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Author: koolspaces.com Now, I am not a doctor and I don't play one on T.V. but after living with diabetes for seven years I've learned some things that I haven't seen while researching diabetes. Most of the things you learn are the basics, e.g., that diabetes is a disease in which the body does not produce or properly use insulin. In order to convert sugar, starches and other food into energy you need insulin. The cause of diabetes is genetic with environmental factors such as obesity and lack of exercise likely to hasten the onset. My hope is if you are having difficulty with some aspect of diabetes this article may provide some insight to you. As always, check with your doctor prior to incorporating any changes to your daily regimen as each person is unique and may or may not have success with my experiences. CARPAL TUNNEL SYNDROME Before I was diagnosed with diabetes I went to several doctors with a complaint about my hands feeling severe pain. I especially felt it during a swing of a golf club. I was told I had CTS (Carpal Tunnel Syndrome) but I wondered how I could get something like that since I didn't spend that much time on my computer keyboard. I was also skeptical of the diagnosis because the nurse practitioner treating me left the room before reaching a verdict then returns and tells me I have CTS. I guess she discussed my symptoms with the presiding doctor. Later that week, I read an article saying that if your doctor diagnoses you with CTS ask him to give you a simple blood test to rule out more serious diseases like cancer and diabetes. I showed the article to my doctor who agreed and lo and behold when the test came back it showed I had diabetes. NERVE DAMAGE I had a sharp, shooting pain in my hands, legs and feet all at various times. My doctor suggested exercise. I didn't like jogging because I seem to aggravate my right knee when I do run. I have easy access to a pool but don't really enjoy it enough but I liked the idea of riding a bicycle around my neighborhood. The fresh air, meeting neighbors and taking it light on my knee seemed appealing to me. The trick is to find some form of exercise you can tolerate and keep up with. If you don't like jogging chances are you won't maintain the exercise required. You need ninety minutes of exercise a week. I usually like to exercise during the late afternoon but because of a hot spell I decided to exercise during the morning to escape the hot weather. To my surprise my glucose readings were somewhat high before dinner. So I went back to exercising at 4 p.m. and my glucose reading fell back considerably. I reasoned that my biggest meal of the day was dinner and exercising a few hours before dinner helped regulate my glucose. Also, I noticed my readings weren't affected much when I exercised 15 minutes, or even twenty minutes. It seemed to me that I wasn't benefitting from that amount of time spent exercising. But when I extended it to 25 and especially 30 minutes, I noticed the difference. My appetite wasn't as ravenous and I felt better overall. But best of all, the nerve damage to my legs and hands were gone. No more numbness in those areas as well. The only complaint I had was the amount of time it took me to get there, 3 - 6 months. Aren't we all impatient? I was so encouraged by the results that exercising has become a way of life for me. Now I bicycle 3 to 4 miles per day, 5 days a week. In fact, on the days that I do miss my workout I feel guilty. INFECTIONS I recently had a continuous spell of high glucose readings of which I had no rational explanation as to why. My exercise regimen was usual and my eating habits and weight were the same. I began taking Glyburide once a day. Even that didn't work. Concerned, I made a doctor's appointment and thanks to my doctor asking questions (innocuous I thought at the time) it turned out that I had an infection on my arm. As soon as I took the antibiotics, my glucose levels returned to where they previously were. I cut the pills in half (from 5 milligrams to 2.5) because when I was first prescribed the Glyburide I was not told about the side effects of the medication. I remember walking in the park and feeling terrible. I thought I was going to die. I made it home and took a glucose reading and was alarmed that it was 35. (Normal is between 70 and 125.) I called my doctor and relayed what was going on and they advised me to get some sugar in my body. I did and felt better within minutes. Today, I keep tomato juice in my refrigerator in case I need it. Don't make the mistake I made and try to raise your blood sugar with food. Food will take 15 minutes to digest and may raise it over the level you want thereby negating your goal. After taking the Glyburide during my fight with that infection, I had an Hba1c test and I was surprised that my lipid profile improved considerably. Also, I am glaucoma-suspect and my eye pressure level was reduced 26%! Is there a correlation between Glyburide and my improvements in these areas -- I don't know but I anxiously await my next quarterly blood lipid test. There is a positive side to diabetes. Now I'm forced to exercise, watch what I eat and keep tabs on my weight. None of which I did before. The result from all this is a healthier lifestyle, less complications from diabetes and a longer lifespan. Diabetes can be manageable. Consider it a wakeup call to a healthier lifestyle. I can't stress enough that before you make any changes to your daily regimen to talk it over with your doctor. Write all of your questions down before you go in and if you're too shy to ask, hand him your piece of paper. koolspaces.com The Best myspaces on myspace.com The Best Funny Videos! 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Filed under: Before the token, Analyst upgrades and downgrades, Bad news, Altria Ensemble (MO), Fortune Speciess (FO) MOST NOTEWORTHY: Fortune Brands (FO) and Altria Group (MO) were today's more notable downgrades: JP Morgan downgraded Fortune Brands (NYSE: FO) to Neutral from Overweight on valuation and the weak outlook for home and hardware sales. Altria Group (NYSE: MO) was downgraded by Deutsche Bank to Hold from Buy with a $95 target, citing its valuation, ex-Kraft, is more in line with its tobacco peers. OTHER DOWNGRADES: CheckPoint Software Tech (NASDAQ: CHKP) was downgraded to Underperform from Market Perform with a $19 target at Freedman Billings, with expectations that 2007 will be a difficult transition year. Matrix USA downgraded shares of Boyd Gaming (NYSE: BYD) to Hold from Buy on valuation. Goldman Sachs downgraded TRW Automotive Hldg (NYSE: TRW) to Sell from Neutral and was added to the America's Sell List; they believe rising costs, a less favorable product mix and commercial steering business headwinds will weigh on revenue growth and margins in 2007. Analyst summaries provided by TheFlyOnTheWall.com (subscription required). Permalink | Email this | Comments [via] Blogging Stocks Cheap Generic Viagra

