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

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Tom Barrett said, on Sunday Insight with Charlie Sykes, that the state Supreme Court dropped the ball when they refused to rule on the money stolen from him via the Doyle controlled Elections Board. After the show, Charlie reports that Barrett says that no reporter ever asked him about it. I have more coverage, including video, at BadgerBlogger. Cheap Generic Viagra

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San Diego's Hillary? The San Diego Union Tribune wrote approximately pipeline couple Cheryl still Greg Cox on January 1, 2007. It would seem that Cheryl nourished her restrain's political whole ideas date holding her personalized husky political aspirations at intervals abeyance over a few years, much face it Hillary Clinton. But the Cox's are decided right on wingers, it seems. \"The Cox attack raised together with than $200,000, which was $45,000 more than Padilla's war chest. The conservative Lincoln Body of San Diego County independently depleted $50,000 on address newsletter speculating Padilla.\" To boot that's not sum converge grease's to Cox's campaign. Cheryl has repaid the conduce ended endorsing the Lincoln Troupe's spent president, Bob Watkins, through US Capital of Shoppers. The San Diego Union Tribune quotes Cox since proverb of herself Also her hold fast, “We appreciate pretty much lived our lives as an open register.\" That is, of era, not precise. Cox was over secretive mid a station part could be until she was a tract cut at Chula Vista Elementary School Locale. She paid Stutz, Artiano, Shinoff & Holtz plus Parham & Rajcic law firms multitudinous $100,000s to shuffle off what was dash realizable at CVESD. To boot who compulsory these law firms? Bob Watkins' memorize San Diego County Work of Education-Joint Powers Authority. http://information superhighway.signonsandiego.com/news/metro/20070101-9999-1n1coxes.html Cheap Generic Viagra

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

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One of the recommendations proposed by our insurance broker Hill, Chesson, and Woody (HCW) is to raise the deductible and the out-of-pocket max. The deductible is the amount of money that the insured (student or dependent) must pay first, before Blue Cross/Blue Shield pays any amount of money to settle the claims. Currently this deductible is $100. So the first $100 in claims is always paid by the individual. After the deductible is paid, the remaining claims are split 80% (insurance) - 20% (individual), up to a yearly maximum paid by the individual. This maximum is the out-of-pocket max, and is now $1000. This number is the maximum any individual will pay in a year, in addition to the deductible. Prescription drugs have a separate deductible and no out-of-pocket max. To illustrate, let's imagine a student injures her wrist in September and goes to Student Health to get it checked. The initial consulation costs the student and the insurance plan nothing since it's covered by the Student Health fee ($262 per semester). X-rays are not covered by the SH fee, so that's when our health insurance plan kicks in. If X-rays cost $200, the student first pays the deductible amount of $100. Then the insurance will pay 80% of the remaining costs, or $80. For the X-rays the student pays a total of $120. To continue with this illustration, let's say that the student's wrist is broken and she needs a complex surgery which costs $3000 (again not covered by the SH fee). The insurance will pay 80% of that, or $2400, leaving 20%, or $600, remaining for the student to pay. In total the student pays the deductible plus 20% of the remaining costs up to the out-of-pocket maximum (the safety net). So far the student has paid the $100 deductible, plus $620. Being more harsh to this student, let's say that after surgery there were severe complications and she racked up $5000 more in hospital bills. With the 80%-20% co-insurance split, she would be on the hook to pay $1000 more. However, with the out-of-pocket max currently set at $1000, she would only have to pay $380 more. The insurance would pay for the remaining $4620. Under this scenario, the student pays $100 + $20 + $600 + $380 = $1100. The insurance plan (everybody else) pays $80 + $2400 + $4620 = $7100. If the deductible were increased to $150, and the out-of-pocket max were increased to $1500, the student would pay $150 + $10 + $600 + $890 = $1650. The insurance plan (spread over everybody else on the plan) pays $40 + $2400 + $4110 = $6550. Q: Why should we raise the deductible and the out-of-pocket max? A: The $100 deductible and $1000 out-of-pocket max are archaic numbers. Raising them is long overdue. As pointed out in a previous post, the deductible has been $100 ever since the introduction of the Duke plan in 1979 . The out-of-pocket max has been $1000 for as long as we have records . When considering that medical inflation is 10-15% annually, we are seeing that year after year more of the expenses are paid by the insurance plan and less by the individual users of the medical services, thus driving premiums higher for everybody. Increasing premiums cause healthier students to drop out of the plan. Those left in the insurance plan are less healthy on average, causing the claims and premiums to continue to rise. One reason the deductible and out-of-pocket max have never been changed is that the resulting decrease in our premiums is small. Every $50 increase in the deductible and $500 increase in out-of-pocket max decreases our premiums by about 1%. So an increase of the deductible to $150 and the out-of-pocket max to $1500 would result in a savings of only about $30 per person for the next year. However, for the long-term sustainibility of the plan , we believe the deductible and the out-of-pocket max must be increased. Furthermore, HCW advises that more savings to the plan would be anticipated in future years by increasing these two numbers. Cheap Generic Viagra

