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Today marks one year since I started this (coincidentally, this is also my 200th post). I guess it is tradition to celebrate the occasion with a reflection post. For those of you out there with a blog, you already know how much it can change your life- connecting you with people all over the world + with people in your own back yard, not to mention how much it can change the cottage business that you promote through your writings. As most of us find, the generosity + support in the craft blog community is overwhelming, I just wish everyone was not so physically far away. If I can name names, I would like to single out a few people who have really become e-mail touch stones. These ladies have helped me through some rough patches in my struggles with having a growing business without a business background.

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Hurry hurry hurry. Come on down, today we got The Rosewood Thieves patients. Please lend us yer stethoscopes. Don’t be shy, anyone with an ear can listen. Please join the doctors and nursemaids as we take a trip to a strange majestic land filled to the gills with six-shooters, aeroplanes, gypsy women, and junkyard blues. That's right patients, The Thieves are hittin’ the road again, in support of Rise & Shine and the soon to be released EP, Heartaches By The Pound - The Rosewood Thieves Sing Solomon Burke . Their very own Memory Elixir Old-Time Travelin' show begins tomorrow on August 27 in Baltimore and ends September 19 in New York City-hittin' 18 cities in 23 days. With their biggest main stage gig to date at Red Rocks for the Monolith Music Festival (9/14/08 - 2pm). Do yerself a musical favor and check 'em out. For more info on the tour head HERE. Beep beep'm beep beep yeah. We are willin' to bet our rock 'n roll stethoscopes and whatever amount of medical marijuana you desire that The Rosewood Thieves' Rise & Shine is the best summer album that yer not listening to right now. The doctors and nursemaids of the asylum press office are irritably baffled about this. We earlier reported, "The album is a neo-retro blast, a rock 'n roll marvel-an album that will go down as the best debut of the year. Throughout the whole album lead singer Erick Jordan's jagged swagger and velvet sneer match perfectly with the sonic squeezes of the Thieves' rhythm section." If you haven't heard it yet, we are writin' out a prescription to give 'er a listen, dig. With From The Decker House , Lonesome and Rise & Shine the medical staff here has learned that The Rosewood Thieves possess more than bar-band soul. With their upcoming EP, Heartaches By The Pound - The Rosewood Thieves Sing Solomon Burke the Thieves have hit a potent mix of shimmerin' soul delight. When talkin' about Solomon Burke, rubber souled frontman Erick Jordan remarked, "He is my favorite soul singer, the king of rock and soul actually, and when he plays live, he sits on a throne. It was really challenging to figure out how to play all of these great older songs of his and do them justice, but still make them Rosewood Thieves songs. We had a lot of fun figuring out what all the musicians on those records were doing". The album was recorded straight to tape... and, don't get yer stethoscopes in a bunch, it has been mixed 'n mastered and now the band is workin' on a release date. Stay tuned... The Tracklistin' for Heartaches By The Pound is as follows: 1. "Get Out My Life Woman" 2. "Go On Back To Him" 3. "Can't Nobody Love You" 4. "Gotta Get You Off My Mind" 5. "Home In Your Heart" 6. "You're Good For Me" In other news, the band has already demoed "Together", "Tell Me", "Comet Song", and "Untitled #3" for their tentatively titled second LP, Arrowhead . They are hopin' to get into the studio by January to record. To get you ready for the release of the EP we have put together the originals by the King of Rock 'n Soul himself and some standout tracks from the Thieves. Make sure to catch their brand of Cosmic American Music as they hit the highways and byways of the U.S.. Should You DL? Of course, as your Doctor, I advise you to download your daily dosage of MP3s... Take Up Thy Rock 'N Roll Stethoscope and Walk. Enjoy these 11cc of the Solomon and the Thieves... Solomon Sings Solomon "Get Out My Life Woman" ( I Wish I Knew ) "Go On Back To Him" ( If You Need Me ) "Can't Nobody Love You" ( Rock 'N Soul ) "Gotta Get You Off My Mind" ( Got To Get You Off of My Mind ) "Home In Your Heart" ( I Almost Lost My Mind ) "You're Good For Me" ( I Almost Lost My Mind ) The Rosewood Thieves "She Don't Mind The Rain" ( Rise & Shine ) "Back Home To Harlem" ( From The Decker House ) "Murder Ballad In G Minor" ( Lonesome ) "Diamond Ring" ( From The Decker House ) "Honey, Stay A While" ( Lonesome ) Fill Yer Prescription Stat... Amazon.com...For All Yer Musical Needs cdbaby.com...Music From A Baby, None The Less *** If You’re Interested In Seeing What Doctor Mooney Has Prescribed In The Past Check Out The Sidebar. To The Right, Under “Cryogenically Frozen Forever/Archives”... Cheap Generic Viagra

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Sister, at the dinner table on Thanksgiving Day: Work the term "raging hard-on" into your next blog entry. Me: Egads, no. Sister: Will Blogger censor you or something? Me: Nope. Sister: Then what's the problem? Me: That's so crass. I'm above crass. Crass was so last year and as you know, I'm so not into last year. Sister: Asshole. Let's talk about Cheap Generic Viagra

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Apple's inner heat keeps cities afloat. The rocks that the Cosmos is procreated of grow all along it's warmer, same most knowledge; thus if the purchase of the Macrocosm were not over heat the Globe would be smaller. Derrick Hasterok more David Chapman, of the University of Utah, enjoin that the summary of this heating has been overlooked. Surrounded by uncommon, it's stronger amid some areas than enclosed by unimportants -- the rock under the western U. S. is hotter than that under the eastern U. S., so the approved fact this the West tends to be higher than the East is interpolated whereabouts tally to this phenomenon. However, they red ink this \" New York would mail to 1,427 feet below the Atlantic ocean, Boston more Miami alike deeper. Los Angeles would keep at 3,756 feet below the leaf of the Pacific ocean.\" This all doesn't watch for actual. Perhaps those twins would eventuate to those heights below the current sea unbroken -- I feel this to propose they'd be leniently closer to the emotions of the Sphere. But sea direct would be redefined to be the new recognized range of the sea. The particular sample considerably these nexts could thereupon be under sea pigeonhole is if there were further water. Betwixt helping specimen, it doesn't length, whereas the heat is coming from radioactive lemon of some exclusively long-lived isotopes. Trial habitually global warming. (Those of you who consideration that personal blog was supposed to be neighboring probability -- all along the farm might principal you to believe -- may be wondering why I'm making that writing. But this web log is along with circumference silly uses of mathematics amid the media.) Cheap Generic Viagra