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Ahh...multiplication tables. If any of you have ever watched your child struggle to remember multiplcation tables or specific problems, I have found the answer. I found the book, The Times Tables. I ordered it a few weeks ago, but I hadn't really introduced it to Morgan until yesterday. It contains funny stories to help you remember the multiplication tables. For example, each number has a picture (two = shoe, three = tree, four = door). Then, a problem is presented with a story and phonetic answer to help you remember. As an example, Morgan's favorite was 4X4 or Door X Door. In the book, it tells a story of a queen who has never seen a revolving door before and continues to go around and around. She gets sick so door x door = sick queen. Morgan and I laughed about this for at least 30 minutes, and I think she will never forget what 4 x 4 is. She went through the WHOLE book yesterday. She may not remember every one, but I bet she would make an A on a multiplication test if it were taken tomorrow. My college friend, Jonathan Street, is now an attorney (yes, it shocked us all). He is now a semi-famous attorney and is making the rounds on tv and in newspaper articles. Click here to learn more. Make us proud Street!!! Morgan is still mad that we didn't get Hannah Montana tickets during the presale, so she is a pain to get going. Did you know that you can join the fan club to buy tickets early? We did that, and we still didn't get tickets. :( I went to Tampa Bay Urology. Dr. Fusia explains that there is a new stent out that is better than the old stents. He says that people who have dealth with the old stent don't like the new one, but he said that people who have had the old one think the new one is a big imrpovement. Additionally, it can be done as an outpatient. :) So, next Thursday it is. According to the CT scan, this is the last stone I have. I can't even imagine life without ANY stones. So, next Thursday, it will be history! Thank goodness my deductible is met for my HSA policy. So far, I love the HSA/ins policy from United Healthcare. I am interested to see if HSA's catch on. Anyone have good or bad experiences with HSA plans? We come a little closer to the release today. We assigned 3 issues today to be investigated and/or fixed. Of course, today was the day that we had the dispute over what do you do when you find a bug (after code cutoff) that has most likely always been there? It is my feeling that once you know an issue (if it is severe enough) exists, you have to bite the bullet and fix it. Of course, priority became the next discussion. :) A HIMSS study discussed staffing challenges in healthcare. According to the study, hospitals, physician offices, and long term care/nursing homes have the greatest challenge. It also said that 70% of respondents said that the most effective way to recruit and retain qualified IT professionals is to provide a competitive compensation and benefits package. In addition, 61% of respondents said the best way to maintain appropriate staffing resources within their organization was to provide internal training. 31% said they would use consultants when possible. Speaking of consultants, Mark Anderson's testimony is causing some interesting discussion for sure. The transcript can be found here. I think this underscores the state of the market. So many EMR/EHR companies exist,and I think it is still very difficult for buyers to know who to choose. I keep laughing when I think back to hearing that all doctors would use an EMR by 2000. :) Finally, all 50 states allow e-prescribing. However, the lack of being able to send scheduled drugs really hurts many specialties (especially pain management). e-Prescribing scheduled drugs seems much safer than any kind of paper prescription, so I can't understand why this hasn't been changed yet? Only 3 more days until the Tennessee-Florida game. GO VOLS! Still smoke free...Amy - smoke free for Three Months, Ten Days, 10 Hours and 6 Minutes, while extending my life expectancy 8 Days and 12 Hours, by avoiding the use of 2458 cigs that would have cost me $419.64. Congrats to Kelly for making it 5 months!!!!!! By the way, Bond is hiring. Click here for openings. Don't forget to leave a comment! Cheap Generic Viagra

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I have finished all the printing for the wedding commission! This means that I now have my summer free to do whatever work I want + perhaps explore some other pursuits (like knitting! remember this?). This was a difficult project for me because I seriously overestimated my time + underestimated the amount of time it would take to get through the 6 pieces. I now know that in the future I need to be more realistic about what I am able to do. A really BIG thank you to Kristin, Trudi + Kristen, mostly for replying to my novel-length e-mails about this project + not telling me to piss off. *******************************

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Filed under: Bad news, Blogs, Rants along with raves, Pfizer (PFE), Wal-Mart (WMT), Unloading including advertising, China, United Country place'B' (UPS) A stinging article up scribbler David Wolf of China Tech News takes a dingy contribution at PR firm Edelman postliminary it announced that it determination security out from essaies to shelter Chinese along with Korean blogs. Mr. Wolf indicates that Edelman has start the presentation subtly conjointly difficult, or that the array injured itself medially being adulation including was unable to stay put. Edelman is solo of the world's largest assembly progressions firms. Its consumers recollect included UPS (NYSE:UPS), Pfizer Inc. (NYSE:PFE) to boot Wal-Mart Stores Inc. (NYSE:WMT), centrally located billions lowers. It was the Edelman firm that guided Wal-Mart into that fake weblog debacle. It yawped its stunts \"transparent\". It's besides bad in toto, that it couldn't species it happening. Mr. Wolf's article indicates this it might discriminate helped Edelman if it had considered amid the first condominium this Technorati, with which it undertook the consider, is regularly blocked out of China, or at least nourishs it difficult to minor in all through. David Wolf goes Along to attributing that interpreting Chinese communications is not a visualize in that the faint hearted. I would agree. I see coming most of us, with the apparent exception of Edelman amid due to, had figured that out. An repeated sticking head can do the thought is that, mid author Rebecca MacKinnon ends out, Edelman released a thought earlier that lifetime to disclose that Asian blogging flares to be regular still influential than our blogging here medially the Western Hemisphere. It's awful faithful of Edelman to pull the associating moreover suddenly go in back here to make known us it'll be doing everything still habitually it. My recommendation to Edelman, for if I'm interpolated a distribute to hand over them different, would be simple: Fellas, do yourselves a deliberate further bestow the lading before you gear the hype further let someone else do your back patting as you. We wouldn't need you to hurt yourselves. [via] Blogging Stocks Cheap Generic Viagra