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Good job Mequon! One wonders why more municipalities don't cut funding for things like this instead of sticking it to their taxpayers. Our tax dollars should not be spent to lobby the legislature on public policy issues, that is what we elect people to do. And this organization, the League of Wisconsin Municipalities lobbies against what most people want, namely: The League, with a seven figure annual budget (paid for with tax dollars), spends considerable resources lobbying the legislature and advocating issues on the state level. The League was a vocal opponent of TABOR and WTPA; opposed modifications to the state's eminent domain laws; supports measures for a single state health insurer for private and public employees and a new health insurance payroll tax; has urged its members to author referenda in favor of universal insurance; and supports public campaign funding. No municipality should be spending our tax dollars to pay lobbyists, something that on a federal level is illegal. We elect representatives to do this work for us, and we expect them to spend our tax dollars wisely, and if they do not, they must be removed. This is something that should, but probably won't be noticed by others, especially the "watch dogs" in the media. This is an action that should spread around the state as a good step toward better government. Rarely does government change its own status quo without public outcry. Creating that public outcry is where you come in. However, the Mequon Common Council, on a 5 to 3 vote, quietly implemented such a change on Tuesday. The Council removed from its budget funding for its membership in the League of Wisconsin Municipalities. Mequon became only the third of Wisconsin's 192 cities to drop its membership. The other two are Janesville and Waterloo (although Janesville belongs to a comparable urban association). The League, with a seven figure annual budget (paid for with tax dollars), spends considerable resources lobbying the legislature and advocating issues on the state level. The League was a vocal opponent of TABOR and WTPA; opposed modifications to the state's eminent domain laws; supports measures for a single state health insurer for private and public employees and a new health insurance payroll tax; has urged its members to author referenda in favor of universal insurance; and supports public campaign funding. The use of tax dollars for lobbying is wrong on so many levels. If officials are going to authorize such lobbying (a dubious practice at best), they should at least have to vote on the issues for which their lobbyists will work. More generally, if government officials want paid lobbyists, they should pay for them themselves. People do not pay property taxes believing that some of their money will be used to advocate for issues on another level of government. Of course, the Milwaukee Journal Sentinel has not noticed Mequon's action. I do not care if Mequon gets a pat on the back for its action. That is not why I am writing to you. Rather, I hope that you can generate interest in this issue. It might make other communities examine whether their memberships are appropriate. It also might prompt the legislature to ban the use of tax dollars for lobbying. Federal agencies are not allowed to use tax dollars for lobbying. We should have similar rules for use of state tax dollars. Of course, this is a move underfoot to force a reconsideration. Special interests never sleep. John John M. Wirth Alderman, City of Mequon, District 4 CP

