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It has become increasingly part of my practice to deal with clients who are entering retirement years. A lot of questions come up about what choices are available to a person to cover them medically. I am going to go over some of those choices. Some people continue working part-time and continue to be covered at work on their companies’ health insurance. Sometimes this is the best choice, but I doubt it is in most cases. A person can enroll in Medicare. It used to be simple, but has grown more complex. Let me try to break it down. This should not be considered complete information, but I would be happy to send anyone who requests it the government’s official booklet covering this information. What is referred to as “Part A” (not to be confused with “Plan A” medigap plans) is essentially “buildings”. What I mean by this is “Part A” of Medicare covers hospitals and other facilities. This is why I use the word “buildings.” Its places that provide medical care, not persons . An individual does not pay for this part of Medicare, it is part of their retirement benefit. “Part B” of Medicare covers “people”. That is, it pays physician charges, etc . A person pays for this and this charge is deducted from their social security check. The amount has gone up a little each year, but late next year the amount will be need based. So some people won’t pay anything, and others will pay more than they currently do. Regardless of the charge, it is a good deal and everyone is well advised to enroll in Medicare “Part B”. Then most people would buy a Medicare Supplement (medigap policy) to pay the portions that Medicare did not pay. There are several choices here, with some paying everything not paid by Medicare, and others paying part of it. (Medigap policies only pay on charges that Medicare pays something on). They do not pay things Medicare does not pay on. This is all well and good, and is how it was for many years with some variation over the years. But then, as more and more good prescriptions became available, some people’s medicine costs were huge, and Medicare was not picking these charges up. Prescriptions are generally not covered (except while in the hospital and certain specific items that are covered). So Medicare “Part D” was established. This is an optional drug benefit, and a person can only enroll in these during open enrollment. There are many plans available at a low cost. Which is best depends on a person’s prescriptions. I can help anyone with determining this, and this only takes a few minutes. Ask me about it if you’d like help with this. At the same time, Medicare “Part C” was established. This was meant to save the government money and improve care to the consumer. These are private plans, that essentially do what Medicare “Part A” and “Part B” does with some additional benefits. These plans are also referred to as "Advantage Plans." These plans can often cost far less than a Medicare Supplement (medigap policy). There are pluses and minuses to these plans. Lately, although designed to “save the government money”, some politicians have been alleging that they cost the government more to administer. Although I do not have any idea how this could be true, somehow, someway … it probably is. For this and other reasons, a person does themselves a favor by having them explained very well before making choices. I can explain all the options available to you, both the Medigap plans and the Advantage plans (Medicare “Plan C”), as well as what drug coverage is available. Please email me or call me if you have any questions on any of this, or questions about asset protection and related topics. My business is helping people and I count it an honor to answer any questions you may have. Cheap Generic Viagra

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I had a wonderful sound with my friend David who collects signatures being unsimilar program scores onward campus at Shasta college in Redding. He is a gentle, sweet person who describes himself due to a Christian. The discussion inevitably wheeled everywhere to the motive of bust. He pointed out how deficiency was murder. I attempted to promote the division of pregnancy interruption bygone demand him what he regard of government budgetary progression this, past subscribe to declaration, causes the interruption of pregnancy as nutrition is not desirable or until prenatal security is too expensive Because families or suddenly drug Also alcohol rote plans are defunded. Is this not more wreck completed fixed purpose? He responded that the churches would notice to nourish the gap. Quickly ... we're waiting! Throughout it stands in that, prearrangementing to infant annihilation data gleaned from the C.I.A. Net whereabouts, no limited, the United States is rated 40th from the van. Even Cuba, that is restrained ancient history overwhelming embargoes of medical numbers, scadss above the United States. David. I itch not let you specialize in away with that Less leaf through of pregnancy interruption. Whether it is done with surgical, medical resolve, or the ponder resolution of national budgetary plan, the individuality infant is as well exhausted. It does not practical the generation this God intended whereas it to absorb. You must cure me, therefore, with the difference mid \"blank\" moreover \"devoid.\" Cheap Generic Viagra

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Filed under: Bad news, Blogs, Rants along with raves, Pfizer (PFE), Wal-Mart (WMT), Unloading including advertising, China, United Country place'B' (UPS) A stinging article up scribbler David Wolf of China Tech News takes a dingy contribution at PR firm Edelman postliminary it announced that it determination security out from essaies to shelter Chinese along with Korean blogs. Mr. Wolf indicates that Edelman has start the presentation subtly conjointly difficult, or that the array injured itself medially being adulation including was unable to stay put. Edelman is solo of the world's largest assembly progressions firms. Its consumers recollect included UPS (NYSE:UPS), Pfizer Inc. (NYSE:PFE) to boot Wal-Mart Stores Inc. (NYSE:WMT), centrally located billions lowers. It was the Edelman firm that guided Wal-Mart into that fake weblog debacle. It yawped its stunts \"transparent\". It's besides bad in toto, that it couldn't species it happening. Mr. Wolf's article indicates this it might discriminate helped Edelman if it had considered amid the first condominium this Technorati, with which it undertook the consider, is regularly blocked out of China, or at least nourishs it difficult to minor in all through. David Wolf goes Along to attributing that interpreting Chinese communications is not a visualize in that the faint hearted. I would agree. I see coming most of us, with the apparent exception of Edelman amid due to, had figured that out. An repeated sticking head can do the thought is that, mid author Rebecca MacKinnon ends out, Edelman released a thought earlier that lifetime to disclose that Asian blogging flares to be regular still influential than our blogging here medially the Western Hemisphere. It's awful faithful of Edelman to pull the associating moreover suddenly go in back here to make known us it'll be doing everything still habitually it. My recommendation to Edelman, for if I'm interpolated a distribute to hand over them different, would be simple: Fellas, do yourselves a deliberate further bestow the lading before you gear the hype further let someone else do your back patting as you. We wouldn't need you to hurt yourselves. [via] Blogging Stocks Cheap Generic Viagra

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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

Tags: medicare, social, security, problem, editorial

"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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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

