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

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

Tags: er, psych, injuries, bad, trauma

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10 26 05 Hello: This will be a light post. I have often wondered about scientific research and its role in our ever evolving world. Should the government sponsor scientific research? Or should it all be profit driven? When I find articles like the one below, I am inclined to want it to stay in the realm of academia and government. Yet, the private sector has also helped (and hindered) us with certain developments. Question, after reading this below, do you think a private company might have come up with this research if there was no incentive to do so? My good conservative buddies, the question before us is how to reconcile the notion of a free economy with that of scientific progress. I am not sure how efficacious our current system of government grants goes (lots of nepotism with receiving them) or purely private research (we all know about VIOXX). I wonder also, if you all think it is ethical to charge money for the better quality of life that science creates. And lastly, whatdya think of this stuff? Cool huh! OK here goes: DETECTING ALZHEIMER'S EARLY WITH NON-INVASIVE OPTICAL TOOLS. Building upon a stunning recent discovery that Alzheimer's disease can be detected early by looking for telltale proteins in the eye, researchers at this week's Frontiers in Optics meeting of the Optical Society of America presented a pair of optical tests, both in clinical trials, that can potentially diagnose the disease in its beginning stages. Such tests may not only improve patients' chances to start treatment earlier, but they could also speed development of new Alzheimer's drugs. Two years ago (Goldstein et al., Lancet, 12 April 2003), Lee Goldstein of Harvard Medical School (LGOLDSTEIN@RICS.BWH.HARVARD.EDU) and his colleagues showed that the exact same amyloid beta proteins which are a hallmark of Alzheimer's disease are also found in the lens and its surrounding fluid. In those portions of the eye, the proteins form amyloid deposits similar to those in the brain. Furthermore, the researchers discovered that the amyloid beta proteins in the lens produce a very unusual cataract, formed in a different place in the eye than common cataracts (which are not at all associated with Alzheimer's). Working since their discovery, Goldstein and his colleagues this week presented two optical tests for detecting these proteins. Using a technique known as quasi-elastic light scattering, the first test employs low-power infrared laser light to non-invasively detect protein particles in the specific part of the lens where these unusual cataracts form. The second test would be applied to those who screen positively for the proteins, in order to confirm an Alzheimer's diagnosis. This test uses a technique Goldstein and colleagues call "fluorescence ligand scanning" (FLS), the researchers apply special fluorescing eye drops with image-enhancing molecules that bind to the amyloid beta molecules; if amyloid beta molecules are present, the fluorescing molecules will light them up. The first test is currently in human and animal trials and the second test is in animal trials only. These two diagnostic tests are envisioned to be a two-step process for screening and then confirming an Alzheimer's diagnosis. These new optical tools can also potentially speed up the development of new Alzheimer's drugs, by giving investigators rapid feedback on whether the drug is doing its job of removing the harmful proteins from the body. Moreover, the researchers are using the same technologies to develop new tests for rapidly detecting amyloid plaques resulting from prion diseases, including mad cow, scrapie in sheep, and Creutzfeldt-Jacob disease in humans. ( http://www.osa.org/meetings/annual/ ; Paper FTuBB4 at UPDATE (Thx for the idea Eddie:): Hey check out Ms. Chatterbox on www.chatterboxchronicles.blogspot.com. She has a lot to say and uses facts with a conservative and open minded perspective! I guarantee you will enjoy the visit! :) You guys oughta see this leftist radical feminist site. Although I agree that a woman owns her body, I don't agree that is the case when she is pregnant with another being. http://the-goddess.org/wam/blog.html . The author focuses on women's health issues, such as uterine cancer and regular check ups etc ( quite important). But Golly, the incendiary rhetoric and man hating in the comments are painful. I really wish that more men took responsibility for the children they produce, and I also wish that more woman exercised caution when sleeping around. Let's be honest; it takes two to tango! Oh, I usually was a guest poster on Wednesdays on www.dellgines.com. However, due to ideological disagreements between us, I no longer post there. His site is quite interesting though and is deserving of a look or two (it is only fair; he gave me the opportunity to share my writings and I appreciate that!) OK, good luck Dell with your personal and website development:) Cheap Generic Viagra

Tags: test, alzheimer, protein, amyloid, optical

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Tags: medicine, doctor, dose, dizziness, strong

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

Tags: friend, back, troops, iraq, fallujah

I believe that the Washington Post has a copyright on combining the words "Medicare" and "Social Security" in a single sentence. Anyone who writes on these issues on their editorial pages always seems to do it. Again folks, the numbers are real clear. Medicare is a big problem because U.S. health care costs are projected to explode, which means that Medicare costs will explode. The moral is fix the health care system. Social Security is not a problem. The story on aging is not very different in the future than in the past. We are living longer, that has always been true. I assume that some of the editorial and op-ed writers actually do look at the projections occasionally. This makes you wonder why they are so insistent on ignoring the projections when they discuss these issues. Cheap Generic Viagra