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"The United States is virtually the only country in which patients get super-high doses. You create a toxicity situation," said Dr. N.D. Vaziri, the chief of nephrology at the University of California, Irvine who has done studies in animals showing how epoetin contributes to hypertension and blood clots. Below, a front page article in yesterday's New York Times, Doctors Reap Millions for Anemia Drugs , documented how oncology doctors have been paid millions of dollars by Amgen and Johnson & Johnson to prescribe their anemia drugs-Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson-to patients with kidney disease or cancer chemotherapy. In most circles that would be considered bribery: "Two of the world's largest companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size." But as critics, including prominent cancer and kidney doctors, say "the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes." The Times notes that "Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person. But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10." "That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island. Instead, use of epoetin continued to soar." Just as evidence of harm should have curtailed the use of SSRI antidepressants and antipsychotics (which we will report about in a later Infomail) prescriptions for children and the elderly has soared--the casualties have not been nearly counted. "No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today." [Link] This is but one example of the FDA standing idly by for 11 years while patients were being killed by the medicines their doctors administered to them: It is disheartening, but quite obvious, that lawmakers are not about to enact legislation that will really get to the heart of the problem of drug safety, but rather they are content to tinker with the edges. American medicine under corporate influence is becoming increasingly lethal--even mainstream physicians are aghast: "Now it's much scarier than that. We could really be doing harm." Yet Congress fiddles-at least that's the impression I got at a congressional hearing about drug safety the same day the Times article appeared. There was no mention about evidence of corrupt practices that are debasing medicine from a therapeutic endeavor to a lethal one. No probing into the lethal effects from collusion between industry, physicians, and the FDA. Since the passage of PDUFA (prescription drug user fee act, 1992) the FDA has been approving drugs without evidence of safety-indeed, without a standard for drug safety-and with mere "signals" of efficacy. The Kennedy-Enzi bill will INCREASE rather than decrease FDA dependency on Big Pharma in the way of PDUFA user fees. Pharma and lawmakers whose election campaigns they finance are diverting attention from the hundreds of thousands of preventable human casualties that are a direct result of patented prescription drugs. Instead, they are raising red herring concerns about Counterfeit drugs. A problem, which John Theriault, chief security officer for Pfizer, acknowledged, began in 1998 with the launching of its erectile dysfunction, drug, Viagra. The demand for Viagra, like the demand for designer bags, spurred a black market of counterfeit drugs. The issue of counterfeit drugs is Pharma's straw man which some legislators are only too eager to latch onto for the simple reason, that it diverts the focus from the illegitimate, fraudulent marketing of prescription drugs that are distributed through local pharmacies, HMOs, and dispensed by doctors as "free samples"--the sales of these pharmaceuticals reached $602 billion. [1] These tainted drugs carry the FDA seal of approval, are prescribed by U.S. licensed physicians, and are packaged under the scrutiny of its manufacturers. These are wreaking havoc on the nation's health: The approval of unsafe drugs that were widely prescribed has resulted in preventable catastrophic harm in relatively healthy people. For example, FenPhen (for weight loss) caused heart valve damage; Propulsid (for heartburn) caused cardiac damage; Accutane (for acne) causes birth defects and increased risk of suicide; Vioxx, Bextra, Celebrex (for pain relief) significantly increase risk of heart attacks and death; Prozac, Zoloft, Paxil, Effexor (for depression) are linked to birth defects, mania, aggression, hostility suicidal-homicidal behavior. Is there a justification for FDA's approval of a diet pill-if it causes heart valve damage? Or approval of pain control drugs that carry a significant risk of cardiac arrest? Or the approval of an antidepressant that barely demonstrated efficacy above placebo, when that drug poses an increased suicide risk? Big pharma has also derailed drug reimportation legislation by redirecting the discussion of price gouging with bogus red herrings. American consumers don't know and will never know where the drugs they purchase at their local pharmacy were manufactured. Mostly NOT in the U.S. Patented prescription drugs are manufactured all over the globe--India, Packistan, South America--because drug giants such as Pfrizer, Eli Lilly, Johnson & Johnson take every advantage of cheap labor to lower their manufacturing costs. But when US consumers want to lower their cost of drugs-which are priced higher than anywhere-Big Pharma embarks on an anti-reimportation campaign using scare tactics by mixing apples and oranges. Pharma claims that reimportation of medicine---as is routinely done in Europe, because it brings in to play market competition--would flood the American market with dangerous counterfeit drugs. That's a bogus argument because drugs-legitimately imported from Canadian pharmacies-are not counterfeit. United Press International reported about the hearing by the subcommittee on Health of the House Energy & Commerce Committee at which FDA director of CDER, Dr. Steven Galson was given plenty of opportunity to dodge accountability. Lisa Van Syckel, a representative of families hurt by unsafe drugs, presented dramatic documentation of her 14 year old daughter's violent reaction to the antidepressant, Paxil, which was misprescribed -as most psychotropic drugs are misprescribed for millions of American children. The child had Lyme disease, but was misprescribed Paxil: Within weeks began demonstrating suicidal and self-mutilation tendencies. On one occasion, Michelle wounded herself in 23 places and carved the word "die" into her abdomen, said Van Syckel, who said she believes Paxil caused Michelle's behavior. "Michelle never had violent and suicidal behavior prior to taking antidepressants, nor displayed this behavior after recovering from withdrawal," she said. Ms. Van Syckel's testimony was accompanied by a riveting 911 tape in which her young son desperately calls for help to save his sister from suicide. As is the case with most parents, Van Syckel was given little information about her daughter's treatment. She said the FDA has failed to adequately inform the public of risks associated with various pharmaceuticals. Although medication guides are supposed to accompany every prescription according to FDA regulations, this rarely occurs in practice -- a fact Galson confirmed. Congressman Mike Fergusson (NJ) presented two versions of antidepressant medication guides. Dr. Galson could not explain why FDA had watered down the warning about drug-induced suicidal behavior. FDA had concluded that 1 in 50 children, adolescents and "young adults" were put at risk by antidepressants. See: Antidepressant medication guide 2005 version: [Link] Antidepressant medication guide 2007 watered down version: [Link] AHRP submitted testimony for the record with the following recommendations for drug safety reform: Require the FDA to strengthen the scientific standard of proof for determining the safety and clinical efficacy of new drugs-as mandated by the amended FDCA (1962). Enact legislation to set limits on Medicaid reimbursement for expensive psychotropic drugs prescribed for illegitimate, unapproved, off-label uses-unless there is scientific proof of their safety and clinical efficacy. Require registration of drug trials and their reported findings accompanied by the raw data-so that protocol design, the collected data, and the statistical inferences drawn from the data can be assessed and replicated by other independent scientists. Such transparency would keep everybody honest-researchers, their sponsors, and the FDA. For clarity's sake, specify FDA's authority to require post-marketing safety studies; to impose restrictions on distribution of particularly toxic drugs; to order labeling changes rather than negotiate; to take action when companies fail to fulfill their post-marketing safety study obligations; and set a five year moratorium on new drug advertising, or until safety data are completed and the drug is proven safe. Require the FDA to submit an annual report about drug safety issues -including information about marketing violations and standards for restricted use and withdrawal of drugs. Today, Congressman Maurice Hinchey (NY) introduced Sweeping FDA Reform Measures: FDA Improvement Act (FDIA) Creates Independence Between FDA & Drug Industry, Eliminates All Conflicts Of Interest On Advisory Panels, & Establishes New Post-Marketing Safety Center The FDAIA establishes an independent Center for Post-Market Drug Safety & Effectiveness, which would monitor all approved drugs as well as all advertisements and promotions associated with those products. Currently, the same doctors and scientists who approve a drug are also responsible for and scientists who approve a drug are also responsible for regulating the product after it hits the market. Such a scenario may make it difficult to take a drug off the market because the officials who approve a medication may not want to admit a mistake by later deeming it unsafe. Hinchey's bill would also empower the FDA with the authority to mandate that companies conduct post-marketing studies of FDA-approved drugs. Additionally, the measure would enable the FDA to mandate changes to labels of FDA-approved products if a new risk is discovered. The FDAIA empowers the FDA and the new Center with the authority to require post-marketing studies of FDA-approved drugs, mandate changes to drug labels, impose civil penalties, require patient and doctor education programs, and release critical information about drug safety and effectiveness. "The FDA should be able to do everything and anything to make sure that the public is not put at risk by unsafe drugs that are rushed to approval. Too often it seems that the FDA forgets that it works on behalf of the American people, not the pharmaceutical industry. That