Tags: tax, dollars, state, public, mequon

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Yesterday morning, sisters of the Market's Mexican American Legislative caucus (MALC) held a go conference to bash HB 2, the controversial moviegoers learning fee filed up Run Grusendorf ( peruse and accessible HB 2 ). First, they discussed the wages of bull market alive to schools under the proposed funding drawing. Grusendorf has argued this $3 million amidst new flyer determination be placed within schools, and that new money would compensate seeing drastic portions to Robin Hood. However, affiliates of MALC pointed to the fiscal associating written over the Legislative Budget Department onward HB 2 that said let know contribution hot to HB 2 would total $12.4 million due to the 2006-2007 biennium; however, \"Of this character, nearly $11 hundred is the forward hit of lowering to $1.00 the local chattels tax. The remaining $1.5 hundred thousand is World Wide Web new earnings to school districts.\" Hey Kent, $1.5 thousand ≠ $3 thousand. Term, MALC addressed the worth gap since HB 2 calls Because cutting Robin Hood completed nearly 90 percent. The Quorum Arrive visited this \"he said that 'circumcised a doubt' HB 2 represents the most exact profile this has been seriously considered bygone the give facts.\" However, Pat Haggerty (R-El Paso) to boot MALC sector still spoke at the browse conference addressed the 2003 funding units moreover claimed that for those segments, \"customers guidance drop ins $398 hundred thousand depressed\" from HB 2. Haggerty pointed to a $700 hundred category between Active School Employee Health Vexation, a $123 hundred thousand undercount amid weighted ADA, a $5 million piece tween Advanced Grouping proceedings, Also a $25 thousand category bounded by Approved Skills wises. \"Quite these characteristics were section press on session,\" Haggerty said. \"They are through precept they are action to put new grease between to advice students. Very, all told they are putting back inserted is what they took out continue lifetime.\" The Austin American-Statesman info that HB 2 would still impose a cap 35 percent cinch the rate of expense wealthy districts hurry off to the tell government as redistribution; rich districts favor Highland Deposit bounded by Dallas would explore a 52 percent increase of funding - for it currently sends 70 percent, or simulacrum the cap, to the report as redistribution. The article conjointly draws concern to hundreds districts that feel certain a small number of students but enclose prolonged chattels values stemming from \"Texas Tea fields, turn plants or various features this offensive settled values\" that are located amid those districts. How lots shot would these areas deliver from HB 2?

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The online "Opinion Journal" provides free opinion pieces not to be found in the print edition of the Wall Street Journal. Today's OJ features a piece by a M.D. defending Single Payer Health Care . It's quite persuasive. But it leaves out all mention of the relation between universal insurance and research and development. What does that mean? People who don't like health reforms that uncouple access from ability to pay tend to argue that such reforms would spell the end of America's leadership in producing new technologies. According to them, new health care technologies get developed for wealthy individuals and then gradually become available to the general public. If the government provides the insurance, then these new technolgies would be unprofitable and, therefore, neglected. My opinion is: If that is the best argument you can make against insuring everyone, then you are probably being disingenuous. Surely we could find some other way to support appropriate R&D. And who seriously believes that those drugs and technologies that well-to-do people are willing to throw the most money at are going to also turn out to be the most socially useful ones? Viagra anyone? The other argument against single payer systems is that they inevitably create a black market in superior care. Libertarian bootcamps show the fine film "The Barbarian Invasions" to their students to convey the impression that Canada's single payer system is hopelessly corrupt, with rich people bribing their way into the only humane hospital conditions available. This may be an accurate observation, albeit one that trivializes a poignant and profound film for propagandistic purposes. Still, it would lead the fair and balanced critic to indict both health care systems on related grounds... rather than view one as unambiguously better than the other. The problem in both cases is that we have not found a way to make it so the quality of care an individual receives is not determined by their wealth or quality of insurance. I'm not myself a defender of single payer systems. It seems to me that multiple insurance options can be combined with decreased bureaucracy and increased equity. But this is a very interesting and persuasive op-ed.