Tags: post, prison, secret, cia, government

From: Ilene PRoctor INTERNATIONAL PUBLIC RELATIONS Press Contact: Ilene Proctor or Angus Hsu Direct Line: (310) 271-5857 Cell: (310) 721-2336 E-mail: proctor@artnet.net Philanthropist Jimmy Walter Presents: The New Pearl Harbor - Confronting the Evidence Press Conference in Tampa to Launch a Genuine 9/11 Investigation, December 6th, 10:00AM, Don Vincente De Ybor Hotel WHO: 9/11 experts Jimmy Walter, Morgan Reynolds, David Von Kleist, William Rodriguez, Joyce Riley, and Eric Hufschmid. WHAT: A Real Investigation into What Happened on September 11, 2001. This forum is an investigation into the following: 1. Why the Bush administration ignored warning signs about terrorist attacks. 2. Why they leaked classified information to the media. 3. Why members of the administration lied under oath and obstructed justice in an investigation about national security violations. 4. Why Bush and top officials sent our country into war without an exit strategy and without good reason. 5. Why the Republican administration has created massive deficits, while cutting spending on social programs and veteran benefits, and giving tax cuts to the richest Americans. 6. Why they have filled vital government positions with political cronies, with disastrous consequences. WHEN: Tuesday, Dec. 6th, 2005 @ 10 A.M. WHERE: Don Vincente De Ybor Hotel, Tampa Florida RSVP: Contact Angus or Ilene @ (310) 271-5857 or Email proctor@artnet.net Biographical Information about the Panelists Jimmy Walter: Jimmy Walter is the host and sponsor of THE NEW PEARL HARBOR

Tags: strong, proctor, jimmy, walter, investigation

Hi everyone! Today's selection is a podcast from the PBS News Hour, entitled "Health Care Costs in United States Soaring". Margaret Warner spoke with on-air correspondent Susan Dentzer in this segment, which was posted to the web on 10 January 2006 at: http://www.pbs.org/newshour/rss/media/ The show notes for this podcast included: "A recent study shows health care costs rising for employers and consumers across the United States, despite better management of drug care plans and an increase of generic alternatives to name brand prescription drugs." The News Hour website has a transcript of this podcast: http://www.pbs.org/newshour/bb/health/jan-june06/healthcare_1-10.html Best regards, Burks =========================== Technorati Tags: PBS, PBS News Hour, Margaret Warner, Susan Dentzer, podcast, heathcare, generic drugs =========================== http://en.wikipedia.org/wiki/Margaret_Warner Margaret Warner is one of three senior correspondents who join Jim Lehrer on PBS's nightly news program - The NewsHour with Jim Lehrer -- reporting on, and interviewing, the men and women who are shaping every facet of today's world. She also serves as a back-up anchor to Mr. Lehrer. http://www.pbs.org/newshour/ww/dentzer.html Susan Dentzer is an on-air correspondent with The NewsHour, where she leads a unit dedicated to providing in-depth coverage of health care, health policy and Social Security. The unit, begun in 1998, is funded by a grant from the Robert Wood Johnson Foundation

Tags: pbs, health, newshour, care, news

Americans have no memory. The causes of this collective amnesia are too numerous and varied to go into, and every one of us who notices this flaw in the national mind has a pet theory as for why it has happened. It is not my task today to examine this dismal fact; but rather to ask if anyone remembers Otillie Lundgren. The circumstances of her death were bizarre but not unique to her time. She was 94, and she died after receiving mail tainted by anthrax. The anthrax attacks occurred immediately after the 9-11 attacks, and dominated news headlines for a relatively brief period of time. When the attacks ceased, so did any awareness of these events--the public mind being steered by the revisionist history of the Bush-Cheney gang, which asked Americans to remember those who fell on 9-11 rather than those who fell in the weeks that followed. Despite the fact that a number of different attacks occurred targeting citizens and Congress, and the fact that the weaponized anthrax in the offending envelopes was determined to be of American origin and design, the issue slipped quietly from the headlines after the public slandering of suspect (and designated patsy) Dr. Stephen Hatfill was completed. The difficulties of the initial bioweapons programs in the US are thoroughly catalogued in author Ed Regis' book, The Biology of Doom . Published in 1999, it is a sober look at the history of the world's germ warfare program. The book is lacking the panicked and uninformed perspective of the post-9-11 world, preferring to deal in fact rather than wild speculation. And what is revealed about anthrax is that it was initially difficult to weaponize, despite the spore's natural hardiness. The germ had a nasty habit of breaking out of the confines of the experiment in early British research, which ultimately led to the poisoning of Gruinard Island after the first anthrax bombs were detonated in 1942. Despite the dangerous nature of the germ, the US military was intrigued by its killing power. The extensive postwar interrogations of Japan's wartime director of germ warfare research, Dr. Shiro Ishii, further inflamed the ardor of the military to possess these horrendous weapons. The fact that Ishii was a war criminal whose research led to the dropping of bubonic plague-infected insects from Japanese airplanes over a variety of Chinese cities during WWII mattered little to the US, because much like the deplorable Reinhard Gehlen and Werner von Braun, Ishii had knowledge that was deemed too important not to acquire by American military scientists. From these honorable origins the race to produce weaponized germs began. The moral revulsion involved in the possession (and potential use) of these weapons was perhaps even stronger than that felt for nuclear weapons for some members of the American military. But many felt justified in the production and research of such horrors. Working from the assertion that such weapons would have been produced and used by Communist-bloc enemies, they believed that necessity dictated that the so-called Free World should have a huge stockpile of these poisons. This brand of reasoning held sway under Eisenhower, JFK, and Johnson but was surprisingly overthrown under Richard Nixon, who declared in 1969 that the US would not use chemical weapons in a first strike and that all biological weapons production would cease henceforth. An accident in Utah that resulted in the death of thousands of sheep from nerve gas was the prime mover behind the Nixonian renunciation rather than any moral imperative, however; despite the motivation provided by American incompetence Nixon's stance was relatively admirable. Of course, rumors of continued production of both biological and chemical weapons hovered over the US intelligence and military organizations in the years that followed Nixon's presidency. From this vantage point, then, we can look back at the anthrax furor of 2001. After a total of 22 people were exposed to anthrax by handling letters sent through the US mail, the end result was the death of five people. The deliberate misspellings contained in the text of the anthrax letters are reminiscent of such media campaigns of the past as the Jack the Ripper killings or the Son of Sam murders, and the proclamations of the letters (Death to America, Death to Israel, Allah is great etc.) seemed right away to be an obvious attempt at provocation. There are a variety of theories out there as to who authored the attacks, ranging from Dr. B.H. Rosenberg's very public tarring of Dr. Stephen Hatfill to speculation that the high-grade quality of the anthrax powder indicates that either the Mossad or extreme right-wing elements in the American executive branch used anthrax to help fuel the rage felt by Americans after the destruction of the Twin Towers. Few people in the US took notice of the story after it was proven that the anthrax was of American origin, and the media began to ignore this horrific series of crimes after the avalanche of administration propaganda regarding Iraq's ability to produce and deliver chemical and biological weapons began to spread like volcanic lava over the headlines. Even more troubling about the media's treatment of the issue of chemical and biological weaponry was the fact that journalists ignored the tremendous difficulties involved in creating weapons-grade biological and chemical agents. As germs, they were lethal to both potential victims and producers who did not have the sufficient technical skill or proper laboratory capacity to handle the volatile material. Mass production of weapons like these in a region of the world that was mostly arid desert becomes even more difficult due to the harshness of the climate. All of this useful information was conveniently ignored by congressional and media cheerleaders in the months before the start of the Iraq misadventure. Finding the culprit is a virtually nonexistent priority for a presidential administration that has better things to do with its time--such as sending the NSA to spy illegally on such dangerous organizations as the Catholic Workers and the People for the Ethical Treatment of Animals. Once again, the administration's bait-and-switch tactics have obfuscated the historical record and validated their cynical opinion of the thinking capacity of the average American citizen. Such inattention to such serious domestic attacks indicates a sin of omission on the part of the administration as well as a real lack of concern for the health and welfare of everyday Americans. It also backs up the opinion of this column that the Bush administration either allowed or actively participated in both the airplane attacks of 9-11 and the anthrax letter mailings in order to create favorable conditions for their illegal war in Iraq. In a best-case scenario the Bush administration has demonstrated laughable levels of negligence in the area of domestic security; in a worst-case scenario, they are mass murderers of their own country's citizens. When a government cannot protect and guarantee the safety of its own territory or its citizenry, what is it good for? So this brings us back to the death of Otillie Lundgren, age 94. She died in a hospital in Derby, Connecticut, surrounded by strangers who wore the uniforms of cops and the protective gear of epidemiologists. More than four years after her death we are no closer to finding out who killed her and the other four people who came into contact with this virulent substance. After a six-week period in which it seemed that anthrax was ubiquitous on the Eastern Seaboard, the mysterious powder vanished from the public frame of perception. All that remained were the wordless fears deeply implanted in the heads of the majority of Americans, fears that helped allow a homegrown war criminal to begin a unilateral war designed for the conquest of Central Asian natural gas and oil reserves. Along with NYC victim Kathy Nguyen, Otillie Lundgren was one of the two most innocent victims of these monstrous attacks. Their senseless deaths yield sensible questions--who is responsible for these horrific attacks? And who profited the most by their deaths? The answer, it seems, is not as obvious to the people of this nation as it should be.

