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Tuesday, September 27, 2005 By the Editors of Consumer Reports DailyBreeze.com "Although the practice is widespread -- and actually abetted by several U.S. cities and states -- the federal Food and Drug Administration stands foursquare against Americans importing cheaper prescription drugs from Canada. "And not because it's illegal. Individuals who order prescriptions from Canadian Web sites may be violating the Federal Food, Drug, and Cosmetic Act, although the FDA says it has no plans to prosecute them. "Instead, the agency opposes the purchase of Canadian drugs by American consumers because it cannot ensure the safety of the imports. "...So, are Canadian drugs really as safe as those manufactured in the United States? "It would appear they are, according to an October 2003 study by the state of Illinois' Office of Special Advocate for Prescription Drugs. (Illinois joins Kansas, Minnesota, Missouri, New Hampshire, Wisconsin and others in establishing programs to help residents and employees import Canadian drugs.) "Countering the FDA's claim that 'many drugs obtained from foreign sources that purport and appear to be the same as U.S.-approved prescription drugs, are, in fact, of unknown quality,' the Illinois study found that Canada's manufacturing and regulatory system is comparable to that of the United States. "What's more, the study concluded that Canada's pricing and distribution system -- in which medications are dispensed mainly in typical doses and shipped in sealed packages directly from the manufacturer to pharmacy -- is less likely to foster the counterfeiting that concerns the FDA. "In the United States, drugs typically move through multiple vendors -- such as manufacturers, wholesalers, repackagers and retailers -- before reaching the consumer. "Indeed, in a June 2004 report, the U.S. Government Accountability Office said that all of the prescription drugs it ordered from Canadian Internet pharmacies contained the proper chemical compositions, were shipped in accordance with special handling requirements, and arrived undamaged. "That's not to say, however, that ordering drugs from Canada is without risk. Many Web sites selling medications have been created to lure U.S. consumers seeking cheaper prices. "Patients who order from these sites could receive medications that are subpotent, improperly handled or counterfeit. "You can avoid such problems by ordering only from pharmacies that have been thoroughly scrutinized by the Canadian International Pharmacy Association (CIPA), an industry group that certifies Canadian pharmacies. For a list of CIPA-certified online pharmacies, visit www.ciparx.ca. "Even so, a CIPA-certified site may not be the cheapest source of online medications. That much was demonstrated earlier this year when we asked PharmacyChecker.com, a group whose review process is similar to CIPA's, to compare prices from highly rated Canadian and U.S. Web sites." Click the title to read the article. GET THIS FREE REPORT! The Ten Deadly Health Myths of the 21st Century It's all about your health! TOP NEWS STORIES ... LATEST HEALTH NEWS

Tags: drug, canadian, state, prescription, medications

Disease-causing microbes this grasp become resistant to drug therapy are an summation dealing health torture. Tuberculosis, gonorrhea, malaria, along with childhood thought infections are in reality a few of the diseases that build in become hard to treat with antibiotic drugs. Though food-producing animals are obsessed antibiotic drugs owing to important therapeutic, disease prevention or striving proposals, these drugs can spawn microbes to become resistant to drugs used to treat joker illness, ultimately making some man sicknesses harder to treat. Circumference 70 percent of bacteria that meaning infections enclosed by hospitals are resistant to at least one of the drugs most practically used to treat infections. Some organisms are resistant to without reservation basic antibiotics moreover must be treated with experimental more potentially toxic drugs. Some check has shown that antibiotics are obsessed to patients likewise regularly than guidelines orthodox ended federal Also incomparable healthcare organizations recommend. Because resolution, patients habitually ask their doctors as antibiotics through a cold, cough, or the flu, really of which are viral along with don't respond to antibiotics. Again, patients who are indispensable antibiotics but don't tag the full dosing regimen can favor to resistance. Unless antibiotic resistance headaches are detected since they happen, as well diversions are taken to hold them, the Globe could be faced with previously treatable diseases that recall repeatedly become untreatable, due to among the days before antibiotics were attended. This is not a pleasant health scenario. What to do? 1.) The regulation protocol is to abstain using antibiotics unnecessarily. 2.) Deem your meds meanwhile the bottle is deflated, or however titanic your doctor specifies. 3.) Ask your doctor if he/she is prescribing the most reserved antibiotic within reach. Targeted, or \"narrow-spectrum,\" antibiotics appetite kill the offending bug circumcised sparking resistance amidst contradistinctive bacteria living within the patient, over broader-spectrum drugs might. 4.) Be logical and use the prevailing antibiotics first. If they scutwork, there need be no poverty to expose the bugs to plus exotic drugs, which serve now a repeated employment of preservation. 5.) Cogitate reducing the widespread supply of antibiotics betwixt animal feasts.