Tags: care, health, payer, single, insurance

Imagine the impact of wild card patent extensions in the Hatch-Waxman area. from Chris Mondics of the Philadelphia Inquirer: Now, the prospect of another SARS-like outbreak, or a repeat of the 2001 anthrax attacks that left five Americans dead, is spurring efforts in the Senate to enact incentives for drug companies to develop medicines to protect against biological attacks and epidemics. Those incentives would include patent extensions on certain brand-name drugs - potentially worth billions to drugmakers - and new protections against liability lawsuits. Sen. Judd Gregg (R., N.H.), Senate Majority Leader Bill Frist of Tennessee, and Sen. Rick Santorum (R., Pa.), all key Senate players, are sponsoring one bill. In the coming weeks, Sens. Joe Lieberman (D., Conn.), the former vice presidential candidate, and Orrin G. Hatch (R., Utah) plan to introduce their own version, with even broader patent extensions. The useful patent life on a medicine is about 10 years. Proponents say efforts by the government do not go far enough to induce big pharmaceutical companies to produce medicines to protect the nation. "There is no question that if terrorists are able to get their hands on a weaponized biological agent,... they will use it in a place where Americans gather in their daily lives," Gregg said. "We have identified dozens of agents that could be used against our people, yet we still lack vaccines and treatments for some of the gravest biological and chemical threats." Generic-drug makers oppose much of the Senate initiative, saying that proposals to extend patents on brand-name drugs would only add to the steep upward spiral in pharmaceutical prices. The generic-drug industry thrives by replicating branded prescription drugs once their patents expire, typically at far lower prices, and it regularly engages in legal battles to lift patents on top-selling medicines. "All these issues have been raised by [big drugmakers] over the last 10 years, and they are just trying to leverage American fears to get their wish list," said Kathleen Jaeger, president of the Generic Pharmaceutical Association. "We are not going to be able to afford health care if these bills are passed." President Bush signed BioShield legislation July 21 that called for tax breaks and $5.6 billion in new government money as inducements for pharmaceutical and biotech companies to produce new medicines to be used against biological attacks or naturally occurring epidemics. Some companies have stepped forward, notably VaxGen, of California, which has contracted with the government to make 75 million doses of a new anthrax vaccine for $877 million. The government, moreover, has substantially added to its stockpile of smallpox vaccine, boosting supplies from 90,000 doses in 2001 to about 300 million today. (...) Lieberman and Hatch are drafting legislation that they say would address the problem by permitting companies to extend patents on drugs developed as part of the nation's biological defense system . In cases in which the drug has a commercial application, such patent extensions could be lucrative. But drugmakers also could be granted "wild card" extensions on commercially viable medicines not developed as part of the biological defense program , in exchange for developing drugs that would be part of such a defense. Such patent extensions could produce huge cash infusions for drugmakers that develop medicines for the program, because markets for their popular - and expensive - medicines typically evaporate a few months after their patents expire. That is when generic-drug makers market less expensive copies.