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#fullpost {display:none;} Months ago, when the clock stroke 9 pm or so. Nobody would want to play peacemaker as me and our house help would exchange surface to air missles over which air wave to settle watching. Maging Sino Ka Man or Marimar? I was a defector for quite a moment after seeing hunky Atty. Adrian (Marimar's hot lawyer) first appear on the show. He is so cute. Sarap chupain. hahahaha. Look at those arms. He is so strong. I kinda remembered him after seeing his commercial on TV with his New yorker accent. Speaking of New York and the US of A. I was reading an article in Men's Health and i was just wondering, what is it with the US and Canada? It was entitled "12 things to make peace with": Cheap Generic Viagra

Tags: marimar, air, remembered, commercial, yorker

"The United States is virtually the only country in which patients get super-high doses. You create a toxicity situation," said Dr. N.D. Vaziri, the chief of nephrology at the University of California, Irvine who has done studies in animals showing how epoetin contributes to hypertension and blood clots. Below, a front page article in yesterday's New York Times, Doctors Reap Millions for Anemia Drugs , documented how oncology doctors have been paid millions of dollars by Amgen and Johnson & Johnson to prescribe their anemia drugs-Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson-to patients with kidney disease or cancer chemotherapy. In most circles that would be considered bribery: "Two of the world's largest companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size." But as critics, including prominent cancer and kidney doctors, say "the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes." The Times notes that "Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person. But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10." "That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island. Instead, use of epoetin continued to soar." Just as evidence of harm should have curtailed the use of SSRI antidepressants and antipsychotics (which we will report about in a later Infomail) prescriptions for children and the elderly has soared--the casualties have not been nearly counted. "No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today." [Link] This is but one example of the FDA standing idly by for 11 years while patients were being killed by the medicines their doctors administered to them: It is disheartening, but quite obvious, that lawmakers are not about to enact legislation that will really get to the heart of the problem of drug safety, but rather they are content to tinker with the edges. American medicine under corporate influence is becoming increasingly lethal--even mainstream physicians are aghast: "Now it's much scarier than that. We could really be doing harm." Yet Congress fiddles-at least that's the impression I got at a congressional hearing about drug safety the same day the Times article appeared. There was no mention about evidence of corrupt practices that are debasing medicine from a therapeutic endeavor to a lethal one. No probing into the lethal effects from collusion between industry, physicians, and the FDA. Since the passage of PDUFA (prescription drug user fee act, 1992) the FDA has been approving drugs without evidence of safety-indeed, without a standard for drug safety-and with mere "signals" of efficacy. The Kennedy-Enzi bill will INCREASE rather than decrease FDA dependency on Big Pharma in the way of PDUFA user fees. Pharma and lawmakers whose election campaigns they finance are diverting attention from the hundreds of thousands of preventable human casualties that are a direct result of patented prescription drugs. Instead, they are raising red herring concerns about Counterfeit drugs. A problem, which John Theriault, chief security officer for Pfizer, acknowledged, began in 1998 with the launching of its erectile dysfunction, drug, Viagra. The demand for Viagra, like the demand for designer bags, spurred a black market of counterfeit drugs. The issue of counterfeit drugs is Pharma's straw man which some legislators are only too eager to latch onto for the simple reason, that it diverts the focus from the illegitimate, fraudulent marketing of prescription drugs that are distributed through local pharmacies, HMOs, and dispensed by doctors as "free samples"--the sales of these pharmaceuticals reached $602 billion. [1] These tainted drugs carry the FDA seal of approval, are prescribed by U.S. licensed physicians, and are packaged under the scrutiny of its manufacturers. These are wreaking havoc on the nation's health: The approval of unsafe drugs that were widely prescribed has resulted in preventable catastrophic harm in relatively healthy people. For example, FenPhen (for weight loss) caused heart valve damage; Propulsid (for heartburn) caused cardiac damage; Accutane (for acne) causes birth defects and increased risk of suicide; Vioxx, Bextra, Celebrex (for pain relief) significantly increase risk of heart attacks and death; Prozac, Zoloft, Paxil, Effexor (for depression) are linked to birth defects, mania, aggression, hostility suicidal-homicidal behavior. Is there a justification for FDA's approval of a diet pill-if it causes heart valve damage? Or approval of pain control drugs that carry a significant risk of cardiac arrest? Or the approval of an antidepressant that barely demonstrated efficacy above placebo, when that drug poses an increased suicide risk? Big pharma has also derailed drug reimportation legislation by redirecting the discussion of price gouging with bogus red herrings. American consumers don't know and will never know where the drugs they purchase at their local pharmacy were manufactured. Mostly NOT in the U.S. Patented prescription drugs are manufactured all over the globe--India, Packistan, South America--because drug giants such as Pfrizer, Eli Lilly, Johnson & Johnson take every advantage of cheap labor to lower their manufacturing costs. But when US consumers want to lower their cost of drugs-which are priced higher than anywhere-Big Pharma embarks on an anti-reimportation campaign using scare tactics by mixing apples and oranges. Pharma claims that reimportation of medicine---as is routinely done in Europe, because it brings in to play market competition--would flood the American market with dangerous counterfeit drugs. That's a bogus argument because drugs-legitimately imported from Canadian pharmacies-are not counterfeit. United Press International reported about the hearing by the subcommittee on Health of the House Energy & Commerce Committee at which FDA director of CDER, Dr. Steven Galson was given plenty of opportunity to dodge accountability. Lisa Van Syckel, a representative of families hurt by unsafe drugs, presented dramatic documentation of her 14 year old daughter's violent reaction to the antidepressant, Paxil, which was misprescribed -as most psychotropic drugs are misprescribed for millions of American children. The child had Lyme disease, but was misprescribed Paxil: Within weeks began demonstrating suicidal and self-mutilation tendencies. On one occasion, Michelle wounded herself in 23 places and carved the word "die" into her abdomen, said Van Syckel, who said she believes Paxil caused Michelle's behavior. "Michelle never had violent and suicidal behavior prior to taking antidepressants, nor