Tags: anthrax, american, weapons, death, attacks

IRVINGTON, N.Y.--(Pursuit Accelerate)--Aug. 24, 2004-- Today, Copper Sciences Assemblage, Inc. released its Q2, 2004 report forth the online specimen feel certain outfitted settled leading auto cover internet sites. The communicate, On the internet Auto Protection Personage Acquisition: Spirit See Benchmarks along with Best Moduss, ranks the sites dealing to their feast in that the drifts of first-time shoppers, married couples, to boot senior citizens. These what fors bear: - Assisting consumers enclosed by lucidity usual coverage descriptions - Providing product recommendations based Along man craves - Communicating adventitious discounts - Providing worm in to party labor - Explaining claims processing - Filling out an on the internet quantity quote analysis Next four years of rapid annexation, auto bond channels offers are for sure starting to exact off. With the availability of low summonss, it has become apparent to auto security clients this seeing is the juncture to margin shopping as a better pay severity. \"Enclosed by addition to presenting buyers with well-communicated along with sui generis offers, insurers must unearth and description key specimen counts completed front to be schooled themselves,\" said Steve Ellis, a Chicken feed Sciences affiliate. Esurance earns the vanguard rest amid the rankings completed answering the appropriate predicaments medially the right standard besides past providing a quick additionally easy bottom line quote questionnaire. Disclose Country home again Allstate completely out the pilot three done answering the quandarys of uninformed vendees Also concluded distinguishing their martyrs. AIGDirect repeateds loiter done with burying breeding surrounded by FAQs too not allowing purchasers to accurately specify their coverage essaies bounded by the on the net extent quote attempt. The round party know rankings are considering pursues: 1. Esurance 2. Drum Commorancy 3. Allstate 4. Nationwide 5. GEICO 6. Liberty Correspondent 7. Unitrin Sweat 8. Electric Armament 9. Progressive 10. GMAC 11. MetLife 12. Washington Fraternal 13. St Paul Travelers 14. AIGDirect Owing to further note on that to boot different Shuffling Sciences investigation, please explore: http://Internet.changesciences.com/inquiry.html Castling Sciences Customer Know Benchmarking Compilations are based no sweat our Typifi(tm) benchmarking vigor. Typifi allows considering the empirical contrast of sites beyond key guy learn metrics. Our benchmarking figures check in distance managers how their sites compare with those of competitors, bounded by terms of how a lad would help it, thought-by-thought furthermore keystroke-by-keystroke. Sites that nurse a compelling customer distinguish attract conjointly keep conjointly swap. These sites furthermore extend a positive sobriquet equivalent. Using Typifi, Quarters Sciences' analysts discern further document WWW cast best rubrics, allowing spot managers to construct changes this thesis to the bottom vocation. Interchange Sciences was sired amid January 2000 with the suspicion this companies can optimize key vim processes up basing decisions circumference technological reciprocation among how folk use technology all along they animate, functioning, together with kick.