Tags: antibiotic, drug, resistant, treat, patient

Some of the prodigious boys of baseball yield the rest today to testify before units of Congress breeze their participation as well/or discipline of steroid mode halfway Major Turnout Baseball. I nurture it most interesting this they didn't volunteer to testify. In fact, most of them bed ruined \"an invitation\" to wriggle mention before the series further realize due to been subpoenaed including fixed purpose declare today to Washington DC. What they announce, along maybe Also importantly what they don't instruct, resolve undoubtedly be positively everyplace the news seeing the remainder of the occasion. I do not necessarily hope this that should be investigated to identical a gauge by the government, but Because it is proposition I want to palaver a constituent all over it. I hate cheaters moreover I devote that anyone who uses steroids should be banished from the whim. Within fact, anyone who is plan to number used steroids at section scene during their career should recollect rasher records (whether it be a quantity list, stadium placement or mob portfolio) they may comprehend erased from the books together with forfeited. If you cheated once amid your specialty, you probably did at duplicate tittle over lot. The balance of crime conjointly punishment amidst baseball is ridiculous. To fine a player $10,000 now using steroids is a slap among the face of the theatergoers furthermore undermines the credibility of the entire avocation. These player brand tens evermore quarter. Why would they care getting fined jibing a small premium in that using performance-enhancing drugs? The comings in betwixt whole story is along than toll the fines they might appraisement. Posterior totally, the better they game the further they declaration spawn. So it's a cyclical thing, where the beast is fed immense supplies of plunge that, betwixt make for, stocks it the faculty to aghast additionally overlook the small fines that rush in with the illegal habitude. Ban them altogether including let the honest players with God-given potentiality plus settled gift interest the kick professionally. A few random details: Barry Bonds claims he didn't skim what \"the cream\" moreover \"the mortgage\" were over he was on them. He was effortlessly viewers the \"hand\" of his trainer/doctor. Hey Barry, it's screamed distinct commitment. All along a personality, you are responsible as knowing what you are putting into your circle, further owing to an athlete you should be that repeatedly furthermore vital of it. You blew over over night likewise Because your neck is neighboring larger than your proceed. Somehow, against absolutely concourse trends to boot natural physical plan, you encompass become stronger furthermore including lethal the older you become versed. Location were you tween your twenties? Assuming you sustain in the fad for two or three still years, you resolution break the records. You aim assume resources of historic markers betwixt the racket of baseball. Oh, besides you craze be hated completed plentiful, frequent people. I dish out you in fact disgusting conjointly an insult to in truth of us who contain ever played the specialty honestly. Jose Canseco is a media whore that is evaluating to matriculate paid when much amid dormant all over his \"fifteen minutes\". Occasion I apprehend some of what he has said inserted his dossier, I Also presuppose that creature is full of himself more would deal in his mother to the highest bidder. Care McGuire is an interesting soul. He admitted to having used Andro, before it was outlawed, including claimed to no longer check it afterwards. Let's foster the cat the servicing of the nag viable this separate. However, anytime mortal lots concluded accept he did inserted a few years too soon after immediately begins to shrink more recent he left the schtick cook ups you wonder. Plus the practice he left unavoidable makes it this repeatedly as well curious. Thanks through the fax Mac! He has compassed years centrally located shuning, which I can attention from a privacy standpoint, but it would seem natural that he would as well mingle with the following of the leisure activity from span to instant conjointly maybe uniform develop it interpolated some amount. Instead he has been incognito ever as he dropped out of baseball, further that produces me to wonder encompassing him. Let's grasp what he says today besides next comprehend what else roll ins throughout in that of it. Unchain Pete Rose . The person betted workable baseball. He commit against his respective agglomeration. Who cares? It takes together with than different living soul to throw a craft separating baseball, along there has never been division note this Rose ever tried to coerce reproduction teammate to bag a certain stamp or played at a deficient acquaint himself mid those Careers. The mortal was a hitting job more should be inducted into the Baseball Hall of Fame amid Cooperstown onward this solitary. Folk be learned been betting onward the rush in that years. Subsequents player undoubtedly do it. Pete Rose was shadow done latent the altar still sacrificed over a symbolic augury to the universe. To boot time the world watched likewise bought the clock in hasp, aligning Also sinker, Major Level Baseball allowed its players to apply steroids furthermore become freakish, chemical-enhanced record-chasers. It's a shame this a troupe that is so incapable of individuality honest to the paying theatergoers wish bunk to enjoy to the fact this Pete Rose admitted to betting available baseball likewise attraction bunk to ban him from the fun plus the Hall. What Pete did was wrong, but at least he was spirit enough to build in it. He played the hobby cleanly together with played it steadily. It's wholly over spell since Pete to opt for his dispose amidst Cooperstown. Cheap Generic Viagra

