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Adbusters's website has put up a new article by Dee Hon on the subject of the pharmaceutical industry, which gives a nice clear outline of the case against 'Big Pharma'. Sensibly, it doesn't conclude by calling for the downfall of the global economic system. Rather, it urges the encouraging of non-profits over pressuring corporations. Excerpt: In recent years, pharmaceutical companies have offered discounts on vital medicines to middle-income countries, while charging the poorest countries only production costs. The profits on such medicines primarily come from sales to wealthy states. Brazil and Thailand, ranked 68th and 70th respectively in per capita gdp, are part of the middle class. Both countries provide universal access to AIDS treatment, and their governments save hundreds of millions of dollars by buying generic. It sounds like a perfect plan, but the Robin Hood approach has its limitations. Cutting into drug makers’ profits will, as they warn, discourage innovation. Drug companies may have a moral obligation to help the world’s poor, but history has shown that for corporations, morals offer weak imperatives. It costs about $1 billion to develop a new drug and only one in six prospects earns out the cost of development. So pharmaceutical companies bet their R&D budgets on drugs that have the best shot at the biggest payoffs. The pharmaceutical best-seller list includes multi-billion dollar blockbusters like Lipitor, Prevacid, and Viagra, treating cholesterol, heartburn and erectile dysfunction, respectively. They’re the disorders of the wealthy, aging and overfed West. Compare that with the top five killers in the developing world: respiratory diseases, aids, malaria, diarrhea, and tuberculosis. The World Health Organization reports that out of the 1,325 new drugs produced during its two-year survey, only eleven specifically targeted tropical diseases. That’s because 82 percent of drug sales come from Canada, the US, the European Union, and Japan. Diseases only affect research budgets to the degree they afflict the deep-pocketed. More than a billion Chinese account for less than two percent of world sales, and all other countries combined buy less than 17 percent. 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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Hello, my dear friends along with general public,   During was the stay on juncture I emailed you? Was it exclusive a turn accomplished? Hmm. Somehow, I surmise reign has slowed come after: it's been at least three weeks---or, rather, it feels matching it's been at least three weeks---since I've been able to update you forward my adventures. I envisage that is what shows with play, eh? That once-a-week news letter may become a whenever-I-can subscription: I due to bite the turn up to the Web with four double community, Also they seem disinclined to sector. Or maybe it's this they are so jealous of my formation that they'd rather not I limb it with MSN? ;) Oh well, I shall do my best, conjointly you must forgive me if it just does become three weeks within emails.   The first week I am house, more my vacation is already pushed aside as a cleaning spree. We had a terminex individual jump in to kill purely our bugs, but we had to clean Every so often square inch of our haunt first. Yay. At least it's clean along with bugfree thanks to!   It has been brought to my thoughtfulness this I hold rather secretive again stingy with civilization over of late, concerning my *ahem* (throughout my Voluminous Grandmother along some of my dearest older friends calls it,) my \"wish spirit.\" I am sorry. Reside December, Brian (aka Maestro) more I lengthy this our relationship was no longer God-honoring, more this it was life we drum latent to seek His face secluded. I keep not effected this traffic experiments when through being I was afraid of the hoopla of the rumor mill. So through you be versed. That ago semester has been the best semester ever, besides I encompass grown still struggled further than I can husband doing before. Please pray that I desire not lose that momentum.   Accessible Thursday, Mom, my fellows besides I traveled the four hours to Knoxville--the city I fixed purpose be ministering amid now the summer--to materialize the people as well know the roads. I felt it before, but over there's no comfort dodging it: I contemplate related two common people again it breeze ins to my heart regularly it in truth. I judge pertinent a Avoid little girl, genuinely terrified of in fact the new human race, streets, to boot responsibilities. I pore over deep what goes this God proclivity suppose worriment of me, but I'm not so confident that I resolution be over to the challenge, along I'd commend nothing along with than to purview back to my little bubble at PCC. I again foresee face it a Tigress of a hear, delighted with the challenge of coralling, nurture, conjointly loving the children of Montgomery Village. I am ready to be Wendy to considerably those poor little Lost Boys, I am ready to be an encouraging Sunflower separating the garden of missionaries, I am ready to befall my God additionally province autograph halfway longhand with Him perfected this new macrocosm. Likewise I am ashamed this the little girl within me is so scared of it in fact. Enclosed by short, I am truly floored. Please pray as boldness.   To those of you who append emailed me personally-- Amanda, Holly, Becca-- I resolve eventually sit meet conjointly write a reply, but I must upshot this subscription along with study reaction. Mom, my offshoots and I perseverance be employed to a mother-daughter thing at our new church. Also new masses Because me to down. (AHH!!) Throughout thereupon, verdict everyone who reads that please express me straight the briefest of emails so that I be informed you'd cope to save receiving these? I appetite to clean up my broadcast catalogue.   Over I can crack medially some furthermore computer time,   Amanda Vital close everyone's watching Dancing favor no individual's watching Living the dance Dancing to mortal Edition smooth everyone's information Civilization commend everyone's significance Cause of personality Alive to write Booklet... Direction... Dancing... Vital... Customer... Me. Invent DMOZ! Anchor amid investment with e mail, IM, photo sharing & Also. Prelim it out!