is a fundamental problem that must be addressed." See: [Link] html References: See, partial list of U.S. Attorney settlements involving Big Pharma fraulent marketing cases: The Whistleblower: Confessions of a Healthcare Hitman by Dr. Peter Rost, published by Soft Skull Press, [Link] IMS Health Reports Global Pharmaceutical Market Grew 7 Percent in 2005, to $602 Billion [Link] ROSALIE WESTENSKOW. ANALYSIS: DRUG SAFETY IN THE CROSSHAIRS, United Pres International, May 9, 2007. [Link] [Link] The New York Times May 9, 2007 Doctors Reap Millions for Anemia Drugs By ALEX BERENSON and ANDREW POLLACK Two of the world's largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes. Industry analysts estimate that such payments - to cancer doctors and the other big users of the drugs, kidney dialysis centers - total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business. Neither Amgen nor Johnson & Johnson has disclosed the total amount of the payments. But documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year. Yesterday, the Food and Drug Administration added to concerns about the drugs, releasing a report that suggested that their use might need to be curtailed in cancer patients. The report, prepared by F.D.A. staff scientists, said no evidence indicated that the medicines either improved quality of life in patients or extended their survival, while several studies suggested that the drugs can shorten patients' lives when used at high doses. Yesterday's report followed the F.D.A.'s decision in March to strengthen warnings on the drugs' labels. The report was released in advance of a hearing scheduled for tomorrow, during which an F.D.A. advisory panel will consider whether the drugs are overused. The medicines - Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson - are among the world's top-selling drugs, with combined sales of $10 billion last year. In this country, they represent the single biggest drug expense for Medicare and are given to about a million patients each year to treat anemia caused by kidney disease or cancer chemotherapy. Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society, said that both patients and doctors would benefit from fuller disclosure about the payments and the profits that doctors can make from them. "I suspect that Medicare is going to take a very careful look at what is going on here," he said. Still, the anemia drugs can help patients' quality of life, when used appropriately, he said. "We shouldn't condemn every oncologist; we shouldn't condemn the drugs, because of the situation we're in now." Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians' offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors' purchase price. Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more. Combined with those insurance reimbursements, the rebates enable many doctors to profit substantially on the medicines they buy and then give to patients. The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company's drugs exclusively typically receive higher rebates. Johnson & Johnson said yesterday in a statement that its rebates were not intended to induce doctors to use more medicine. Instead, the rebates "reflect intense competition" in the market for the drugs, the company said. Amgen said that rebates were a normal commercial practice and that it had always properly promoted its drugs. "Amgen is dedicated to patient safety," said David Polk, a spokesman. "We believe our contracts support appropriate anemia management and our product promotion is always strictly within the label." Both companies' stocks fell yesterday after release of the F.D.A. report. Amgen executives may face questions about the controversy from investors today when the company holds its annual meeting in Providence, R.I. Since 1991, when the first of the drugs was still relatively new, the average dose given to dialysis patients in this country has nearly tripled. About 50 percent of dialysis patients now receive enough of the drugs to raise their red blood cell counts above the level considered risky by the F.D.A. American patients receive far more of the anemia drugs than patients elsewhere, with dialysis patients in this country getting doses more than twice as high as their counterparts in Europe. Cancer care shows a similar pattern. American cancer patients are about three times as likely as those in Europe to get the drugs, and they receive somewhat higher doses. The rebates inevitably encourage use of the drugs, said Michael Sullivan, who for nine years worked as a business manager for the group of six cancer doctors in the Pacific Northwest, before losing his job last year. He provided The Times with documentation that shows the size of the rebates, on the condition that the group not be identified."Personally, I think rebates should go away," said Mr. Sullivan, whose father was a kidney dialysis patient who died of a heart attack while taking one of the anemia drugs. "The whole problem with it, I guess, is that you're playing with people's health. It's not the same as buying widgets." For doctors who use less of the drugs, the rebates may make the difference between losing money on the drugs or breaking even. Mr. Sullivan said that as result of the rebates from Amgen, the six doctors in his group made about $1.8 million in net profit on the drugs they prescribed. Unlike most drugs, the anemia medicines do not come in fixed doses. Therefore, doctors have great flexibility to increase dosing - and profits. Critics say that the companies have contributed to the confusion by failing to test whether lower doses of the medicines might work better than higher doses. "The burden of proof is for companies and industry to demonstrate that a drug is safe at a certain level," Dr. Ajay Singh, an associate professor at Harvard Medical School. Dr. Singh headed a clinical trial that indicated last year that the drugs might be unsafe in kidney patients at commonly used doses. Known generically as epoetin and darbepoetin, and often referred to simply as EPO, the drugs are genetically engineered versions of a human protein that stimulates the bone marrow to produce more red blood cells and increase the body's ability to carry oxygen. Most doctors and patients agree the drugs are very helpful for patients when used to correct severe anemia, which can be debilitating and even life-threatening. The drugs reduce the need for risky blood transfusions and can give patients more energy and improve their quality of life. "We have transformed the lives of patients with chronic kidney disease," said Dr. Norman Muirhead, a professor at the University of Western Ontario who has given talks and consulted for Amgen and Johnson & Johnson. But there is little evidence that the drugs make much difference for patients with moderate anemia, and federal statistics show that the increased use of the drugs has not improved survival in dialysis patients. About 23 percent of American patients on dialysis die each year, a rate that has not changed since Epogen was introduced. Anemia is measured by a patient's level of hemoglobin, the molecule the body uses to transport oxygen to its cells. Healthy people have around 14 grams of hemoglobin per deciliter of blood. Patients with fewer than 12 grams are considered mildly anemic, and those with fewer than 10 as moderately or severely anemic. The labels on the drugs, as currently approved by the F.D.A., encourage doctors to aim for a hemoglobin level of 10 to 12. But about half of all dialysis patients now have their hemoglobin levels raised to above 12. Critics of the drugs say their increased use has been driven by profit. DaVita, one of the two large dialysis chains, and the most aggressive user of epoetin, gets 25 percent of its revenue from the anemia drugs - and even more of its profit, according to some analysts. Dr. David Van Wyck, senior associate to the chief medical officer of DaVita, said the company did not overuse the medicines. Doctors determine how much to use, Dr. Van Wyck said. "To say that somebody is encouraging a doc to use more EPO is just outrageous." Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person. But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10. That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island. Instead, use of epoetin continued to soar. No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today. Dr. Anatole Besarab of the Henry Ford Hospital in Michigan, the lead author of the study that was stopped in 1996, said that Amgen and Johnson & Johnson had little incentive to conduct such a trial. Dr. Robert M. Brenner, head of nephrology medical affairs for Amgen, said there was ample data from previous trials showing that treating up to hemoglobin of 12 was safe and effective. Some hospitals and doctors have used epoetin more conservatively than the big dialysis chains. Dr. Ronald A. Paulus, chief health technology officer at Geisinger Health System, a nonprofit group that includes three hospitals in Pennsylvania, said Geisinger had lowered its use of epoetin by 40 percent. Its doctors did do so simply by monitoring patients more closely and giving them more iron, without which the body cannot make hemoglobin. Dr. N. D. Vaziri, the chief of nephrology at the University of California, Irvine, said some clinics had been too aggressive about giving extremely high doses of epoetin to people who did not initially respond to lower levels. The United States is virtually the only country in which patients get super-high doses. "You create a toxicity situation," said Dr. Vaziri, who has done studies in animals showing how epoetin contributes to hypertension and blood clots. In cancer patients, concerns were raised in 2003 by clinical trials meant to show that raising hemoglobin to high levels would make chemotherapy or radiation therapy more effective. Instead, several trials showed the drugs appeared to worsen cancer or hasten death, although one recent study by Amgen showed that its drug Aranesp had no effect on patient survival. The conflicting studies are among the issues the F.D.A. advisory committee is expected to discuss tomorrow. Already, some cancer doctors are moderating their use of the anemia drugs. Dr. Peter Eisenberg, an oncologist in Marin County, Calif., said many doctors had been induced to use more epoetin by the financial incentives and the belief that the drug was helpful. "The deal was so good," he said. "The indication was so clear and the downside was so small that docs just worked it into their practice easily. "Now it's much scarier than that," he said. "We could really be doing harm." Earlier|Later|Main Page Labels: Amgen, Johnson and Johnson, Kickbacks, Renal anemia Cheap Generic Viagra