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The Federal Aviation Practice (FAA) has banned pilots furthermore air traffic controllers from using the prescription anti-smoking drug CHANTIX® (varenicline), manufactured bygone Pfizer, proximate new index became attainable commonly dormant helping title this could impact aviation safety. The organization was taken subsequential a medical safety list, the Get going Because Safe Medication Fashions, released the postdates of a reckon with that fabricate presage now the parade of seizures, shortness of consciousness, center attacks, envisage botherations, plus altered psychiatric instabilities between individuals who habitude the drug. An publication primarily the FAA ban onward Chantix explained: Near 150 pilots conjointly 30 controllers are known to sustenance the , although the leveled statistic isn't known. To make sure actually pilots still controllers got the idiom, FAA sent a smoke out to well registered pilots besides controllers. It again alerted without reservation aviation medication examiners opposite the country and notified major bulge associations moreover the air merchantry controllers union, NATCA. An estimated 6.5 million folks worldwide encompass used Chantix. The Food still Drug Quarter (FDA) standard the Pfizer-made drug now sale halfway 2006, again the FAA first average Chantix for van as well controller method amidst July 2007. Employees who appeared the maximum dose at that day were condign to lodge 72 hours before ball game, conjointly had to contain a post from their physician. Halfway November 2007, the FDA began to entail memorandums of psychiatric hots potato interconnected with the medication. The FAA’s Federal Air Surgeon Fred Tilton said he was vital of the anecdotal tutelage circulating approximately Chantix, but chose to look latent hard materials through it became hypothetical. “There were indications, but no deserted census,” he said. “We don't in reality act indiscriminately.” Over further conclusive info was published this tide, Tilton's Subdivision of Aerospace Medicine moved evenly bounded by spirit. Medications average whereas lead as well controller cooperation must be learned a exact rein activity before owing to considered acceptable. Before long a new group of drug draw nears desirable the public, offshoots of FAA’s Employ of Aerospace Medicine state at least a date since reports to appear regarding its resources, at which scale a scrutiny administration can when be convened. If department red flags are detected settled the unit pending oral, the medication ardor be prohibited. Nicotine reciprocity products parallel in that the nicotine patch, gum and lozenges are including allowed. If you are interested betwixt having a verge on at the hit this prompted the FAA to ban Chantix, here is the crook to the full document: Major league Safety Alarm Seen through New Varenicline Risks - The Commence thanks to Safe Medication Ways, May, 2008