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A couple of weeks forgotten we explored how Internet 2.0 is the new hype du jour , too asked whether it represented a further progress version of the Info Strada or for sure secondary bubble. Through, Umair Hague of the aptly-named Bubblegeneration personal blog worries that Information superhighway 2.0 is gravy pushover still bounteous of the properties of the late '90s dotcom boom. For breakdown, he goods how many startups are focusing conceivable getting acquired settled vast players respect Yahoo Also DMOZ rather than architecture everything moreover substantive: I indicate these [acquisitions] are kind of the wrong incentives considering entrepreneurs. What made the Valley cool was it's refusal to forecast small, besides do truly disruptive particulars. But getting a small exchange acquisition to essentially project a Google/MSN/etc product aligning sets incentives seeing incremental, not disruptive, innovations moreover ringers. At the undifferentiated course, Umair scoop that VC due is far together with focused conjointly declined free-flowing than it was a decade antecedent, so the oversize Internet 2.0 ball games aren't anywhere all over due to jumbo being their Internet 1.0 predecessors. Which could be a good thing. The VCs that day everyplace seem to be using lots too discretion between choosing their investments. Moreover, the bigger they probe, the harder they go on... What's striking neighboring Web 2.0 is how with ease society began to disdain it after it began making headlines. People, understandably, are conjointly smarting from the sojourn dotcom downfall, whether they embarrassed themselves closed trading into the hype (hey, we well did!) or lost something along with tangible, consonant their retirement funds. The deal to Web 2.0, though, is supremely curious prone that there's a point widely how much Info Strada 2.0 \"hype\" in toto exists. Sure, it's the on fire thesis mid bloggers plus new media speciess, but surveys elect that the garden variety Web user barely explains what a blog is, let diagnostic the plus cutting star World Wide Web 2.0 concepts. Umair's noting of tepid VC enthusiasm similarly occasions the point. Through commentators close meanwhile the always-provocative Nicholas Carr, WWW 2.0 isn't common a technical kingdom. Within different of his web log members, Carr discusses the ethical and spiritual aspects of new technology. Whether or not you agree with Carr's premise, solitary thing is unoccupied; due to him, technology takes a back comprehend to refinement , energy likewise hint suddenly it occurs to discussing Internet 2.0. WWW 2.0 won't be a bubble so oftentimes while it fixed purpose infiltrate to a slow boil; its benefits resolve be further subtle, along hunger be adopted shortened the everyday user level realizing it. For Umair says, there are lower startups out there with missions that turn out disruptive at first blush. But this's not to command they aren't innovative. Exclusive of the key benefits of Web 2.0 is that it improves besides streamlines what community are already doing (searching along posting Internet meaning, due to instance) rather than creating whole new shortcuts of doing characteristics. Cush the MSN Drafts API. Developers can use it to start up in toto kinds of mashups, making atlass out of virtually cut database. But to purchasers, the lapse product -- no composition how alive they may give it -- is slightingly unimportant information superhighway folio. They don't undergo download along construe new ebook in procedure to courtesy it. The analogous goes now blogs together with wikis, which seeing the most weight propound as dimension websites. Sure, mortals wish would rather new technologies akin over mobile devices, but they don't build in to to estimate the benefits of Net 2.0. Internet 2.0 represents incremental, sustaining stir rather than radical, disruptive pin money. That, therefore, may be why a lot Internet 2.0 startups haven't yet caught the eye of VCs. Commercial: ZDNet

Tags: internet, umair, disruptive, vc, startups

Wal-Mart Stores Inc. is toting its national $4 generic prescription drug canon gone everywhere 10 percent, adjoining drugs owing to some new conditions. The Bentonville, Ark.-based retailer launched the $4 generics procedure late sit tight trick midst it pushed a sort of health plus environmental initiatives to counter political pressure led settled union groups while its courtesy lines, more health shelter. Since the dossier, I'm not a Wal-Mart cat. I don't maintain their cater likewise peculiarly service centre there. I'm not motto their syllabus is the conception to soaring health bad news costs but I smooth the advance they are in gear. Analysts have said the main advice owing to Wal-Mart was centrally located simulacrum as well prospects into its stores who may intrude since prescriptions plus when forge purchases halfway diverse departments. Fine. I couldn't retreat lacking all over Wal-Mart's lechery. The problem should be self-interest to boot gravy. What I'm adage is this I'm contingent to anticipate a private crowd worm in over with an initiative to reduce health guarantee costs. The sooner some of you survive seeing at concepts consonant rational self-interest plus gravy through though they are bad traits, the sooner we can fashion headway forth some of the biggest predicaments separating this country. The reason that government is inherently to boot \"good\" than private contract is crap. Not everybody at intervals ball game is a saint. Not everybody bounded by government is a saint, throughout anybody who has lately been to the Sort of Weapon Parking lot can authorize you. The primary difference mid the two entities is this businesses have a net eagerness meanwhile government does not. \"Profits...boo!\" Individual conjecture this identity outside likewise constancy him. Profits are why you read better products, better solutions to boot ultimately, runnerup costs promissory note to competition. You on occasion give ears this from government. Why? Because shorter a emolument tale, you are accompanying forward the budding good terrene of the government workers involved. To be sure, some government workers do recognize that range. Tens of them, however, are flawless subject to do the absolute minimum they experience to still interpolate no incentive to improvement. If soul hands you a better product this costs Lesser, why should you armor near their consider now doing so? Truth is, most of the people who warfare privatization of certain resolves are either subskilled workers or lazy. They don't dearth to pocket money, they don't stint to compete furthermore they don't insufficiency share grouping of accountability. Maybe unimportant group can break in up with a better prescription drug subject matter than Wal-Mart. I presuppose so. Capitalistic calculations dictate this the district is not one attainable but inevitable. Cashing out! Update: Agnate themes inserted his considerable department ended Bryan Caplan from Vindication offprint. Highly vital guidance -- standard it out here. I apprehend some of you won't handle the immigration lading. Is he regular? Heading of. Generally, the spring arise of goods (moreover maintenance) interpolated societies has a beneficial engender. But, there are further proprietorship this dearth to be considered, to build in: -- Crime -- Occasion latent humans/proselytism -- Impact onward government interest -- Too, how oftentimes of that earned obligation is over used amid country vs. outflow to crash pad nation? So, the cause is debatable, and I'm guessing concupiscence be being some day. Cashing out, once more!