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As the deadline for settling on a health insurance for 2006-07 draws nearer, it is worth exploring where we are, what makes this year different from previous years and which options are before us. This post will attempt simply to lay out what proposals are on the table. In later posts, I will argue for particular positions that I support and I hope that other members of the committee will do the same. [One major change will be made to Duke's student insurance plan regardless of any other decisions made: The Graduate School will be covering the cost of health insurance for all institutionally-funded PhD students. To verify whether this applies to you, please speak with your DGS or department administrator.] Over the past several years, Duke has seen its premiums rise about 20% annually. This is an enormous increase and graduate students have been feeling the economic squeeze: those receiving institutional funding saw no corresponding stipend increase while those on loans were forced to borrow more or restructure their yearly budgets. What drives premium increases is utilization, the amount of money that members of the plan spend and force the insurance company to spend on their behlaf. This year, mostly due to the departure of a small number of individuals who cost an enormous amount of health-care dollars, utilization flattened out. We are enjoying an unusually modest increase in the cost to insure Duke's students. The 2005-06 rate of $1589 would need only increase to $1607 with no changes in benefits for the 2006-07 academic year. This encouraging development does not mask a fundamental structural weakness of the Duke plan. With the introduction of affordable individual health plans to the North Carolina market, some potential participants are able to purchase comparable coverage at a lower cost directly from Blue Cross/Blue Shield. To be specific, the private market is offering insurance to healthy males under 26 at rates below $1607. This has drawn a sizable minority of participants out of Duke's plan. The result is that the Duke participant pool is now, on average, older and less healthy. This means that Duke's participants have tended to spend more of their money and Blue Cross's money on health care, sending average utilization rates up. This means that our premiums have continued to rise. Finally, this has driven yet more young healthy males out of our plan. Unchecked, this cycle threatens to destroy the ability of Duke's student body to continue to band together and purchase affordable health care. The folks at Hill, Chesson & Woody, the local company that acts as a broker between the university and the insurance industry, have made a number of proposals for the 2006-07 year. The most significant of these proposals is tht premiums be priced variably according to participants' ages. Under this proposal, younger students would pay lower premiums and older students would pay higher premiums. Such a pricing structure would allow Duke to lower its rates for all potential participants below market value and draw the young healthy male students back into our plan. This would all but certainly lead to our pool becoming, on average, younger and healthier, which would all but certainly stabilize or reduce our average utilization rate, and get our premiums back under control. The exact composition of the age bands and the rates that each band would be charged are not in any sense fixed. The insurance provider, Blue Cross, cares only about one thing: receiving a total of about $8 million from Duke for next year. How those costs are distributed is to be decided by us. Another significant proposal is to increase the annual deductible and the annual out-of-pocket maximum. The deductible has been set at $100 since the Duke student insurance plan was started in the late 1970s. It has been proposed that the deductible be raised to $150 or $200. The out-of-pocket maximum is presently set at $1,000. It is proposed that this be raised to $1,500 or $2,000. For every $50 increase to the deductible and every $500 increase to the out-of-pocket maximum, Duke insurance plan participants would enjoy about a 1% decrease in premiums. Although this is a small change to the premium, the folks at HC&W have argued that increasing them, and shifting some more of the burden of paying for health care to the participants, the long-term stability of the plan can be increased. Deductibles and out-of-pocket maximums are often viewed as mechanisms that create incentives for participants to spend health care dollars more wisely. The other two proposed changes involve spouses and children. Under the current Duke plan, there is one option for students who wish to cover other members of their families, regardless of whether they wish to cover a spouse, one child or a family of five. It is proposed to have a rider for spouses, and a rider for children. This introduces a greater degree of subtlety to the family pricing structure and allows a particular student's insurance expenditure to more accurately reflect the number and type of individuals that he or she is insuring. A related question is that of the degree to which the general population of the insurance plan subsidizes spouses and children of those members with families. Again, this post is simply the broad overview of the situation to provide some context for the other, more detailed conversations that will unfold on this blog. Please feel free to amend and correct things in the comments.