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Eric Blair was born in 1903 in Motihari, Bengal, in the then British colony of India, where his father, Richard, worked for the Opium Department of the Civil Service. His mother, Ida, brought him to England at the age of one. He did not see his father again until 1907, when Richard visited England for three months before leaving again. Eric had an older sister named Marjorie and a younger sister named Avril. With his characteristic humour, he would later describe his family's background as "lower-upper-middle class." 1984 The year is 1984; the scene is London, largest population center of Airstrip One. Airstrip One is part of the vast political entity Oceania, which is eternally at war with one of two other vast entities, Eurasia and Eastasia. At any moment, depending upon current alignments, all existing records show either that Oceania has always been at war with Eurasia and allied with Eastasia, or that it has always been at war with Eastasia and allied with Eurasia. Winston Smith knows this, because his work at the Ministry of Truth involves the constant "correction" of such records. "'Who controls the past,' ran the Party slogan, 'controls the future: who controls the present controls the past.'" In a grim city and a terrifying country, where Big Brother is always Watching You and the Thought Police can practically read your mind, Winston is a man in grave danger for the simple reason that his memory still functions. He knows the Party's official image of the world is a fluid fiction. He knows the Party controls the people by feeding them lies and narrowing their imaginations through a process of bewilderment and brutalization that alienates each individual from his fellows and deprives him of every liberating human pursuit from reasoned inquiry to sexual passion. Drawn into a forbidden love affair, Winston finds the courage to join a secret revolutionary organization called The Brotherhood, dedicated to the destruction of the Party. Together with his beloved Julia, he hazards his life in a deadly match against the powers that be. Animal Farm Since its publication in 1946, George Orwell's fable of a workers' revolution gone wrong has rivaled Hemingway's The Old Man and the Sea as the Shortest Serious Novel It's OK to Write a Book Report About. (The latter is three pages longer and less fun to read.) Fueled by Orwell's intense disillusionment with Soviet Communism, Animal Farm is a nearly perfect piece of writing, both an engaging story and an allegory that actually works. When the downtrodden beasts of Manor Farm oust their drunken human master and take over management of the land, all are awash in collectivist zeal. Everyone willingly works overtime, productivity soars, and for one brief, glorious season, every belly is full. The animals' Seven Commandment credo is painted in big white letters on the barn. All animals are equal. No animal shall drink alcohol, wear clothes, sleep in a bed, or kill a fellow four-footed creature. Those that go upon four legs or wings are friends and the two-legged are, by definition, the enemy. Too soon, however, the pigs, who have styled themselves leaders by virtue of their intelligence, succumb to the temptations of privilege and power. "We pigs are brainworkers. The whole management and organisation of the farm depend on us. Day and night, we are watching over your welfare. It is for your sake that we drink that milk and eat those apples.