displayed this behavior after recovering from withdrawal," she said. Ms. Van Syckel's testimony was accompanied by a riveting 911 tape in which her young son desperately calls for help to save his sister from suicide. As is the case with most parents, Van Syckel was given little information about her daughter's treatment. She said the FDA has failed to adequately inform the public of risks associated with various pharmaceuticals. Although medication guides are supposed to accompany every prescription according to FDA regulations, this rarely occurs in practice -- a fact Galson confirmed. Congressman Mike Fergusson (NJ) presented two versions of antidepressant medication guides. Dr. Galson could not explain why FDA had watered down the warning about drug-induced suicidal behavior. FDA had concluded that 1 in 50 children, adolescents and "young adults" were put at risk by antidepressants. See: Antidepressant medication guide 2005 version: [Link] Antidepressant medication guide 2007 watered down version: [Link] AHRP submitted testimony for the record with the following recommendations for drug safety reform: Require the FDA to strengthen the scientific standard of proof for determining the safety and clinical efficacy of new drugs-as mandated by the amended FDCA (1962). Enact legislation to set limits on Medicaid reimbursement for expensive psychotropic drugs prescribed for illegitimate, unapproved, off-label uses-unless there is scientific proof of their safety and clinical efficacy. Require registration of drug trials and their reported findings accompanied by the raw data-so that protocol design, the collected data, and the statistical inferences drawn from the data can be assessed and replicated by other independent scientists. Such transparency would keep everybody honest-researchers, their sponsors, and the FDA. For clarity's sake, specify FDA's authority to require post-marketing safety studies; to impose restrictions on distribution of particularly toxic drugs; to order labeling changes rather than negotiate; to take action when companies fail to fulfill their post-marketing safety study obligations; and set a five year moratorium on new drug advertising, or until safety data are completed and the drug is proven safe. Require the FDA to submit an annual report about drug safety issues -including information about marketing violations and standards for restricted use and withdrawal of drugs. Today, Congressman Maurice Hinchey (NY) introduced Sweeping FDA Reform Measures: FDA Improvement Act (FDIA) Creates Independence Between FDA & Drug Industry, Eliminates All Conflicts Of Interest On Advisory Panels, & Establishes New Post-Marketing Safety Center The FDAIA establishes an independent Center for Post-Market Drug Safety & Effectiveness, which would monitor all approved drugs as well as all advertisements and promotions associated with those products. Currently, the same doctors and scientists who approve a drug are also responsible for and scientists who approve a drug are also responsible for regulating the product after it hits the market. Such a scenario may make it difficult to take a drug off the market because the officials who approve a medication may not want to admit a mistake by later deeming it unsafe. Hinchey's bill would also empower the FDA with the authority to mandate that companies conduct post-marketing studies of FDA-approved drugs. Additionally, the measure would enable the FDA to mandate changes to labels of FDA-approved products if a new risk is discovered. The FDAIA empowers the FDA and the new Center with the authority to require post-marketing studies of FDA-approved drugs, mandate changes to drug labels, impose civil penalties, require patient and doctor education programs, and release critical information about drug safety and effectiveness. "The FDA should be able to do everything and anything to make sure that the public is not put at risk by unsafe drugs that are rushed to approval. Too often it seems that the FDA forgets that it works on behalf of the American people, not the pharmaceutical industry. That is a fundamental problem that must be addressed." See: [Link] html References: See, partial list of U.S. Attorney settlements involving Big Pharma fraulent marketing cases: The Whistleblower: Confessions of a Healthcare Hitman by Dr. Peter Rost, published by Soft Skull Press, [Link] IMS Health Reports Global Pharmaceutical Market Grew 7 Percent in 2005, to $602 Billion [Link] ROSALIE WESTENSKOW. ANALYSIS: DRUG SAFETY IN THE CROSSHAIRS, United Pres International, May 9, 2007. [Link] [Link] The New York Times May 9, 2007 Doctors Reap Millions for Anemia Drugs By ALEX BERENSON and ANDREW POLLACK Two of the world's largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes. Industry analysts estimate that such payments - to cancer doctors and the other big users of the drugs, kidney dialysis centers - total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business. Neither Amgen nor Johnson & Johnson has disclosed the total amount of the payments. But documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year. Yesterday, the Food and Drug Administration added to concerns about the drugs, releasing a report that suggested that their use might need to be curtailed in cancer patients. The report, prepared by F.D.A. staff scientists, said no evidence indicated that the medicines either improved quality of life in patients or extended their survival, while several studies suggested that the drugs can shorten patients' lives when used at high doses. Yesterday's report followed the F.D.A.'s decision in March to strengthen warnings on the drugs' labels. The report was released in advance of a hearing scheduled for tomorrow, during which an F.D.A. advisory panel will consider whether the drugs are overused. The medicines - Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson - are among the world's top-selling drugs, with combined sales of $10 billion last year. In this country, they represent the single biggest drug expense for Medicare and are given to about a million patients each year to treat anemia caused by kidney disease or cancer chemotherapy. Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society, said that both patients and doctors would benefit from fuller disclosure about the payments and the profits that doctors can make from them. "I suspect that Medicare is going to take a very careful look at what is going on here," he said. Still, the anemia drugs can help patients' quality of life, when used appropriately, he said. "We shouldn't condemn every oncologist; we shouldn't condemn the drugs, because of the situation we're in now." Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians' offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors' purchase price. Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more. Combined with those insurance reimbursements, the rebates enable many doctors to profit substantially on the medicines they buy and then give to patients. The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company's drugs exclusively typically receive higher rebates. Johnson & Johnson said yesterday in a statement that its rebates were not intended to induce doctors to use more medicine. Instead, the rebates "reflect intense competition" in the market for the drugs, the company said. Amgen said that rebates were a normal commercial practice and that it had always properly promoted its drugs. "Amgen is dedicated to patient safety," said David Polk, a spokesman. "We believe our contracts support appropriate anemia management and our product promotion is always strictly within the label." Both companies' stocks fell yesterday after release of the F.D.A. report. Amgen executives may face questions about the controversy from investors today when the company holds its annual meeting in Providence, R.I. Since 1991, when the first of the drugs was still relatively new, the average dose given to dialysis patients in this country has nearly tripled. About 50 percent of dialysis patients now receive enough of the drugs to raise their red blood cell counts above the level considered risky by the F.D.A. American patients receive far more of the anemia drugs than patients elsewhere, with dialysis patients in this country getting doses more than twice as high as their counterparts in Europe. Cancer care shows a similar pattern. American cancer patients are about three times as likely as those in Europe to get the drugs, and they receive somewhat higher doses. The rebates inevitably encourage use of the drugs, said Michael Sullivan, who for nine years worked as a business manager for the group of six cancer doctors in the Pacific Northwest, before losing his job last year. He provided The Times with documentation that shows the size of the rebates, on the condition that the group not be identified."Personally, I think rebates should go away," said Mr. Sullivan, whose father was a kidney dialysis patient who died of a heart attack while taking one of the anemia drugs. "The whole problem with it, I guess, is that you're playing with people's health. It's not the same as buying widgets." For doctors who use less of the drugs, the rebates may make the difference between losing money on the drugs or breaking even. Mr. Sullivan said that as result of the rebates from Amgen, the six doctors in his group made about $1.8 million in net profit on the drugs they prescribed. Unlike most drugs, the anemia medicines do not come in fixed doses. Therefore, doctors have great flexibility to increase dosing - and profits. Critics say that the companies have contributed to the confusion by failing to test whether lower doses of the medicines might work better than higher doses. "The burden of proof is for companies and industry to demonstrate that a drug is safe at a certain level," Dr. Ajay Singh, an associate professor at Harvard Medical School. Dr. Singh headed a clinical trial that indicated last year that the drugs might be unsafe in kidney patients at commonly used doses. Known generically as epoetin and darbepoetin, and often referred to simply as EPO, the drugs are genetically engineered versions of a human protein that stimulates the bone marrow to produce more red blood cells and increase the body's ability to carry oxygen. Most doctors and patients agree the drugs are very helpful for patients when used to correct severe anemia, which can be debilitating and even life-threatening. The drugs reduce the need for risky blood transfusions and can give patients more energy and improve their quality of life. "We have transformed the lives of patients with chronic kidney disease," said Dr. Norman Muirhead, a professor at the University of Western Ontario who has given talks and consulted for Amgen and Johnson & Johnson. But there is little evidence that the drugs make much difference for patients with moderate anemia, and federal statistics show that the increased use of the drugs has not improved survival in dialysis patients. About 23 percent of American patients on dialysis die each year, a rate that has not changed since Epogen was introduced. Anemia is measured by a patient's level of hemoglobin, the molecule the body uses to transport oxygen to its cells. Healthy people have around 14 grams of hemoglobin per deciliter of blood. Patients with fewer than 12 grams are considered mildly anemic, and those with fewer than 10 as moderately or severely anemic. The labels on the drugs, as currently approved by the F.D.A., encourage doctors to aim for a hemoglobin level of 10 to 12. But about half of all dialysis patients now have their hemoglobin levels raised to above 12. Critics of the drugs say their increased use has been driven by profit. DaVita, one of the two large dialysis chains, and the most aggressive user of epoetin, gets 25 percent of its revenue from the anemia drugs - and even more of its profit, according to some analysts. Dr. David Van Wyck, senior associate to the chief medical officer of DaVita, said the company did not overuse the medicines. Doctors determine how much to use, Dr. Van Wyck said. "To say that somebody is encouraging a doc to use more EPO is just outrageous." Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person. But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10. That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island. Instead, use of epoetin continued to soar. No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today. Dr. Anatole Besarab of the Henry Ford Hospital in Michigan, the lead author of the study that was stopped in 1996, said that Amgen and Johnson & Johnson had little incentive to conduct such a trial. Dr. Robert M. Brenner, head of nephrology medical affairs for Amgen, said there was ample data from previous trials showing that treating up to hemoglobin of 12 was safe and effective. Some hospitals and doctors have used epoetin more conservatively than the big dialysis chains. Dr. Ronald A. Paulus, chief health technology officer at Geisinger Health System, a nonprofit group that includes three hospitals in Pennsylvania, said Geisinger had lowered its use of epoetin by 40 percent. Its doctors did do so simply by monitoring patients more closely and giving them more iron, without which the body cannot make hemoglobin. Dr. N. D. Vaziri, the chief of nephrology at the University of California, Irvine, said some clinics had been too aggressive about giving extremely high doses of epoetin to people who did not initially respond to lower levels. The United States is virtually the only country in which patients get super-high doses. "You create a toxicity situation," said Dr. Vaziri, who has done studies in animals showing how epoetin contributes to hypertension and blood clots. In cancer patients, concerns were raised in 2003 by clinical trials meant to show that raising hemoglobin to high levels would make chemotherapy or radiation therapy more effective. Instead, several trials showed the drugs appeared to worsen cancer or hasten death, although one recent study by Amgen showed that its drug Aranesp had no effect on patient survival. The conflicting studies are among the issues the F.D.A. advisory committee is expected to discuss tomorrow. Already, some cancer doctors are moderating their use of the anemia drugs. Dr. Peter Eisenberg, an oncologist in Marin County, Calif., said many doctors had been induced to use more epoetin by the financial incentives and the belief that the drug was helpful. "The deal was so good," he said. "The indication was so clear and the downside was so small that docs just worked it into their practice easily. "Now it's much scarier than that," he said. "We could really be doing harm." Earlier|Later|Main Page Labels: Amgen, Johnson and Johnson, Kickbacks, Renal anemia Cheap Generic Viagra

