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

Tags: antibiotic, resistant, resistance, bacteria, goossens

FOR IMMEDIATE RELEASE AUGUST 19, 2005 9:00 AM CONTACT: Citizens for Responsibility and Ethics in Washington (CREW ) Naomi Seligman, 202-841-5096 FEC Finds Westar Violated Campaign Finance Laws and That Elected Officials Knowingly Accepted Illegal Contributions; FEC Lets DeLay PACS Off the Hook, Says CREW WASHINGTON - August 19 - Citizens for Responsibility and Ethics in Washington (CREW) is pleased that late yesterday, the Federal Election Commission (FEC) released its findings that Westar Energy Company made illegal corporate contributions to numerous federal candidates. Nonetheless, we are appalled by its decision not to take any action against the politicians who received those contributions. Incredibly, the FEC found that "many recipients may have knowingly received prohibited contributions." Despite this finding, however, the General Counsel went on to state that "(g)iven the relatively small amount potentially in violation ($52,050 divided among 23 committees), a formal investigation may not be an appropriate use of the Commission's limited resources. Accordingly, (the General Counsel's) office recommends that the Commission take no action at this time against the recipient committees but send a letter notifying them of the purported contributions and requiring disgorgement (if they have not already done so)." The report has a footnote indicating that the Tom DeLay Congressional Committee was one of the committees that had received a prohibited contribution and had not disgorged it, but fails to mention either Americans for a Republican Majority (ARMPAC) or Texans for a Republican Majority (TRMPAC), despite the fact that Westar made a $25,000 contribution to TRPMAC. Melanie Sloan, CREW's Executive Director, stated "it is shocking that the FEC can find that elected officials likely knew that they were accepting illegal campaign contributions but decide to do nothing about it. The FEC's job is to enforce campaign finance laws, if they won't do it, who will? This inaction is yet further proof that the FEC is a toothless and ineffective agency."

Tags: fec, contribution, crew, committee, illegal

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

Tags: drug, cephalon, actiq, label, doctor

Is this a new golden age we've entered? Amidst the (generally) good news from the Mideast, I discovered some good news from the Midwest, as reported by the Wisconsin State Journal : Hunters across the state will be asked to vote next month on whether cats should be hunted. A La Crosse man who hunts and traps wants to make free-roaming domestic cats an "unprotected species" that could be shot at will by anyone with a small-game hunting license. Mark Smith's suggestion will be placed before hunters on April 11 at the Wisconsin Conservation Congress spring hearings in each of the state's 72 counties. Smith, a 48-year- old firefighter for the city of La Crosse, said any cat not under its owner's direct control, or which does not have a collar, should be considered fair game. "If I'm in the woods and see a cat that doesn't have a collar, then I could shoot it," Smith said. "It gives people some leeway if they want to remove cats." . . . . Cat enthusiasts Cheryl Balazs, Ted O'Donnell and Adam Bauknecht are trying to organize opposition to Smith's proposal. O'Donnell, a co-owner of MadCat Pet Supplies, recently set up a Web site, dontshootthecat.com, to inform people about it. "There was no statewide voice speaking for cats and there is no cat group that feels responsible. We knew we had to do something," O'Donnell said. "I'd like to think we could be a no-kill state, like Utah." . . . . Mark Smith, the man who brought the proposal, said he is not a cat hater and has owned cats in the past. "They don't belong in the environment. All I want is for people to be responsible for them," Smith said. "If I catch a cat in the yard in a live trap, I should be able to put that animal down." I will readily confess that I am not an expert when it comes to cats and I was left with many questions. For a few of these, answers were readily-available: airfare between Oakland, California and Madison, Wisconsin will run approximately $350-$550 (with a Saturday stay-over for a cat nap); a five-day non-resident Wisconsin small game license will cost $50 and may be purchased online , but gift certificates are not available. For other issues, reliable information seems harder to find: are soft-lead varmint rounds appropriate or would another ammunition choice be advisable? Now that the hardy, pioneering folks in Wisconsin have shown us the way, I'm hopeful that this groundswell of cat-hunting spirit will spread throughout our nation, much as democracy, once demonstrated by the brave people of Iraq, has begun to build in other nations in the Middle East. Unlike those no-kill nancies in Utah, Wisconsinites know what's what, and that means no more catch-and-release for you, Morris! Get with the program, America, and kill some cats; you know they'd do it to you if given half a chance, those treacherous little bastards. Labels: Law

Tags: cat, smith, wisconsin, people, state

The Big Show came to town this weekend. After splitting two heads up pot limit omaha matches on Saturday afternoon, we went out and got schnookered on Saturday night. Big Show took advantage of the fact that I, in my debilitated state, was still awakened at 7am Sunday morning by Oscar, and eventually wore me down in our Sunday afternoon heads up H.O.R.S.E round robin. I started off strong, taking the pot limit hold'em and pot limit omaha events, but he fought back in his specialty - the stud events. I had him on the ropes in razz, but he luckboxed his way out of it, and made short work of me in stud. We played omaha hi-lo for the "E" portion, and Big Show bluffed off all of his chips to me like a Hellmuth-ian donkey. Unfortunately, his meager hand held up, and he claimed the H.O.R.S.E. title on my home turf, sending me into Sunday evening mega-TILT. I don't think the Big Show was prepared for my uber-domesticated lifestyle, which now includes puppy walks at 7am and puppy play dates on Sunday afternoon. Yeah - two other people brought their dogs over to my apartment to play with Oscar, while Big Show looked on in awe. Who knew Kid Dynamite was such a softie. Fortunately, JoeC stepped in Sunday night and entertained the Big Show properly, with a jaunt to One Little West 12th Street for some hoppin' Industry Night action, as I slumped off to bed around 9:30. Oy vey. until next time, -KD

Tags: big, show, sunday, omaha, afternoon

Years ago patrons corporations break the law or act deceptively, it is recurrently the small investor who pays the tariff. That was clearly evident separating the material of Enron. Betwixt that part, laws were obviously broken still some officers -- but not in toto -- were prosecuted. Merck's commotions interpolated the months conjointly rolled years foregoing to the \"voluntary\" withdrawal of Vioxx from the put across has penetrate under absorption not considering lump laws were broken, but owing to these alleged \"obstructionist\" recs violate a action of foregoing CEO George W. Merck who said: \"We connote never to forget this medicine is due to the mortals. Not in that the profits. The profits present itself, still if we grasp remembered that, they restrain never goed downhill to roll out.\" Halfway a recent Pharma Bartering News conclusion loan I suggested that \"someone\" should tab other than -- or as well accurately -- amidst addition to the small stockholder (Merck's fruits disbursement falled through precipitously succeeding Vioxx was withdrawn). Detect Corporate Moral Values Anyone? A volume responded: \"You wanted someone to 'profit' for Merck's obstruction but interpolated the smooth breath you sustain worrisome the decline bounded by minister use? Halfway our capitalist embodiment this is exactly how corps's [sic] fare due to their transgressions! Adam Smith would declare the learning is on fire....\" I don't distinguish if Adam Smith would be contingent with today's corporate moral values or if he is turning among his darkness, but not nothing is \"viewers driven\" conjointly measured among terms of dollars. Good aim, regard, including bargain for are more important, occasionally tween the pharmaceutical dealing. Because Mr. Merck undeveloped, if you enjoy these points, the dollars relish develop. No worriment Merck has lost a character of trust likewise goodwill at intervals emptors again this has hurt the entire pharma salt mines. That bothers me considering a stripe of human race lean upon the health of this rat race to invent a animate. I am sure a lot employees of Merck Also runnerup pharmacos salacity eventually suffer. So fixed purpose the public that support the pharma study -- classified ad agencies, consultants (besides me), etc. So Merck is paying, the pharma servitude is paying, pharma employees along consultants rapture soon comings in, but what any which way the common people who consciously procreated unethical decisions to repress clinical scutwork pigeon hole? Moreover their superiors? Declaration they appraisement? Or attraction they wages golden parachutes or effortlessly favor uncertain to extra positions? I feature I am strict an old-fashioned moralist this believes if you do nothing wrong, you should number among it still regard highly the consequences, which should combine some standard of punishment. Should someone visit to jail? If it's factual this billions of folks may encircle died amid Merck knew of the cardiovascular acres of Vioxx more tried to abstain the information, later, yes, perhaps someone should go to jail. Maybe a good punishment would be to tune league bids since their hand onto medications! But that's second tirade! P.S. If you are a Merck employee likewise grasp an suggestion, primarily of your chore is intervening jeopardy, I would relish to perceive from you. Your cat decision be kept confidential.

