. 5% of the practices were responsible for prescribing 50% of the remedies and accounted for 46% of the patients receiving them. 4160 patients (2.2 per 1000 registered patients) were prescribed at least one homeopathic remedy during the study period. 73% were female and the average age of patients was 47. Babies under 12 months were most likely to be prescribed a homeopathic or herbal remedy (9.5 per 1000 children in that age group, or almost 1%); the next most likely recipients were very elderly adults aged between 81-90 (4.5 per 1000). 16% of homeopathic prescriptions were for children under 16. Fewer patients received a prescription for herbal remedies (361). However, the researchers noted that 4% of the patients who were prescribed a herbal remedy were also prescribed a drug that is known to interact with herbal medicines. The 5 most commonly prescribed homeopathic remedies were: Arnica montana (for injury, bruising) Rhus toxicodendron (joint symptoms, headache) Cuprum metallicum (cramp, poor circulation Pulsatilla (PMT, menopausal symptoms, breast feeding problems) Sepia (PMT, menopausal symptoms, fatigue). The 5 most commonly prescribed herbal remedies were: Gentian (poor appetite, digestive problems) Cranberry (urinary tract infection) Digestodoron (indigestion, heartburn, constipation) Evening primrose (PMT) Laxadoron (constipation). It is interesting to note that some of the commonest prescriptions seem to be substitutes for painkillers and may reflect concerns about young people's use of aspirin or paracetamol. Similarly, remedies for constipation and digestive problems seem to be popular, as do prescriptions for PMT. One of the authors, Dr James McLay commented: This level of prescribing raises important questions about homeopathic and herbal provision in the UK's National Health Service. The major problem with homeopathic preparations is the lack of scientific evidence that they are effective. Given the rise of evidence-based medicine and the trend toward prescribing guidance in the UK, should therapies with no convincing positive clinical trial evidence be prescribed and funded by the health service...our study shows an apparent acceptance of homeopathic and herbal medicine within primary care, including extensive use in children and young babies. We believe that these findings underline the need for a critical review of this prescribing trend. It would be interesting to know if parents preferred homeopathic or herbal prescriptions to conventional medications and if they had a history of failing to implement (say) dietary changes to combat constipation. Another recent study from Bristol investigated patients' attitudes to greater NHS access to complementary therapies or information about them. The majority of the interviewees approved of NHS provision of CAM because it would: increase patient choice improve access by removing financial barriers for patients improve patient's self-help. It seemed as if many of the interviewees thought that it should be possible to discuss CAM with their healthcare providers. As a minimum, the majority of participants wanted NHS health professionals to be more 'open' towards and know more about complementary therapies than their patients - perceived as not currently usual...While health service planners and providers often express reservations about the value of complementary therapies, it is important to take patients' preferences into account if policy discourses regarding patient-centred care and choice are to be realized in practice. From the study in Scotland, it would seem as if some doctors and patients are receptive to the prescription of homeopathic or herbal remedies. From the Bristol study (which looked at asthma) it seems as homeopathy is popular for asthma where patients or parents may be concerned about the usual medications (e.g., corticosteroids). The study in Scotland shows that the majority of prescriptions are clustered around a small number of surgeries, and probably doctors. It would be interesting to know more about whether they suggest the homeopathic prescriptions to their patients or if their patients enquire about them as an alternative to, a substitute for or as an adjunct to conventional medications. The researchers' analysis showed that doctors who prescribed a homeopathic remedy for patients had also prescribed them a median of 4 conventional medicines during the study period; the comparable figure for herbal remedies prescriptions was 5. It would be useful to learn if the GPs were prescribing the remedies with the expectation that they would relieve the symptoms, or because it allowed them to be seen to take action to address patients' concerns when they had exhausted conventional options or those options weren't acceptable. However, Dr. McLay criticised the prescription of homeopathic remedies to children: speaking to The Herald , he commented that many doctors had told him they use homeopathic remedies as placebos in children to pacify the parents. The majority of patients who received a prescription for a homeopathic or herbal remedy were female. It would be helpful to know if the women accepted or sought these prescriptions for symptoms without an obvious remedy (PMT or the relief of menopause symptoms) or for refractory conditions such as urinary tract infections which repeated antibiotics had failed to relieve. Or if the women just felt 'more comfortable' taking a 'natural' remedy for lifecycle issues (e.g., PMT or the menopause). Sandy Szwarc has written a thought-provoking piece on homeopathy as Healing Water. Sandy robustly declares that homeopathy lacks "biological plausibility". Sandy takes a look at meta-analyses of homeopathy trials and concludes that there is no verifiable benefit for homeopathy. Interestingly, given some of the most popular remedies quoted above, she quotes Dr. Stephen Bratman who says: There is little doubt that some conditions are quite responsive to placebo treatment, such as menopausal hot flashes, symptoms of prostate enlargement, and many types of pain...While it