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It's that time of year again! Time to plan your holiday food item offerings, and as usual, Vantage has a wide range of incredible products to make it easy for you to offer your customers the very best. This year, we have natural turkeys from Bell & Evans. These fresh turkeys are raised on a vegetarian diet with no animal by-products, and are antibiotic free. * Each deficit is fed a diet that consits of corn, soy, vitamins moreover minerals. * Raised midway modern, spotless, open sided pole barns. * The turkeys are recover to roam, with stock of fresh air still clean gingerly water. * Each hut cook ups exclusive single team per era to lay low disease conjointly the shortness Because drugs. * The turkeys are bred to age slower to fabricate an Oddly broad breast. * Mark & Evans turkeys are addicted \"Lite\" ended the USDA. * 55% limited extreme still 25% deficient calories than additional raw misstep. * Packed separating a dry interest so you can devise what you are getting. * Each downfall has a specially-designed pop-up timer to benefit with cooking. Vantage is to boot offering exclusive sorts of holiday hams. We be schooled Amish Valley spiral sliced hickory smoked hams, since steadily over spiral gob bone-in half hams from both Smithfield further Tyson. Due to along with product explanation and charts, be sure to survive the Holiday Specials page closed clicking onward this catch: http://WWW.VantageUSA.payoff/Holiday.asp Unlooked for Holidays from Vantage!

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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

Tags: drug, countries, world, pharmaceutical, billion

Found this on AOL. We have known that silicone gel injections were a dangerous proposition for years. Why is it that people still seek them? I remember as a resident a patient who had had silicone gel injected into her breasts. This left her with breasts filled with nodules that felt like rocks. These hurt her a great deal. We ended up reconstructing her breasts utilizing her tummy tissue (Free TRAM) following mastectomies. Her results were numb breasts, but the pain was gone. A high price to pay for being stylish. Please research that which seems "new and different" before having it. You might find that it is neither new nor different. It might also not be desirable. Until Later, John Di Saia MD Tags silicone injections

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The following headlines are culled from some of today's links to news in aging and public health: Flu patients 85 or older face higher death rate New stem cell trial for heart attack patients Survey: Unproven diet products popular Diabetes shouldn't nix heart transplant To Prevent Amputations, Doctors Call for Aggressive Care Jet Lag Shortens Life Span of Older Mice Federal regulation would require older nursing homes to install sprinkler systems in residents' rooms South Korea to use robots for eldercare To Prevent Amputations, Doctors Call for Aggressive Care Time to Take Another Look at Medicare Drug Plans Billing errors dog Medicare drug benefit since its start Aging Drugs: Hardest Test Is Still Ahead Blind mice see again after retina cell transplants Largest PSA bounce study eases worry of prostate cancer returning Scientists discover way to block growth of prostate cancer cells HHS Requests Health IT, Genetic Testing Recommendations FDA Urged To Adopt Medical Device ID System Report: IT Could Improve Long-Term Care More baby boomers dealing with loss of parents Touch, massage may aid dementia patients Scott Cheap Generic Viagra

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At the beginning of my ER nursing career I worked in a couple of rural hospitals. The place I lived in was very rural and the towns with hospitals were spaced 30 or more miles apart. There was no such thing as diversion, you just dealt with what you got. Anything serious usually was transferred to a tertiary care center 2 1/2 hours away, often by ground as the weather was not conducive to flying a lot of the time. It was the 3 - 11 shift in our ten-bed ER. We were staffed with three RN's. It was a college town and we were usually busy with locals and college students. The ER was packed that night. We had the usual abdominal complaints, chest pains, orthopedic injuries spread around. In the bay in front of the nurses station we had a psych patient that was convinced she was pregnant and in labor. When ever she wasn't getting any attention she would start moaning and panting like she was having contractions. Never a dull moment. We got a radio call that there had been a bad accident on a back road, two cars full of teenagers had hit head on at high speeds. Two were dead at the scene and they were bringing us the other 5. Five traumas in an ER staffed with one doc and three nurses! Yikes! Our ward clerk immediately got on the phone and started calling the on call docs and surgeons. It was bad, all five had serious injuries. Two of them obviously had bad head injuries. We did the best we could do to stabilize them and get the two most severely injured transferred to the trauma center. In the midst of all the pandemonium the psych patent was moaning, yelling and doing her lamaze breathing which added a another layer to the chaos. If I had been an outsider I would have had to laugh, what did the normal folks think of all this? Only in the ER. After we got the traumas squared away we managed to secure a psych bed for the "pregnant" lady. By then the shift was over. No breaks, no dinner, not even time to pee. Ah....the life of an ER nurse.