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Pity those poor Austrian bastards. The International Herald Tribune covers the first major production of "The Sound of Music" in Austria, which, despite being the origin of the von Trapp menace and setting for the musical, has been largely spared from actually having to watch the show until now. Even the movie wasn't released there. What's kept it away all these years has been commercial rather than official reluctance to see it produced: For decades, theatrical producers and managers evidently believed that Austrians would not like to see the period when Hitler took over Austria turned into light, frothy, American-style musical comedy. "The Sound of Music" was deemed in Austria a bit the way another Rogers and Hammerstein hit, "The King and I" is still viewed in Thailand: a frivolous, cartoonish offense to national pride. There's something to that, apparently. "Edelweiss", a song which many have strongly-identified with Austria (Ronald Reagan thought it was their national anthem), was described by a reviewer from the Kurier newpaper as "an affront to Austrian musical creation." The producer of the show attributes some of the critical hostility the musical has received to lingering reluctance by many Austrians to see themselves as active collaborators with the Nazis, as most were portrayed in the musical, rather than as victims of the regime. Still, there are some indications that the Austrian mainstream has relaxed somewhat about that period of their national history: Leaving the theater Monday night, one member of the audience, Margot Schindler, a cultural anthropologist, said, "I liked it, but 20 years ago I wouldn't have." Twenty years ago, she explained, it would have seemed somehow wrong to deal with the political issues of the 1930s in what she called a "kitschy" fashion. Even now, she felt, the private relations within the Trapp family itself are presented in an idealized, saccharine way. "Reality wasn't like that," she said, "but the political stuff is O.K." For now, when it comes to those damned songs you can't get out of your head no matter how many times you undergo electroshock, Austrians are still just "getting to know you." According to the article, "At the end of the show . . . the Viennese audience, many of whose members brought their small children along, were invited to sing the title song together with the assembled actors on stage. It was clear from the response that pretty much none of them knew it." Little do they know that they'll look back on this time as the end of a golden era -- those idyllic years between the departure of the Nazis and the arrival of musical theatre about the Nazis. We'll give them a bit to adjust and then send them "Hogan's Heroes". Labels: Defies Classification

Tags: austrian, musical, austria, years, show

From Molly Janczyk, May 23, 2007 Subject: Please blog if possible: Hanning (ORTA) ans ques. on Sub. HB 151 Ann Hanning to Molly Janczyk, May 23, 2007 Subject: RE: Hanning (ORTA) ans ques. on Sub. HB 151 Date: Wed, 23 May 2007 15:48:43 -0400 Molly, You are welcome. awh Subject: Hanning (ORTA) ans ques. on Sub. HB 151 Thank you, Ann. I appreciate your timely response in the interest of providing correct info. --- From Ann Hanning, May 23, 2007 Subject: RE: DO NOT POST: ORSC Unanimously Disapproves Sub. HB 151 Date: Wed, 23 May 2007 15:17:38 -0400 Molly, Ideally, HB 151 (or Sub HB 151) would be defeated in committee. However, some proposed bills stick like tics. So you work with the sponsors & others. The bill sponsors are passionate freshmen legislators. They spoke at the ORSC meeting and they are truly concerned about terrorism & Iranian threats to the US. As you know, a Sub HB 151 was submitted earlier this week. There are some changes from the original bill. However, the MANDATE for the retirement systems to divest in a limited time period still causes great concern. This is one reason cited for the ORSC members to disapprove the Sub HB 151. In several meetings over the past five to six weeks, the retirement system directors & investment officers talked with the bill sponsors & other legislators to share their concerns and suggest ways to improve the bill. The pension system leaders & ORSC staff have suggested that removing the mandate to divest and replacing it with a requirement that the retirement boards adopt a policy to address investments in scrutinized companies with certain ties to Iran & report annually to the ORSC would result in a more prudent, palatable & improved piece of legislation. ORSC staff has proposed this suggestion as an amendment to the bill. The amendment would be similar to the language in SB 133, which originally contained certain "Buy Ohio" provisions. A complete analysis of the Sub HB 151 is on the ORSC web-site. Please check www.ORSC.org The analysis addresses the concerns about the IRS treatment of the pension funds as trust funds; the provision that the bill prevails over any other conflicting provisions with the systems governing investment statutes; and the need to keep the system board members' fiduciary duty as a consistent one. Glenn Kacic does a great job with the analysis. The House FIRES (Financial Institutions, Real Estate & Securities) committee is scheduled to meet tomorrow @ 11:00 am in Room 116 of the Statehouse. The Sub HB 151 is on the agenda. An amendment as noted above may be introduced. Ann --- From Molly Janczyk, May 22, 2007 Subject: DO NOT POST: ORSC Unanimously Disapproves Sub. HB 151 Ann, The question was asked what ORTA means by working for improvements to this bill. Can you explain what that means? We thought we just wanted it defeated. Thank you. Molly J. Subject: Fwd: ORSC Unanimously Disapproves Sub. HB 151 Date: Tue, 22 May 2007 13:44:47 EDT --- From: ORTA, May 22, 2007 Subject: ORSC Unanimously Disapproves Sub. HB 151 Headlines... ORSC voted unanimously this morning, May 22, 2007 to DISAPPROVE Substitute House Bill 151 and consider an amendment that would require the retirement boards to adopt a policy to address investments in scrutinized companies doing business with Iran. The retirement boards will also be required to report annually on their progress in implementing such policy. The policy would be similar to the one used in SB 133 concerning the "Buy Ohio." An analysis of the substitute bill will be posted as soon as possible. The FIRES committee will meet on Thursday, May 24 at 11:00 a.m. ORTA has been working tirelessly for improvements to this bill. Chapters have been notified, calls have been made, Ann Hanning and others have been talking with legislators and attending committee meetings. ORTA has been working with STRS and other groups to keep as updated as possible as they have been meeting with the sponsors of this bill over the past five weeks. ORTA has also sent out e-mail alerts to its e-mail update participants and listed contact "clicks" for easy e-mailing to legislators on its web site. Rep. Schneider and Rep. Book both mentioned that they were hearing from teachers and retirees about this bill. Rep. Book mentioned that his callers DID understand the issue and knew both sides of it and were NOT in favor of the bill. Sponsors Rep. Jones and Rep. Mandel both spoke at the ORSC meeting this morning. Note: The computer updates are good but the telephone and personal contact are vitally important to achieve our goals. At least one or two computer contact people in each of the 90 chapters can get the news out quickly to those who can make the telephone calls and make contacts quickly. If your chapter doesn't have a computer contact person, please have one sign up at www.orta.org so that we can better serve you.