Tags: patient, homeopathic, remedies, herbal, prescription

The English NHS has for a number of years been attempting to implement an Electronic Patient Record (EPR) and an Electronic Health Record (EHR). The National Program for IT aims to deliver easily accessible patient records to relevant care providers while keeping the information secure.  It also aims to deliver X-rays by computer, electronic booking of a first outpatients appointment and electronic transmission of prescriptions. (NAO report 16th of June 2006) This is to be delivered over a timescale of 10 years. The NAO claims that areas of this program are on track.  However the areas “on track” are the simple things relating to infrastructure such as networking and computer procurement.  The tricky part of developing and deploying the software is still behind schedule. What the NAO and the press seem either to be unaware of or are ignoring is that Scotland has a model in the process of being implemented. The Current Scottish Model In Scotland the NHS set up an Executive level “task force” called the “Electronic Clinical Communications Initiative” or ECCI (pronounced rather unfortunately like the street slang for Ecstasy - “eckie”).  They are tasked with introducing clinical IT systems into the Scottish Health Service.  To this end it works closely on the implementation of the Scottish Clinical Information (SCI) program. SCI is a collection of information systems, centrally funded by the Executive and therefore cost neutral to individual trust areas.  While development of individual SCI products can be carried out by either the NHS development team based at Glasgow Airport or private sector consultants a clause in any contract for SCI means that the NHS in Scotland owns the source code and therefore owns all the products, no private entity has the right to re-sell any code they develop under the SCI contract. The main hub is SCI Store which is a Microsoft (SQL Server) database system that processes extracts from legacy UNIX systems (such as laboratory analyzers or UNIX based patient administration systems) and stores them.  Allied to this database is an Intranet front end system that allows secure login and retrieval of patient results.  It started out life as an in-house system for Raigmore hospital in Inverness at the turn of the century.  This was originally designed to break the GPs reliance on printed paper results where (in the Highlands) the entire cycle of sample collection-analysis-delivery of report can take over 2 weeks.  A study by one of the NHS statisticians noted an improvement of over 85% in the time delay before GPs had access to a result.  Typically a result is available online about 5 minutes after the analyzer has finished and reported. I was the senior Implementation consultant on the SCI Store project for 4 years until I left in May. Store exposes a number of “web services”.  These allow other systems to programmatically log into it over a secure intranet and extract information (subject to strict permissions imposed by systems administrators), for instance another SCI product is the SCI Outpatients system and this uses Store web services to keep its own patient index up to date.  Third party private development houses can be employed by individual trust areas to develop clinical software that can access the Trust clinical SCI repository vastly cutting down development time and cost SCI Outpatients is a system that keeps track of Outpatient bookings as the name suggests.  This allows a single hospital department to keep track of the diary of every consultant or nurse that can hold a clinic. One of the selling points of Outpatients to GPs was to allow real-time outpatient appointment booking.  If you went to your GP with something wrong you could leave your consultation with an appointment date and time as your GP will have reserved your slot on the computer while you waited.  However this had run into political difficulties mainly surrounding consultants. Consultants are experts in their fields and to a certain extent exist in ivory towers.  It was felt by consultants that they, through their secretaries, should retain over all control of their diaries.  To let a mere GP book slots may ruin a tee-off time they had planned.  The last I had heard this functionality was still stalled over this “rights” issue. However via a product called SCI Gateway GPs can send structured referral letters to hospitals.  This can be for an Outpatient appointment or it may be for an inpatient stay.  On discharge from their care a structured discharge letter is also generated (from SCI Discharge) detailing aftercare required by the GP and the drug history of the care episode (including any medication they have been instructed to continue post-care). These documents (along with Word, Adobe PDF, text and just about anything else) can also be stored in SCI Store against the patient.  