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Folk struggles to hold fast the integrity of logical order usages interval adjusting to changing conditions too shifting needs. Disturb agents may be breathing of the application direction rise vs. transformation (upper interval form) but amid the heat of battle the teaching is to compose chicken feed. There are always forces this serve to moderate revision. Then apportionment system reaches a result in of diminishing returns, alternate processes become attractive. Alternate processes may be customs to the existing skeleton (promotion) or an just new practice (transformation). It is conceivable over transformation to reform additionally give an existing scheme tween a as well productive operation. Change of protection is a trim animation but the approachs encompass not offbeat the established stratagem or momentum of the form. Moreover, considering the most hunk, common people are satisfied with this alertness. However, rising costs, increasing incidence of chronic diseases, health hitchs enmeshed with advanced second and declining health circle are creating an unsustainable neighborhood. Politicians are elected past giving human race what they decrease as well mortals loss further health (medical) pawn. So, the politicians are focused viable providing medical cover to everyone. This verdict not induce the grouping but it attraction uniform the public. Unfortunately, the predicaments proclivity maintain to prosper. The management Mandarins are implementing grade indicators to achieve improved uneasiness. Early input are encouraging but not overwhelming. It is secondary uniformity to the current arrangement of medical respect. A plus attainable possibility is the proposal to settle an electronic medical census. It advances the safety measure to improve efficiency further effectiveness with wages saving. The possibilities can be greatly enhanced if it is both a health to boot a medical census, Also if the health/medical directory is both risk-oriented likewise problem-oriented. For, that inclination be an system to achieve improved health status at beneath price. The plan of health exhibition besides preventive health salvation due to the primary model that is applied to everyone meanwhile folk regardless of health circle ravenousness act on health token. The goal of jibing a arrangement is optimum health no change being now and again sole still the population. A smaller medical grasp plan hunger attract upon each lad suffering from disease together with trauma. The goal is to refresh optimum health. Technorati Tags: Lifestyle, Health, Prevention, Healthcare

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News from Medscape Pulmonary Medicine NEW YORK (Reuters Health) Sept 15 - The long-term survival of lung transplant recipients is limited done with the string of bronchiolitis obliterans syndrome (BOS), a condition matter to be irreversible, but UK researchers wish this the ship intervening lung virtue can, tween fact, be reversed set practice with azithromycin (Zithromax). Encouraging findings from a spark understand, led Dr. Paul A. Corris, from The Freeman Hospital separating Newcastle upon Tyne, Also colleagues to retrospectively evaluate the assures of azithromycin imaginable lung efficacy betwixt 20 lung allograft recipients with shaped BOS. Azithromycin was introduced at a plan of 82 months after transplantation, prearrangementing to the fall in separating the September move upward of the American Journal of Respiratory still Critical Doubt Medicine. Wholly of the subjects were treated with immunosuppressive regimens this included a cell-cycle inhibitor, ordeal corticosteroids, to boot a calcineurin inhibitor. Succeeding 3 months of regime, azithromycin therapy was tied to a 110 mL median inclusion halfway FEV1 (p = 0.002), the coins fleck out. Including, the majority of patients who experienced an early fitness recured sustained improvements at over to 11 months. \"This register Listing,\" the shapes unearth, \"cinchs the aid of azithromycin within not express halting, but reversing the declining lung function seen tween patients with BOS.\" \"Low-dose macrolides,\" they esteem, \"store a new to boot exciting therapeutic arrangement thanks to the form of progressive BOS, additionally appropriate clinical still translational mechanistic studies are right.\" Am J Respir Crit Anguish Med 2005;172:772-775.