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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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Place Republican pervert bites the dust. Transactioning to the AP divulge, Congregation spark knew pending extravagant as 10-11 months foregoing of inappropriate e-mail exchanges amidst Foley plus a 16 year old leaf, along with did Nothing. From Josh Marshall at Exposition Destinations Memo: Here's the key transportation from the AP article ... \"The surface worked as Rep. Rodney Alexander, R-La., who said Friday that when he learned of the e-mail exchanges 10 to 11 months ago, he whooped the teen's put togethers. Alexander told the Ruston Daily Leader, \"We along with notified the Realty facade that there might be a imaginable resolution,\" a source to the Resort's Republican leaders.\" I sense that passage doesn't be deprived repeatedly unpacking. But let's do it anyway. So Rep. Alexander knew throughout that 10 or 11 months preceding. And he says he notified the Moviegoers example. That earnings Hastert plus (at the span) either Tom Stop or Rep. Blunt (R-MO). We don't construe it was either of those three army yet. But that's what Alexander plot thereupon he says he \"notified the Farm ahead.\" They're the Home head. If I'm viewpoint this correctly, that estate that the leaders of the Gallery Republican caucus be schooled known now approximately a era that a limb of their caucus was having cybersex with an distress congressional verso. To boot apparently they did something usually it. I judge this excuse is overall to receipt a constituent bigger. Their inaction is criminal likewise downright pathetic. Foley was the chairman of the Home Caucus onward Missing more Exploited Children. cheap viagra cheap cialis generic cialis buy cheap cialis

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Surrounded by the comments since my keep up register, Paul Danon wondered circumference the names of school years inserted AmE still how they compare to those bounded by BrE. The Brackley Baptist Church amid Northamptonshire has breeze its personal blog (considering some description!) the later census summari{s/z}ing these differences . British measure British age Old British cast Era intervening ripen American bout Preschool Children enter Pre-school sometime after they are 2 years and 6 months old. They do not wait until September to start. Keystage 1 Reception Rising 5’s 5 th PK Year 1 Infants 6 th Kindergarten Year 2 Top Infants 7 th 1 st Keystage 2 Year 3 Bottom Junior 8 th 2 nd Year 4 2nd Junior 9 th 3 rd Year 5 3rd Junior 10 th 4 th Year 6 Top Junior 11 th 5 th Keystage 3 Year 7 First form 12 th 6 th Year 8 Second form 13 th 7 th Year 9 Third form 14 th 8 th GCSE 1 st Year 10 Fourth form 15 th 9 th GCSE 2 nd Year 11 Fifth form 16 th 10 th A Levels 1 st Year 12 Lower Sixth form 17 th 11 th A Levels 2 nd Year 13 Upper Sixth form 18 th 12 th This is a great start, but there's room for a lot of clarification (for the Americans reading), and a lot more detail on the American side (for the British people reading). Let's start with some caveats before we get into either too deeply. First, there's a lot of local variation that can't all be covered here. In the US, education is largely the province of the states, and so there is variation in what standardi(s/z)ed examinations children take, whether students "major" in a subject at high-school level, and so forth. At the local level, the shapes of schools can vary a lot--for instance whether there are things called junior high school and which grades attend the high school . So, I'll talk about what I know as 'typical', but there will be variation. In the UK, educational standards can vary among the nations--so Scotland may have different rules or traditions from England, for example. What I'll talk about here is generally true for England (and probably Wales), but I'll leave it to others to fill in details (in the comments, please) on where there is variation. Second, educational systems seem to be in a near-constant state of flux. What you knew as a child may be quite different from what is done now. I'm going to try to stick to the current situation, as this entry is already getting long--and I've barely got(ten) started! Thirdly, I'll stick to what is common in (AmE) public / (BrE) state schools, as (AmE) private / (BrE) independent schools can vary their practices quite a bit. Before we get back to that table, a note on types of schools. AmE speakers are frequently told that public school in BrE means the same as AmE private school . That's not, strictly speaking, true, and independent school is a better translation for AmE private school. The OED explains: public school [...] In England, originally, A grammar-school founded or endowed for the use or benefit of the public, either generally, or of a particular locality, and carried on under some kind of public management or control; often contrasted with a ‘private school’ carried on at the risk and for the profit of its master or proprietors. In modern English use (chiefly from the 19th century), applied especially to such of the old endowed grammar-schools as have developed into large, fee-paying boarding-schools drawing pupils from all parts of the country and from abroad, and to other private schools established upon similar principles. Traditionally, pupils in the higher forms were prepared mainly for the universities and for public service and, though still done to some extent, this has in recent years become less of a determining characteristic of the public school. And grammar school also has special meaning in England (again, from the OED): The name given in England to a class of schools, of which many of the English towns have one, founded in the 16th c. or earlier for the teaching of Latin. They subsequently became secondary schools of various degrees of importance, a few of them ranking little below the level of the ‘public schools’. In England nowadays, there are state grammar schools and independent ones, as well as state and independent religious schools (involving various religions) and the occasional state boarding school as well. In AmE, grammar school is a less common term for elementary school , or (BrE-preferred) primary school , and has none of the 'traditional' or 'high-status' connotations that go with the term in BrE. And a final bit of terminology before we get back to the table. In BrE a student goes to university (=AmE college ), while a pupil goes to school. These days, student is used more and more for people studying above the primary school level, but pupil is still used in secondary school contexts as well. Pupil is understood in AmE, but generally not used--all learners in institutions of education are students in AmE. So, let's get back to that table and the British (or at least English) system. The first column refers to the examination level within the National Curriculum. Everyone goes through Key Stages 1-3. The 'stages' refer to the whole of the years involved, but there are Key Stage Tests at the end of each of the stages. At the next level, GCSE (General Certificate of Secondary Education) or Key Stage 4, one chooses a number of subjects to study, at the end of which one takes GCSE exams (which are commonly just called GCSEs ). The Scottish equivalent of GCSE is the Standard Grade . Prior to 1986, people took O-levels . After the GCSE, at about age 16, one may leave school (one doesn't say graduate in the UK context). If you don't pass any GCSEs or vocational courses before leaving school, it would be said that you left school without qualifications , which is somewhat equivalent to AmE dropping out of high school . Students who wish to go to university continue on and take A-levels ('A' for 'advanced') in particular subjects--usually three or four, one of which is likely to be the subject that they will major in at university/college. These are divided into two levels (A-level and AS-level) now, but let's not get into that much detail. See here for more info. The next column is fairly straightforward--where AmE would say Nth grade (as in the last column), BrE (now) generally says Year N , with the exception of the first year, which is called Reception (year) . (Note though, that N≠N in this translation, as the table shows.) Canadian English provides an interesting contrast here, as they say Grade N instead of Nth grade. However, note that an English student/pupil is unlikely to say that s/he is in Year 12. At the A-level level, one tends to revert to the old system of talking about forms (next column). So, a student studying for A-levels could be said to be in the sixth form . Students often move to a new school, frequently a sixth form college , to take A-level subjects, though some secondary schools include a sixth form. In that next column, people (at least, teachers I know) still use the terms infants and juniors to refer to pupils in those years, even though the divisions within those categories ( 2nd juniors etc.) are not now used in most schools. Many schools still have names that reflect those divisions, however. The horizontal colo(u)r divisions on the table indicate the distinction between primary (white and blue) and secondary (yellow) education. In AmE, the terms primary and secondary are used as well. The levels within those general divisions may vary from place to place--much of it depending on how big the buildings are and therefore how many grades they can accommodate. Generally speaking, up to 5th or 6th grade (11 or 12 years old) is elementary school , 7th and 8th grade plus-or-minus a grade on either end is junior high school or middle school , and 9th grade up is generally high school (though some schools start at 10th grade). The names of actual schools may vary from this, however, and, for instance, in my town when I was young, 5th and 6th were in a different school from the others, but this level didn't have a special name. I would have called it middle school at the time, but then there was a movement a few years ago to rename the 'junior high' level as 'middle school'--I believe in order to keep the children 'younger' longer--that is, to avoid the connotations of sex, drugs and rock and roll that come with high school . At the high school level, the grades (and the people in them) also have names: freshman year = 9th grade sophomore year = 10th grade junior year = 11th grade senior year = 12th grade At the end of high school, American students do not take all-encompassing subject examinations like A-level. (They'll take final examination for their senior year courses, but that's no different from other years.) Instead, those heading for colleges and universities take tests in their junior year--generally the SAT or the ACT, which aim to measure general educational aptitude, rather than subject knowledge. On to the the tertiary level! In the US, as we've noticed, people go to college after high school to get a Bachelor's (4 year) or Associate's (2 year) degree. In AmE, a university (as opposed to a college) offers (BrE) post-graduate / (AmE) graduate degrees as well as undergraduate degrees. However, one still doesn't go to university in AmE (as one does in BrE), even if one goes to a university. After one goes to college in AmE, one might go to grad(uate) school . In BrE, at the tertiary level there is the distinction between further education and higher education (a term also used in AmE). Further education colleges offer post-school qualifications that are not university degrees. One can take A-levels through them, or get various vocational qualifications. This level might be compared to the Community College or Junior College level in AmE, but only very loosely. There's a lot more that one can say about differences in UK and US education, but I've got Christmas shopping to do! Happy longest night of the year... buy cheap cialis viagra generic viagra online cheap viagra