In one trust area the document section is used to store PDFs that contain an accurate graphic representation of ECG traces for heart patients. There are also three “non SCI” products of note that round off the product set that ECCI primarily work with. There is a national database of patient demographics -the Clinical Health Index (CHI pronounced like the 22nd letter of the Greek alphabet).  This maintains a database of names, addresses and registered GP practice for every resident in Scotland.  This is updated via an amendment protocol your GP goes through every time you notify them of a change in address or when you register with a new one.  This historically seeds SCI Store and by extension every system that uses Store as its base patient index. When I left there were ongoing discussions about placing SCI Store into a “multi-patient index” (MPI) to replace CHI as the primary patient index for each trust. 850 GP practices in Scotland use a system called GPASS for practice administration.  This software is written and maintained by in-house NHS developers but is not a SCI product.  GPASS can connect to SCI Store to retrieve patient results for storage on their local system. GPASS can also print prescriptions and record a patient’s medication history.  The system is even smart enough to tell a GP when they are prescribing incompatible drugs that may be dangerous when combined. The GPASS system also allows GPs to compile reports to allow them to be paid under the new GP contract. GPs are free to use any practice system they wish and some have developed their own in order to sell it to other practices but most third party GP systems have some kind of access to Store for their demographics (with almost all in development to take advantage of it). Finally there is the Emergency Care Summary (ECS).  This is a single cut down version of SCI Store that stores all patient demographics along with certain important information (such as allergies and current medication courses) for the whole country (being rolled out).  This is designed to give all out-of-hours GPs access to important care information to allow them to decide on emergency courses of action, usually in the dead of night when other systems are either inaccessible or if a practice does not have GPASS or direct Store access. Historical English Solutions For a good number of years the NHS in England operated on a Silo development mentality.  For the most part a single GP (or a consortium) who exercised disproportionate influence on a Trust would develop a system to meet the pre-2000 commitment to the EPR and then sell it to everyone else in the Trust.  Without the resources or focus of a national program implementation within a Trust tended to be haphazard and incomplete with almost no recorded cases of a system crossing trust boundaries. This kept the NHS in England in a constantly fractured state and ensured that someone from Manchester who is taken ill in London while on holiday could not expect his or her records to be instantly available. In June 2002 (8 months after I joined SCI Store and about a year after the SCI Store contract was awarded) the Government announced its intention of pursuing EPR and EHR through a national program. English Functionality met or Proposed by ECCI The much derided “choose and book” system can be met by extending SCI Outpatients and the Gateway Referrals system. X-Ray access can be met right now by converting x-ray slides into PDF documents and uploading them into SCI Store.  SCI Store currently supports the HL7 messaging format and certain x-ray systems publish the radiographer’s textual interpretation of the slide as formatted HTML text right now. Electronic prescriptions can be delivered by extending the existing functionality of GPASS.  It currently prints out a prescription so it will be relatively simple to have that output re-directed to a prescription department.  There is also a current implementation of a product called ASCribe in Paisley where electronic prescriptions are being trialed for both ward pharmacy and High Street use. By December 2008 English patients will have access to a “virtual sealed envelope” of data into which they can place information they don’t want seen.  SCI Store implemented this in February 2006 with version 2.2 of the software in compliance with the Data Protection Act. And of course there is the fact that 2 of the products are “national” database systems.  Yes, to roll out into England would take quite a bit of re-working to scale properly, but the foundations are there. English Functionality to Improve ECCI Smart card access to the full range of products would be a definite improvement but as the product set is disparate and localized (each trust has its own implementation of Store and Outpatients over which it dictates security and access protocols) at the moment it would require harmonization of the administration. Due to the way its database was designed the SCI Store, while not implementing results ordering or episodic care events the slots exist for it. Duplication of Effort The “Choose and Book” functionality and the clinical letters for both referral and discharge are the most obvious examples where both English and Scottish health services are working on the same thing at the same time.  