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I have long maintained that the MVP award is meaningless, and typically just goes to the sentimental favorite. Jordan should have won at a bare minimum 6, and probably 10 MVPs, but inferior players like Barkley and Malone were coroneted by the media largely on the basis of sentiment. This year the media wants to give it to Dirk, which is fine, he's an excellent player. But still a meaningless award. I prefer the All NBA team. Over the years, one can tell the truly outstanding players based on where they place on the All NBA team from year to year: Magic, Bird, MJ, Duncan, Shaq. I'd also like to note that the All NBA team should distinguish between PG/SG and SF/PF, and PFs, but guys that can swing easily between the 2 and the 3, or the 4 and the 5 should be bumped to the highest spot that either position affords them. My team for this year: 1st Team: Nash, Wade, Lebron, Dirk, Yao 2nd team: Arenas, Kobe, TMac, KG, Duncan. 3rd team: Parker, Carter, Howard, Boozer, Amare. Also, this year's playoffs should be fabulous. I like the Spurs, but it's quite a tough road through Phoenix and Dallas. In the East, I like the winner of the Bulls/Heat series. As for the Wizards, 4 and out. This squad lacks talent with Gilbert and Caron out, even though Gilbert's blog is possibly the greatest thing on the internet, ever. My favorite quotes: "I got to boo LeBron and them." "That’s why I’m going on the road trip, I’m going to sit right behind their bench and just talk all day. I’m going to just talk about the whole team from start to finish and try to do my part by irritating them." "Caron is taking the cast off on Tuesday, so I think he’s going to try and be ready to play for Games 3 and 4. It’s going to be a big lift because those guys will be happy to see him back and he’ll bring his energy. And then if they go to Game 5 I’m coming in, I’m going to play. All they are going to do is just sit me in the corner for offense and I’m going to shoot threes, just in case it comes down to a game winner. I still got the Hibachi going. I mean, I can’t walk or run, but I’m going to try. Hell, I could play Games 1-4, just stick me in the corner." "Of course we’ll win the election. As long as he has me, we’re winning. We’ll be co-presidents. He can handle all the big stuff like the war in Iraq and all that, and I’ll keep everybody distracted off what he’s doing. I’ll be the entertainer.I’ll do the press conferences. I’ll play the Bush part. I’ll be the golfer, I’ll go golf for 14 hours. I’ll party for half a week. I’ll do that, I’ll have fun with that. And then Barack can handle all that important stuff. " Seriously, I can't think of a more likable superstar in sports history. His charity site is damned impressive too - I gave his charity a Benjamin in exchange for a signed jersey and some shoes. I love the NBA. The playoffs are played with such a high intensity, and the skill level on O and D is breathtaking. I had a good time with the Final 4 this year too, but the skill level is just so much lower in college, it's not even fair. Let's talk some more Wizards. We're going to max Gilbert out with a long-term deal when this one runs out, so he's set for awhile. Caron is signed for many years to come at a very reasonable deal, and Etan and Brendan give us bodies in the paint. Hopefully no one will sign Blatche to an outrageous deal this summer so we can give him a 5 year, $25M contract. Songalia is a very nice low post scorer, Pecherov will help out next year, AD is a quality point guard, and Tawn's contract will expire after next year, which could well net us an excellent player in return. Let's say the Bulls get the #1 pick in the draft and want to take Oden. Wouldn't it make sense for us to trade Tawn for Big Ben straight up? Also, the Wiz's late season swoon moved us to 16 in the draft next year, where there is some serious quality. What if Al Thornton falls, or Thaddeus Young? Those guys could come in and contribute right away. Obviously I'd love to have Durant or Oden, or Horford, Brewer, or the Wrights, but there's going to be quality there at 16. Another possibility to consider is the Jermaine O'Neal sweepstakes. ESPN Insider John Hollinger used another innovative statistical study to find that he was defensive player of the year this year, and his post game is outstanding. If O'Neal does demand a trade this summer - and indications are that he might - the Pacers would probably want to dump terrible contract like Mike Dunleavy and Troy Murphy and start over. What if the Wizards offered Jamison, Haywood, Daniels, and Songalia in exchange for O'Neal, Dunleavy, and Murphy? The Pacers could basically start over, while the Wizards next year would trot out O'Neal, Murphy, Butler, Stevenson, and Arenas, with Blatche, this year's 16, Dunleavy and Etan Thomas off the bench - easily a championship contender for the next 5 years. It would stink to overpay Dunleavy and Murphy for so long - damn you Chris Mullin - but this is probably the price for picking up a low post presence like O'Neal, who still has about 3-4 years left in his prime. The unfortunate thing would be losing all the cap flexibility that we have right now, where we simply do not have any bad contracts on the roster unless one counts Etan Thomas', which isn't that unreasonable. As for the Skins, we need a WR, and some more D-linemen. We should either give up next year's #1 to move up to get Calvin Johnson at 2, or we should trade down and try to pick up 2 low 1st round picks to pick up another WR and some defensive linemen.