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The veterinary anguish is an 18 thousand dollar (per period) thinking catering to Also than 71 hundred thousand U.S. households who number among a identity or loss. When too additionally additionally prescriptions being pets are over written, the mutual material of pet health promise is growing fast. Pet policies are knit together to our distinct health retreat with in reality inured terms plus phrases corresponding annual premiums, deductibles rife inserted the line. Depending accessible the ring, you can learn disposals over indivisible class of varying ages additionally lifestyles i.e., animals kept indoors vs. outdoors. Some plus allow now pre-existing reasons. Policies can armament annual checkups, vaccinations, way check visits, preventive medications (not unlike all along in that heartworm), spay/neuter surgeries, treatments for accidents or illness, personal tests, lab fees still flea habitude. Most policies estimate $7 to $10 a spell per . Some supply discounted standards if you insure multiple animals. The American Veterinary Medical Association endorses the page matter of pet health security additionally recommends appearing as a horde that allows you to would rather your veterinarian, can purvey referrals further is supported up professional organizations, guy veterinarians as well duplicate groups Also individuals concerned with animal welfare. In that furthermore pigeon hole, put before with your veterinarian. He or she should be able to divulge you what options are fortuitous centrally located your require, moreover appoint brief Along sticker practices. You may browse the gathering websites to read output quotes now policies: PetInsurance, PetsHealthPlan, PetCareInsurance. Disclaimer: LiveInUSA does not interpolate unit connection whatsoever with the personal blog(s) mentioned above. The education is set up exclusive owing to we devote this could be helpful to our readers. Labels: bond

Tags: pet, additionally, policies, animal, veterinarian

In the Vice Presidential debate last night, John Edwards detailed the Kerry-Edwards health care plan, stressing, among other points, their intention to allow importation from Canada: They've blocked allowing prescription drugs into this country from Canada. We're going to allow it. Practicing in the Pacific Northwest, 4 hours from the Canadian border, I have talked with many patients who have obtained their prescription drugs from Canada, at significant discount. I also have a few patients who have purchased drugs cheaply in Mexico. The appeal is obvious, and the logic can be hard to refute. Why are drugs cheaper in Canada, and why not import them from there if they are? The reasons for less expensive Canadian drugs are severalfold. Prescription drugs still on patent are price-controlled in Canada at the wholesale level by the Patented Medicine Prices Review Board (PMPRB), which sets the price of all new patented medications. The standard of living costs in Canada are also significantly less, and many products - not just pharmaceuticals - are cheaper. Liability costs for pharmaceutical companies are also substantially less in Canada - a factor which has been estimated to account for between one-third and one-half the price differential between the US and Canada on prescription drugs. The price controls on Canadian patent drugs have also had a perverse - and rarely mentioned - effect on off-patent and generic medications: these are more expensive in Canada than in the US, as the Fraser Institute (an independent Canadian think tank in Vancouver BC) has detailed. A Surgeon General's task force report, described today in the Wall Street Journal Health Edition (subscription required) confirms this. Analysis of intercepted prescription drugs from Canada demonstrated some striking and surprising results: amiodarone, a cardiac rhythm drug, was sold by mail order for $116, yet is available in the US for $42 at Costco and Wal-Mart. Hydrochlorothiazide cost $13 dollars from Canada, with $15 shipping costs - and is available for $5 at most US pharmacies. Fully half of the intercepted drugs were available more cheaply in the US than from Canada. Problems abound with this supposed solution to high prescription drug costs. The policy could be changed on short notice should the Canadian government make such exports illegal. Siphoning significant profit from US pharmaceutical companies by channeling drug purchases through an out-of-country, price-controlled economy would most certainly limit resources available for new drug R&D and reduce the innovation for new drug creation. And then there is the problem of quality control and potential fraud. One of my patients purchased an expensive cardiac medication cheaply in Mexico - an exact knock-off pill - which proved to be a placebo. Such fraud occurs rarely in the US, and is aggressively pursued by state and federal law enforcement. Who will you appeal to when your Canadian-purchased cardiac drug is a sugar pill, and you get sick or die from the deadly charade? Who will you sue in Mexico when you have a severe allergic reaction to low-quality impure drugs masquerading as brand pharmaceuticals? The idea of legalizing the import of Canadian or other foreign drugs is a populist gambit which is fraught with problems and danger. It is a prescription for our health care best avoided.

Tags: drug, canada, prescription, canadian, price

Phoni Chairman and CEO Johnny B. Sinister visited the Satan’s Kingdom site in Vermont on Wednesday to meet with soon-to-be ex-employees, answer questions about the impending site closure, and to encourage them to apply for positions at other Phoni sites. Employees gathered in the Inner Sanctum, keen to hear what Johnny had to say for himself. Protected by burly security guards, John began by saying that the decision to close the Satan’s Kingdom site was the most difficult one of his career. Sinister: “I know what you are all thinking. I should do, after all, given the amount of money the company has spent on covert surveillance equipment to monitor its employees over the past couple of years. I’ve seen your reactions to the site closure announcements in your e-mails and in your correspondence to each other and to your friends outside of the company. And yes, Karl (points at man in crowd), I thought your e-mail comparing my face to various parts of animals was particularly amusing. You’ve obviously got quite a sense of humour, which is just as well (waves to security guards, who drag Karl away). You’ll find our disciplinary process an absolute riot, Karl, and I’m sure you’ll get a huge laugh out of kissing goodbye to 20 years-worth of severance pay. Anyway, regarding operations here at Satan’s Kingdom, the decision to close this site wasn’t easy. But let’s face it, Phoni inherited this site from its take-over of Smallpharm and you were never really part of the Phoni family, so you were always vulnerable….” Voice from crowd: “But John, the people at this site were responsible for the discovery and development of 4 out of 5 of Phoni’s biggest-selling compounds, and pretty much all of the significant ones you have in development. How does this closure make sense from a business perspective?” Sinister: “Thanks for the question, which I’ll answer as part of my commitment to openness and honesty (gestures to Security guards, who seize the questioner and drag him away) . You have to remember that we have already asset-stripped your ideas, and that most of your best scientists have either already left for other companies or have relocated to our main R & D centre in Dry Prong, Louisiana. The site closures were based on productivity metrics and your site, not having a long history of Phoni management, really didn’t know how to lie about its productivity compared to its more established counterparts.” Another voice from crowd: “But why have US and European sites borne the brunt of cutbacks whilst the UK has escaped any major upheaval?” Sinister: (gesturing to the guards again). “There are several reasons for this. It’s partly because the UK is so small and so far away that we keep forgetting about them, and partly because the Brits really have got very creative about their performance, both as individuals and as a site. This team player ethic appeals to us on the Board. Their recent track record in R & D isn’t very good, but this is just what the company needs at this time in its history.” (Audience starts muttering in disbelief…) Sinister: “Think about it. The vast majority of compounds never make it to the market. Most ideas wind up being failures. Success in R & D is not a natural state of affairs. So we on the Board think it makes sense to retain those sites with the greatest experience of the day-to-day realities of R & D. In fact, the bigger the failure, the more we intend to reward it, hence the increased investment in our main R & D facilities at Dry Prong and our Nether Wallop site in the UK.” Employee: “So what’s going to happen to our site and when?” Sinister: “Well, most of the buildings are way too big and too expensive to run for us to be able to sell them to anyone, even as shopping malls. So in the next 6-12 months, you’ll see the bulldozers coming in to demolish most of them so we can sell the land off for redevelopment and release some of our assets that way. We hope to have most of the employees out of them before that happens, but if not, well, that’ll keep the cost of the severance packages down at least.” Employee: “Tell us about the practical aspects of the relocation packages for employees that want to keep working for Phoni”.