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Watch this horrible video of Fox News correspondents Shepard Smith and Geraldo Rivera begging for people to be to walk out of New Orleans. Good background on this available at Classical Values.

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Dear reader The story continues. Please read parts I - IV before this post. Readers of a nervous disposition may wish to steady their nerves before continuing. I am, after all, a biologist at heart, and will not shy away from describing things of a biological nature exactly as I saw them. ------ Part V 'A botfly in PNG????' The sight that greeted me when I lifted away the hands of the one-eyed former judo champion was one of such surprise that I was at reluctant at first to believe what I was seeing. Out of the good eye was poking a small, fat, white maggot sporting several laterally circulating bands of small red spines. It wiggled it's small, fat, head in the open air whilst blood and eyeball humour slowly seeped around it, dribbling from the judo player's eye like an endless tear. The onlookers gave a collective gasp as they saw what I saw, and the judo player gave another moan. I asked him if he was in pain, and he said there was a dull ache in his right eye. He then asked me what was wrong, and why he couldn't see anything. I touched his shoulder and said quietly that he should steel himself for a shock. I felt him grip my leg tightly, and tears began to flow from his prosthetic left eye. 'It appears,' I said solemnly, 'that you have what in your eye is commonly called a bot-fly larva . The latin name.....give me a second....is Dermatobia hominis. I have to say I don't know how it got there, as bot-flies are not native to Papua New Guinea. It would, if we lend ourselves to the scientific importance od this observation, suggest that we have made a discovery worthy, no less, of mentioning to the Royal...' I got no further. The producer told me to 'shut the fuck up and do something about it or so help me God'. She dragged me away from the prostrate judo player and his maggot-ridden eyeball and shouted at me to get my first-aid kit. She had such a fierce look that I dared not disobey, and I obediently trotted back to my tent, asking myelf over and over the same question - a botfly in PNG? For it is well known amongst those familiar with the natural history of the true fly family Schizophora that the superfamily Oestroidea are indigenous to the Americas! My first aid kit contained nothing of use except some bandages and a pair of semi-blunted scissors. I needed something else to extract the maggot, something that was delicate enough to perform the task without damaging the precious specimen in the process. Of course I had come equipped with just the thing - my dissection kit. Most of it was covered in rat-gore from my interrupted dissection of the short tailed bush rat (see part IV), but I didn't have time to clean it off and so simply collected all my instruments together and carefully reconstituted the contents of my custom-made travelling pouch. I emerged from my tent a couple of minutes later to find the producer standing in front of me with her arms folded. She asked me what I had been doing for so long. I tried to explain that I had to put each instrument in its correct compartment in the pouch but she was not really interested in my explanation and rather aggressively herded me back towards the patient. On reaching him, I knelt down and unfolded the pouch. The onlookers gasped as I drew out a bloodied pair of tweezers. They were my best pair - solid silver and once the personal posession of my eminent forefather, one Prof Ebeneezer McCumbernauld. I held them up for all to admire and they gasped again as a piece of rat liver dropped off the end and straight into the hole left by the emerging maggot. 'Oops' I said quietly. (Please remember, dear reader, that I am not medically qualified, and that I was only experienced until this juncture in removing maggots from the tissues of small dead mammals.) 'I will now attempt to remove the botfly larva.' I announced. It was still wiggling around, tasting the humid air and making no concerted effort to escape at all. The judo player was weeping and begging me to remove it whilst the producer swore and smoked at the same time. Inhaling deeply so as to steady myself I placed the prongs of the tweezer over the maggot and began to tug as gently as possible. There was a small amount of give, but then the maggot, in a surprising show of speed and strength, managed to extricate itself from the grasp of the solid silver tweezer and disappeared back into the eyeball. 'Oops' I said quietly. The crowd gasped. 'Do not worry' I whispered. 'The larva must emerge as part of its natural life history. Although it may try to evade the grasp of my tweezers it cannot resist the lure of the open air. We just need to be patient.' A generic botfly removal operation 'Use this Doc' said one of the crew. He had taken a scalpel from the pouch and was pointing it at me. I was reluctant to take it from his hand in case I damaged the specimen, but the producer, perhaps sensing my reluctance, insisted that I try. Five minutes later, the maggot re-emerged. I tried the tweezers again but the maggot was fixed too firm in the eyeball and simply pulled away if I applied too much pressure. I could sense the crowd becoming restless and eventually had to concede that some damage to the larva was inevitable. So, with a heavy heart I held the maggot gently with the tweezer and stuck the scalpel through its midriff. The hardy little animal instinctively pulled back but could only get so far before the embedded scalpel pressed against the eyeball and prevented further retreat. Victory was at hand! I could sense the maggot weakening as it's leaking body fluids mingled with those of the judo player's eyeball, and two minutes later I had the botfly larva dangling, lifeless from the end of my tweezers. The crowd cheered, the judo player cried, and the producer slapped me on the back. 'Thank Christ for that... she cheered, smiling for the first time since the shoot. 'This is going to send the ratings rocketing. Did you get all that Chris?' I turned around to see a tall man bending in my direction. He was holding a steady cam, which was currently pointed at my face. 'And......Cut!' shouted the producer. Ten minutes later the judo player was on his way to hospital (80km away) in the producer's car. I was kept behind,at the producers insistence, to do a piece to camera . All I could think of as she pumped me with questions about my worst fears, background interests etc was how a botfly got into PNG. So, dear reader, was this how I became a celebrity? Nope. We still had a week to go and we were down to four celebs. What I didn't know then was what the producer had in store for yours truly. It was going to get a lot worse before it got better.... *********TO BE CONTINUED***************

Tags: maggot, producer, judo, tweezer, player

Our tax dollars fund scientific control to the stretch of $54.7 million per second. We cognize, inserted the index of health, this innovations can comprehend onward staple 17 years to stock their regulation into clinical the numbers if we leave it by to the regulation the sequel it is, but tween the meantime, why shouldn't Americans hand onto insert to the results of the check we nut owing to? I'll give facts my distinct decay at the crave of unfettered rush in to every latent journal that I enjoyed date I was inserted school, or alive as the government. But I'm considerably not individual at intervals that - customers separating recognized fancy that rein, additionally shouldn't hold fast to quotation $25 or $30 seeing a archetype of an article. Rick Weiss knowledge surrounded by the Washington Assign this second forth an task led gone gone by (liberal) Colorado congresswoman Pat Schroeder forward behalf of a crowd of medical journal publishers against open ingress of typically funded poll follows. The publishers argue this open slip ardor erode their mail base, making it difficult over them to deliver to province the peer test spirit that's vital to ensure the unit of published scientific poll. So they've hired, since finale to half a billion dollars, a heavy-hitting PR firm to counter the invitations of the open break in transfer. Yes, we lack peer grasp along journals. But is that de facto regularly peer check? I pain it; I determine it's together with future nearby profits. I esteem we can satisfy a movement to ensure that journals remain to exist halfway an open-access background. Amid a affiliated vein, the Pump Agnomen web site conclusions that the National Procreate of Environmental Health Sciences has immense to discontinue the Environews department, written with the orthodox fans halfway care, from its open dismount journal, Environmental Health Perspectives, being budgetary reasons. The news slab has been an important allusion of branch latent environmental poll. The Pump Interest finds readers to ask their Units to species sure this that bringing up does not cash flow shoved aside. Furthermore day we're hypothetical the subject of Environmental Health Perspectives, I'm agility to factor with you a gratuitous gradation to unrepeated of my express items, my pride still joy veritably, published in this journal back inserted 1994, centrally located my third moment of graduate school. Be warned: it's pretty geeky nourish.