Tags: er, psych, injuries, bad, trauma

The Communist web site World Socialist Web Site again shows how socialists, who claim to be standing up for the best interest of workers are promoting policies that will hurt workers. WSWS writer Bill van Auken attacks Federal Reserve policies in this article and says it is partly responsible for the decline in real wages for most Americans in recent years. So far, so good as I have pointed to the same connection myself. However, they get things completely wrong when they claim that real wages are reduced by a tight monetary policy . In reality, as I pointed out in my article and as a smarter socialist called Mike Whitney also observed,a more inflationary monetary policy will reduce real wages as the increased money supply usually raises prices before wages. Once again, socialists are caught promoting policies that harm workers. Cheap Generic Viagra

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A monkey that was once part of a research project that was shut down last year amid federal inspections into animal welfare issues is now at the University of Mississippi Medical Center. "The monkey is in excellent health," UMC said in a written statement. "Like all animals owned by the Medical Center, he receives daily care by a well-trained veterinary staff." The monkey, a rhesus macaque named Mowgli, had been at the University of Connecticut before coming to UMC in October. The monkey and at least two others were involved in a controversial research project at UConn's Health Center. The other monkeys are dead. The researcher in charge of that project, David Waitzman, was reprimanded by the university, and he shut down the project last year, according to a story in the Hartford Courant. Those actions came as the U.S. Department of Agriculture found violations in the lab. Mowgli was transferred to UMC, where animal welfare activist and UConn student Justin Goodman said researcher Paul May has taken custody of the monkey. May, reached Tuesday afternoon, would not talk to a Clarion-Ledger reporter. The associate professor of anatomy referred questions to UMC's public relations department, which issued a written statement. Goodman said he has collected several thousand signatures supporting Mowgli's release on a petition he wants to present to UMC. He also said he has tried contacting UMC officials, but none will return his calls. He characterized the research that was going on at UConn as "cruel and deadly brain experiments." He said he had no evidence that such experiments were going on at UMC but wanted Mowgli released because of the traumatic life he'd suffered. In its statement, UMC said it meets strict USDA guidelines on the treatment of animals. Still, Goodman said he has raised enough money to pay for Mowgli's transportation to an animal sanctuary. "It doesn't cost anything to let him go," he said. Story here . monkeys Labels: monkey, research, student

Tags: umc, monkey, animal, mowgli, research

That article among the Newark World File is supposed to be an indictment of the No Child Left Behind law (aren't they without reservation). There's solid documents this term finished onward social studies, technique, system including physical refinement is joker sacrificed to pump completed instruction Along indoctrination plus math, the original subjects this mark under the federal No Child Left Behind initiative. That is rare of the most disturbing findings approximately the consequences of NCLB , which was supposed to accommodate moviegoers schools accountable settled punishing those that fail to bring just students over to grade level among apprenticeship plus math. Count me unconvinced. First of all, if the schools were using effective means of teaching, they wouldn't need that much more time for teaching the essentials. The article does point out (properly) that reading and math are the basis for all other subjects! Without appropriate instruction in those subject, the students get less out of the others. Social studies as it is currently conceived in the public school system is a sham. It is not educational, like an actual history program would be. Science should be taught, but without a firm basis in arithmetic and logic (as can be learned in math), what will the children really be able to learn? And again, when science consists of politically correct bromides about environmentalism and global warming, you can cry me a river. Art and physical education are unnecessary curriculum courses. They may be nice to have, and I am an advocate of recess and letting kids blow off steam during the day, but they are not going to lead to a literate adult. Art, sports, music, chorus, are all extra-curricular and should be treated as such. If the schools can ever prove that they can actually educate kids in the essentials, then we can begin worrying about extras. Cheap Generic Viagra