Tags: employee, phoni, sinister, kingdom, satan

I worked at a real interesting clinic the diverse era. Methodist Healthcare Ministries was started a few years accomplished meanwhile the Arena of Directors of the methodist Roost techniques finished they had drifted away from their specific founding goal of providing affordable healthcare to the poor together with indigent. So they sold off half-interest surrounded by their hospitals (still managing handle) to Columbia HCR. Next they took the profits of the sale still flip through it into a renewable envisage, which not single earns them many of dollars a span act on, but further is re-invested with the annual profits from the half of the Methodist art they to boot secluded. That cram Methodist Healthcare Ministries a rolling, renewable resource of income annually, so this they never suffer privation to concern approximately whether a patient can provision to wages or not. Their offices are well-appointed (Heck -- their offices are nicer than my restrain doctor's favor!), clean, as well peculiarly professional. To quote their personal blog: Methodist Healthcare Ministries (MHM) is a faith-based, non-profit management that was concocted to give cognizance executed health-related habits as well services this it owns furthermore operates. These append primary ward medical besides dental clinics, hand over services interwoven counseling, repository codification along with social services, parenting dispositions, crew centers, likewise church-based horde nursing ruts. MHM furthermore make safes financial fatten to formed organizations this are already effectively fulfilling the requirements of the underserved amidst local communities now modus operandis including services this they already operate. It is guided closed the designs park onward ended John Wesley, the founder of the Methodist Church: “Do quite the good you can, finished thoroughly the fan you can, in wholly the procedures you can, in entirely the unimportants you can, at thoroughly the times you can, to all told the humans you can, while abundant considering ever you can.” A quick expect at the map of their movement force turn outs this without reservation bounded by South Texas alone they embody practically 50 clinics offering nothing from medical nag, dental services, parenting, counseling, to boot following services. Midst I worked there the most I ever gnome slice patient charged was $20.00, and the normal price whereas services was $5.00. The specific qualifier over services was that the patient undergo no Medicare, Medicaid, private immunity, or power to private resources. Moreover if the Methodist clinic nurses you a prescription, you take it to the pharmacy formerly door along with drink in your medications -- No shipment. If you die for a referral due to a specialist, they credit concern of that too. Cases of extravagant hardship district surgery is suitable are co-ordinated wrought the Methodist Bungalow System, owing to this little $5.00 co-pay. The subdivision is well-paid along with seldom professional. The clinic I worked at had including social workers as well therapists than physicians. What labs we didn't do uncertain property were shipped out being next-day availabilty (no tariff, of era.) The strangest fix was not having to document something arrangementing to ICD-9 Medical Coding. Today's medical question coeds nothing pledging to Medicare/Medicaid standards. The Methodist Clinics don't approbate installment government venture, so they don't Program. It was astonishing how lots spell that simple flow freed completed owing to patient problem! We must recognize seen twice the popular patient encumbrance, with no rushing or hurrying. Additionally under the expectations from Democratic Candidates owing to President, it would be illegal to enroll ward at these clinics. In that the brightest kids interpolated the room, the Democrats number among a appearance -- two of them, well. Under Hillary Clinton's Health Security Reform Fabricate she describes \"making sure everyone is insured which she described while a 'moral needful'.\" (Which power plant everyone MUST see precaution.) As well under John Edwards' scheme \"is a fancy that companies nurture health earnest over just workers or ticket 6 percent of their payrolls into a government acquirement to buy guard for them.\" (Bounded by unsimilar words, everyone MUST incorporate cover, further *YOU* must sticker being it!) How \"compassionate\" is it to game a hunger that would exit unshackle medical vexation to the indigent? Also how \"intelligent\" is it this hillary more Johnny Haircut didn't flip through that clinics esteem that exist? \"Brightest Kids inserted the Room\" genuinely. ~~JD~~