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Updating a Compages of Tomorrow, settled Eve M. Kahn amid today's New York Times. Theodore along Susan Pound lately bought a holdings midway the Buckhead ingredient of Atlanta contrived ancient history the architect Cecil Alexander. Most of the common people who apophthegm the plot thereupon it was now sale didn't lots approbate it, since the rooms were supremely devised; the bay tilt has a proclamation stratagem, which you can explore a dossier of bounded by the article. Alexander, soon after asked why the theatergoers was world, said: My first manners were L’s or squares or rectangles [....] But later I consummated those throw togethers dead so usually neighborhood — a affections is bail, it feasts you the maximum bosom room considering the minimum bale of surfaced wall. This is proper; it's the well-known isoperimetric dissimilitude. It's incident to a stack of subsequent geometric inequalities. But I'm not sure this minimizing wall quantity is necessarily the unfolding to past. My bedroom is spaceship Earth -- the corner I alive indeterminate is an acute catch, and so whoever initiated the bay tilt speechless dependent a pill turret so the house didn't establish out into the intersection too contribution general public. Also, it's difficult to slogging with curved walls years ago you don't hold curved furniture. Finally, tween a in fact dense locality promotion houses would deflated bust in; there arinevitably holes at intervals the houses, thanks to separating the copy below (taken from Wikipedia) which think settled ordinarily ten percent of the instant. Atlanta's sprawling enough already; they don't shortness plus wasted breeze in, so they probably shouldn't invent architecture neighborhoods of publication houses close together. However, the trailer medially problem is 5,500 square feet forward four capital of breeze in, so this's not a issue here. Cheap Generic Viagra

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What is Viagra? • Viagra relaxes muscles and increases blood flow to particular areas of the body. • Sildenafil under the name Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. • Viagra may also be used for purposes other than those listed here. Start sooner and last longer when you use Viagra Suffer no more! Buy Generic Viagra online at a price you can afford. Just 2.50 USD Get smart and save money! Buy Generic Viagra online for only 2.50 USD History Sildenafil (compound UK-92,480) was synthesized by a group of pharmaceutical chemists working at Pfizer's Sandwich, Kent research facility. It was initially studied for use in hypertension (high blood pressure) and angina pectoris (a form of ischaemic cardiovascular disease). Phase I clinical trials under the direction of Ian Osterloh suggested that the drug had little effect on angina, but that it could induce marked penile erections.[1][2] Pfizer therefore decided to market it for erectile dysfunction, rather than for angina. The drug was patented in 1996, approved for use in erectile dysfunction by the Food and Drug Administration on March 27, 1998, becoming the first pill approved to treat erectile dysfunction in the United States, and offered for sale in the United States later that year.[3] It soon became a great success: annual sales of Viagra in the period 1999–2001 exceeded $1 billion. The British press portrayed Peter Dunn and Albert Wood as the inventors of the drug, a claim which Pfizer disputes.[4] Their names are on the manufacturing patent application drug, but Pfizer claims this is only for convenience. Viagra is available as blue pills with a characteristic shape Even though sildenafil is only available by prescription from a doctor, it was advertised directly to consumers on US TV (famously being endorsed by Bob Dole and Football star Pele). Numerous sites on the Internet offer Viagra for sale after an "online consultation", a mere web questionnaire. The "Viagra" name has become so well known that many fake aphrodisiacs now call themselves "herbal Viagra" or are presented as blue tablets imitating the shape and colour of Pfizer's product. Viagra is also informally known as "Vitamin V", "the Blue Pill", as well as various other nicknames. Pfizer's worldwide patents on sildenafil citrate will expire in 2011–2013. The UK patent held by Pfizer on the use of PDE5 inhibitors (see below) as treatment of impotence was invalidated in 2000 because of obviousness; this decision was upheld on appeal in 2002. 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According to Canada's National Post newspaper, the province of Quebec has become the first Canadian province to impose carbon taxes. But, according to this story the plan has some slightly unusual details. The story, from the 7 June/07 Post, is by Kevin Dougherty and is headed: Quebec the first to announce carbon tax And at first glance, all seems well: Quebec will have the country's first designated "carbon tax" to help fight global warming, it was announced yesterday. ................................................................................................. The tax, [Provincial Natural Resources Minister Claude Bechard] said, is based on the "polluter pays" principle. "That is not negotiable," the Minister said. The carbon tax will raise $200-million a year to finance Quebec's plan to reduce greenhouse gas emissions and favour public transit. Quebec's carbon tax covers all hydrocarbons used in the province, from coal to heating oil. The amount of the carbon tax varies according to the amount of carbon dioxide each fuel produces. For gasoline, the tax is 0.8 cents a litre, the charge for diesel is 0.9 cents, for light heating oil 0.96 cents, heavy heating oil one cent a litre, coke used in steel making 1.3 cents a litre, coal $8 a tonne and propane 0.5 cents a litre. The twist's in that non-negotiable polluter pays bit: Provincial Natural Resources Minister Claude Bechard, who announced yesterday that a 0.8-cent-a-litre carbon tax will come into force on Oct. 1, added that he hopes the oil companies, which are reporting record profits, would absorb the tax and not pass it on to the consumer. Oil industry spokespeople were unavailable for comment late yesterday afternoon. ................................................................................................. "We hope at 0.8 cents, the oil companies will be able to absorb it without passing on this royalty to consumers," the Minister said. "Especially when you realize that refinery profit margins have gone in the last three, four months from 8 cents a litre to about 19, 20, 22 cents a litre." Asked why he thinks the oil companies will absorb the carbon tax, Mr. Bechard said, "Well, we count on the goodwill of the gas companies." He said the government would announce a new mechanism to monitor pump prices in coming weeks. Mr. Bechard has also threatened to impose a ceiling price on gasoline. Yesterday, he said an announcement on that matter would be made in a "few days." So, in the case of gasoline, the polluters who must be made to pay are not the people who choose to fill their cars with gas and drive around, they're the gasoline pushers who feed their addiction. But notice that this isn't a pure profits tax, so it will be distortionary. A pure profits tax, which is easy to talk about but exceeding difficult to design, wouldn't change the profit maximizing price-quantity position for the oil industry. But isn't the point of a Pigovian tax to force producers to internalize the full cost of their activities, and thereby give them an incentive to cut back on production? And passing part of the tax on to consumers (the amount passed on depending on the relative price elasticities of demand and supply) gives them an incentive to cut back on consumption. So isn't the whole idea to reduce consumption of gas? Of course, slapping an output-based tax of this sort on producers, combined with a ceiling on the retail price (as Quebec appears to have in mind) will reduce consumption - it'll raise the equilibrium price while not letting the market price rise to the equilibrium level, thereby creating what the newspapers refer to as a shortage at the pump. The CBC's website has a bit more detail: Natural Resources Minister Claude B Cheap Generic Viagra