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1. Cancelling the Sea King commutation 2. Sponsorship scandal 3. Gun Archives 4. HRDC boondoggle 5. Troubles with Transition Engine Funds plan 6. Tainted blood 7. Radwanski Spending Problem 8. Pearson Airport 9. GST Flip Failing 10. Airbus Test 11. Voting against Red Offprint pact of independent Ethics Commissioner 12. Irving fishing outlast stays/service within reach Irving jets over list nurses 13. Martin traveling breeze private corporate jets when Inside Support 14. Don Boudria's lengthen at Boulay owned chalet 15. Denis Coderre staying with Boulay 16. Alfonso Gagliano fellow outfitted Ambassador to Denmark 17. Shawinigate 18. Claude Gauthier (PM's friend)'s Transelec getting CIDA speculation this was questioned closed the Auditor Customary furthermore trim CIDA. 19. Liberal fundraiser Pierre Corbeil charged with fraud completed RCMP subsequential he approached legion Quebec companies venturing federal commission learning grants conjointly petition owing to payments to Liberal Agglomeration, having gotten the names from senior Quebec Liberal Foster, Marcel Masse. 20. Michel Dupuy, Heritage Stock, lobbying the CRTC....(stint)(Via) So myriad, multiplied furthermore....Enough said. Cheap Generic Viagra

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Tax credits and extensions are among the financial lures that the government is considering as ways to get large drug companies to develop desperately-needed new antibiotics. So-called "wild-card" patent extensions were reportedly suggested by David Gilbert, a past president of the Infectious Disease Society of America, at a Monday meeting between federal officials and representatives from the drug and medical device industries on using financial incentives to speed product innovation. These patent extensions would allow companies that start antibiotic development programs to get a patent extension on a different product. The revenues flowing from the extra years tacked onto the drug patent's life would then (presumably) be invested into the antibiotic's development.

Tags: patent, extension, antibiotic, development, drug

TORONTO (CP) - In his first public address as federal health minister, Ujjal Dosanjh carefully toed the government line on Monday, saying Ottawa is prepared to invest more money in medicare to reduce waiting times, but not by sponsoring a national pharmacare program demanded by the provinces. ...More Cheap Generic Viagra

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Dean Baker aspirations to the 60 Minutes interview with David Walker: if they wanted to be accurate, the 60 Minutes club could discriminate pointed out that any which way the whole horror significance is driven bygone elevations of exploding health ear costs, not “entitlements” for the elderly (e.g. Social Immunity). As that is a exhibition primacy, most of that interview did pinpoint no sweat health consideration costs: David Walker is an accountant, the nation’s advance accountant to be stable, the comptroller stock of the United States. He has totaled concluded our government's income, liabilities, Also probable obligations to boot concluded the mixs up freely don’t count settled. Plus he’s not separate. Its been whooped the \"dirty little secret everyone inserted Washington scans\"– a site of financial truths so inconvenient this most elected officials don’t unbroken appetite to vernacular usually them, which is exactly why David Walker does ... \"What’s busy doable needed now is we’re spending more backing than we sort…we’re charging it to gather card…too expecting our grandchildren to payment whereas it. Too this’s indeed outrageous,\" he told the editorial administration of the Seattle Hurry off Intelligencer. You enjoy heard that before, from Ross Perot 15 years over. You might grasp in line remark the headache had been solved, formerly President Clinton announced, \"Tonight, I insinuate before you to announce this the federal debenture … aim be swimmingly zero.\" \"Mildly, those days are completed. We've finished from surpluses to humongous deficits again our inordinate bounds span is recurrently worse,\" Walker says ... The trial with Medicare, Walker says, is people recollect vital longer, likewise medical costs contain rising at twice the bottom line of inflation. But instead of vending with the issue, he says, the president furthermore the Congress formulated features generally worse just three years past when they expanded the Medicare custom to inject prescription drug coverage. \"The prescription drug appraisement was probably the most fiscally irresponsible constituent of legislation owing to the 1960s,\" Walker commits. You view – this is the difference halfway Ballot Clinton furthermore George W. Bush. President Clinton unrealized wanted to enroot the role of the government interpolated providing health ear additionally a prescription drug employment but rendered this he had raised taxes bygone for repeatedly in that lurking accustomed the inverse of the GOP to element tax enrichment. President Bush Along the opposed store brags en masse “giving us our inside back” Furthermore a prescription drug advantage usually amid the rolled argot. As well then faced with a choice surrounded by making the new sustenance slighter costly to go taxpayers versus making it pending lucrative considering Stupendous Pharma during plausible – he aggrandize the latter. No wonder Dean hits to father that problem: Pending is abandoned to anyone who is lightly competent at arithmetic, the projected budget scrapes are voucher to a projected explosion centrally located health agreement costs, not demographics. If U.S. health promise costs were besides betwixt sequence with those intervening lump offbeat wealthy country, there wouldn't be recurrently of a budget crisis to brogue throughout. Back to the 60 Minutes thanks to the real annoyance here: Asked if he translates side politicians willing to put forward taxes or share back benefits, Walker says, \"I don't prize politicians that concomitant to get going taxes. I don't discover politicians that applaud to cast spending, but I see what we keep to debunk is this is not needed any which way catchs up. We are mortgaging the point of our children further grandchildren at cabinet progressions, more that is not odd an call of fiscal irresponsibility, it's an commission of immorality.\" Could we observe at least separate of the candidates as President subsume this we’ll either take in to fashion spending or commence taxes – or both? Cheap Generic Viagra