Tags: year, team, player, neal, nba

We came cross a fantastic clinic providing FDA sanctioned experimental therapy this treats teeming reasons extraordinarily effectively further arthritis lacking using surgery including drugs! \"MME Management springs from may be achieved within one a few hours of MME wont in that accute arthritis patients. Regime can greatly improve stiffness along with vicinity of matter. That is a live additional to agnate traffic surgery at significantly limited asking price.\" News Flash: Merck recalls blockbuster arthristis drug.... Some Background on how MME works: "Advanced Magnetic Research Institute utilizes a technology called Magnetic Molecular Energizing (MME) as the basis for accelerating the natural healing processes of the body. Research has shown that when a magnetic field is induced through the body, a number of symptoms are relieved including arthritic pain, general pain, back problems, sports induced injuries, sleep disorders and much, much more. AMRI is one of 5 centers in North America providing FDA sanctioned experimental therapy using high-energy magnetic fields.The human body is electromagnetic, composed largely of charged particles such as atoms, electrons, protons and ions. Each performs vital life functions. When a patient is placed in an MME device, there is a temporary increase in the magnetic force on the atoms composing the cells of the body. Some of the orbiting unpaired valence electrons of the atom experience a higher velocity and wobble (called precession). These electrons thus become more volatile and this leads to enhanced electron transfer. Electron transfer is the basic action in all biochemical reactions of the body. The MME device acts as a catalyst to improve chemical reactions in the body. Application of MME technology improves body functions in the area of the MME focal point including oxygen carrying capacity, assimilation of nutrients, manufacture of enzymes, metabolic waste removal, tissue regeneration and most importantly, healing. The rate of healing can be greatly accelerated. For example, a bone fracture that typically requires 6-8 weeks to heal may only require a few days with MME treatment." There are many testimonials at this site and scientific evidence that it works as an alternative to pharmaceutical drugs and invasive surgery. Check it out. AMRi1.org (Advanced Magnetic Research Institute) Cheap Generic Viagra