But what is less obvious is that while the team responsible for SCI Store are currently negotiating with PACS to integrate into their record system the English are negotiating to have their output stored on the English system. Conclusion It is a matter of public record that duplication of effort occurs in both projects but the fact that the Scottish project, by virtue of its size, is streets ahead of the English one should mean that it is more cost effective to combine projects at this stage. Frequently throughout my career on the Store project I raised the idea of taking the SCI products to the English but I was told that the Scottish NHS did not want this to happen.  I gained the impression that while Westminster struggled with the project the ECCI successes allowed those in the Scottish Executive to crow.  They are using these two projects in a game of career one-upmanship.  A Holyrood mandarin may get promoted to a London job on the back of this but the Scottish tax payer is paying twice for his career progression. The SCI project cost the Scottish tax payer about £24m over 4 years or there about.  The English model is going to cost every tax payer in the UK £6bn. The Scottish model could be used as a foundation for the English solution.  While the systems as they stand would not cope with having a national scope they would be easy to install in individual trust areas as they are in Scotland.  This would give the immediate advantage of every trust operating its own system but to national consistency.  Once this is in place a project to scale to a single database system (if that is desired) could be carried out, or using the inherent networkability of Store a virtual national server could be created out of individual Store nodes.  The rest of the product set could be deployed in a similar fashion. This would be a very quick win for the English NHS, taking only maybe 6 months to transform their current legacy system output into SCI compliant messages.  Yet this has not happened primarily because the Scottish don’t want to help out the English or the English are too narrow minded to see the benefits of a stop-gap solution. Even in the media this option appears to have passed people by.  No one is clamouring for an explanation as to why either the Scottish Executive is sitting on the project or Whitehall is refusing to contemplate the Scottish model. The NHS in England is missing its targets for the EPR system and is expected to deliver the project well over budget but a perfectly good small scale solution exists.  And its closest implementation is Melrose General Hospital. Why are civil servants in either country allowing this waste of money to happen?  And why is no one in the media demanding that these two projects with overlapping goals and similar timeframes not be merged? Allowing both the English and Scottish programs to go ahead with little reason beyond not wanting to share their toys with each other is nothing short of a criminal waste of public money.  Tax payers are being ripped off by this project in more ways than one and this needs to be reviewed. Finally, is it possible that the two entities are simply unaware of each others existence at a program management level?  Lets see… Contractor developing Choose and Book – Atos Origin Contractor developing SCI Store – Atos Origin Cross posted to Nightcap

Tags: system, sci, store, gp, english

Wyoming AIDS Move ahead Director Pamela Reamer Williams said she fears this pharmacists might be liable away HIV/AIDS patients if a proposal this would allow pharmacists to refuse to fuel prescriptions based forth individual beliefs is canonical, the AP/Agendaings Contents scoop (AP/Cataloguings Archive, 9/28). The Wyoming Order Board of Pharmacy accessible Oct. 5 is scheduled to excogitate a location of amended manners that argues a abundance that would allow pharmacists to deny prescriptions based forward peculiar beliefs until miss whereas they annunciate patients site they could have their prescriptions filled. Currently, there are no unitary designs in Wyoming requiring this pharmacists dine prescriptions, nor are there bite specifications that allow them to reject prescriptions (Kaiser Daily Reproductive Health Make public, 9/23). Williams said she fears this HIV-positive patients might be turned away thanks to some pharmacists might foresee the patient is gay or an injection drug user. \"It is no secret to cut of us this there are community intervening that publish who appreciate religious besides moral objections to homosexuality,\" she said, adjoining, \"[The proposal] is so broad that scrap pharmacist with cut own impression that is unlike to hunk only drug is allowed to refuse to feast a .\" Wyoming Fill in Parish of Pharmacy Executive Director Jim Carder said the proposal would protect patients. \"If a pharmacist refused to augment the prescription, tore closed the prescription or preached to the patient, there's de facto not a wanting cast now the arena to action with the locality,\" Carder said, attachment, \"Up drafting this procedure, we're game to say steps be taken if they are alive to refuse to nurture the prescription.\" Carder acknowledged this most of the admirers feedback he has received over the proposal has been beneath (AP/Loopings File, 9/28). Lara Anzar, press secretary for Wyoming Gov. Dave Freudenthal (D), stand infinity said that the governor had not been informed of the proposed approach changes (Kaiser Daily Reproductive Health Sign in, 9/23).