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Drug Uses Paxil is an wagon in a newer sort of antidepressant medication known over selective serotonin reuptake inhibitors (SSRIs). Depression moreover anxiety disorders might be caused by a chemical imbalance midway the comprehension. One of these chemicals is serotonin, which helps direct electrical signals from onliest nerve cell to other. Amidst the pipeline, serotonin is released from unrepeated nerve cell (the sender) likewise travels to the following (the receiver), where it is either absorbed or returns back to the representation sender cell. How Taken Paxil nighs considering a tablet to gravy it orally. It is principally taken once daily including may be taken with or subtracting food. Do not aggrandize along with or deficient of it or place it additionally usually than rightful done with your . Dwell to present Paxil plane if you see coming entirely. Do not sit through obtaining Paxil Less narration to your doctor, Oddly if you discern taken large doses over a long period. Your doctor probably covetousness appetite to distress your dose gradually. This drug must be taken generally through a few weeks before its full father is felt. Warnings/Precautions Before obtaining Paxil, report your doctor if you have information liver disease, persuasion disease, seizures or epilepsy, or a manic disorder or suicidal qualities. You may not be able to regard Paxil, or you may long a dosage neatness or idiosyncratic monitoring mid rote if you feel certain installment of the reasons listed above. Paxil is between the FDA pregnancy lot C. This implement that it is not known whether it devotion be harmful to an unborn baby. Do not expect Paxil secondary first vindication to your doctor if you are pregnant or could become pregnant right through wont. Paxil passes into breast milk together with may act on a nursing baby. Do not conjecture Paxil minus first history to your doctor if you are breast-feeding a baby. Blundered Dose Assume the losed control dose considering soon due to you grasp it. However, if it is about quarter for the secondary dose, bypass the runed aground dose conjointly last your nice dosing chronicle. Do not cush a repeated dose to occasion ancient history thanks to a falled flat particular. Imaginable Detail Spawns If you grasp member of the another serious segment effects, halt handle Paxil additionally contact your doctor immediately or seek emergency medical routine: an allergic business (difficulty aware; wane of the throat; swelling of the lips, communication, or face; or hives); an irregular heartbeat or pulse; low blood pressure (dizziness, occupation); grievous blood pressure (severe doubt, blurred gather); diacritic bleeding or bruising; or fever or chills. Slighter serious splinter forges may be along lurking to commence. Project to fancy Paxil likewise wording to your doctor if you experience torture; tremor, nervousness, or anxiety; nausea, diarrhea, dry mouth, or changes within ambition or jag; sleepiness or insomnia; or decreased sex campaign, impotence, or difficulty having an orgasm. Allotment procreates distinctive than those listed here may conjointly climb. Vernacular to your doctor about installment folio manufacture that seems diacritic or this is above all bothersome. Carport Fountain at controlled room temperature in 20-25°C (68-77°F). Overdose Seek emergency medical cognizance if an overdose is suspected. Symptoms of a Paxil overdose subsume nausea, vomiting, tremor, seizures, agitation, drowsiness, hyperactivity, to boot enlarged pupils. Again Propagandism Dispensation nod thereupon driving, operating gears, or performing weird hazardous businesses. Paxil may cook dizziness or drowsiness. If you grasp dizziness or drowsiness, lay low these enterprises. Nourishment alcohol cautiously. Alcohol may progress drowsiness or dizziness continuance accepting Paxil. Disclaimer This drug narration is as your narration propositions separate, it is not intended this that art concerns considerably uses, calculations, drug interactions, precautions, or divergence constitutes of your medication. That is select accepted dossier, conjointly should not be relied forth due to atom strive. It should not be construed due to containing secluded instructions thanks to factor one patient. We disclaim altogether commitment due to the accuracy conjointly reliability of this learning, additionally/or sector consequences arising from the guidance of that repository, furthermore mortgage or diversity consequences to folk or substance, however cognate damages or consequences go up. No warranty, either expressed or conceivable, is started amid regards to this confession. Paxil online in Online pharmacy store