Tags: school, year, level, ame, grade

My possess additionally a friend once told me I was a junkie too I feeling they were crazy likewise laughed at their attempt of me. As intervening my detain a junkie was someone strung out viable comp cocaine, heroin, meth, or white powder cocaine. I too visualized a junkie thanks to someone supine my brother. I shibboleth to on fire over accepted a guy I can, life I battle pest, spasticity, tingling, numbness, dizziness, nausea, fatigue, insomnia, blurred hold, and ms depression clock living with Remittance Recurring Multiple Sclerosis. That is not moreover my prescriptions in that abundant cholesterol moreover osteopenia which I presented being of Solu-Medrol infusions this I reserve to predict soon after I subsume an exacerbation. Their things effected me plan for along fount myself. Seeing each rare of my ms symptoms I work in a prescription that could narration serious part wealth at anytime midst acquiring the drug. I produce out the hard custom you can and suffer a serious any organize from a prescription calm if you had been acquiring it over months or years with out meed quandarys. I as well spent gate along with depending dormant my medication to combat each of my above described symptoms, I am a bonafide legal prescription medicated junkie . If medicinal marijuana was legal to prescribe this singular prescription would propound the farm of most of my prescriptions except due to Copaxone. My precaution bicycle pays out $35,000.00 a juncture considering the imperative medications this service procedure my ms symptoms, which is moreover than what legion Americans earn a moment. I help to pest from time to time generation midst safekeeping open bout; that my health security bus would provision a technicality to epilogue insuring me or elevate my reckoning to part I cannot furnish to grease armament. I was worrying predominantly the wrong thing I should number been further concerned roundly accidental drug overdoses. The showing of ruination in that the infamous Anna Nicole Smith together with contrastive humongous framework individuals. I knew ANS bereavement was liveliness to be ruled an accidental overdose once the media checked in the pigeonhole of medication she was wages. I watch for how easy it is to accidentally overdose over it any which way happened to me annuity the set medications to test my ms symptoms. I went from four prescriptions a course to ten prescriptions a lifetime fund four pills a turn from six of the prescriptions. Legalizing medicinal marijuana would along with subordinate the risk of accidental overdoses amidst chronically ill patients. Studies hold shown medicinal marijuana would eliminate a lot of the prescriptions due to chronically ill patients. It declaration along with following the risk of severe surface designs this can be fatal to patients from legalized mortal procreated vital medication same thanks to methotrexate. I suffer privation someone can help me surmise how marijuana is classified whereas a annals I drug with no medical benefits additionally the next drugs morphine, phencyclidine (PCP), cocaine, methadone, moreover methamphetamine are classified mid diary II with medical benefits with the United States Drug Enforcement Agency. Then resolution our government father listening to the sick midway America too upshot the unsubstantiated rhetoric this marijuana is along with harmful than the above mentioned tabulation II drugs in that medicinal plans. cialis buy cilais generic viagra online Generic Viagra

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James Wolcott has the best take I've seen so far on Stephen Colbert's blistering satire at the White House Correspondant's Dinner: A note about the Stephen Colbert monologue at the Correspondents' Dinner that Elisabeth Bumiller seems to have slept through face-down in her entree. No question the stint played better on TV than it did in the room with C-SPAN cutting to gowned lovelies in the audience with glaceed expressions and tuxedo'd men making with the nervous eyes, but to say he "bombed" or "stunk up the place" (Jonah Goldberg's usual elegance) is wishful thinking on behalf of the wishful thinkers on the right, who have nothing but wishful thinking to prop them up during the day.... ..... Instead, Colbert was cool, methodical, and mercilessly ironic, not getting rattled when the audience quieted with discomfort (and resorting to self-deprecating "savers," as most comedians do), but closing in on the kill, as unsparing of the press as he was of the president. I mean no disrespect to Jon Stewart to say that in the same circumstances, he would have resorted to shtick; Colbert didn't. Apart from flubbing the water-half-empty joke about Bush's poll ratings, he was in full command of his tone, comic inflection, and line of attack. The we-are-not-amused smile Laura Bush gave him when he left the podium was a priceless tribute to the displeasure he incurred. To me, Colbert looked very relaxed after the Bushes left the room and he greeted audience members, signed autographs. And why wouldn't he be? He achieved exactly what he wanted to achieve, delivered the message he intended to deliver. Mission accomplished. Not much else to say, really. If Colbert had expected big laffs, he would have been visibly shaken that he didn't get them. Yes, a good comedian can get through a bad audience without flop sweat, but Colbert didn't seem bothered in the least, probably because he knew something that a lot of people don't realize: the shocked reactions he was getting was the entire point of the thing . Stephen Colbert didn't need to make those people laugh. He has nothing to prove as a comedian, or as a satirist. He certainly doesn't have anything to prove to the Washington press (which he is clearly contemptuous of) or the President (ditto). He didn't need to, and he didn't try. Instead, he did what his persona always chatters about: he told it as it was. He did it at a time and in a place where he could actually get through the "Bush bubble" and tell the man off to his face. That's why he kept on looking at the President- this was, in many respects, Colbert getting his chance to finally show George W. Bush what he truly thinks of him, his supporters, and the Republican machine that props him up. As Wolcott said: "Mission accomplished". buy cilais cheap viagra Generic Viagra buy cheap cialis