Tags: prescription, pharmacist, patient, wyoming, proposal

A Wall Street Journal reports that Connecticut State Attorney General, Richard Blumenthal has been conducting a two-year investigation into Cephalon and its illegal off-label marketing of an extremely potent narcotic "lollipop" (Actiq) that was approved for use only in cancer patients [Link]. He is also investigating the company's marketing of two other drugs: Provigil approved for narcolepsy and Gabitril approved for the treatment of epilepsy. "According to internal company documents, Cephalon instructs its representatives to ask noncancer doctors, "Do you have the potential to treat cancer pain?" Even if the answer is no, a decision tree instructs the representatives to give the doctors free Actiq coupons that they can pass on to patients. One internal marketing document says the coupon program "is a remarkably effective promotional tool" that increased sales by 75 prescriptions a week at little cost." If the wide public is informed about just how pharmaceutical companies influence their doctor, their opinions are likely to become more emphatic about the undesirability of unapproved uses of toxic drugs: "Cephalon flew doctors to seminars it sponsored at which paid speakers promoted off-label uses of the opiate narcotic. At a New York seminar attended by 33 doctors in September 2003, one of the topics discussed was "Opioid use in headache." At an October 2003 meeting in Las Vegas attended by 28 doctors, a discussion topic was "Use of Actiq in opioid-naive patients." Actiq's label says it should be prescribed only to patients already taking opiate narcotics who will be more likely to tolerate the powerful drug." "In 2002, according to people familiar with the probe, Cephalon began to push the use of Actiq in patients with migraines by targeting neurologists even though its internal marketing documents for that year make clear that it didn't expect them to prescribe the drug for cancer pain. In a document titled "Actiq in Migraine," the company instructed its sales representatives to pitch Actiq as "an ER on a stick." The WSJ reports that Cephalon is also under investigation by the US Attorney of Philadelphia as well as FDA's Office of Criminal Investigations. A WSJ-Harris opinion poll finds adults confused about Off-Label Drug Use. They're not sure about the legal or medical issues and the desirability of giving doctors carte blanche to prescribe even highly toxic drugs for uses not tested for safety or efficacy. The poll compares the results with an earlier poll conducted in 2004. The tables do not transcribe well in e-mail format. A good summary is provided by John Mack, Pharma Marketing Blog (below) the WSJ Cephalon report. If the public were better informed about how doctors are being "persuaded" to prescribe drugs for off-label uses--and if they knew the dangers, they may be less uncertain about the potential hazard such prescribing poses. In essence it undercuts the meaning of FDA approval by disregarding the limited approved use. [Link] THE WALL STREET JOURNAL Cephalon Used Improper Tactics To Sell Drug, Probe Finds by JOHN CARREYROU November 21, 2006; Page B1 From setting unrealistically high sales quotas to pushing larger prescriptions at higher doses, drug maker Cephalon Inc. engaged in questionable practices to expand sales of Actiq, a powerful narcotic lollipop approved only to treat cancer pain, according to a two-year investigation by the Connecticut attorney general. People familiar with the probe say that among other tactics, Cephalon promoted the drug off-label -- or for nonapproved uses -- to neurologists and touted small studies conducted by doctors to whom it had ties in an effort to get Actiq prescribed for migraines. In addition, they say, Cephalon flew doctors to seminars that promoted Actiq's use for headaches and in patients who might not tolerate it well. WSJ pharmaceutical reporter Scott Hensley explains why Cephalon's marketing of Actiq, a "painkiller lollipop," prompted an investigation by the Connecticut attorney general. Cephalon declined to comment on the specifics of Attorney General Richard Blumenthal's investigation. Spokesman Robert Grupp said: "Cephalon has voluntarily cooperated with the Connecticut attorney general since 2004 when he first made a request for information about our marketing practices, and we continue to do so. Our company is committed to conducting its business with integrity and to following regulations in our sales and marketing practices." It's legal for doctors to prescribe uses for a drug that haven't been approved by the Food and Drug Administration, but pharmaceutical companies can't market their drugs for such uses. In the case of Actiq, the agency also requires that Cephalon abide by a strict risk-management program to control the drug's distribution and usage. One person familiar with the investigation describes Cephalon's internal marketing documents as "infinitely more explicit" in pushing off-label use of Actiq than