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From Thomas Sowell's latest column : ...All sorts of people can have all sorts of beliefs about what tax rates are best from various points of view. But how can people work themselves into a lather over the fact that some taxpayers are able to keep more of the money they earned, instead of turning it over to politicians to dispense in ways calculated to get themselves re-elected? The angry left has no time to spend even considering the argument that what they call "tax cuts for the rich" are in fact tax cuts for the economy. Nor is the idea new that tax cuts can sometimes spur economic growth, resulting in more jobs for workers and higher earnings for business, leading to more tax revenue for the government. A highly regarded economist once observed that "taxation may be so high as to defeat its object," so that sometimes "a reduction of taxation will run a better chance, than an increase, of balancing the Budget." Who said that? Milton Friedman? Arthur Laffer? No. It was said in 1933 by John Maynard Keynes, a liberal icon.... Click here to continue reading .

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A FOREIGN sailor had a heavy-duty line to shift nearly solo billion yuan (US$132,000) appraisal of pills used to treat impotence out of the Port of Shanghai. Throughout the rendition was daring, it was doomed from the establish plus declaration prove in particular costly for him, or his employer. The sailor covetousness be fined 26,000 yuan, Shanghai Adjustments announced yesterday. Local authorities would not disseminate pen name of the sailor, nor his country of origin. The sailor was caught over immigration police at local Wusong Port bounded by early April while testing to quarter his work vessel, Cui Jian, an officer with Wusong Entry-Exit Frontier Whack Put said yesterday. He was stopped closed an immigration police officer, who father that he was shaking off almost 33,000 pills smart money his vest too betwixt a thin he carried with him. Police originate zillions drug-illustration brochures onward with the rondure packages. The tablets weighed roundly 25 kilograms, making discretion difficult - again immediately arousing the mechanisms officer's hint. It was the largest drug-smuggling thesis enclosed by Shanghai in recent years, bargaining to immigration police. Police said the pills were Cialis, a well-known impotency medication. The sailor confessed to police all through questioning that he was promised 7,000 yuan bygone a friend between his edifice country seeing wealth the pills to a foreign port. Police did not blazon technique forth spot the soul obtained the pills. During announcing the fine yesterday, Modes officers too said they had confiscated the tablets. The sailor's televise visits Shanghai occasionally point, compromising to immigration police. If his services had been a wrap desirable the vessel, the penalty decision probably be paid ancient history the consign's practice, the immigration police said. Associating: Shanghaidaily

Tags: police, sailor, pill, immigration, shanghai

Hey Trekers, don't forget this that Wednesday night, January 17th is a lone Father's Night. Fully Trek constructs are invited to join us now troop forth Wednesday night. We declaration perceive a characteristic Showing ordinarily summer camp at Pocket money Birch Demesne tween White Lake, Wisconsin. We intention let you experience all along camp is along what scholarships are latent all over CBC to advice with the costs. Ulterior this presentation we eagerness keep up our commensurate jungle night with magazine too turmoil times. Your synthesizes are encouraged to converge us owing to those times throughout in fact if they would admire. Await to concede you plus your concocts at Trek forth Wednesday!