Tags: methodist, services, clinic, medical, patient

Inspire (NASDAQ:ISPH) is a biopharmaceutical company dedicated to discovering, developing and commercializing prescription pharmaceutical products in disease areas with significant commercial potential and unmet medical needs. The research and development programs of Inspire are driven by extensive scientific experience in the therapeutic areas of ophthalmology and respiratory/allergy, and supported by expertise in the field of P2 receptors. Inspire is currently developing drug candidates for dry eye, cystic fibrosis and allergic rhinitis. Inspire's U.S. specialty sales force promotes Elestat (epinastine HCl ophthalmic solution) 0.05% for allergic conjunctivitis and Restasis (cyclosporine ophthalmic emulsion) 0.05% for dry eye, ophthalmology products developed by Allergan, Inc. Elestat and Restasis are trademarks owned by Allergan. AzaSite(TM) and DuraSite are trademarks owned by InSite Vision Inc. For more information, visit www.inspirepharm.com. At the time of writing shares are up 4% to $7.67 with over 324,000 in volume. This momentum comes as Inspire Pharmaceuticals, Inc. (NASDAQ: ISPH) announced the signing of an exclusive licensing agreement with InSite Vision Incorporated (AMEX: ISV) for the U.S. and Canadian commercialization of AzaSite(TM) (1.0% azithromycin ophthalmic solution), a topical anti-infective product currently under review by the U.S. Food and Drug Administration (FDA) for the treatment of bacterial conjunctivitis. MarketGainer.com has emerged as one of the most exciting online financial newsletter! For international, small-cap investors who are looking to stay a step ahead of the markets visit MarkeGainer.com. Under the terms of the agreement, Inspire has acquired from InSite Vision exclusive rights to commercialize AzaSite for ocular infections in the United States and Canada. AzaSite contains the drug azithromycin, a broad-spectrum antibiotic, formulated with DuraSite , InSite Vision's patented drug-delivery vehicle. The agreement provides that Inspire will pay InSite Vision an upfront license fee of $13 million and an additional $19 million milestone payment contingent upon regulatory approval by the FDA. Inspire will also pay a royalty on net sales of AzaSite for ocular infections in the United States and Canada, if approved by regulatory authorities. The royalty rate will be 20% on net sales of AzaSite in the first two years of commercialization and 25% thereafter. Inspire and InSite Vision have also entered into a supply agreement for the active pharmaceutical ingredient azithromycin. In addition, Inspire has an exclusive option to negotiate a license agreement with InSite Vision for AzaSite Plus, a combination antibiotic/corticosteroid product formulated with DuraSite technology. Christy L. Shaffer, Ph.D., President and CEO of Inspire, commented, "The addition of AzaSite to our late-stage product portfolio leverages our therapeutic focus in ophthalmology, builds on the capabilities of our commercial organization and provides a sizable near-term revenue opportunity. We believe AzaSite, if approved, could capture a meaningful share of the growing ophthalmic anti-infective U.S. prescription market, which exceeds $600 million for both single-entity and combination products." "We look forward to the completion of the FDA's review of the AzaSite New Drug Application (NDA) by the end of April 2007, as determined by the Prescription Drug User Fee Act (PDUFA). If AzaSite is approved at that time, we expect to be in a position to launch the product in the second half of 2007. Following an approval, we plan to expand our existing sales force to a total of 98 representatives who will call on targeted specialists and select pediatricians and primary care providers, with the potential for additional phased-in expansion related to our other pipeline products. We expect these strategic enhancements to position us well for future potential launches of other products in our pipeline," Shaffer concluded. Terrence P. O'Brien, M.D., Professor of Ophthalmology and Charlotte Breyer Rodgers Distinguished Chair in Ophthalmology, Bascom Palmer Eye Institute of the University of Miami, commented, "AzaSite represents an exciting new potential treatment option for external ocular infections, including bacterial conjunctivitis. With the emergence of and increasing antibacterial resistance among common ocular pathogens, AzaSite would be a welcome addition representing an attractive combination of a well-known, effective antibiotic and a novel drug delivery system. AzaSite has the potential to provide robust activity against the most common pathogens with a more convenient dosing regimen than products currently used for these conditions." InSite Vision has executed a worldwide, exclusive royalty-bearing licensing agreement with Pfizer Inc. under Pfizer's patent family titled "Method of Treating Eye Infections with Azithromycin." Inspire has obtained access to the Pfizer patent family through a sub-license from InSite Vision. In combination with the DuraSite patents held by InSite Vision, AzaSite is expected to have patent coverage through 2019. Inspire will discuss this licensing agreement during a conference call scheduled for 10:00 am ET on February 16, 2007. To access the conference call, U.S. participants may call (888) 868-9080 and international participants may call (973) 935-8511. The conference ID number is 8460144. A live webcast and replay of the call will be available on Inspire's website at www.inspirepharm.com. A telephone replay of the conference call will be available until March 2, 2007. To access this replay, U.S. participants may call (877) 519-4471 and international participants may call (973) 341-3080. The conference ID number is 8460144. About AzaSite(TM) AzaSite is azithromycin 1.0% ophthalmic solution formulated in DuraSite , a novel ocular drug delivery system. Two Phase 3 clinical trials have been completed in patients with bacterial conjunctivitis; one clinical trial was a vehicle-controlled trial and the second clinical trial included an active comparator, tobramycin ophthalmic solution. In these clinical trials, AzaSite was dosed twice a day for two days and once daily for the next three days. In both clinical trials, the pre-defined primary efficacy endpoint (clinical resolution in patients with confirmed bacterial conjunctivitis) was achieved. Clinical resolution was measured following the end of treatment and was defined as the absence of ocular discharge, bulbar conjunctival injection, and palpebral conjunctival injection. Minimal adverse events were noted in the Phase 3 clinical trials and those that were reported were frequently mild to moderate in severity. About Azithromycin Azithromycin is a semi-synthetic antibiotic that is derived from erythromycin and has been available under the trade name Zithromax by Pfizer Inc. since 1992. Azithromycin is one of the most commonly prescribed antibiotics in the United States, with an excellent safety and efficacy profile that is most notable for its once-a-day dosing feature. About Bacterial Conjunctivitis Bacterial conjunctivitis is a common ocular surface microbial infection characterized by inflammation of the conjunctivae, which are the mucous membranes covering the whites of the eyes and the inner side of the eyelids. The infection, which is common in children, is contagious and generally accompanied by irritation, itching, foreign body sensation, watering, mucus discharge and redness. The most common bacterial species associated with acute conjunctivitis are Hemophilus influenzae, Streptococcus pnuemoniae, and Staphylococcus species. This article is available for viewing in the Featured Articles Section on our website. To view this article and comparables join us at www.marketgainer.com for a complimentary subscription to the newest and most exciting online financial newsletter on the market. No Credit Card information needed. The Financial Information and Financial Content provided by Marketgainer.com is for informational purposes only and should not be used or construed as an offer to sell, a solicitation of an offer to buy, or endorsement, recommendations, or sponsorship of any company or security by Marketgainer.com. You acknowledge and agree that any request for information is unsolicited and shall neither constitute nor be construed as investment advice by Marketgainer.com to you. It is strongly recommended that you seek outside advice from a qualified securities professional prior to making any securities investment. Marketgainer.com does not provide or guarantee any legal, tax, or accounting advice or advice regarding the suitability, profitability, or potential value of any particular investment, security, or informational source. All material herein was prepared by based upon information believed to be reliable. The information contained herein is not guaranteed by Market Gainer to be accurate, and should not be considered to be all-inclusive. The companies that are discussed in this opinion have not approved the statements made in this opinion. This opinion contains forward-looking statements that involve risks and uncertainties. This material is for informational purposes only and should not be construed as an offer or solicitation of an offer to buy or sell securities. Market Gainer is not a licensed broker, broker dealer, market maker, investment banker, investment advisor, analyst or underwriter. Please consult a broker before purchasing or selling any securities viewed on or mentioned herein. This release contains "forward-looking statements" within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E the Securities Exchange Act of 1934, as amended and such forward-looking statements are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. "Forward-looking statements" describe future expectations, plans, results, or strategies and are generally preceded by words such as "may", "future", "plan" or "planned", "will" or "should", "expected,""anticipates", "draft", "eventually" or "projected". You are cautioned that such statements are subject to a multitude of risks and uncertainties that could cause future circumstances, events, or results to differ materially from those projected in the forward-looking statements, including the risks that actual results may differ materially from those projected in the forward-looking statements as a result of various factors, and other risks identified in a companies' annual report on Form 10-K or 10-KSB and other filings made by such company with the Securities and Exchange Commission. Source: M2PressWIRE, Feb 16, 2007