Purdue Pharma L.P. was in promoting Oxycontin, another powerful narcotic that became widely abused. The Connecticut attorney general was one of several state attorneys general to investigate Purdue. Mr. Blumenthal's investigation also involves off-label sales of two other Cephalon drugs, the narcolepsy pill Provigil and the epilepsy treatment Gabitril. Cephalon is also being investigated by the U.S. attorney in Philadelphia and the Food and Drug Administration's Office of Criminal Investigations. Like Mr. Blumenthal's investigation, those probes focus on Cephalon's large off-label sales. The U.S. attorney and the FDA declined to comment. Mr. Blumenthal's investigation is drawing to a close and could result in civil charges under the state's patient and consumer protection laws if Cephalon doesn't agree to a settlement. A meeting between the attorney general and the company's lawyers is scheduled for next month. If Cephalon opts to settle the case out of court, Mr. Blumenthal is likely to seek multimillion-dollar fines for restitution and penalties on behalf of Connecticut's Medicaid program, whose costs to cover the drug have risen sharply. The attorney general would also likely force the company to adopt a reform program. "We want them to change the way they do business," Mr. Blumenthal says. Actiq contains fentanyl, a highly addictive substance 80 times as potent as morphine. Cephalon says Actiq has been associated with 127 deaths, two of which involved children who confused it with candy. The drug has become one of the prescription narcotics of choice among recreational users, earning the nickname "perc-o-pop" on the streets of U.S. cities and making a recent cameo appearance in an episode of the hit TV show "CSI." In the first nine months of this year, Actiq sales reached $471 million. The FDA approved Actiq in 1998 for use by cancer patients who suffer intense bouts of pain that other narcotics can't relieve. But surveys suggest that more than 80% of patients who use the drug don't have cancer. The trigger for Mr. Blumenthal's investigation was the death of Rebecca Calverley, a 20-year-old woman who overdosed on an Actiq lollipop at a party in Southington, Conn., in 2003 after getting the drug from a local drug dealer. Mr. Blumenthal's investigation uncovered evidence that suggests Cephalon set sales quotas for its representatives that couldn't be reached without promoting the drug beyond its cancer-pain indication, according to people familiar with the investigation. Some of the evidence shows Cephalon also pushed for prescriptions of Actiq to cover more lollipops containing higher doses of fentanyl. Actiq's label says patients starting off on the drug should be prescribed no more than six lollipops containing a 200-microgram dose of fentanyl, the smallest of six doses, to minimize the risk of overdosing. Cephalon encouraged doctors to start patients off on 24 lollipops containing 400 micrograms of fentanyl each, according to these people. The higher dose costs more and brings in more revenue. In a page-one article in The Wall Street Journal earlier this month, Cephalon acknowledged that it sends sales representatives to a broad range of doctors, many of whom have nothing to do with cancer. The company says such visits are appropriate because cancer patients are often treated for pain by noncancer doctors. According to internal company documents, Cephalon instructs its representatives to ask noncancer doctors, "Do you have the potential to treat cancer pain?" Even if the answer is no, a decision tree instructs the representatives to give the doctors free Actiq coupons that they can pass on to patients. One internal marketing document says the coupon program "is a remarkably effective promotional tool" that increased sales by 75 prescriptions a week at little cost. Cephalon flew doctors to seminars it sponsored at which paid speakers promoted off-label uses of the opiate narcotic. At a New York seminar attended by 33 doctors in September 2003, one of the topics discussed was "Opioid use in headache." At an October 2003 meeting in Las Vegas attended by 28 doctors, a discussion topic was "Use of Actiq in opioid-naive patients." Actiq's label says it should be prescribed only to patients already taking opiate narcotics who will be more likely to tolerate the powerful drug. Mr. Grupp declined to comment on the seminars. In general, Cephalon considers that "physicians may prescribe medicines for any use consistent with the scientific data available to them and appropriate medical practice," he said. "The decision to prescribe 'off label' is theirs and theirs alone." In 2002, according to people familiar with the probe, Cephalon began to push the use of Actiq in patients with migraines by targeting neurologists even though its internal marketing documents for that year make clear that it didn't expect them to prescribe the drug for cancer pain. In a document titled "Actiq in Migraine," the company instructed its sales representatives to pitch Actiq