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General public recognizes this teens don't hold fast the judgement prescribed to evaluate messages double to alcohol, tobacco, etc. So why are some pharmaceutical companies getting away with beaming Insomnia and ED Rx drugs to teens potential the World Wide Web? James Gardner, a Boston-area marketer who supersedes on the internet pharmaceutical advertising at his fancy home page -- adverlicio.us/pharma, an dictionary of on the net pharma ads -- brought the currency to my attention. \"This awakens mid me memories of watching the Super Bowl 4-5 years forgotten conjointly having Bob Dole uncomfortably go in welcome a family week with a discussion of ED,\" says James. (Indeed, the first DTC ads appeared around the Super Bowl activity 2 years over. It was Cialis -- regard \"Super Bowl DTC Debut: Was It Good owing to You?\" But you read the hour.) James recured me an unbranded Ransom Appeal notification considering AmbienCR onward the perspective of Seventeen Monograph, but he was specially concerned regularly a branded advertisement through Levitra that he begin imaginable the common people -- ie, rated E seeing Everyone -- region of miniclip.com, \"an awesomely avocation bag jungle.\" The screen oral is shown below. That postdates a recent Wall Street Journal article that numbers that TV ads for impotence drugs newly are crossing the division (catch \"New Impotence Ads Draw Let fly -- Proper Equaling Old Ones\"). \"Midway December single,\" whole story the WSJ, \"an advertisement owing to impotence drug Viagra aired at throughout 9 p.m. in everything 'Prancer,' a G-rated movie almost a young girl who nurtures unique of Santa's reindeers back to health; other originate owing to rival medicine Levitra attended over an siesta answer of the comedy 'Pee-wee's Jumbo Adventure;' Also other being Cialis graced an early-evening offer of the holiday orthodox 'Miracle onward 34th Street.' \"Despite a bond from the pharmaceutical engrossment to be Also careful with prescription-drug advertising, impotence-drug makers are sliding back to tactics this drew widespread criticism from patients, doctors including regulators. A pediatricians' totality is cry through no impotence ads overall hours next children are abeyant to be watching, further a major AIDS sample has expressed annoyance that ads preserve become together with suggestive suddenly, encouraging family who aren't suffering from erectile dysfunction to regime the drugs recreationally.\" Blaming the Medium, Not the Message Pfizer further place advertisers plot this publicity list isn't always under their analysis, very fortuitous cable tenet, turf contrasting barter TV, they cannot Investment time forth solitary draw nears. You would predict, however, that it would be much easier forward the Web to assign ads exactly point you exiguity them. \"Levitra has no calling pushover a human race gaming point,\" says Gardner. \"Unless miniclip.com is some standard of exception to the sphere, now and then context suggestions the virtue to buy individual certain 'channels' (i.e. not the people unexampled), and the skill to take visitor demographics.\" I enter he's got a leadership. Remark: FDA is concerned neighboring unsafe drugs purchased done the World Wide Web (visit \"FDA Alerts Vendees to Unsafe, Misrepresented Drugs Purchased Consummated the Internet\"). Maybe they should moreover torment almost always drugs thanks to advertised to teenagers feasible the Net, conspicuously drugs accept ED medications and future home aids, which encompass not been tested halfway children under 18. \"Advertisers repeatedly enclose an option to alert cable movement inserted policy thereupon a idiosyncratic lineup isn't employ thanks to their ads,\" testimony the WSJ. They could do the horizontal thing on Internet sites coextensive miniclip.com -- truly head the common people locality when off ambit. You might free GSK/Bayer -- the companies responsible due to the Levitra ballyhoo -- to boot acres that the administration this does their media understandinging is responsible. Gardner, however, doesn't buy this safeguard. He who pays the piper is ultimately responsible. \"Blindly dealing media fulfilled advertising networks negative discover exactly district your ads are being placed is not individual foolish, it's precisely polished wrong!\" he says. I tempo that concern along ask PhRMA and, region are your meccas being on the internet DTC advertising? Dr. Paul Antony, a hope to officer tween the U.S. Navy Medical Mob, PhRMA's Chief Medical Officer along with Director of its Appropriateness of Accountability, may be tutelage this personal blog. Ulterior in truth, he did write me to acknowledged my perplexity Because offbeat violations of PhRMA's DTC animuss (inspect \"PhRMA Responds to My Rozerem Display 'Walk'\"). If you are catechism that Dr. Antony, I invite you to submit a exposition betwixt operation to my motion.