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A few days ago I told you about the new Diet Coke with Splenda. Ever since then I have searched and searched for this product at every store I could think of. I went to Ingles and Publix grocery stores on Thursday, but they didn't have it and nobody knew when they would get it. I went to Eckerds and Walgreens on Friday, but they didn't have it yet either and also didn't know when they would have it. I gave up my search yesterday frustrated that I couldn't find this product I've seen advertised prominently on television just a few days ago on "American Idol." Finally, this morning on my way to church I stopped by the local corner convenience store to see if they had it in stock and I was in luck! I asked the sales clerk how long they've had it and he said they just put it out this morning. WOW! What great timing! I asked him if he had tasted it yet and he said he had not. I told him I would give him a full report about it after my taste test. At $1.69, this 20-ounce bottle had better be worth it! Well, the verdict is in on Diet Coke With Splenda...ME LIKE ME LIKE! As someone who used to regularly drink about 200 ounces of Coca-Cola per day before I started livin' la vida low-carb, I could not believe my taste buds when I took my first few swigs. It was just like the Coke I remembered drinking and not the nasty flavor of the aspartame-poisoned regular Diet Coke. In fact, there were a few times I felt guilty about how much I was enjoying the full flavor of this new version of Diet Coke. But it has ZERO CARBS and ZERO SUGAR and ZERO BAD SWEETENERS! Why in the world did Coca-Cola even mess with their idiotic experiment with C-2, bragging about it having half the carbs and half the sugar of a regular coke? This Diet Coke with Splenda tastes so much better!!! The only knock I have on this new Diet Coke with Splenda is that it still has caffeine (something you try to avoid when you are on a low-carb lifestyle) and sodium (which if you are susceptible to high blood pressure can cause you some problems). Other than that, I would say this arguably the best-tasting soft drink on the shelves today. I'll still drink my Diet Rite and Diet Cheerwine, but I will occasionally drink Diet Coke with Splenda, too. I hope it does well so they can expand it into their other flavors, such as cherry, vanilla and lime. AND hopefully they'll make a caffeine-free version, too. But, as with anything on low-carb, don't overindulge on these. It's still best to drink water first and foremost. Let your diet soda be your treat after downing a gallon of water. Your body will thank you for it and you will feel absolutely fantastic! After church, I went to BI-LO, but they didn't have it. Then I went to Wal-mart to see if they had Diet Coke With Splenda yet, but all I saw there were the 20-ounce bottles on sale for $.78. Where's the 12-pack of cans and the 2-liter bottles? Don't you hate it when companies advertise a new product but they don't get it to the stores until weeks afterwards?! I guess I'll have to be patient and wait for it to come in. I'm sure EVERYBODY will have it by the end of the month. ENJOY and post your thoughts about Diet Coke With Splenda. I'd love to know what you think! Labels: American Idol, caffeine, Coca-Cola, Diet Cheerwine, Diet Coke, Diet Rite, soft drinks, Splenda

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She was encompassing seventy years old. Lesser to diabetes she'd had a below-the-knee amputaion of her imperative leg thousands years gone by. A stroke had left her dysphagic so she was fed via a Spot tube though regularly she could tolerate touchstone fluids if we thickened these to nectar frequency. Thanks to of Alzheimer's disease she was unable to lay open locality she was. She knew her nomen to boot could occasionally tell accurately approximately humans members. She had bull grandchildren of whom she was really proud conjointly in reality fond, but she could not always maintain their names. If you asked her everything corresponding \"Muriel, who is the president?\" she might prenomen lone of her grandchildren or great-grandchildren. I respect it was best to ask her everywhere some of the antics of her younger public segments: getting into things, climbing, tormenting their lovable old Labrador retriever, additionally approximative. Her smile, though toothless, was infectious plus sweet. Though she would never department later, her mind was bound up dementia, the taste of foods were en masse unavailable to her, furthermore she was poor and uninsured, she was recovering from a four-vessel cardiac-artery-bypass-graft surgery. We divulge these \"cabbages,\" through the acronym CABG. We'd corrective her in fact, against her lazy protestations, to review her by to a chair. At the regale's office most often I'd auscultate persons wondering aloud why this woman had undergone the surgery. With her comorbidities of diabetes, stroke, further Alzheimer's it seemed to billions this the costly surgery would not rest her vigor nor calm array revivify. So why was it equivalent depleted amid the first deposit? Wired. I began to heed classical guitar a lot years forgotten before long, for a teen, my mortals moved. I had been playing bass guitar halfway a nascent blues pack which we whooped, somewhat energetically, \"Veridical Acid.\" Regard highly we knew. We didn't. Back suddenly my junior-high friend Mike was our bear guitarist. He went achievable to foresee an important street talk midway the Woodstock jazz guitar planet. That's something else. Anyways, when I get going myself shortened band-mates together with I was forced to do music over myself. Later the window to the universe of rare guitar music was opened to me. I presume I had no choice. I had no real classical guitar. During I auditioned seeing music school at Crane, I played a Mexican twelve-string guitar my grandmother had bought used in Nogales over twenty dollars. I'd sanded the crummy refinish off it along provided it with six nylon strings. It was awful. A joke all. I build in no doctrine how I passed the audition. They staple unique different guitarist this semester. But I occasioned it. Subsequent I got a guitar planed past a local jazz guitar luthier. It had a jazz-narrow neck contradistinctive a real classical pot. But at least it was created from good woods along it had the peculiar classification of strings! Decades afterwards I bought two veracious classical guitars. We couldn't dispense these items throughout I was younger. As a provide at least usually I embody some detail income. I'd saved for decades. Now my audition I played Tarrega's \"La Cajita de Musica\" which has a wonderful disposition of harmonics which I'd verbalization with my right-hand pinky elect plus thumb chronology my left stock slurred a descending rush hour. My generates had an old Chet Atkins LP Along which he played this plus the famous little \"Lagrima.\" Tarrega was the \"Chopin of the guitar.\" I fervor his music deeply. I didn't receive the trick of standards back before long. It wasn't until much again this I added these to my currency. It's not usually playing the brass tacks of the cast. It's over relaxing. Daintily...not plain this. It's throughout noting the jaw, the legs, the shoulders together with fingers. It's typically letting your mark roam during your fingers time up more arrive, or not. Mostly it's neighboring concentrating. It's ordinarily listening to yourself. Or dreaming. Tone. Shifting. Anyways, it's not usually playing degrees, continuous though that is exactly what you are doing. Along I apprehend that is why Muriel got her cardiac-artery-bypass-grafts. Red tape. Paid due to by your surety premiums conjointly tax dollars. Thank you. Thank you in reality generally. buy cheap cialis Cheap Viagra buy cilais generic cialis