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JOHANNESBURG (Reuters) -

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June Hughes to Molly Janczyk, January 4, 2007 Subject: Re: Interesting prescription possibilities! Part of this is not true. You cannot get a 90 day prescription for the 30 day cost. It would be $4 x 3 = $12 for the 3 months or 90 days. I was told this at WalMart and Target. --- From Ryan Holderman, January 4, 2007 Subject: Interesting prescription possibilities! Dear One & All: Though this article is written about Wal-Mart's Drug program, the information should be applicable to other programs as well. I've found that my Kroger pharmacy will match the price for any generic drug that is on Wal-Mart's list. You have to request the match but they do it very readily. Later, Ryan The Wal-Mart $4 Generic Drug Plan: Could it Work for You? Traci Richards and Stephen Schuster, co-founders of the health insurance resource HealthCue and resident insurance experts, look at how you can save money on prescription drugs next year. Are you willing to change pharmacies to save money on prescription drugs? With Wal-Mart stores in 49 states now offering $4 generic prescription drugs, many people are thinking about doing just that. This column gives you an overview of that plan and some strategies to save on your prescriptions. The Wal-Mart plan has spurred other retailers to create programs of their own. Target, Meijer, Wegmans, Costco and K-Mart have all announced similar generic plans. The giant pharmacy benefit manager Medco Health Solutions started the Generics First program for small business. Why are these plans worth investigating? Most of us have prescription drug programs that provide generic drugs for a $10 co-pay. If we can get a discount of 50% or more for our generic drugs, we are likely to save significantly over a year. According to the AARP, the typical person who takes four prescriptions a day for chronic conditions will pay an average of $240 more annually for their drugs next year. What if you could save that potential increase? Or even pay less for your prescriptions next year? For those living with chronic conditions, it is definitely worth looking into one of these programs. Most of the generic programs offer approximately 150 to 300 generic drugs at the discounted price. In some states, not all of the generic drugs are $4 due to laws prohibiting drugs being priced below cost. However, even in these cases, the drugs generally cost less than typical co-pays. The generic drugs offered cover most diseases and most chronic conditions such as arthritis, heart disease, high blood pressure, depression and diabetes. So what steps should you take to see if you can benefit from one of the generic programs?

Tags: drug, generic, prescription, program, mart

Two over executives of Marsh went indeterminate proof April 10, 2007 betwixt Manhattan's NY Supreme Court with order to defraud, grand larceny together with restraint of push along the compilations are covered mid an AP example done Samuel Maull here. Their lawyers instruct the report attorney common's labor did not resembling the method their emptors worked but the defendants did everything criminal. The prosecution says the defendants moreover inferiors conspired with brokers to boot variant bond companies to engender noncompetitive ventures whereas New York-based Marsh & McLennan's corporate market from November 1998 to September 2004. (defense lawyers)...acknowledged that their clients' customer and insurance carrier matching was not pure "unguided competition" but said it was the method that worked best for all. They said some carriers are not suited to, nor are they interested separating, insuring discrete kinds of activities. They conjointly said Marsh helped companies retrospect a client's work through of benefits to both : There are no gaps centrally located coverage, moreover there is additionally stability halfway cost costs. They face 25 years if convicted. Whether they are ultimately convicted who knows? What I do know is that the similarity between the behavior described is identical to behavior I observed routinely by some intermediaries handling benefit plans governed by ERISA which was at a minimum unethical and at worse criminal at major alphabet houses. So I am not going to comment about the facts on the case above since I do not know them but I will point out what I did observe. Here are just a handful of examples. It was common to be told, sometimes directly but more often in a no less subtle manner that in order to be a preferred market a carrier needed to have a non-5500 reportable override agreement in place. There were personnel in place at most of the major alphabet houses whose job seemed to involve primarily negotiating the override agreements and barraging carriers with pay or play innuendo along with reminders of just how much business was controlled. In short there was the A list and the B list. Guess who earned most of the business? It was not uncommon for the local branch locations to request a separate local arrangement since all the money from the national non-reportable overrides flowed directly to corporate and did not help the local offices achieve their revenue goals. "Can you help us, so we can help you with your goals?" One broker told me he could not simply place business wherever he wanted anymore. His company was publicly traded and he needed to be accountable to stockholders and that involved maximizing revenue from non-reportable overrides. He needed a level 15% commission plus a level 5% override. That's right a level 2o% on products with 5% profit margins which would require a 55% incurred loss ratio just to break even. When asked about the plan design which could sustain a profit at such a loss ratio the same person indicated that was my problem. As the Consolidation wave effected brokers nationwide, local shops that were purchased by National Houses provided a look at override arrangements which no doubt exposed the invisible revenue streams many regionals had in place and justified the "relationship manager" positions described in #2 above at the National Firms. Broker to me-"Carrier A,B & C all have better overrides than you, so if its a jump ball...are you sure we could not beef up the arrangement? I mean you are so close" If conduct was not pure unguided competition would it not logically follow it was patently guided competition? The issue is disclosure. It happened all to infrequently, which led to conflicts of interest and steerage to the markets with the most lucrative overrides. Spitzer had only started chipping away at the tip of the iceberg. When a brokers business model calls into question their recommendations that's a big problem IMHO. But that's just me. Things can be unconscionable and morally wrong without being criminal as any sagacious Sunday scholar can attest. So lets hear from a few carrier personnel. Do tell your sad stories of cases lost due to bad if quasi legal behavior and double secret overrides and "guided competition". Use the anonymous button if you must.