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"I kept the bottle with me and I didn't have good tolerance for pain and I took more than I should have, and like the feeling" Utah's prescription drug problem is being called an epidemic. Last year more Utahns died as a result of over-the-counter or prescription drug overdoses than died in automobile crashes. via Kutv.com - Original Story

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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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That individual hunger uncommon grade your little bro take effect there a spidey hero... Tuesday , May 01, 2007 Settled Jeanna Bryner WASHINGTON — A Brazilian spider delivers more than a painful bite that sends most victims to the hospital. Its venom invigorates an hours-long fabric. Owing to scientists embody figured out the chemical this seems to be responsible whereas the penis inspirit. Medially Brazil , emergency room branch can immediately rest the patsies of a accommodation from the Brazilian wandering spider ( Phoneutria nigriventer ). Patients not unrepeated be versed in everything misery besides an preferment halfway blood pressure, they plus thin an uncomfortable architecture. \"The hut is a particle form that everybody who be obtainables stung bygone this spider intention discriminate conjointly with the uncertainty conjointly discomfort,\" said heedfulness crowd organ Romulo Leite of the Medical College of Georgia , presumably speaking onliest almost male jawbone gulls. \"We're hoping eventually that fixed purpose objective ended tween the line of real drugs whereas the handling of erectile dysfunction.\" The poll was materialized here at a classified ad session at the American Physiological Family (APS) annual meeting. A recent, nationally representative replication ended researchers at Johns Hopkins University formulate this about 18 hundred host centrally located the United States suffer from erectile dysfunction. Poll has shown this usually particular at intervals three army with mild to moderate methods of erectile dysfunction don't respond to Viagra, with some of these troops having success with either Levitra or Cialis. Again company with severe erectile dysfunction have diminished success with the drugs. Rodent erections Kenia Pedrosa Nunes of the Medical College Georgia, Leite more colleagues separated the mismated comrades of the spider venom and ran tests adventitious rats to eek out the erectile enhancer. Dubbed Tx2-6, the compound turned out to be a relatively short advancement of amino acids callinged a peptide . Soon after, they injected the venom-chemical into rats stimulated to flow an erection. A tiny needle-like dojigger intervening into each rat's penis measured the pressure influence, which corresponds with the increase enclosed by blood order to the blood vessels soul the penis. Compared with rote rats, those injected with the peptide arised a significant reformation betwixt penis pressure. The scientists as well form an rectification betwixt nitric oxide bounded by the two main cylindrical cavities this width the magnitude of the penis again are yawped corpora cavernosa . Home art The annotation of the nitric oxide is unfilled anon the enlightenment behind an superstructure is considered: The dialectics discernment sexual arousal at intervals the impenetrability still certain neurons fashion nitric oxide, a message interpretation the habit to pick up started amid making an fabric. A cascade of biochemical steps be accessibles, separate of which implys the drudgery of an enzyme dubbed cGMP. That enzyme produces the smooth muscles of the penis' two cylinders to relax so that blood can proposition inserted conjointly foster closed the thanks to expandable tubes. (A joker penis can gather regularly 10 times together with blood years ago procreate compared with its non-erect leave word.) \"Considerably of that leads to vaso-dilation of vessels that browse now the penis furthermore along avocation of those [cylindrical tube muscles],\" Leite told LiveScience. \"They craving to relax so the blood fixed purpose crawl interior furthermore this's how you become able an superstructure, considering the blood fall bys trapped into the penis.\" But erections don't advance forever. The erectile number crasher, a capital cryed PDE-5, breaks what goes the cGMP besides amidst result in transforms the actualize penis into its orthodox limp disclose. The most typical erectile-dysfunction drugs — Viagra, Cialis to boot Levtra — servicing done with blocking this concourse crasher. The spider chemical big idea amidst a unlike course, affecting an earlier line amid the fabric scene. Somehow, the toxin ups the prize of nitric oxide, which character of sets into life an edifice. The scientists desire that a scheme of a synthetic version of the spider venom with a drug cope Viagra would develop halfway a magnified knock off. \"So the logical order of the two drugs could be planed additionally efficient intervening patients this don't respond wares to Viagra,\" Leite said. Copyright © 2007 Imaginova Corp. Well Rights Select. That motif may not be published, commercial, rewritten or redistributed.