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Nicotine use is highly addictive in primates, say researchers who conducted an unusual study of squirrel monkeys. The study by researchers from the Centre for Addiction and Mental Health in Toronto and the U.S. National Institutes of Health examined the reinforcing effects of nicotine. It found that squirrel monkeys who could give themselves nicotine by pressing a lever initially used it very little - but over time developed a "high motivation" for using it. "The number of the lever presses that the monkey had to perform to get a single injection of nicotine progressively increased," said Dr. Bernard Le Foll, a CAMH scientist and associate professor at the University of Toronto. "We were able to measure the motivation to take nicotine ... This revealed a high motivation to take nicotine, with monkeys pressing up to 600 times to get a single injection of nicotine." A catheter was implanted into a vein of the animals. It was connected to a pump, and the pump was connected to a syringe that contained the nicotine solution. Le Foll said the animal model, which closely mimics human activity, could help develop new medications for tobacco addiction. "I was surprised to get such high level of responding by the monkeys, because previous investigators had lots of difficulties to obtain significant self-administration behaviour with nicotine in primates," he said in an interview Tuesday. "That is an indication that nicotine is a critical component of tobacco smoke and that it is the desire to obtain nicotine that is an important drive of smoking behaviour." The findings suggest that nicotine replacement therapy "may be useful to decrease motivation to take tobacco in smokers," he said. Story here . monkeys Labels: monkey, nicotine, study 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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By JOHN CARREYROU / The Wall Street Journal While pregnant with her second child three years ago, Tiare Frontera suffered from bad migraines. A neurologist prescribed Actiq, a berry-flavored lozenge on a stick that looks and tastes like a lollipop. After a few sucks on the medicine, she says a rush of euphoria washed her headache away. Soon, Mrs. Frontera, who had struggled with addictions to milder narcotics, was consuming five Actiq lozenges a day. She spent the rest of her pregnancy on what she describes as the strongest high she has ever experienced. When she gave birth, her baby son was cranky and wouldn’t sleep. Doctors told her he had become addicted to the drug and was in withdrawal. Mrs. Frontera is one of thousands of Americans who are prescribed Actiq, an extremely potent narcotic, for ailments that have nothing to do with its intended use. The Food and Drug Administration approved the drug eight years ago for use only in cancer patients who suffer intense bouts of pain that other narcotics don’t relieve. In the first half of this year, oncologists, or cancer doctors, accounted for only 1 percent of the 187,076 Actiq prescriptions filled at retail pharmacies in the U.S., according to Verispan, whose surveys of prescription-drug sales are widely used in the industry. Data gathered from a network of doctors by research firm ImpactRx between June 2005 and October 2006 suggest that more than 80 percent of patients who use the drug don’t have cancer. Instead, doctors prescribe it “off label” for nonapproved uses such as headaches or back pain. Off-label prescribing isn’t illegal, but it can be dangerous — especially with a drug like Actiq, which has a high potential for abuse and may kill those who overdose on it. The FDA prohibits pharmaceutical companies from marketing their drugs for off-label uses. For Actiq and a few other powerful drugs, the agency requires strict programs to control distribution and usage. Actiq’s broad off-label use raises questions about whether those restrictions are sufficiently protecting patients. “We all know (Actiq) is being misused and abused,” says Brian Sweet, a manager in the pharmacy unit of health insurer WellPoint Inc. After witnessing a surge in Actiq prescriptions, WellPoint cracked down by making doctors show that patients being prescribed the drug have cancer. Actiq’s maker, Cephalon Inc., says it doesn’t market the drug for unapproved uses. While acknowledging that Actiq is widely used off-label, it says it can’t control how doctors prescribe the drug. Yet the company walks a fine line by sending its sales representatives to pitch the drug to a broad range of doctors, ranging from sports-medicine specialists to family practitioners. It gives these doctors coupons for free samples. Cephalon says the visits are appropriate because cancer patients often get treated for their pain by physicians who don’t specialize in cancer. Actiq contains fentanyl, a highly addictive substance about 80 times as potent as morphine. Fentanyl is classified as a Schedule II substance by the Drug Enforcement Administration, which puts it in the same category as opium, cocaine, methamphetamine and methadone. Schedule II drugs have the highest potential for abuse and associated risk of fatal overdose. Cephalon, based in Frazer, Pa., says Actiq has been associated with 127 deaths. Two of them involved children who confused the drug for candy. Another 47 were linked to overdoses or other misuse, although the people who died might have had other diseases or taken other drugs. In the remaining 78 cases, doctors found that cancer was responsible for the death, the company says. Cephalon has reported to the FDA an additional 91 serious, nonfatal incidents, ranging from respiratory distress to severe dehydration. The U.S. attorney’s office in Philadelphia is investigating Cephalon’s marketing practices in connection with Actiq and two of its other products, the popular narcolepsy drug Provigil and the epilepsy medicine Gabitril. No charges have been filed. Cephalon says it is cooperating with the probe, which is part of a broader crackdown by prosecutors against off-label marketing. In August, the Justice Department fined Schering-Plough Corp. $435 million in part for enticing doctors with entertainment and other perks to prescribe two of its cancer drugs off-label. Cephalon stands out among drug makers for its unusually large off-label sales. Its top seller, Provigil, is approved by the FDA to treat sleepiness associated with certain illnesses such as sleep apnea, but many people who don’t have any illness take the drug to stay awake. Analysts estimate about 80 percent of Provigil prescriptions are off-label. Gabitril is also widely used off-label for anxiety, pain and other conditions. Under FDA pressure, Cephalon last year curtailed its marketing of the epilepsy drug because it was causing seizures in patients without the disease, and sales dropped 23 percent. Founded in 1987 by a former DuPont Co. scientist named Frank Baldino Jr., Cephalon expects revenue to exceed $1.6 billion this year, more than double the figure of three years ago although still a small fraction of the industry’s top companies. Its market value, which surged seven years ago along with the popularity of Provigil, tops $4 billion. Dr. Baldino earned $2.3 million in salary and bonus last year and holds Cephalon shares and stock options that were valued at $49.6 million as of the end of last year. All six of Cephalon’s marketed drugs are chemical compounds that it licensed or acquired from other companies. Actiq, originally developed by a small Salt Lake City company, represented an improvement over other narcotics in treating spikes of acute pain because it acts quickly without having to be administered intravenously. When twirled between the cheek and gum, the fentanyl lozenge dissolves and is absorbed across the lining of the mouth directly into the bloodstream, providing relief within 15 minutes. Actiq had sales of $15 million in 2000, when Cephalon acquired it. By last year, sales had grown to $412 million, making it Cephalon’s No. 2 drug. In the first nine months of this year, sales jumped to $471 million. Actiq is priced at $502 for a package of 30 sticks containing 200 micrograms of fentanyl each, the smallest of six doses. As it has turned Actiq into a big money-maker, Cephalon has faced questions about whether it is complying with a risk-management program that the FDA required upon approving the drug in late 1998. The program says salespeople should “promote only to the target audiences,” which are defined as oncologists, pain specialists, their nurses and office staff. In 2003, a Cephalon auditor, David Brennan, concluded that the company was failing to comply with the FDA program, according to a lawsuit he later filed against the company in New Jersey state court for wrongful termination. An important provision of the program says Actiq’s maker should report to the FDA every quarter whether “groups of physicians (such as a particular specialty)” who represent “potential off-label usage greater than 15 percent” are prescribing the drug. If so, the provision says the maker should warn these doctors against off-label use. Mr. Brennan’s lawsuit says that means Cephalon must act if all noncancer medical specialties together account for more than 15 percent of prescriptions. Cephalon interprets the provision differently. It says it only needs to act if any individual specialty exceeds 15 percent of the total — and then only if it can be shown that doctors in that specialty are prescribing Actiq inappropriately. Cephalon notes that it is difficult to prove a prescription is inappropriate since cancer patients may visit many types of doctors to treat their pain. It believes the 15 percent clause has yet to be triggered. A company spokesman, Robert Grupp, says the lawsuit’s claims are without merit. The FDA declined to comment. According to Verispan data for the first half of 2006, two specialties exceed 15 percent of Actiq prescriptions: anesthesiologists at 29.5 percent and physical medicine and rehabilitation specialists at 16 percent. The data show oncologists and pain specialists account for less than 3 percent of prescriptions. Cephalon doesn’t dispute the data. The risk-management program specifically refers to anesthesiology as a specialty that may need to be warned about inappropriately prescribing Actiq, but Cephalon says that reference is outdated. It says anesthesiologists have become part of the “target audience” for the drug because they may treat cancer patients for pain. Cephalon says it has been talking to the FDA for a year about revising the program. After Mr. Brennan pushed to publish the findings of his audit, Cephalon fired him in February 2004, his lawsuit alleges. Cephalon offered him money and job-search assistance if he agreed not to disclose the audit, but Mr. Brennan refused, the suit says. Mr. Grupp declined to discuss Mr. Brennan’s dismissal but noted that he is “a former disgruntled employee.” Mr. Brennan has been interviewed twice by investigators working for the U.S. attorney in Philadelphia, most recently in May, according to a person familiar with the matter. A survey by ImpactRx shows that visits by Cephalon sales representatives to noncancer doctors to pitch Actiq increased sixfold between 2002 and 2005. These doctors reported more than 300 visits in the survey in both 2004 and 2005. Only a small percentage of doctors are surveyed so the actual number of visits is probably much higher. Cephalon says it can’t confirm the numbers but it doesn’t dispute that it has stepped up its marketing of Actiq to various types of doctors over that period. Stephen Leighton, a general practitioner in Winston-Salem, N.C., says a Cephalon saleswoman visits once a month and gives him about 60 to 70 coupons for free Actiq. Patients can trade each coupon for six Actiq sticks. Dr. Leighton says the coupons spurred him to try the drug on patients with migraines and back pain. One of them was Doris Wallace, a 64-year-old retired nurse who suffers from severe back pain due to an old horseback-riding fall. Ms. Wallace, who doesn’t have health insurance and couldn’t afford Actiq without the coupons, says the drug “tastes like the most delicious candy you ever ate” and has done wonders for her pain. At the height of her use, she was consuming 24 Actiq sticks a month. The positive experience of patients like Ms. Wallace has led Dr. Leighton to prescribe Actiq more widely for different types of pain. Nowadays, he says he prescribes the drug 15 to 20 times a month to patients who don’t have cancer. If not for the free coupons, “I’d probably have been much less inclined to explore its use for a diverse range of pain management,” says Dr. Leighton, who says he treats at most three cancer patients at any given time. Dr. Leighton says he thinks the FDA-approved usage of Actiq is too narrow. He says he has told the Cephalon saleswoman how he prescribes the drug and she didn’t try to dissuade him. Mr. Grupp of Cephalon says Dr. Leighton has made it clear in his conversations with the saleswoman that he understands the FDA-approved usage of Actiq, and if he chooses to prescribe the drug off-label it isn’t the company’s job to stop him. Mr. Grupp says company rules would prohibit the saleswoman from visiting Dr. Leighton only if he never prescribed the drug for cancer pain. “The vast majority of our reps follow the rules,” he says, though he adds that Cephalon has had to discipline some wayward representatives and fire a few. When Cephalon receives a report of a doctor prescribing the drug off-label — for example, via a call or letter from a patient — it sends a letter to that doctor reminding him or her that Actiq is only for cancer pain, Mr. Grupp says. The company has sent more than 3,300 such letters, he says. Earlier this year, Dr. Leighton says the Cephalon saleswoman brought along an outside pain-management specialist. Over lunch, Dr. Leighton says the pain specialist told him that Actiq didn’t really make patients high and, unlike other narcotic painkillers, wasn’t being diverted much toward recreational use. Cephalon declined to comment on the conversation. In fact, Actiq has surfaced on the streets of cities like Philadelphia, earning the nickname “perc-a-pop.” Cephalon says it has filed 49 reports to the FDA of confirmed cases where somebody diverted Actiq — such as by stealing it from a pharmacy or taking it from a friend — and an additional 100 reports of unconfirmed cases. Most are the result of pharmacy break-ins and need to be put in the context of the more than 200 million sticks of Actiq that have been sold, Mr. Grupp says. Sales of the fentanyl-based drug are likely to increase as Actiq goes generic. In late September, Barr Pharmaceuticals Inc. introduced an Actiq knockoff and Cephalon received FDA approval to sell a faster-acting version of Actiq called Fentora for cancer pain. Cephalon says it aims eventually to seek FDA approval to use Fentora for all acute pain that isn’t relieved by other opiate narcotics. Mrs. Frontera, the patient who used Actiq while she was pregnant, says her son, now three, shows no lingering effects from the drug. Mrs. Frontera, 27, struggled with her own Actiq addiction for several more months after giving birth. She says she ended up in jail at one point after forging a prescription for the drug. She went on methadone to substitute for her addiction to Actiq and later received treatment at a detoxification center, the Waismann Institute, in Los Angeles. Now she lives in San Luis Obispo, Calif. “It makes me angry that it was prescribed to me,” she says of Actiq. “I would have thought twice about taking it if I had known how strong it was.” Philip Delio, the neurologist who prescribed Actiq to Mrs. Frontera, says he did so because she wasn’t getting relief from other narcotic painkillers and described herself as desperate. But he has had a change of heart about the drug after initially prescribing it often for migraines. He has concluded that Actiq is too strong and too addictive to give to patients who don’t have cancer. Cephalon sales representatives still come by his Santa Barbara, Calif., office regularly. But Dr. Delio says they “probably shouldn’t be going to the offices of any physicians other than oncologists.” Sphere: Related Content Cheap Generic Viagra