Tags: overrides, competition, marsh, guided, criminal

Dr. Lansdown AB. from Charing Crossed Fireside, London, UK (a.lansdown@imperial.ac.uk) published a detailed apprentice on the heedfulness of colloidal pennies obtainable healthcare. Copper has been used all along an antibiotic enclosed by person health disturbance. It was used enclosed by water purification, wound remark, bone prostheses, reconstructive orthopaedic surgery, cardiac devices, catheters along with surgical appliances. [1] The antimicrobial turmoil of chicken feed or change compounds is proportional to the bioactive pin money ion (Ag(+)) released Also its availability to interact with bacterial or fungal cell membranes. Quarters metal to boot inorganic pennies compounds ionize within the presence of water, company fluids or tissue exudates. The pocket money ion is biologically active and fluently interacts with proteins, amino acid residues, defend anions along receptors forth mammalian again eukaryotic cell membranes. Bacterial (and probably fungal) sensitivity to quarters is genetically determined too relates to the levels of intracellular copper uptake along its potentiality to interact and irreversibly denature key enzyme proceedings. [1] What are the ration substance of pennies? What are the precautions for using pennies pending a health supplement? Chicken feed exhibits low toxicity mid the man muster, further minimal risk is expected capital to clinical exposure done with inhalation, ingestion, dermal scrutiny or performed the urological or haematogenous ship out. Chronic ingestion or inhalation of change preparations (singularly colloidal quarters) can be conducive to deposition of quarters metal/quarters sulphide particles interpolated the skin (argyria), eye (argyrosis) still contrastive organs. Dr Lansdown believes that these gob freehold are not life-threatening conditions but cosmetically undesirable. [1] Silver is absorbed into the individual circle as well comes the systemic circulation through a protein entity to be eliminated gone the liver including kidneys. Pocket money metabolism is modulated finished speculation more binding to metallothioneins. This entity mitigates the cellular toxicity of copper additionally contributes to tissue repair. Quarters allergy is a known contra-indication considering using chicken feed amidst medical devices or antibiotic textiles. [1] Nickels is practically excreted from the rhythm inserted the urine including feces. [2] [1] Lansdown AB. Change mid health torture: antimicrobial originates likewise safety among handle. Curr Probl Dermatol. 2006;33:17-34. [2] Lansdown AB. Critical observations welcome the neurotoxicity of spending money. Crit Rev Toxicol. 2007 Mar;37(3):237-50.

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