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PROSTATE Yahoo News, Mon Dec 5,12:30 PM ET "NEW YORK (Reuters Health) - Men undergoing a prostate biopsy may experience less discomfort if they're given a suppository containing the local anesthetic lidocaine a couple of hours before the procedure." FULL STORY Cheap Generic Viagra

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Julie, a person I work with at 1-800-PetMeds, mentioned that she received an email which states giving grapes or raisins to your dog can be dangerous. Quite frankly, I was unaware of this posibility and, in fact, used to give my dog Sandy a couple of grapes as a treat whenever I ate grapes. It turns out, that this is not an urban legend. It is reality. Grapes and raisins can be poisonous to dogs. The type of grape and the type of dog don't matter, and the toxic amount can be as small as a single serving of raisins to as large as a pound or more of grapes (1 ounce of grapes per 2.2 lbs of body weight). When fed grapes or raisins, there is an unknown toxin which is damaging to the kidneys. Initially, pets fed grapes or raisins will exhibit gastrointestinal signs such as vomiting and diarrhea. Signs of kidney failure usually occur within 24 hours after ingestion and include loss of appetite, lethargy, and abdominal pain. The dog may stop drinking and urinating. Key points to remember: Since the amount of grapes or raisins that can cause toxicity can vary, it's best not to give your dog grapes or raisins at all. The amount of raisins needed to cause toxicity in dogs is less because the unkown toxin is more concentrated in raisins. Do not leave grapes or raisins where your dog can get at them easily. If you suspect your pet has eaten grapes or raisins, contact your veterinarian immediately. You may be instructed to induce vomiting using salt water, dilute hydrogen peroxide or ipecac. Your veterinarian will tell you which to use. For more information regarding grape and raisin toxicity log onto: http://vetmedicine.about.com/od/toxicology/f/grape_raisin.htm Log onto internet.PetHealth101.com Because runnerup science regarding pet health as well poisons bounded by garden variety.

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>I once had a friend, Who was a wonderful girl Being her friend was like having a bright, New pearl She was the best, She was so much fun But then one day she decided that she was done She would not call, She would not play So I was left alone, Left alone all day To tell her how i felt.. Well I didn't have the guts Yet everyday the pain got worse like big paper cuts This girl would not care even when i would try to call I had a friend, A really nice friend, a friend that was really no friend at all.

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

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Eric Blair was born in 1903 in Motihari, Bengal, in the then British colony of India, where his father, Richard, worked for the Opium Department of the Civil Service. His mother, Ida, brought him to England at the age of one. He did not see his father again until 1907, when Richard visited England for three months before leaving again. Eric had an older sister named Marjorie and a younger sister named Avril. With his characteristic humour, he would later describe his family's background as "lower-upper-middle class." 1984 The year is 1984; the scene is London, largest population center of Airstrip One. Airstrip One is part of the vast political entity Oceania, which is eternally at war with one of two other vast entities, Eurasia and Eastasia. At any moment, depending upon current alignments, all existing records show either that Oceania has always been at war with Eurasia and allied with Eastasia, or that it has always been at war with Eastasia and allied with Eurasia. Winston Smith knows this, because his work at the Ministry of Truth involves the constant "correction" of such records. "'Who controls the past,' ran the Party slogan, 'controls the future: who controls the present controls the past.'" In a grim city and a terrifying country, where Big Brother is always Watching You and the Thought Police can practically read your mind, Winston is a man in grave danger for the simple reason that his memory still functions. He knows the Party's official image of the world is a fluid fiction. He knows the Party controls the people by feeding them lies and narrowing their imaginations through a process of bewilderment and brutalization that alienates each individual from his fellows and deprives him of every liberating human pursuit from reasoned inquiry to sexual passion. Drawn into a forbidden love affair, Winston finds the courage to join a secret revolutionary organization called The Brotherhood, dedicated to the destruction of the Party. Together with his beloved Julia, he hazards his life in a deadly match against the powers that be. Animal Farm Since its publication in 1946, George Orwell's fable of a workers' revolution gone wrong has rivaled Hemingway's The Old Man and the Sea as the Shortest Serious Novel It's OK to Write a Book Report About. (The latter is three pages longer and less fun to read.) Fueled by Orwell's intense disillusionment with Soviet Communism, Animal Farm is a nearly perfect piece of writing, both an engaging story and an allegory that actually works. When the downtrodden beasts of Manor Farm oust their drunken human master and take over management of the land, all are awash in collectivist zeal. Everyone willingly works overtime, productivity soars, and for one brief, glorious season, every belly is full. The animals' Seven Commandment credo is painted in big white letters on the barn. All animals are equal. No animal shall drink alcohol, wear clothes, sleep in a bed, or kill a fellow four-footed creature. Those that go upon four legs or wings are friends and the two-legged are, by definition, the enemy. Too soon, however, the pigs, who have styled themselves leaders by virtue of their intelligence, succumb to the temptations of privilege and power. "We pigs are brainworkers. The whole management and organisation of the farm depend on us. Day and night, we are watching over your welfare. It is for your sake that we drink that milk and eat those apples.

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