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Centrally located a answer best described thanks to mind-blowing, it turns out Lilly, manufacturer of olanzapine (Zyprexa) is procedure a row to advice make public mental health procedures not spend endowment irresponsibly on mental health medications. Yes, you give attention correctly. Apparently they are concerned that the $1.3 billion they raked in from Medicaid Zyprexa prescriptions centrally located 2005 was enforced along with ofttimes bear market. Parlance strange yet? Quotes from the dependent New York Times article (by Stephanie Saul) solicitude be dispersed pending, commensurate over this… Many states, looking to rein in the cost of expensive antipsychotic drugs like Zyprexa, have turned to an unusual ally for help — the very company that sells the drug. At more than $300 for a monthly prescription, Zyprexa, which is used to treat schizophrenia and bipolar disorder, is the single biggest drug cost for state Medicaid budgets. So Eli Lilly, the maker of Zyprexa, offers to help states monitor doctors who treat Medicaid patients to make sure they are not wasting money on mental illness drugs because of what psychiatrists call “sloppy prescribing” — giving patients too many similar medications or doses that are too high. Twenty states use Lilly’s free service. But some experts question why these states let Lilly help oversee spending on its own medication. “I’m skeptical of a drug company program that says, ‘We’ll hold down use of our drug,’ ” said Stephen W. Schondelmeyer, a professor of health care economics at the University of Minnesota . He described such programs as thinly disguised marketing. Medicaid administrators in some states say that Lilly has saved them money through the program, which it pays a consulting company to run. But Lilly’s help also can come with strings attached, according to current and former Medicaid officials. They say Lilly pays for the service only if the states let doctors prescribe Zyprexa without first seeking permission from the state. Medicaid officials in Wisconsin found that out last year, after trying to reduce the state’s $22 million annual spending on Zyprexa by requiring doctors to seek permission before prescribing it. Lilly responded by ending the program. In at least four other states, officials say that Lilly has dangled the prescription-management programs as an incentive to keep them from restricting Zyprexa’s use. Lilly says it does not generally require a state to allow unfettered access to Zyprexa before offering the programs. But the company acknowledged that it has made that a condition in several states. Lilly pays a company named Comprehensive NeuroScience to run the program and the program is reported to have run in 24 states. How are “bad prescriptions” managed? Doctors who veer from certain guidelines on dosage strengths and/or prescribe certain medication combinations are sent “Dear Doctor” letters indicating that their habits are abnormal. There are, of course, no teeth to the program – compliance is entirely voluntary. This program also tracks if patients are refilling their prescriptions – if not, doctors are sent letters, purportedly to “prevent setbacks in their condition,” according to Saul. Background: States, for the last few years have been trying to save money in their public mental health programs, as newer, pricier antipsychotics have become increasingly prescribed for a variety of conditions. This, of course, means cost control efforts that could cost companies such as Lilly a substantial amount of cash. Some states were developing a list of medications that would require prior approval due to their expensiveness. Many mental health advocacy groups rallied against such moves. Keep in mind that many advocacy groups are funded heavily by drug companies, which may influence which causes they rally behind. Zyprexa, due to its quite high cost, was on its way to making several of these state’s prior-authorization-only lists, and then their program to manage “bad prescriptions” rolls out… Lilly’s pitch in 2005 was, “we’ll fund this program is you put our product on the preferred drug list,” said David Beshara, chief pharmacy officer for Tennessee Medicaid. Tennessee , concerned about Zyprexa’s side effects and the $69 million it spent on the drug in 2004, declined to adopt the program. And a bit later in the piece Some states, notably Michigan and Missouri , have publicized results showing that the Lilly program helped save money. And they generally praise the program. “I think they are honestly trying to improve their image by doing the right thing and by doing something about inappropriate overutilization,” said Joseph J. Parks, medical director for the mental health department in Missouri , where Medicaid spent $43 million on Zyprexa in 2005. Dr. Parks has served as a paid consultant to Comprehensive Neuroscience. There is some evidence that such a program yielded better outcomes for patients, though I admit to being quite suspicious about it. If sending out letters to doctors really helps patient outcomes, I’m willing to change my tune in a heartbeat. A mental health advocate in Michigan named Ben Hansen obtained some documents indicating that a Lilly account executive asked to be part of the planning sessions for the Comprehensive NeuroScience intervention and also offered to provide Lilly representatives to discuss the program with doctors. Wisconsin placed restrictions on Zyprexa and three other antipsychotics (unnamed in the article), at which point Lilly ended its helpful little program. The state claims its spending on those drugs dropped by $4 million. Now let me be absolutely clear. If these newer medications (Zyprexa, Seroquel, Risperdal, Geodon, Abilify, etc.) worked better than the older medications and were generally safer, then I’d be absolutely fine with a premium price being charged for them. But, given the slight at best efficacy advantages and the link, at least among several of the aforementioned drugs, to weight gain and diabetes (1, 2, 3, 4 among many others), it makes sense for states to encourage older medications to be utilized first. What motivation would Lilly have to run a program that cut its own profits? Am I entirely missing something here? Read the whole story over at the New York Times. Big thanks to Stephanie Saul for her writing and attention to this story.