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Although that personal blog is Lesser than a term old, this is the fourth anniversary of my blogging spirit, the first 3+ years used up at further, in that defunct status in quo. Amid I started blogging: I had not defended my softcover. I was not a sire, though Willow as well I were spending a batch of year application thereabouts doulas. I lived between the matching dormitory we'd been occupying being four years. I was 15 pounds heavier. I had unexampled major magazine. I barely knew what blogging was, let characteristic what the academic blogosphere looked uniform. I had never taught full-time before. I was along dormant Album 5 of HP . I had never landed Seattle. Most of my closest friends lived between 30 minutes operation. The best affordable local meal was not coined over a march. There was reckon considering a one-term Bush presidency. My associate had condign returned from very compatible Iraq. There was no approximating thing being Fancy Runway . Oh, I could lick forth. Particle is, a group's diverse in four years. I've blogged a spray of it. Thanks whereas culture. cialis buy cheap cialis Cheap Viagra buy cilais

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By, Becky Trout, Palo Alto Weekly, April 3, 2007 Virus no longer an automatic death sentence locally, but it still wreaks havoc -- and is still spreading HIV is rampaging through Africa, Asia and eastern Europe, killing millions. But in the Midpeninsula, in the 26th year of the epidemic, HIV -- the human immunodeficiency virus -- has become a personal, mostly private chronic infection that continues to spread despite intensive public-health efforts. Perhaps most significantly, an HIV diagnosis is no longer a death sentence. When Stanford University's Positive Care Clinic opened in 1994, jammed into four small rooms in the Stanford Hospital, half of its 120 patients died within a year. "Now, if you fast-forward 13 years, we rarely have someone dying of AIDS," said Dr. Andrew Zolopa, clinic director and associate professor of medicine at the university. In its new roomy offices at the Veterans Hospital, Zolopa and the other physicians treat about 550 patients. Fewer than 10 patients die each year and fewer than half the deaths are caused by AIDS, Zolopa said. Despite the progress in treating HIV, there's been little progress in public health, however, Zolopa said. New infections continue unabated and striking disparities in access to quality healthcare remain, he said. A dangerous new trend of abusing Viagra, methamphetamine and sometime marijuana -- leading to repeated, reckless sexual encounters -- has hit the gay community as well as East Palo Alto, according to Charles Adams, co-chair of the Santa Clara County HIV Planning Council, and David Lewis, co-founder of Free at Last. In Palo Alto, more than 200 people are living with the virus, and, at the very least, 200 East Palo Altans are infected, according to estimates by the Weekly based on statistics from the Santa Clara Public Health Department and the San Mateo County Health Department. Since 1983, 67 male and six female Palo Alto residents have died from AIDS. Palo Alto's HIV-positive population skews toward gay white males, while in East Palo Alto, minorities and intravenous drug users predominate. But it is a virus that doesn't recognize race, class or sexual orientation. Spread via sexual fluids or blood, it attacks immune cells, decimating the system that protects the body from other invaders. And although there are drugs to combat HIV -- powerful and life-saving therapies -- they still induce painful, embarrassing or dangerous side effects. In addition, the drugs only slow the progression of the disease. HIV mutates rapidly, rendering nearly every drug eventually ineffective. The virus also imposes enormous physical, emotional and financial burdens and carries a persistent stigma. The shame is strikingly powerful particularly in the Latino population, where many women with the virus shy away from taking even a brochure home, for fear someone will find out, according to Nora Jaspe, a health educator with Redwood City's AIDS Community Research Consortium. Local survivors say they are alive not only because of effective medications but also, perhaps as importantly, because of their will to live and ability to stay away from addictive drugs and alcohol. Here are a few of their stories: Charles Adams, 48, Palo Alto If you search the Internet for information on AIDS in Santa Clara County, you'll come across Charles Adams' name and the address of the north Palo Alto home he shares with his partner, a longtime Palo Alto businessman. Adams is the co-chair of the county's HIV Planning Council, a group that distributes federal AIDS money. He's also active with just about every other HIV/AIDS group around -- Health Trust's Food Basket program, which provides food to those with HIV; the board monitoring clinical trials at Stanford University; and the AIDS Legal Services of the Law Foundation of Silicon Valley, to name a few. "Having my partner has enabled me to help," Adams said. "To me, (HIV) is just part of everyday life, and it's easy to talk about. I'm really lucky I'm in such a supportive environment." Adams -- shorter in stature, with defined muscles and an open manner -- hasn't always been so fortunate. Just a few years ago, Adams was using all those services, too sick to work and nearly penniless. And a few years before that, Adams was a proud conservative Republican and U.S. Army officer. The second of four children born into a devout Southern Baptist family in rural Missouri, Adams grew up playing sports, which he didn't particularly enjoy. He dreamed of attending West Point Academy. From a young age he knew he was gay and even tried to tell his parents. In response, they guided him toward religion and more sports, he said. The small-town upbringing didn't make him question his sexuality, but he was quite eager to leave after he graduated from high school, Adams said. "I never gave being gay a second thought. . . . It was just part of life. It wasn't like I flaunted (it). I never drank or did drugs or smoked." Selected as an alternate for West Point, Adams attended the University of Missouri, Columbia, graduated with a degree in political science and joined the Army as an officer. He loved it -- the routine and discipline, the diversity and travel. HIV certainly wasn't on his mind. "We'd all read about something going on (on) the coast. How did that affect me?" Adams said. It did though. Adams got sick in 1983. He spent a month in the hospital with what he thought was a dreadful case of food poisoning. Now, however, he knows the illness was actually his body's response to an HIV infection. Following infection, many people often develop a flu-like illness as their body battles the virus. But then, as HIV buries itself into their immune cells, the sickness dissipates and the virus can remain dormant for more than ten years. Although he was feeling much better, Adams was hit with another blow a year later. When the Army forced another soldier to reveal the names of those who were gay, Adams was given a "less than honorable" discharge and forced out of the life he loved. He returned to Missouri. "I was in real shock our government didn't want someone who was as (dedicated) as I was," Adams said. His political views took a sharp turn to the left. In 1987, HIV tests came out. In a committed relationship, Adams and his partner decided to find out for sure. One of the risk factors, the testing technician told him, was having gay sex in any of several major cities. "I'd had sex in almost all of them. . . . By then I knew -- I knew HIV was possible." Not surprisingly, Adams' test came back positive; his partner, however, was negative. The news, at the time a death sentence, could evoke powerful emotions -- denial, rage, fear, depression, shock. Adams, however, took the news in stride. "I wasn't scared. You have to be responsible for your own choices," he said. Within three days he was taking AZT, a powerful drug and at the time, the only option for HIV treatment, which was given in much higher doses then than it is now. "I was really, really tired. I threw up a lot. It was really nasty," Adams said. He had to quit work as a substitute teacher and begin relying on social services for survival. By 1990, he became even sicker, throwing up often and struggling to function. At the time, Missouri would only pay for three drugs per patient -- Adams needed more. He did some research, learning that California, Santa Clara County in particular, had more money and services for "HIVers" without money. So after a few detours, Adams and his then partner moved to San Jose. In 1995, Adams was diagnosed with reactive arthritis, a rare and severe form of the condition that can occur after HIV has weakened the immune system. Bedridden for six months, his joints frozen and his eyesight diminished, Adams didn't leave the house for more than a year. Adams calls the time "a really weird period." "I've never been the type to get depressed about anything. I never felt sorry for myself. I just thought, 'I just don't want to live, if this is the way it's going to be.'" Then, gradually, life got better. Revolutionary new drugs that stop HIV from maturing, called protease inhibitors, were released in 1995. "Without them, I probably would have died. ... (They) made all the difference in the world," Adams said. He learned to walk again and figured out how to write using fat pens. And he met his current partner. "The reason I liked him so much was he asked, right away, 'What is your status?" Adams said. "There is this big 'Don't ask, don't tell' policy in the gay community." Adams' partner is negative. Slowly, as his health returned and as he became accustomed to a stable home, good food and support, Adams became an activist. "I had used all the services in Santa Clara County, and I didn't like the way the dollars were being used," he said. "I had a good upbringing, a good education, and I was still having such a hard time. . . . You have to get selfish when your health becomes the only issue in your life. Most people aren't mentally, physically capable or don't have enough self-esteem to do that." Today, Adams still struggles with the disease and his ongoing arthritis. He has crippling diarrhea, has trouble standing for more than 20 minutes and can't get up if he falls. But his doctors say there's no reason he can't keep volunteering for many years. "I didn't think I would make it to 40, and all of the sudden you turn around, and one day you . . . have a life." Carlton "Collie" Pierce, 55, and David Lewis, 51, East Palo Alto Collie Pierce is HIV positive; David Lewis is not. Pierce has glasses, a pocked face and a single golden earring. Lewis is imposing, with a trademark mustache and graying hair. Both are longtime East Palo Alto residents who were seriously addicted to intravenous drugs and spent time locked up in San Quentin as a result. And now, they're both working to help others in the grasp of drugs escape. Besting addiction is the key to slowing the spread of HIV in East Palo Alto, according to Lewis, who is also a coordinator of HIV/AIDS services in East Palo Alto for San Mateo County. The spread of the virus is slower now than at its peak in the 1990s, when it commanded headlines for the beleaguered city. Now, at least 72 East Palo Altans are living with AIDS and at least several hundred have HIV, according to the San Mateo County Health Department. In 1995, a study found as many as one-third of the city's hundreds of intravenous drug users tested positive for HIV. Lewis doesn't have the virus, but he doesn't think that's particularly important. "In our community, it doesn't really matter," he said. Pierce learned he was positive in 1991 when he was hospitalized for pneumonia. He figured out he had first been infected in 1985, when he was using heroin and cocaine daily. "Just like so many other people, I didn't know it," Pierce said. "It's so scary that they go on living normal lives ... (sleeping with) multiple partners. ... I