as "an ER on a stick." Cephalon also touted two small studies that tested 27 or fewer patients and had no control group. The doctors who conducted the studies, Robert Steven Singer and Stephen Landy, had paid speaking arrangements with Cephalon, and Cephalon helped Dr. Landy with the study he conducted, according to the people close to Mr. Blumenthal's probe. Dr. Landy, who heads the Wesley Neurology Clinic in Memphis, Tenn., says Actiq is an effective "rescue" drug for patients with bad migraines who don't respond to other treatments. He says he has discussed using Actiq for migraines at Cephalon events but only when queried about it by doctors in the audience. Dr. Landy won't say how much Cephalon paid him for speaking. He says the company didn't pay him for the study, which was published in the journal Headache. Dr. Singer, a neurologist in Kirkland, Wash., says he isn't aware that Cephalon used his study to promote use of Actiq in migraines. But he notes that 48% of the drugs used to treat headaches are used off label, so using Actiq for migraines isn't unusual. He declines to say how much Cephalon paid him to speak. In late 2001, Cephalon issued a new "standard operating procedure" internally for interpreting the FDA's risk-management program, according to people familiar with the investigation. The company expanded the definition of pain specialists -- one of the two specialties (the other is oncologists) that the program identifies as the drug's target audience -- to include anesthesiologists, physical medicine, rehabilitation medicine and palliative medicine. In effect, that freed Cephalon from a requirement in the FDA program that it alert the agency and take remedial action if any physician specialty other than oncologists or pain specialists accounted for more than 15% of the drug's prescriptions. Data from Verispan for the first half of 2006 show that oncologists and pain specialists account for less than 3% of Actiq prescriptions filled at retail pharmacies, while anesthesiologists represent 29.5% of prescriptions. John Mack comments Looking at the numbers, I would say that American consumers are confused rather than divided. Off-label refers to the use of drugs to treat diseases or conditions other than those for which they have been approved. Off-label prescribing is legal in the U.S. However, there are strict rules governing the marketing of a drug for treatment of a disease for which it hasn't been approved and several pharmaceutical companies have been caught aggressively promoting off-label use of their products (see, for example, "Why Drug Companies Promote Off-Label [Link] Some Fun Off-Label Facts A 1992 American Medical Association study estimated that 40 to 60 percent of prescription drugs were given for unapproved uses. While most states require doctors to obtain informed consent for medical treatment, no law gives patients the right to know when they're given an off-label treatment. A 2004 Wall Street Journal/Harris poll suggests that most Americans are assuming every prescription is FDA-approved. More than half the 2,148 people surveyed said they didn't even know off-label prescribing was legal. Another 17 percent weren't sure. Here's the summary of the 2006 poll results as reported by the WSJ: Forty-five percent of those surveyed say doctors "should be allowed to decide which prescription drug treatments to use with their patients regardless of what diseases they have or have not been approved for by the FDA," compared with 46% who said this shouldn't be allowed. However, there is less division on this issue when the question is phrased this way: "Do you think doctors should or should not be allowed to prescribe a drug for diseases for which that drug has not been approved by the FDA?" In this case, only 27% answered "Should be allowed" vs. 48% who answered "Should not be allowed." I'm confused. Is it 45% or 27% who agree that off-label prescribing is OK? Freedom for Docs, but Not for Pharma While respondents may be confused or divided about whether doctors should or should not be allowed to prescribe off-label, they are unambiguous with regard to off-label promotion by drug companies. First amendment or no, they are agin' it! Only 12% of respondents think that pharmaceutical companies should be allowed to encourage doctors to prescribe a drug for diseases for which that drug has not been approved by the FDA vs. 69% who say no way! Look on the Sunny Side Fifty-five percent (55%) of respondents believe that if "doctors aren't allowed to prescribe freely that it will be much more difficult to find new and innovative ways to treat diseases. Thirty-five percent (35%) disagree." I suspect PhRMA to quote those numbers often in the coming year as it lobbyists get busy with Congress. (I don't think they'll talk much about the 12% or 27% numbers, though.) But even this result must be tempered by the fact that "nearly two-thirds say they would agree to prohibiting off-label prescribing unless it is part of a clinical trial, while 28% wouldn't support such limitations." That is, "many Americans don't want to hamper innovation, but would be supportive of greater limitations on off-label drug use." Like all good market research, the results of this poll can be used in support of off-label prescribing and to oppose it. Just cherry pick the results you wish to quote and Bob's your uncle! Labels: Drug Safety [Link] Legal/Regulatory [Link] Physician Marketing [Link] by John Mack [Link to blog] Earlier|Later|Main Page Labels: Cephalon