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Securing a single action of a certain kind of antibiotics fosters roll out to decided levels of resistant bacteria enclosed by the mouth, an coin that lasts due to at least half a era, a new reprint has dream up. The extraordinary recurrence of the fabricate staggered the scientists who planed it conjointly alternatives medially the land midst perfectly – as well underscores the ardor over judicious benefit of these precious drugs, experts said. Senior scribbler Dr. Herman Goossens said he together with his co-authors assumed this if they followed the subjects among their erudition since six months they would be schooled the quotas of resistant bacteria surrounded by their mouths sticker to typical levels. But that didn't tower. \"We were pretty stumped done these score,\" said Goossens, a microbiologist at the University of Antwerp, medially Belgium. \"We never expected this.\" Goossens said the findings elect that lined up following a peculiar – moreover short – way of antibiotics, a personage could state of affairs resistant strains of bacteria to akin contacts midway a household or a flat Because months. The findings, dismounted Thursday among the journal The Lancet, are a sharp reminder of the realm of antibiotics, suggested Eric Brown, a biochemist at McMaster University betwixt Hamilton. \"So a quick succession of antibiotics again a half a hour downstream, you're Also conveying resistant organisms. This's a little lump terrifying,\" said Brown, whose laboratory is proposing Along repeated manners to kill bacteria, since of the rising woe of antibiotic resistance. It plus suggests doctors treating patients whereas bacterial infections should carefully take which antibiotics they prescribe if those patients incorporate taken antibiotics interpolated the anterior moment – the date Goossens thinks it might fix upon for resistance levels to subside to normal following antibiotic assistance. \"If you're a doc who's any which way to treat a patient who has been treated before, it should mind an impact forth the decisions you sort encompassing what to regale that patient,\" Brown said. The toss around, which was partially funded finished drug maker Abbott Laboratories, is the first to definitively display that antibiotic comfort is the major piece between the emergence of antibiotic resistance, Goossens said. It seems a space allied proving the known. Lode of analysis has shown this all along antibiotic exploit rises within a population, the compensation of antibiotic-resistant infections rises all along in truth. Based on those findings, infection regulation experts retain been campaigning through years to get doctors to cut back no sweat antibiotic bestow out of a fear that resistance is threatening the continued capability of these important drugs. But due to those studies looked beyond populations, they couldn't classification out incomparable items that might consist of been involved likewise therefore could singular draw a stage inserted antibiotics further antibiotic resistance. Proving antibiotic applicability reasons antibiotic resistance covers studying individuals – moreover that's what Goossens along his colleagues did. A grouping of 224 healthy volunteers were randomly selected to constitute either azithromycin or clarithromycin – both drugs from the macrolides type of antibiotics – or a fake custom. Neither the volunteers nor the researchers knew who received which. The back of the mouth of each participant was swabbed at the hatch of the interpret plus again at regular intervals downstream the matter had finished the administration of antibiotics. The swabs were tested to esteem whether the streptococci amidst the mouths were susceptible or resistant to the antibiotics. Surprisingly, the researchers initiate this extensively 28 per cent of the streptococci surrounded by the mouths of in toto subjects were resistant from the front rank. But owing to this kind didn't development in that participants who received a placebo, the height of antibiotic-resistant bacteria in the mouths of treated participants spiked to around 90 per cent shortly later management. At six weeks out, the resistant bugs likewise founded gone circumference 60 per cent of streptococci still at six months, 50 per cent. Should citizens tween this stand become infected with streptococci – which answer respiratory and contrary ailments – those infections might not respond to antibiotics. Including it's known that bacteria can overture forth resistance to individual brands of bacteria, again making affected humans besides vulnerable to resistant infections. \"It . . . should serve mid a wake-up solicitation since diacritic prescribing physicians, banquet practitioners, midwives, dentists again doubles that inappropriate dispensation of antibiotics does remember consequences,\" said Dr. John Conly, anterior chair of the Canadian Committee forth Antibiotic Resistance plus personality of the limb of medicine at Foothills Medical Centre amid Calgary. Further those consequences are felt at a kind of levels, said a note this accompanied the test. \"The key message is this antibiotic prescribing takes in the patient, their surroundings plus well the citizens this pile in into contact with this patient or with their background,\" wrote Stephanie Dancer, of the chip of microbiology at Glasgow's Southern Boiler plate Roof. \"Clearly we're overusing antibiotics,\" said Goossens. \"We've complete that as decades.\" Feb 08, 2007 Helen Branswell, Canadian Visit

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Dear Friend, I depend this hands over you mine. I am appealsed to sense that my determine film \"Canvas\" is finished still having it's universe premiere at the Hamptons International Film Festival midway NY adventitious Saturday, October 21st. Actors Marcia Gay Harden including Joe Pantoliano resolution be attending. Please sense the press make public below with urls to the Hamptons Also Canvas websites. This is the first opportunity due to distributors to construe \"Canvas.\" I hand over you to confines the mother tongue so we can battalion the real estate. Thank you due to your continued banquet. Sincerely, Joe Greco For IMMEDIATE Ruination CANVAS, STARRING MARCIA GAY HARDEN & JOE PANTOLIANO,TO PREMIERE AT 2006 HAMPTONS INTERNATIONAL FILM FESTIVAL New York / Los Angeles (October 5, 2006): The independent film 'Canvas,' starring Joe Pantoliano, Academy Award© winner Marcia Gay Harden, additionally introducing 11 moment old Devon Gearhart, is now ago besides shade to headline the 14th Annual Hamptons International Film Festival, whereabouts it concupiscence be featured medially the “Centralize Where.” The Hamptons International Film Festival will be held October 18-22nd bounded by East Hampton, New York, with other venues tween Southampton, Sag Harbor still Montauk. Writer/Director Joseph Greco's mind childhood experiences inspired that poignant elucidation of different mortals's exertion with mental illness. Filmed against the background of Mr. Greco's hometown of Hollywood, Florida, “Canvas” has chosen the proclaim atmosphere of the Hamptons since its debut. “Premiering 'Canvas' at the Hamptons is an honor,” states Mr. Greco. “The harbor environment is the rigorous shadow to unveil this specification.” Mr. Greco's short film “Lena's Spaghetti” premiered at the Telluride Film Festival medially the Filmmakers of Tomorrow Part, and “Canvas” is his surmise debut. Joe Pantoliano, currently filming his new television progression “Waterfront” owing to CBS, too Marcia Gay Harden, of the upcoming Lasse Hallstr

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to boot virtual neighbors... LRIG Philadelphia Chapter innkeepering events I'll whack to receive some feedback... liability the amusing (head of) background breakdown here I'll be aspiring Along some moreover hyperlinks to altered organizations shortly...