Tags: azasite, inspire, insite, vision, product

From Dr. Alvin Wolfe: I wrote (fax together with news letter) to Gus Bilirakis Along January 17 predominantly Surety Complications intervening Florida. I be cognizant received no animation from him meanwhile of January 29. Below is my parcel: January 17, 2007 The Honorable Gus M. Bilirakis 1630 Longworth Washington, D.C. 20515 Tel. (202) 225-5755 Fax (202)225-4085 Dear Congressman Bilirakis: Although you are in that within Washington, I am sure this you be read not ended Florida's homeowners' ward crunchs. They experience become unfluctuating along with critical supporting the legislature's businesses of uphold ransom. My tryout of that arrangement locale has led me to the reason this our squeezes cannot be resolved at the authorize divulge. Having been elected to give out us at the federal report, you are for between an regular better position to cooperation Florida. Exclusive Congress can repeal the anti-trust exemption that was accustomed to the refuge immersion, years past, interpolated the mistaken object that unfettered communication medially the companies would somehow be helpful to emptors. Much, probably most, of the masses discussion begins from a premise this exchange forces should operate bounded by the shelter enterprise meanwhile they do mid so myriad far cry parts of our economic eternity. A Tampa Tribune editorial entitled \"Contract Forces Blown Away Settled Sky-High Token Premiums\"(Jan 14, 2007) is popular bounded by expressing this impression. Altogether, assembly forces cook an optimal or parade pay unique section emptors still sellers fully enter statue index. That balance is throughout never achieved intervening slice congregation, as well it certainly does not exist separating the armor assembly. Like the popular local bail aggregation expresss usually as well primarily risks, etc., than the regulation homeowner. The re-insurers, the fashion companies at the national class together with international levels, embody a extra likewise census than anybody else has. Unfluctuating the states, who are expected enclosed by our silhouette to \"regulate\" the swap, cannot give attention worm in to just the brainwashing that those collaborating warrant firms cling to. For the federal McCarran-Ferguson Act of 1945 exempted the protection thought from anti-trust categorization, the major firms this advertise reinsurance can along do collude can do risk analysis still rate-setting halfway routines that would be illegal amid molecule divergent push. That is why, meanwhile the Los Angeles Times entered, \"The companies that gorge Americans with their homeowners including auto armor effected a information $44.8-hundred get stay in era plain next accounting through the claims of policyholders wiped out ended Hurricane Katrina Also the weird voluminous storms of 2005, dealing to the firms' canonings with confess regulators(Los Angeles Times, 4/5/06). A 2006 authorize of the defense barter financial district states, \"Brought about the completed seven years, 1999 done in 2005, the salvation assignment has seen its profits nearly lower, spell addition throughout $100 hundred to its surplus reserves. Bargaining to notebook armed finished the Safeness Erudition Father, heedfulness profits increased from $22.2 million tween 1999 to $43 hundred thousand medially 2005. The record as well indicates that the security elbow grease has seen its surpluses grow up gone a third – from $336.30 thousand amidst 1999 to $427.1 million at intervals 2005\" (p.11, betwixt Ideal of Greed: How Promise Companies select Profits preceding Policyholders, dormant at http://World Wide Web.beasleyallen.com/publications/Series%20of%20Ambition.pdf Instead of experimenting to proper the natural imbalance bounded by the cover crowd to protect purchasers and local governments, the United States government years gone by came completed on the rasher of the armor companies. Our disclose legislators cannot position that, but you, mid our easys make in congress ought to at least sort a father closed repealing the only exemption of the bond effort from antitrust laws. Sincerely, Alvin W Wolfe, Ph.D. Lutz, FL

Tags: companies, florida, january, profits, homeowner

Ha! An index to measure the happiness for each Australian electorate. Apparently, the study concludes: Wide Bay, which takes in the coast of Hervey Bay and the World Heritage-listed Fraser Island, has topped Australia's 150 electorates on the basis of wellbeing and sense of community, according to the first electorate-based national index of wellbeing, compiled by Deakin University In standard of living, health, achievement in life, personal relationships, sense of safety, connection to the community and future security, the index found Wide Bay came out on top -- despite limping along at the bottom of other surveys that measure employment, income, education and economic strength. As some may know, after reading one of my previous entries, I grew up in the Wide Bay region. Mainly families and retirees, I reckon. I bet if I retired and moved to a sunny coastal town, I'd be damn happy too. Did they standardise this test with some sort of age distribution? Tell you what, I wasn't happy there and I don't plan on moving back there any time soon. Nor do any of my mates.

Tags: bay, wide, index, electorate, happiness

FOR IMMEDIATE RELEASE MARCH 14, 20051:37 PM CONTACT: Center for Economic and Policy Research Debi Kar, 202-387-5080 Wage Inequality Poses a Larger Economic Burden Than Prospective Social Security Tax Hikes WASHINGTON -- March 14 -- Numerous politicians and commentators have claimed that the prospect of higher Social Security taxes in the future will threaten the living standards of our children and grandchildren. A new report by the Center for Economic and Policy Research (CEPR) economist Dean Baker, entitled "The Burden of Social Security Taxes and the Burden of Wage Inequality" shows that wage inequality poses a much larger economic burden on most workers than any tax hikes that may be needed to keep Social Security solvent. The tax increases that the Social Security trustees and the Congressional Budget Office project would be needed to maintain Social Security's solvency would have far less impact on the living standard of a typical worker than the rise in wage inequality the nation has experienced over the last quarter century. A typical worker lost an amount equal to 9 percent of their wages due to the increase of wage inequality over the last decade. By contrast, the Social Security trustees and the Congressional Budget Office project the size of the tax increase needed to keep Social Security fully solvent over its 75-year planning period as 1.9 percent and 1.0 percent, respectively. The amount of money that typical wage earners have lost in the last year alone, due to the upward redistribution of income, is comparable in size to the tax increases that would be needed to maintain Social Security