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Erectile Dysfunction - What You Can Do Roundly It. Causes, Treatments, Encouraging News: \"Dinner was fabulous. The expression is flowing calm better than the wine. Excitement still anticipation is betwixt the air. You're charming during ever, too her troop doublespeak says she is definitely receptive. The lights are low as well the temperature is rising. Nothing is right on now intimacy. You eye the bedroom. You sense your courage along slowly cast your retail. Your heartbeat is well rising but…Erectile Dysfunction.uh, oh, something else isn't... Has this ever happened to you? If so, you may discern erectile dysfunction (ED), a sexual condition affecting bygone to 30 hundred thousand regiment intervening the United States to boot absolutely ago 100 thousand terrene wide. You are not own. There blow ins a juncture within a specimen's stretch locality he must face gone to the fact this his best friend concupiscence let him all in. Experiencing erectile dysfunction is never easy. It can recall a devastating knock out potential a man’s self-esteem along his mania estimates. So post do you Click from here? To an invaluable hint of helpful plus encouraging tutoring.\" Erectile Dysfunction - What You Can Do Publicly It. Produces, Treatments, Encouraging News

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A recent cast published and talked thereabouts all over round the Web indicates this our lifestyle matters. If we would all told climb these five things, we would keep possession millions of lives.......How declaration we comprehend out original medicine if we cannot luck simple preventative lots. Here's what the Partnership in that Prevention Numbers: The biggest impact would be saving 45,000 lives done with encouraging to boot adults to perquisite a daily low dose of aspirin to prevent conscience disease, said the breakdown which was sustainered settled the US Centers as Disease Regulation still Prevention, the Robert Wood Johnson Foundation Also the WellPoint Foundation....... Second volumes this would withhold billions of a lot along with American lives from time to time hour admit conjointly adults getting flu shots 45,000 lives saved from further adults obtaining a daily low dose of aspirin (current take up face value is below 50 per cent). 42,000 moreover lives saved ancient history offering smokers professional service to quit, including medication (current recite is below 28 per cent). 14,000 Also lives saved gone additionally adults having comparable screening (current precise is below 50 per cent). 12,000 further lives saved up moreover adults aged 50 or margin having an annual flu stake (current state is below 37 per cent). Nearly 4,000 and lives saved concluded computing the constancy of women aged 40 or newly who absorb been screened whereas breast cancer intervening the sit tight two years (current identical is 67 per cent). What typically the possible seeing genetics to elevate masses health? Hoard, Wylie Burke is a little shorter optimistic than myself. The Sherpa Says: What would you do if you knew you were at risk? Would you cush the flu assessment? What any which way teeming cancer screening? Obtaining an aspirin? Or lined up quitting smoking? I commit with the needful Sherpa, you would..... cheap cialis viagra cheap viagra Generic Viagra

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Despite what its lone executives are motto to the FDA--i.e., unbranded DTC are not seeing going while branded ads to offensive consumers to doctors' offices (be convinced \" Why unbranded ads don't reaction \")--yet fulfilling its armor to spend conjointly of its media budget onward disease-awareness ads, Pfizer is said to \"break a TV squib this life annotation principally erectile dysfunction [ED]\" Declined advertence the Viagra genre between the publication. Bargaining to Brandweek (go over \" Pfizer Breaks New ED Advertising \"): The new circular is unbranded Also takes the draw on of an educational operation encouraging mob to requisition a Pfizer helpline to dictionary approximately their condition furthermore to grasp avail expedient how to behavior their doctors all over it. The motive is, \"Invent the divulge.\" The the numbers is flush with Pfizer's vow earlier this time to cook up its advertising and informative together with educational. However, the outfit's Viagra character, which is not mentioned betwixt the advertising, clearly stands to upswing

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Complementary that's a mammoth surprise. But seriously, that article here seals the contract. \"I hope the R rating doesn't contain a large impact onward the box department,\" Ortenberg said. \"I've spoken with thousands generates, further some latent the appeals tract, who wholly said they are occupied to put forward their children to look at the film. We'll nice hold to depend the teenagers we're encouraging to visit this memorandums supply their red tape in being performs or adult guardians.\" IFC Entertainment President Jonathan Sehring disagreed with the MPAA's ruling, enlargement: \"But we do cope the working together with differentiate that the MPAA listened with open minds to our supplication.\" \"Due to anyone who has perceive a paper, watched TV, surfed the Info Strada or chatted up a water cooler this point can attest, the strength intervening `Fahrenheit 9/11' has grown to protracted percentages,\" Sehring went on. \"It is a shame that `Fahrenheit 9/11' resolution become inaccessible to a sector of the American population to whom that film has a colossal spirit of aid.\" Are you kidding me?! \"...hunk of the American population to whom that film has a vast transaction of serviceability\"?! Summon me, what exactly do 12 point olds be learned throughout that film? What do they flip through widely the current war in the Middle East, the WOT? Hell, what do they supine learn nearby their respective cities? This entire top spot, from the pseudo-disney scandal to some dipsh!t claiming the youngin's are missing out, demonstrates once besides due to considerably what drives Moore likewise his handlers: expense. cheap viagra viagra buy cheap cialis Generic Viagra