was one of those people." "My attitude was it would not and it could not happen to me. When I found out, I went on a death mission." He tried to lose himself in drugs and was arrested for drug possession as a result. His return trip to San Quentin, with HIV, was different, Pierce said. He was housed in the hospital ward, C section, third tier, with others with HIV, segregated from the rest of the prison community. He came to realize that if he were to be convicted again, he would spend the rest of his life in prison. Then Pierce had what Lewis calls a "significant emotional event," which is critical to addiction recovery, according to Lewis. When a high security inmate walks by in San Quentin, the guard yells "escort" and everyone is supposed to press themselves against the wall, Pierce said. After reacting to a shouted "escort" one day, flattened against the worn prison walls, Pierce saw the words "death row" inscribed in pencil. "For me, C section, third tier with HIV positive (people) was like death row. . . . I related to that (inscription)," Pierce said. "That was my last trip to prison. I made a commitment to do anything I could not to return." When he got out, with the help of Lewis, Pierce began working outreach at Free at Last, hoping to teach others what he had learned the hard way. He's been clean and sober for 11 years. "I try to be the best advocate I can. That's why I am so very open. People need to know," Pierce said. "It still goes on. You might not hear about it. But it still goes on; that's why they call it 'the quiet killer.' People are still spreading it; people are still dying." Pierce himself has been fortunate. He hasn't taken an HIV drug since 1999 and feels fine. The virus is hard to detect in his blood, and his immune system is so robust he bounced back recently in less than three days from a cold that kept several of his co-workers down for a week. Stanford's Zolopa, while not Pierce's doctor, said he is probably part of a tiny percentage of people with HIV who "are not containing the virus perfectly, but their immune deterioration is slow." He will probably eventually need medicine, Zolopa said. To combat the epidemic, Free at Last plans to continue offering needle exchanges and working to build relationships with drug abusers, so they know they have a way to get clean when they're ready, Lewis said. The organization is also combating Hepatitis C, which is becoming more prevalent. Hep C is a virus, transmitted with dirty needles, that attacks the liver. Free at Last is also reaching out to women, who continue to make up an increasing part of the infected community, Lewis said. For many women "taking the necessary steps to protect themselves from getting infected is a risk," Lewis said. Stephanie Marshall, 38, Hilmar, Calif. Hilmar is a small town in the Central Valley, a few miles south of Turlock. Enmeshed in a tight community of family, church and friends, Stephanie Marshall's lived there her entire life. Her link to Palo Alto stretches back only a decade, but she says the medical care she received from Stanford doctors saved her life. Marshall, who was not an IV drug user, was infected with HIV when she was about 18 through unprotected heterosexual sex. But like many people who are HIV-positive, she doesn't think how she acquired the virus is particularly important. "We get this illness because of choices we made. ... We have to stand up and take responsibility," Marshall said. "We choose not to use protection. It's nobody's fault but our own. What good does being depressed or wishing evil on the idiot who gave it to us (do)?" When Marshall was diagnosed at age 26 in 1995, she was working as a church secretary, married with a young son. Both her husband and son tested HIV negative. Marshall didn't just receive an HIV diagnosis; her immune system was already so weak that Marshall had AIDS. "I knew nothing about AIDS. We don't have a large homosexual community. I didn't know anybody who had it. It just wasn't in my radar," Marshall said. She quickly learned. "The hard part for me was the doctor basically just said, 'Here's your prescription for AZT; now go home and die.'" Self-described as "sassy," dying wasn't in Marshall's plans. She refused to take AZT, however. Why take a drug that would make her so sick? And as she got sicker, she decided to let everyone in the community know. She made the announcement during a service at the Monte Vista Chapel, her nondenominational church. "The doctors got up and explained how you get it and how you don't get it. The elders laid hands on me," Marshall said. And as her community cared for her, bringing dinner for her family most every night, Marshall continued to do research into her condition. Then she fell in with a group that didn't believe HIV caused AIDS. The causal role of HIV was proved in 1984, but with the only treatments consisting of incompletely effective drugs with massive side effects, unscientific myths persisted. Marshall went to Santa Cruz for a bit to live with an aunt. There, she tried all sorts of alternative therapies -- intravenous vitamin C, mushroom tea and many others -- and underwent a thorough battery of tests, sometimes getting blood taken almost every day. Nothing capable of causing her symptoms, other than HIV, could be found. Marshall began to accept the virus was responsible for her illness. Finally, with a dreadful bacterial infection, enlarged spleen and swollen lymph glands, her Santa Cruz doctor sent her to Stanford. She met Zolopa in 1997. At the time, she weighed only 90 pounds and was wasting away, Zolopa said. He asked why she wasn't taking AZT, Marshall recalled. Marshall explained she didn't want to take such a harmful drug. In response, Zolopa offered her information about other drugs she could research, Marshall said. She hadn't known there were other drugs available. "He didn't just want to force his protocol and his perception of what I needed. (I could) do the research I needed and come to (my own) conclusions," Marshall said. Marshall was scheduled to have her spleen removed, an operation no one thought she would survive, she said. Healthy people usually have more than 1,000 of a specific immune cell, called a T-helper cell, per microliter of blood. Marshall, at her lowest, had only three. An individual has AIDS if his or her T-cell count slips below 200. Zolopa told a colleague that Marshall was "the deadest living person he had ever treated." Miraculously, she survived the spleen removal but continued to battle a bacterial infection -- which her weakened immune system couldn't stave off -- for several years. Now, Marshall drives to Palo Alto only four times a year. Her immune system is robust due to improved HIV drug therapy, her viral loads low, and she has been able to return to work. "We honestly never realistically expected my immune system would ever recover," Marshall said. Marshall's son is grown now, and she was divorced last year. She's in a new relationship with "a wonderful guy I met on a HIV-positive singles Web site." "We understand where we're both coming from. ... We have each others' back." Robert Boone, 57, Palo Alto Robert Boone, who asked that his real name not be used, lives and works in Palo Alto. Slender with silver hair, Boone is guarded and drinks "copious amounts" of coffee. Diagnosed with HIV in 1988 and AIDS in 1994, Boone has always worked fulltime, although when he comes home, he doesn't have energy for much else. Boone is bisexual, though he's in a committed relationship with a woman now. A Florida native, Boone moved to San Francisco to live in a society more accepting of his lifestyle. For about 13 years, Boone said he was very promiscuous. "Did I play safe? Obviously not safe enough," Boone said. "In 1980, I decided it was time to grow up and be respectable," Boone said. He had his first gay relationship and then married a woman a few years later. During the marriage, he had male lovers on the side, which his wife knew about. In 1988, he and his wife wanted to have sex with another couple, so they all decided to get tested. The others were negative; Boone tested positive. "I definitely knew it was in the realm of possibility. Was I expecting it? Probably not," Boone said. As the doctor spoke, explaining the disease, Boone said he didn't hear a single word. The doctor had to discuss the diagnosis with his wife. "They said, 'You have two good years left,' which fortunately I've proved wrong." Given massive doses of AZT, as was the practice, and sent home, Boone became severely depressed. "I did the dumb thing of not trying to get treated for it," Boone said. His marriage started to unravel. "It put a real damper on our sex life, to say the least," Boone said. "I'm just as much at fault. But finally she said, 'I just can't deal with you being sick.'" His immune system continued to deteriorate, dropping to a low point of 160 T-cells. Nonetheless, Boone still worked 40 hours a week. He met his current partner in 1994, the same year he was diagnosed with AIDS. "Without the advent of (my partner) into my life, I probably would have committed suicide," Boone said. This time, he sought out medical treatment for depression. "Things started to level out and then go upwards." Boone jokes that he got his "green card to Palo Alto" in 1995. Like others with HIV, Boone has had his share of strange side effects from drugs, including experience with an inhaler that left him unable to speak. Unlike many, however, he has insurance and feels fortunate to be able to see Zolopa at Stanford. "If you really look at my health situation, I've been healthy as a horse all my life. Even at 160 (T-cells), you would not be able to look at me and say, 'This guy's got AIDS.'" Brown said he has a love/hate relationship with the drugs. "Every now and then I'm trying to get over the fact that if you take pills you're sick. I'm not sick, but I take pills." AIDS is like diabetes now, Boone said, something you can live with. "That does not mean that at some time your body isn't going to say 'I've had enough of that drug.' That's the scary part ... and, and, and 'Is this the beginning of the end?'" Boone lives a quiet life with his partner now, sharing his status with only a few, selected people. "I've given up the men in my life," Boone joked. Boone is slow to preach or judge others' behavior. "I told my mom, 'It doesn't matter how I've got it, the fact is, I've got it.' ... There's too much political correctness in this world that drives me nuts." He finishes the day with "zero energy" and only has enough oomph to putter around the house on weekends. But he, unlike many, many of his friends, is still alive. 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Now, the latest from the idol of the gay left, the man who HRC has publicly fawned over and declared "courageous", and a card-carrying proud gay Democrat and leftist. The estranged wife of former New Jersey governor James E. McGreevey knew he was gay before they married, he claimed in court papers filed Monday. McGreevey wrote that Dina Matos McGreevey "knew of my sexual orientation before our marriage[;] she chose to either ignore it or block it out of her mind, even when questioned by her friends." The former governor does not detail how she knew he was gay but objects to his wife's contention in recent court papers that he is bisexual. "On the offhand chance she wasn't paying attention, I AM A GAY AMERICAN," he wrote, referencing the term he used to describe himself when he announced his resignation as governor in August 2004. "She is in deep denial." Or she's simply thinking about the fact that the baby she carried around for nine months didn't get there as a result of playing Parcheesi. Thanks once again to HRC, NGLTF, and the other gay organizations who were so eager to lick this man's balls and hold him up as a fine example of an "honest and straightforward" gay person. (h/t GayOrbit) UPDATE: And, if that were even possible, it gets better. MUCH better. Is the point there the same as hiring a burglar to do security systems? (h/t GayPatriot) Generic Viagra buy cilais cialis generic viagra online