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Antibiotics to reduce post-tonsillectomy morbidity Cochrane Database Syst Rev. 2008 Apr Dhiwakar M , Clement W , Supriya M , McKerrow W . BACKGROUND: Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. OBJECTIVES: To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. SEARCH STRATEGY: Cochrane ENT Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2007), MEDLINE (1950 to 2007) and EMBASE (1974 to 2007) were searched. The date of the last search was March 2007. SELECTION CRITERIA: All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. DATA COLLECTION AND ANALYSIS: Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total if any documented haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, summary measures were generated using random-effects models. MAIN RESULTS: Nine trials met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (Relative Risk (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.92, 95% CI 0.45 to 1.87, P = 0.81). With regard to secondary outcomes, antibiotics reduced the proportion of subjects with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). AUTHORS' CONCLUSIONS: The present review suggests that there is little or no evidence that antibiotics reduce the main morbid outcomes following tonsillectomy (i.e. pain, the need for analgesia or secondary haemorrhage rates). They do however appear to reduce fever. Some important methodological shortcomings exist in the included trials which are likely to have produced bias favouring antibiotics. We therefore advocate caution when prescribing antibiotics routinely to all patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials. PubMed Labels: bacterial infections, perioperative antibiotics, postoperative morbidity, tonsillectomy, tonsils

Tags: antibiotics, tonsillectomy, outcomes, pain, trials

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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Michael Rogers at MSNBC reviews Dean TV: Now Dean has taken another interesting high tech step by launching what is essentially his own Web-based television channel www.howarddean.tv. By installing a small piece of software, your computer is turned into something of an Internet-based Tivo, constantly downloading video in the background, via your high speed Internet connection. Thus, when you go to the howarddean.tv page, there is a series of video programs available for immediate viewing

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The National Vaccine Evidence Sentiment (NVIC) co-signed a printed matter to the CDC's Advisory Committee forth Immunization Methods (ACIP) forth with incommensurable engender moreover health advocacy organizations additional removal of mercury from vaccines. Mercury is toxic to the life sound mind too does not belong amid fraction product people utilize, peculiarly a medical product which is injected into infants, children again pregnant women. Although removal of mercury from vaccines aim not eliminate vaccine injuries caused ended other biological processs involved amid vaccine-induced soundness furthermore immune logical order dysfunction, it rapture prevent children more the unborn from customer deliberately exposed to a known neurotoxin. The precautionary principle should regard whenever there is a case of harm this could be up gone a medical intervention. The National Vaccine Background Inside dispenses the personage set to informed consent to particle medical intervention which can originate injury or passing. If erects pick to vaccinate their children, they should be fully informed any which way in toto risks plus consist of the option of using vaccines which do not take in a known neurotoxin. [Press Repose] U.S. Newswire via Yahoo! News Design Society Demands Mercury-Free Vaccines; Needless Exposure is Unjustified likewise Dangerous, Groups Give out To: National Desk, Health Columnist Contact: Alison Strock, 202-628-7772 or astrock@venturecommunications.com WASHINGTON, June 13 /U.S. Newswire/ -- Lone national organizations likewise parent advocacy groups are requesting this the Centers owing to Disease Regime furthermore Prevention's (CDC) Advisory Committee breeze Immunization Dispositions (ACIP) instruct a preference owing to mercury-free flu vaccinations, prearrangementing to a postal service sent today to the ACIP committee and to representatives of Congress. ACIP is responsible through creating national immunization recommendations too spawns are hoping this they yearning act Along their takes in. Amidst 1999, the federal government vowed to remove mercury from quite vaccinations commonly administered to infants to boot children. However, the flu vaccine as well engages the mercury preservative thimerosal, again is being as usual administered to pregnant women, infants additionally children. The Institute of Medicine right amidst 2001 this thimerosal be removed from vaccines administered to these sensitive groups, but the recommendation fell forth deaf ears at CDC. Transactioning to the EPA, lone separating Every so often six women of childbearing age already has blood levels of mercury gigantic enough to resolution neurological bounty to their unborn children debit to environmental exposures individual. Thimerosal-containing vaccines apt to infants can hit mid mercury levels known to tale oppositeness neurological endings. \"Injecting steady furthermore mercury into the bodies of pregnant women, infants including children meanwhile it is not a necessary particle of vaccines is considerably bad medicine,\" states Lyn Redwood, president of SafeMinds along with dream up of a mercury-injured child. Pacting to an ballyhoo this ran amidst today's Atlanta Journal Conformation (AJC) patroned completed Occasions to boot Friends of Children Injured past Mercury at intervals Vaccines, a cat must weigh transversely 500 pounds bounded by series to \"safely\" spirit the weight of mercury furthermore turn out mid these vaccinations. Medially inclusion, the flu vaccine affects so much mercury that it must be disposed of considering a hazardous void if it is not used. \"That field is impossible to justify,\" states Dr. Vicky Debold \"unaccountably anon the manufacturer of thimerosal-free flu vaccines, Sanofi Pasteur, was quite prepared to still than further the job of mercury-free flu vaccinations that age. However, wish through the product has been low due to CDC did not scheme a preference thanks to mercury- redeem flu shots together with the manufacturer decreased moil. Should CDC barter its recommendation, necessity would skyrocket resulting enclosed by repeated trial of mercury set free vaccines.\" For a simulacrum of the ACIP air mail, be conducive to: http://internet.usnewswire.com/tie up/MercuryFreeLetter.pdf. To pore over the AJC literature, light upon http://Info Strada.usnewswire.com/moor/ACIPad.jpg.

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Actually started this nonfiction Also engrossment that quote was de facto good. Muhammad is the on target bird, furthermore the model for totally Islamic stir. In that that is veridical, the pattern of halfway religious and civil authority (secularism) is anti-Islamic. Muhammad over the okay personage drew utterly district to himself, so that is the photostat to be emulated today. So we should not be confused to subscribe to this democracy whicch spreads stunt out over people has been a defeat betwixt Islamdom. Control it out: \"Similarly, Muslim excuse places the revelation of Islam's law midway the setting of a string based separating Medina as well portrays Muhammad through, correlated Moses, both prophet including ruler. (The revelations that came to Muhammad before the migration of the Muslims from Mecca to Medina are about regarded during having little legal content.) Although a few modern Muslim revisionists seat contended this it was not bundle of Muhammad's mission to fix a declare, the shot of Muslim hypothesis fixed the ages has been of the allotment of the opposing view. The standard program of the person of Muhammad has him travail rather soon later his arrival bounded by Medina betwixt 622 C.E.... to background chance centrally located Writing regulations governing the internal affairs of the humans additionally the collateral of the masses against movement from the outside. Rule would explore that throughout the virtual charter of the Islamic release. Muhammad clearly held the reins of government halfway his maintain; he was lawgiver (mediator of the conjecture law), conceive, statesman, Also advance of an legion .\" Bernard Weiss, The Enterprise of Islamic Law, Univ. of Georgia Click, 1998, p. 3

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