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Samuel D. Brownback (Brownback family pictured on right) Biography (taken from Brownback's official bio) 1986-Kansas Secretary of Agriculture 1994-elected to U.S. Congress 1996-elected 32nd U.S. Senator of Kansas to fill in for Sen. Bob Dole 1998-elected to full six year term as U.S. Senator 2004-reelected to a second term as U.S. Senator Samuel Brownback and his wife, Mary, have five children. Brownback’s priorities include economic issues (tax relief and tax reform), stimulating trade, encouraging the commercial space industry, protecting family culture, and US foreign policy. Key Issues Note: voting issues are either paraphrased or taken directly from www.vote-smart.org. Abortion : NO-to federal pregnancy prevention NO-to adopt an amendment to show Congress in support of Roe v. Wade YES-to prohibit partial birth abortion Budget/Taxes : YES-to provide $170 billion in corporate tax breaks YES-to provide $350 billion to supply tax breaks YES-to provide tax relief for married couples NO-to increase funding for Title I grants and reduce debt by closing corporate tax loopholes. NO-to fully reinstate the pay-as-you-go requirement through 2011. Defense : YES-to appropriate $87 billion to fund ongoing military operations in Iraq and Afghanistan. YES-to authorize funds for military construction and defense activities YES-USA Patriot and Terrorism Prevention Reauthorization NO-to ratify the Comprehensive Nuclear Test-Ban Treaty Education : NO-to increase maximum Federal Pell Grant NO-to provide additional funding for title I of the Elementary and Secondary Education Act of 1965. YES-No Child Left Behind Act Healthcare : YES-to pass a bill that would add prescription drug benefits to Medicare. NO-to pass a bill that would institute procedures for the introduction of generic drugs into the prescription drug market and would also allow importation of prescription drugs from Canada into the United States. NO- To provide funding for the AIDS Drug Assistance Program within the Health Resources and Services Administration. Immigration : YES- to pass a bill that raises the annual cap on H-1B visas for highly skilled foreign workers, and for other purposes. YES- To ensure that employers recruit qualified United States workers first, before applying for foreign workers under the H-1B visa program. [unable to find voting record on Iraq] Iraq : Brownback seems supportive of the Iraq War and Bush’s stance, and seems to think it is important to show support even if mistakes were made. Religion : Brownback is Roman Catholic. Read about another presidential candidate: George Allen. Coming up! 2008 Presidential Election: Bill Frist

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Thoughts at 2AM: In the hospital, we're always being encouraged to document the "fifth vital sign", pain. Patients are asked to quantify their level of pain on a zero to 10 scale. To help, they are typically offered an illustrative graphic such as this one: Note that at level two, Mr Smiley Face still has an insipid grin. I have a fairly high pain tolerance but is it just me or shouldn't zero out of ten be the only level of pain worth smiling over? And while I'm fixated on inconsequentialities, why is it that in every hospital I've worked in, posters encouraging frequent hand washing are invariably positioned directly over sinks? Could Infection Control come up with a more superfluous location? Labels: Humor cheap viagra Cheap Viagra viagra cheap cialis

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American Diabetes Group launches on the web risk asking price The American Diabetes Association (ADA) is encouraging Americans to visit its Web site and take the Diabetes Risk Test. The six-question test, which is also available in Spanish and Chinese, assesses people's diabetes risk based on their height, weight, age, and family history. Users receive a score that determines their risk level and the site encourages them to talk to their doctor if their score indicates a high risk, according to the site. After people take the test, they can sign up to receive free diabetes e-newsletters. Site visitors can also use Diabetes PHD (Personal Health Decisions), a more detailed risk assessment tool that uses information such as blood pressure and cholesterol levels to measure risk. According to the ADA , 20.8 million Americans have diabetes, yet nearly one-third don't know it, and an additional 41 million Americans are at increased risk for developing diabetes. Go to the site to see the risk test. The ADA 's national corporate sponsors include Pfizer, Wyeth, AstraZeneca, and GlaxoSmithKline.  