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Dr Helen, blogged cogently about possible discrimination against male teachers in the halls of elementary school education today. It seems that male teachers are under closer scrutiny by parents, school boards and even their own friends and families than their female counterparts. Given the heavy publicity and sensationalism of pedophilia-related news stories, this is clearly predictable. Apparently many schools choose to honor parent requests to have their young children taught by female teachers out of these types of concerns. Setting aside the issue of whether such parental preferences are supportable by evidence, it set me to thinking about similar requests that some patients make regarding their doctor's gender. Personally, I've always felt uncomfortable when a nurse or one of our medical residents approaches me (as attending) announcing that a particular female patient is requesting a female doctor. (Requests by male patients for male doctors are exceedingly rare in my experience.) I never know quite how to handle such situations. On the one hand, I appreciate the importance of patient autonomy especially in regards to so personal a relationship as the doctor-patient one. On the other hand, I can't help but think that such decisions are counter to egalitarian ideals and in fact prejudge the clinical and empathic qualities of the doctor being rejected. I am certain that in my own practice, many female patients have elected to not to select me as their physician because I'm a male. I cannot deny that that reality in no way disturbs me. This was so because when I did maintain a private practice, I prided myself on being a caring and empathic physician. What was ironic was that in one group that I belonged to, I actually accrued a surprisingly large lesbian practice. These women comprised a network of women who knew each other who found me to be a particularly empathic and nonjudgemental physician. It therefore hurts me that some patients would not allow a subset of our medical residents the opportunity to demonstrate their ability to appropriately care for them in a manner deserving of the dignity of all patients. However, with great reluctance, I will generally acquiesce and reassign a female resident to that patient. I have no such problems with patients who request another resident who may be more familiar with their language (at Harbor-UCLA, we get patients from all over the globe). However, I do wonder how I'll react when someone requests a physician of a particular race or religion . Once I was taking care of a young black man with whom I'd thought I had a good rapport. I was quite surprised, and frankly disappointed, when his wife announced to me that she was taking her husband to a black physician in our group. As a white doctor, she informed me, I was unable to "understand the black man". Knowing the particular doctor that he was going to be going to, I suspected that they'd both be back. A month later, they were. Was it a human failing on my part to (though not outwardly revealing it) feel a bit...smug? cialis generic viagra online Cheap Viagra cheap viagra

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