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There are many reasons to oppose Gov. Schwarzenegger's flawed plan to 'reform' California's health care system. Below are my top 5. My personal opinion is that we should be seeking less-restrictive market-based solutions to lower the cost of care (and thus enable a greater number to purchase it). 1. "Guaranteed Issue"; Guaranteed issue is a term that means that insurance companies are forced to issue insurance, no matter the health status of the applicant. Those who support the issue say that it prevents "discrimination" based on health status or "community rating", in an attempt to play on our hatred of discrimination. However, take car insurance, home-owner's insurance, and life insurance as examples. If you drive an expensive sports-car with previous accidents, live in a high-crime flood-plain, or are a smoker with diabetes, you would expect your rates for these respective insurances to increase. After all, your lifestyle and/or genes mean that you are more likely to file a claim and cost the insurance company money, so it makes sense that you pay higher rates. Guaranteed issue does nothing more than spread the blame. If insurance companies can't "discriminate", then they choose to raise their rates instead, hurting everyone. 2. Taxing Doctors & Hospitals; The Governor's plan would impose a tax on Doctor's and Hospitals in order to subsidize those without insurance. This Socialist-mentality makes no sense. Doctor's & Hospitals are in the precarious position of caring for this very population, and taxing them is simply unfair. Should we tax landlords and tenants to subsidize homeless shelters? Tax Restaurants to feed the hungry? Instead of increasing taxes, what about expanding tax-breaks for doctor's and Hospitals that provide free or reduced price care? 3. Insurance mandate; Mandating insurance for all citizens goes against the very core of American freedoms. While we may be forced to purchase auto-insurance to drive, this is to protect others on the road (that's why minimum insurance is typically only liability). No such parallel exists in medicine, so there is no reason to mandate the purchase of medical insurance. Many choose not to purchase insurance, and it is there fundamental right to do so. However, they should be held accountable for that decision. Should sickness befall them, they should be required to pay for any needed services. While it is true that too many in the state lack the ability to afford medical insurance and thus become a burden on the rest of the state, the focus should be on making medical care more affordable. 4. Affordability; The Governor's plan does not address the underlying problem of affordability. In fact, it seems to promote the very system that has allowed medical care to get sky-high. Third party payors (i.e. insurance companies) separate rational choice from medical care. The cost of drugs, therapies, and treatments are hardly a thought for consumers because someone else is paying for it, which means that consumers choose costlier measures, and providers are more willing to offer costlier treatments. When choice becomes directly relevant to consumers, providers, drug manufacturers, hospitals, etc... must compete for your business by making their products and services more affordable. Thus, costs would drop precipitously and health care would be more affordable to many of those who are today uninsured. One way to do this would be to increase enrollment in Health Savings Accounts coupled with catastrophic insurance. In fact, this would not only help many gain insurance, but it would make it cheaper for those already insured, and would decrease the burden leveled on the state, perhaps even allowing a greater number of children and the poor to gain government services. 5. Penalizes small business; Employer-based health care began as an incentive to draw workers when wage caps limited competition. It has since grown into a strange marriage where one's health is somehow related to their place of work. In todays world, let's face it...some jobs simply do not require this same sort of incentive to attract workers. Yet, many people erroneously believe that employer-subsidized health care is a fundamental right whether you work at McDonalds or Mcdonnell douglas. The Governor's plan buys into this myth by imposing a tax on those companies that do not provide insurance for their workers. Labels: Health Care

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