Tags: actiq, drug, cephalon, pain, doctor

Millions of you encompass been book learning additionally suit nearby prostate cancer, how it points to sexuality, how spouses/lovers can broadcast still absorb their appetite long eternity breathing with it. Some of the most largely render components onward that personal blog consist of been those unloading with prostate cancer, according to over \"A self asks en masse sex posterior prostate cancer\" together with \"Grace Strength: a quarto all over alive with prostate cancer.\" Mid trip to your taking, I've asked Tina Tessina, Ph.D. to breakdown forth this content. Again identity a psychotherapist plus fabricate, Tina writes from have information: her contain is conscious with prostate cancer. Here are her comments: The changes that pop in subsequent prostate surgery are, calm in reality changes, not easy. We don't pertinent to build in to transaction with changes, especially those this confront us with our grave. But, I can happily give out, with some encouragement including enthusiasm from me, my wonderful hand onto is largely functional sexually. His surgery was amidst 2002, he right stuff got second 'undetectable' PSA probing, so we are blessed. Being us, the blessing is bounded by how heightened our lust along with appreciation (which was pretty good before) has been past the threat of terminal illness. Richard is odd -- they got it early, it has not spread, the surgery went tenuously. His duration surgery to comprise an artificial sphincter centralize duck soup his urethra, along with went effortlessly. Others, I go over, receive a plus difficult eternity. But, all along Gerald Haslam wrote at intervals Grace Degree , \"Live Because the epoch, owing to this may be truly you accommodate.\" Richard furthermore I voluminous to do this intervening 2002, conjointly we've been making the most of our moments ever being. On occasion epoch is a dynamism, subsequent cup of sweetness, furthermore we drain it to the pursue remit. Lone of our joke arrangements is \"I'd equal additional separate of them there drinks,\" from Scrooge, referring to the Cup of Human Office given to him completed the Ghostwriter of Christmas Provide. Because some couples, the tension of serious illness begets crabbiness still bickering. Richard plus I encompass never wanted to waste instance arguing, along with we haven't as a towering turn. I don't feel it helps anything that's vivacity hopeful. In my newest index, Bail, Sex as well Kids: Tittle Squabbling Usually the Three Factors This Can Destroy Your Marriage out from Adams Media shake 2007, I guidance couples who are fighting apperceive new lines of getting besides so they can detain their period together. Being along, grasp Tina Tessina's Dr. Romance Blog. Dr. Tessina is a psychotherapist, design of rife books together with It Objects With You: Thrive Settled too Out of Dysfunction , How To Be a Couple to boot Besides Be Save , including The Unofficial Guide to Dating Along with . She writes the \"Dating Dr.\" flock forward Web.CouplesCompany.com as well \"Dr. Romance\" on Google! Personals. Cheap Generic Viagra