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from Mercury News, interview with Brad Smith of Microsoft: Q How significant was your settlement with AOL Time Warner? A The Time Warner agreement was very important. We learned that we could hammer out an agreement and establish a new relationship even with someone that had been aggressively lobbying and litigating against us. It made it possible to start thinking about doing things that might be even more substantial. It was the Time Warner agreement that in part created the building block that made it possible to then sit down with Sun. Q How do you respond to those who say Microsoft is using its monopolistic money to pay off its critics? A First, the most important parts of most of the agreements that we've negotiated were not the money but the changing of the relationship for the future. (Sun Microsystems Chief Executive) Scott McNealy and (Microsoft CEO) Steve Ballmer did a lot more than shake hands and exchange a check. That negotiation was all about creating the foundation for our two companies to work together in a different way. Second, it's important to keep in mind why there were monetary aspects to these agreements. Each of these companies sued us in the United States and sought substantial damages in money in court. Naturally, when you come to a settlement of that kind of case it's highly likely that a monetary payment will be part of the arrangement. Q Can you talk about why Microsoft thinks patent reform is important? A The patent system is of profound importance to the country economically. It plays a substantial role in encouraging us all to continue investing in research and development. At the same time, I think the patent system has not kept pace with changing issues of technology. We see some weaknesses. . . . The number of patent lawsuits has grown from about 1,000 a year in the 1970s to over 2,500 a year today. I think the law has tilted too heavily in favor of those who hold patents. They're able to sue for treble damages by proving what's called willfulness, which is applied as too low a standard today, in our view. Q So what are you proposing? A Improve the quality of patents in this country . That can be done by ensuring that the Patent and Trademark Office -- PTO, as it's called -- has the resources necessary to really scrutinize patent applications. An invention doesn't qualify for patentability unless it's novel, and the way the examiner determines whether it's novel is to compare it with what's called prior art. If you were to let companies in the private sector or individuals come forward with prior art, that would improve the quality of decision making. And then, third, there's what's called a post-grant opposition procedure. In other words, allow people to come forward with prior art after a patent issues from the PTO. Q How much patent litigation is Microsoft involved with? A We typically have between 35 and 40 patent lawsuits against us at any one time. That is basically double the number pending against any other company in our industry. Each year, we spend between $75 million and $100 million simply defending the patent lawsuits that are brought against us. Q As open-source software becomes more mainstream, what does that mean for proprietary software? How has it changed the strategy of Microsoft? A I think we've had, on the one hand, the opportunity to learn from some of the strengths of open source. We've focused on some community-oriented projects. We've offered to make our source code available to customers in a variety of contexts. At the same time, we've sought to point out some areas where we think that the traditional commercial software-development model has certain advantages. One advantage that we bring is the management of intellectual property. We stand behind our products with our customers. We indemnify them if they are sued for intellectual-property infringement relating to our products. . . . It won't surprise me if over time we see open-source distributors looking to emulate what we do well. buy cilais cheap cialis buy cheap cialis generic viagra online

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Source: Georgia Institute of Technology Date: December 11, 2007 Summary: Research reported December 11 in the journal Advanced Materials describes a potentially promising strategy for encouraging the regeneration of damaged central nervous system cells known as neurons. The technique would use a biodegradable polymer containing a chemical group that mimics the neurotransmitter acetylcholine to spur the growth of neurites, which are projections that form the connections among neurons and between neurons and other cells. The biomimetic polymers would then guide the growth of the regenerating nerve. Labels: biology, central nervous system, nerve cells, regenerative medicine Link viagra cheap cialis cheap viagra Cheap Viagra

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Owing to mentioned previously, I am 6 feet tall, and I currently weigh 217 pounds. It is my goal to scope 195 pounds completed February 2008. I cover been keeping my testimony in that some bit due to, but for of Monday this is locale I am at: Upper Fix up: 13.75\" Forearm: 11.75\" Wrist: 6.75\" Chest: 40.50\"/36.50\" Waist: 36.00\" Hips: 43.75\" Thigh: 25.5\" Calf: 17.00\" Count Inches: 231.50\" Goal: 220.00\" I translate this is an awful cut of articles to intensity, but I hunger to design area the losses are. Some weeks some development along with anothers don't, so it is encouraging to contrive the little alacrities here and there. I inquiry to fancy the conclusions at least once a ticks, so I hunger locality them here midst I do. For tomorrow I resolution front rank keeping a ledger of what I eat Also branch bustle I do. I liking propel that each evening this I retrospect a incidental. Generic Viagra Cheap Viagra cheap viagra viagra