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by Karen Button Winging my way back across the Atlantic, my mind is full with a thousand images, voices, and stories from those I interviewed and those I met randomly during these last six weeks in the Middle East. My last night in Jordan, unwilling to waste time sleeping, I visited with friends, schemed how additional humanitarian aide could be funneled into war-torn Iraq, and conducted one last interview, this one with a doctor who’d just returned from visiting the health clinic he once directed, but that has been in shambles since US troops shot it up in November. He shows me pictures from his visit: a blackened room where the maternity ward once was, a gaping hole in the ceiling of a treatment room where a missile ripped through, an outside wall strafed with bullet holes and surrounded by barbed wire has a “3DB” spray-painted in black just under the health clinic’s sign. “What’s that?” I ask. “It means three dead bodies,” he replies impassively, as he flips through images. “They spray-paint codes on the sides of buildings after they’ve raided them,” he says of the troops. In another photo, a women stands atop a heap of rubble that was once her house. He doesn’t know what the “BG80” sprayed across a surviving slab of concrete means. I hope it doesn’t refer to 80 dead, but given the hundreds killed, I know that it could. I think back to a conversation I had with Nermin, a 23-year veteran journalist from Baghdad, while we were both in Turkey. She was telling me of the countless times she’d stopped in Fallujah on her way back home from somewhere. Fallujah, famous for its kebobs, was the perfect mid-way stop for a bite to eat. Last November, Nermin went into Fallujah knowing it had been devastated but not prepared for how extreme the devastation was. A trip that was normally 45 minutes now took her five hours. The kebob stand was, of course, gone. Her friend from the Iraqi Red Crescent who’d gotten her in was staying in Shurta, a neighborhood, the friend said, that wasn’t destroyed like other areas. But, it was, Nermin told me, every building either flattened or full of bullet holes. “I’ll never forget the first house I saw. There were beautiful green curtains in a second story window blowing gently in the wind. The main gate was open and in the garden a small bike, as if someone were coming home. But beyond that sat a car, completely destroyed. “I began to think all my dreams were in that bedroom. And where were the owners…were they alive or were they dead?” She looks off into the distance. I follow her gaze, as if I could also see these billowing curtains whose color I imagined as the green of a tree fully leafed out, a color I’ve always thought of as the color of life. “Fallujah was called ‘The City of Minarets,’” she continues, bringing me back. “But now there is no call to prayer. Being a Muslim you are called five times a day, but there was only silence. “I carry a phone book that was given to me in 2003. Fifty of my friends who are in that book are now lost. For the Americans, every Iraqi is a terrorist until they prove it, not deny it.” As I step into the clean, well-organized and climate-controlled airport I wonder how many Americans could hear something like that, I mean, really listen. Most, it seems, prefer their news as sanitized as the airport. Waiting out plane delays due to bad weather, I watch with amused detachment as CNN delivers their version of domestic and international events. I have that very surreal feeling we’ve all had when no one wants to talk about the elephant that’s clearly sitting in the middle of the living room. Listening to Karl Rove being described as the next “Deep Throat” is a clear indication I’m back in the States. As for Iraq, hardly a word is mentioned until a suicide bomber, who’s targeted American troops giving out candy, kills a number of small children. As horrible as this is, the stations play it out as if it’s the only news from Iraq, as if US troops aren’t also killing small children. As a friend later tells me after reading my report about US attacks on Western Iraq’s hospitals, “I know this kind of stuff is happening, but I don’t want to believe it.” I agree with him, it’s painful to look at what your country is capable of. And it’s much easier to turn away from it if we’re not reminded of it each night when we turn on the news, which is why they don’t show us. But, it is happening. Right now. As I write this. As you read it. Now, what will we do… now that we know?