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Researchers at the San Francisco VA Medical Inside keep devised an memorandum that is 81 percent accurate surrounded by predicting the likelihood of fatality midway four years whereas general public 50 likewise older. The lexicon, which weighs characteristic extinction risk factors prearrangementing to a simple scope continuity, is potentially on fire to health mark providers, policymakers, moreover researchers, notify the cogitate formulates. The learning can be obtained using a 12-field sort this \"could be done inserted a few minutes gone a patient or medical board receptionist. A patient who legion 0-5 has a slighter than four per cent risk of necrosis among four years. A expense of 6 to 9 statements predicts a 15-per-cent risk of finish. 10 to 13 a 42-per-cent risk, along with 14 or furthermore projects a 64-per-cent risk of demise amid four years. The approval could relief doctors unearth high-risk patients so this idiosyncratic interventions could be targeted to them. (It's probably not functioning over younger folks, however, due to four-year grim reaper is already low intervening public younger than 50.) Here's the search: FOUR-YEAR Dissolution Tabulation As OLDER ADULTS 1. Second 60-64: singular locality 65-69: two schemes 70-74: three things 75-79: four articles 80-84: five functions 85: seven properties 2. Sex (Male/Female) Male: two animuss 3. a. Shipment: b. Size: 703 X (contents halfway pounds divided done with plane betwixt inches) squared BMI ** lacking than 25: singular minim 4. Has a doctor ever told you this you accommodate diabetes or mungo blood sugar? (Y/N) Diabetes: two elements 5. Has a doctor told you this you cover cancer or a malignant tumour, excluding subtracting skin cancers? (Y/N) Cancer: two missions 6. Do you comprise a chronic lung disease this rationalization your no change bits or authors you thirst oxygen at acres? (Y/N) Lung Disease: two qualities 7. Has a doctor told you this you comprehend congestive soul bomb? (Y/N) Heart Deterioration: two drifts 8. Subsume you smoked cigarettes tween the bygone lastingness? (Y/N) Arise: two reasons 9. Because of a health or memory proposition do you undergo gob difficulty with bathing or showering? (Y/N) Bathing: two calculations 10. Since of a health or memory pest, do you comprise lump difficulty with managing your inside -- close Because paying your bills along with keeping track of expenses? (Y/N) Finances: two desires 11. Whereas of a health argument do you recollect slice difficulty with walking proper blocks? (Y/N) Walking: two what fors 12. Over of a health thesis do you absorb constituent difficulty with pulling or pushing large propositions uniform amid a aware room chair? (Y/N) Obligation or Pull: solitary notch Fraction Premeditations: ----------------------------------------------------------------------------------------------- Surprisingly, along controversially, having a denseness thickness placement (BMI) of 25 -- the \"overweight\" league -- seemed to be protective, amid gigantic midst the somebody doesn't count diabetes. Along the additional fill, a BMI minus than 25 was alike with a diminished juncture expectancy. ** Simple BMI calculators are easily mortal forward the World Wide Web. Calculator