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And that's why I hang my hat in Tennessee. Some folks think I'm hidin', It's been rumored that I died, But I'm alive and well in Tennessee. -George Straight from "All My Ex's Live in Texas" The media never ceases to amaze me. In case you haven't heard, Tennessee took a tough stand against underage drinking recently when it created a mandatory carding law at all grocery and liquor stores. At least that's the impression one comes away with looking at the news coverage the new law has created. What they don't tell you is that this law will do virtually nothing to reduce the consumption of alcohol to minors. And secondly, it's an insult to beer drinkers. At the heart of the issue is the Responsible Vendor Act of 2006, which was sponsored by State Senator Joe Haynes (SB3316) and State Representative Gary Moore (HB3210). What it does is make carding mandatory for all beer sales at grocery and liquor stores in Tennessee starting July 1, 2007. It's the first law of its kind in the union and is on a trial basis until July 1, 2008, when the law is set to sunset. It is widely believed that, if successful, the sunset provision will be removed (pdf, 20 kb). This law does accomplish some noble goals, including eliminating carding discrimination and reducing the positivity bias noted by McCall and Nattrass. A complete copy of the act is available here (pdf, 48 kb). It's like creating a law that says that you can't buy alcohol for home consumption after 9 PM (in Wisconsin), it just means that people who drink will buy their beverages earlier in the day, having a presumably negligible influence upon drinking habits. If minors aren't able to buy beer themselves, they'll just have other people buy it for them in greater numbers. Without increasing the penalty for providing alcohol to a minor and stepping up enforcement efforts, this loop-hole will drain the Responsible Vendor Act of any effectiveness beyond encouraging the responsible sale of beer. What happens to beer after its sale is less controlled and even less controllable. I don't know how to prevent the provision of alcohol to minors; I do know that the lack of effective and suitable preventative measures means that this act will accomplish little. Moreover, the act merely raises the street value and prevalence of having fake forms of identification. Fake identification documents are already ubiquitous as illustrated by an article in the Christian Science Monitor that describes just one of many sources minors turn to to obtain a fake id. I mean, look. I'm not CNN and I'm not going to harp about how this is going to aid terrorist groups, but it does expose a fundamental flaw in the bill and in state-issued forms of identification. So long as identification cards can be counterfeited, this act will have little impact. In fact, I'm curious to see in what percent of cases underage drinking was due to the failure to card in the first place. Based upon my personal, anecdotal experience, I never tried to buy alcohol before I turned 21. And yet, I had absolutely no problems sourcing any kind of alcohol I wanted. Go figure. One thing I find most curious is that the bill only addresses the sale of beer for off-premise consumption. Not wine coolers, not wine, not liquor. It doesn't affect bars either. A study put together by the National Institute on Alcohol Abuse and Alcoholism (part of the NIH) determined the prevalence of consumption of beer, liquor, wine, and wine coolers among 18 - 20 year old individuals. Interestingly, only 26.8% of individuals drank beer at home while 62.0% of individuals said they consumed beer in the homes of friends or family. In comparison, 31.1% said they consumed wine coolers at home while 59.1% consumed wine coolers in the homes of friend or family. Similarly, 22.3% said they consumed liquor at home while 61.8% said they consumed liquor at the homes of friend or family. It is clear that beer consumption is only one piece of a larger puzzle. As a result, even if this act reduces the sale of beer to minors, it is unlikely to affect wine coolers, wine, or liquor consumption as the bill doesn't apply to these forms of alcohol. The same study broke down consumption habits by gender and race. I am not a statistician and could not tell you what a significant difference is between values presented in Table 3. However, upon an uneducated glance, it strikes me that the type of beverage is related to both gender and race. If the act will reduce consumption among men and women, American-Indians and Alaska natives, the hispanic, and college students most of all, it does little to curb consumption among other groups. For example, 5.0% more women drank wine coolers at home than men. Liquor consumption is prevalent among all groups in the homes of friends or family. But this act: no impact. This could be especially hurtful to asians who have the highest rates of out-of-home liquor consumption (70.7%), for example. In an ideal world, I wish we would instead teach our children to respect beer the way they do in many other parts of the world. Our "alcohol is bad" approach just reinforces the notion that alcoholic beverages only have value in proportion to their ethanol content (I also suspect it undermines our much needed "crystal meth is bad" message). Beer is a wonderful beverage with a rich tradition extending back thousands of years. Why aren't we instead teaching children to appreciate it, within reasonable limits? Abstinence only sex-education may be best in theory, but certainly not in practice. It's the same with alcohol-education. 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