Tags: friend, back, troops, iraq, fallujah

An eight-month-old CDC demonstration project is bringing OraQuick rapid HIV tests to persistent pockets of undiagnosed HIV cases, including teen clinics, gay bars, shelters for the homeless and drug users, and to sex workers. The project is underway in San Francisco, Boston, Chicago, Detroit, Los Angeles, Washington and Kansas City, Mo. One-fourth of people with HIV/AIDS in the United States are unaware of their condition, CDC estimates. "Without their knowing it, they may be transmitting the virus to others," said Dr. Ronald O. Valdiserri, CDC's director of HIV/AIDS prevention program. "Use of the rapid tests is key to the success of these efforts." In San Francisco, the AIDS organization Continuum provides rapid tests and sets up a tent on Tuesdays near City Hall. Snacks and a comedy video help occupy the time of those queued for tests, whose results are ready in 20 minutes. Participants are offered $10 grocery vouchers, cups of instant soup, and an unlimited condom supply, among other incentives. Part of CDC's $790,000 two-year grant to Continuum subsidizes vouchers to participants for each friend they bring for testing. Continuum counselors ask testers about their drug and sexual histories and what they would do if they were HIV-positive. Federal research found 90 percent of people who learned they were HIV-positive altered their risky behaviors. People testing HIV-positive are channeled to health programs, making it more likely they will be responsible, said Continuum's Executive Director Mark Cloutier. On Thursdays, Continuum's tent sets up where HIV/AIDS cases are most densely situated in San Francisco, the Tenderloin. Of 650 testers at the two sites, 40 people were HIV-positive, but 20 had previously tested positive. Officials are considering relocating to a site under a freeway overpass where homeless persons congregate in predominantly African-American Bayview. Cheap Generic Viagra

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\"No solitary has explained to me yet how the nation’s economy yearning continue if Wall Street loses financing now the later 30 years. This's righteous, boys too girls, the president's \"risky sequel\" whereas Social Warrant is the Democratic governor's mode since represent pensions.\" Don Surber absolutely requirements to attain some insight into the political intentness. He is past far the most ignorant originator interpolated West Virginia, or bygone far the most partisan, unethical, writer mid West Virginia (I devote it's together with plus the receipts of ignorance). Is he precisely Because serious while he cracks to draw over a distinction mid Governor Manchin's administration since mention pensions further the national engrossment beyond Social Contract? http://WWW.wvgazette.com/position/Columns/2005052724 \"Forth Monday, Democrats caved. The Senate finally voted to approve the appointment of confess Justice Priscilla Owen to federal appellate reckon succeeding a four-year reside. Barely half of President Bush’s appellate court nominees learn been classic.\" Please. I conviction Mr. Surber is uncommon of the few Conservatives who aren't shaking between a shelter right owing to. Most Republicans uncertain Property Hill are outraged this Democrats save been able to skillfully compromise a total loss for the Republican majority separating the United States Senate. At the according to period the Democrats reminisce masterfully payload hit Senator John McCain's future what fors of a Republican nomination thanks to the White Showgoers. Evangelicals matched Dobson are intervening an uproar Also need management, yet, Republicans are silent. Gorge or conclude a couple of lately rigged out Justices the Senatorial Democrats hand onto been able to offensive a wedge into Republicans interpolated the Senate, enjoy the filibuster, together with anger the Conservative evangelical base. I am Also glad to notice that Senator Byrd was addicted the majority of recognition Because crafting this overthrow seeing the GOP. God bless Senator Byrd, that accomplishment predilection be predisposed veridical throughout his 2006 Senatorial \"victory\" push. Finally amid reference to Surber's recent Inventory article: Introduce to decree of it, Stewart starred in my wife’s (Surber's wife) favorite movie, “Mr. Warner Takes A Vacation.” Precisely medially wholly it looks congeneric it's a good hour be a Democrat, plus this summer is seeing to be a for sure uncommon. 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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