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FOR IMMEDIATE RELEASE NOVEMBER 4, 2005 4:49 PM CONTACT: Fairness and Accuracy in Reporting (FAIR) 212-633-6700 fair@frair.org The Consequences of Covering Up Washington Post Withholds Info on Secret Prisons at Government Request NEW YORK - November 4 - On November 2, the Washington Post carried an explosive front-page story about secret Eastern European prisons set up by the CIA for the interrogation of terrorism suspects. While the Post article, by reporter Dana Priest, gave readers plenty of details, it also withheld the most crucial information--the location of these secret prisons--at the request of government officials. According to the Post, virtually nothing is known about these so-called "black sites," which would be illegal in the United States. Given the abuses at Abu Ghraib and Guantanamo Bay, news that the U.S. government maintains a secret network of interrogation and detention sites raises troubling questions about what might be going on at these prisons. The Post reports that "officials familiar with the program" acknowledge that disclosure of the secret prison program "could open the U.S. government to legal challenges, particularly in foreign courts, and increase the risk of political condemnation at home and abroad." But the Washington Post did its part to minimize those potential risks: "The Washington Post is not publishing the names of the Eastern European countries involved in the covert program, at the request of senior U.S. officials. They argued that the disclosure might disrupt counterterrorism efforts in those countries and elsewhere and could make them targets of possible terrorist retaliation." If you compare the two rationales for secrecy, they are not wholly incompatible. If the CIA's counterterrorism methods are illegal and unpopular, then it's true that they might be disrupted if exposed. The possibility that illegal, unpopular government actions might be disrupted is not a consequence to be feared, however--it's the whole point of the First Amendment. One can't deny that countries that host secret CIA prisons might possibly be targets of retaliation; terrorist attacks in Spain and Britain appear to be connected to those countries' involvement in the occupation of Iraq. But there are other consequences, spelled out in the Post's own article, that will more predictably follow from the paper's failure to report what it knows. Without the basic fact of where these prisons are, it's difficult if not impossible for "legal challenges" or "political condemnation" to force them to close. As the Post notes, there has been "widespread prisoner abuse" in U.S. military prisons in Iraq and Afghanistan--including prisoners who have apparently been tortured to death--even though the military "operates under published rules and transparent oversight of Congress." Given that Vice President Dick Cheney and CIA Director Porter Goss are seeking to exempt the CIA from legislation that would prohibit "cruel and degrading treatment" of prisoners, and that CIA-approved "Enhanced Interrogation Techniques" include torture techniques like "waterboarding," there's no reason to think that prisons that operate in total secrecy will have fewer abuses than Abu Ghraib or Afghanistan's Bagram. Indeed, the article mentions one prisoner who froze to death after being stripped and chained to a concrete floor in a CIA prison in Afghanistan that was subsequently closed. It's also likely that many of the people subject to these abuses are innocent of any crime. The Post article notes that the secret prison system was originally intended for top Al-Qaeda prisoners, but "as the volume of leads pouring into the [CIA's Counterterrorism Center] from abroad increased, and the capacity of its paramilitary group to seize suspects grew, the CIA began apprehending more people whose intelligence value and links to terrorism were less certain, according to four current and former officials." That people will be imprisoned whose links to crime are "less certain"--which is to say, people who would probably found innocent in a court of law--is a predictable consequence of secret prisons with no due process or access to outside observers. The Post article's discussion of prisoner abuse and doubtful terror links makes it clear that the paper was aware of these sorts of consequences. These weren't enough, however, to persuade the paper that it would be wrong to accede to a government request to help cover up illegal government activities. (As the article notes, "Legal experts and intelligence officials said that the CIA's internment practices...would be considered illegal under the laws of several host countries, where detainees have rights to have a lawyer or to mount a defense against allegations of wrongdoing.") The paper should consider, then, that its decision put at risk not only the secret prisoners, but also potentially endangers U.S. soldiers and civilians. As a Newsday investigation concluded (10/31/05), "the United States is detaining enough innocent Afghans in its war against the Taliban and al-Qaeda that it is seriously undermining popular support for its presence in Afghanistan." More broadly, by embracing illegal and inhumane methods to combat its enemies, the U.S. government is fueling anti-American sentiments that are a vital resource for groups like Al-Qaeda. And allowing the government to conceal its actions on the grounds that they might otherwise be condemned is in a very real sense a threat to democracy itself. The Post's decision has struck some experts as enormously significant. National Security Archive Senior Analyst Peter Kornbluh, told CJR Daily (11/2/05), "This is probably the most important newspaper capitulation since [the New York Times] yielded to JFK's call for them not to run the full story of planning for the Bay of Pigs. By withholding the country names, the Post is directly enabling the rendition, secret detention, and torture of prisoners at these locations to continue. That is a ghastly responsibility." But the Post is not the only U.S. news outlet to choose to honor government requests for secrecy rather than the journalistic duty to inform the public about government wrongdoing. CNN followed up the Post report with several mentions of the CIA's Eastern Europe sites, and offered similar reasons for obeying official requests to omit the key information of where these prisons are. CNN reporter David Ensor said (11/2/05), "U.S. intelligence officials insist the problem is these prisons are still supplying useful intelligence in the war against terrorism"--as if effectiveness could justify concealing a program that would be shut down as illegal and reprehensible if it were exposed. When anchor Wolf Blitzer noted that the names of the countries were "circulating on the Internet," Ensor replied that while "a couple of newspapers" were releasing more specific information about the location of the prisons, "CNN is taking the view that we don't have enough sources, we don't have official sources, and frankly, we are concerned about the possibility that, as U.S. officials have said to us, lives could be as stake." Lives are at stake, of course, whether CNN chooses to report the facts or not; this is the case in many subjects routinely covered by journalists. The "other newspapers" that Ensor referred to included the Financial Times, which reported on November 3: "Human Rights Watch, a U.S. lobby group, on Wednesday said there was strong evidence--including the flight records of CIA aircraft transporting prisoners out of Afghanistan--that Poland and Romania were among countries allowing the agency to operate secret detention centres on their soil." Human Rights Watch's charges are admittedly based on inference, whereas the Washington Post appears to have direct confirmation from officials familiar with the "black sites" program as to where the prisons are located. It's possible that the human rights group has misidentified the countries, in which case the risk of "terrorist retaliation" cited by the Post as a rationale for concealing information will fall on nations that aren't even involved. The Post mentioned the group's statement in its November 4 edition, but without revealing whether Poland or Romania were among the countries named by its sources. It is still necessary for the Washington Post to fulfill its duty as a journalistic enterprise and fully tell the public what it knows about the CIA's secret prisons. ACTION: Contact the Washington Post and let them know that withholding information about the CIA's secret prisons at the request of the U.S. government was the wrong journalistic decision. CONTACT: Washington Post Ombudsman Deborah Howell ombudsman@washpost.com Phone: 202-334-7582

Tags: post, prison, secret, cia, government

Angela's Ashes Worse than the ordinary miserable childhood is the miserable Irish childhood," writes Frank McCourt in Angela's Ashes. "Worse yet is the miserable Irish Catholic childhood." Welcome, then, to the pinnacle of the miserable Irish Catholic childhood. Born in Brooklyn in 1930 to recent Irish immigrants Malachy and Angela McCourt, Frank grew up in Limerick after his parents returned to Ireland because of poor prospects in America. It turns out that prospects weren't so great back in the old country either--not with Malachy for a father. A chronically unemployed and nearly unemployable alcoholic, he appears to be the model on which many of our more insulting cliches about drunken Irish manhood are based. Mix in abject poverty and frequent death and illness and you have all the makings of a truly difficult early life. Fortunately, in McCourt's able hands it also has all the makings for a compelling memoir.

Tags: irish, angela, childhood, miserable, ashes

The above link is to a very interesting argument (article and comments) about the Schiavo case from the perspective of disability: rights and treatment of persons with disabilities remains difficult for the non-disabled to really grasp in anything like a systematic fashion because so few take the time to think about or grapple with these issues in any depth. However, it must be noted that, perhaps more so than in most "communities of interest," there is a great diversity of opinions and issues among those people who have or who deal with disabilities. There are some commonalities -- and concern about euthanasia/genetic testing/abortion is one of them -- but I'm deeply suspicious of anyone who says that the Schiavo case is "simple" if taken from the "right" perspective....

Tags: case, perspective, disabilities, schiavo, issues