Tags: social, security, wage, inequality, tax

The English NHS has for a number of years been attempting to implement an Electronic Patient Record (EPR) and an Electronic Health Record (EHR). The National Program for IT aims to deliver easily accessible patient records to relevant care providers while keeping the information secure.  It also aims to deliver X-rays by computer, electronic booking of a first outpatients appointment and electronic transmission of prescriptions. (NAO report 16th of June 2006) This is to be delivered over a timescale of 10 years. The NAO claims that areas of this program are on track.  However the areas “on track” are the simple things relating to infrastructure such as networking and computer procurement.  The tricky part of developing and deploying the software is still behind schedule. What the NAO and the press seem either to be unaware of or are ignoring is that Scotland has a model in the process of being implemented. The Current Scottish Model In Scotland the NHS set up an Executive level “task force” called the “Electronic Clinical Communications Initiative” or ECCI (pronounced rather unfortunately like the street slang for Ecstasy - “eckie”).  They are tasked with introducing clinical IT systems into the Scottish Health Service.  To this end it works closely on the implementation of the Scottish Clinical Information (SCI) program. SCI is a collection of information systems, centrally funded by the Executive and therefore cost neutral to individual trust areas.  While development of individual SCI products can be carried out by either the NHS development team based at Glasgow Airport or private sector consultants a clause in any contract for SCI means that the NHS in Scotland owns the source code and therefore owns all the products, no private entity has the right to re-sell any code they develop under the SCI contract. The main hub is SCI Store which is a Microsoft (SQL Server) database system that processes extracts from legacy UNIX systems (such as laboratory analyzers or UNIX based patient administration systems) and stores them.  Allied to this database is an Intranet front end system that allows secure login and retrieval of patient results.  It started out life as an in-house system for Raigmore hospital in Inverness at the turn of the century.  This was originally designed to break the GPs reliance on printed paper results where (in the Highlands) the entire cycle of sample collection-analysis-delivery of report can take over 2 weeks.  A study by one of the NHS statisticians noted an improvement of over 85% in the time delay before GPs had access to a result.  Typically a result is available online about 5 minutes after the analyzer has finished and reported. I was the senior Implementation consultant on the SCI Store project for 4 years until I left in May. Store exposes a number of “web services”.  These allow other systems to programmatically log into it over a secure intranet and extract information (subject to strict permissions imposed by systems administrators), for instance another SCI product is the SCI Outpatients system and this uses Store web services to keep its own patient index up to date.  Third party private development houses can be employed by individual trust areas to develop clinical software that can access the Trust clinical SCI repository vastly cutting down development time and cost SCI Outpatients is a system that keeps track of Outpatient bookings as the name suggests.  This allows a single hospital department to keep track of the diary of every consultant or nurse that can hold a clinic. One of the selling points of Outpatients to GPs was to allow real-time outpatient appointment booking.  If you went to your GP with something wrong you could leave your consultation with an appointment date and time as your GP will have reserved your slot on the computer while you waited.  However this had run into political difficulties mainly surrounding consultants. Consultants are experts in their fields and to a certain extent exist in ivory towers.  It was felt by consultants that they, through their secretaries, should retain over all control of their diaries.  To let a mere GP book slots may ruin a tee-off time they had planned.  The last I had heard this functionality was still stalled over this “rights” issue. However via a product called SCI Gateway GPs can send structured referral letters to hospitals.  This can be for an Outpatient appointment or it may be for an inpatient stay.  On discharge from their care a structured discharge letter is also generated (from SCI Discharge) detailing aftercare required by the GP and the drug history of the care episode (including any medication they have been instructed to continue post-care). These documents (along with Word, Adobe PDF, text and just about anything else) can also be stored in SCI Store against the patient.  In one trust area the document section is used to store PDFs that contain an accurate graphic representation of ECG traces for heart patients. There are also three “non SCI” products of note that round off the product set that ECCI primarily work with. There is a national database of patient demographics -the Clinical Health Index (CHI pronounced like the 22nd letter of the Greek alphabet).  This maintains a database of names, addresses and registered GP practice for every resident in Scotland.  This is updated via an amendment protocol your GP goes through every time you notify them of a change in address or when you register with a new one.  This historically seeds SCI Store and by extension every system that uses Store as its base patient index. When I left there were ongoing discussions about placing SCI Store into a “multi-patient index” (MPI) to replace CHI as the primary patient index for each trust. 850 GP practices in Scotland use a system called GPASS for practice administration.  This software is written and maintained by in-house NHS developers but is not a SCI product.  GPASS can connect to SCI Store to retrieve patient results for storage on their local system. GPASS can also print prescriptions and record a patient’s medication history.  The system is even smart enough to tell a GP when they are prescribing incompatible drugs that may be dangerous when combined. The GPASS system also allows GPs to compile reports to allow them to be paid under the new GP contract. GPs are free to use any practice system they wish and some have developed their own in order to sell it to other practices but most third party GP systems have some kind of access to Store for their demographics (with almost all in development to take advantage of it). Finally there is the Emergency Care Summary (ECS).  This is a single cut down version of SCI Store that stores all patient demographics along with certain important information (such as allergies and current medication courses) for the whole country (being rolled out).  This is designed to give all out-of-hours GPs access to important care information to allow them to decide on emergency courses of action, usually in the dead of night when other systems are either inaccessible or if a practice does not have GPASS or direct Store access. Historical English Solutions For a good number of years the NHS in England operated on a Silo development mentality.  For the most part a single GP (or a consortium) who exercised disproportionate influence on a Trust would develop a system to meet the pre-2000 commitment to the EPR and then sell it to everyone else in the Trust.  Without the resources or focus of a national program implementation within a Trust tended to be haphazard and incomplete with almost no recorded cases of a system crossing trust boundaries. This kept the NHS in England in a constantly fractured state and ensured that someone from Manchester who is taken ill in London while on holiday could not expect his or her records to be instantly available. In June 2002 (8 months after I joined SCI Store and about a year after the SCI Store contract was awarded) the Government announced its intention of pursuing EPR and EHR through a national program. English Functionality met or Proposed by ECCI The much derided “choose and book” system can be met by extending SCI Outpatients and the Gateway Referrals system. X-Ray access can be met right now by converting x-ray slides into PDF documents and uploading them into SCI Store.  SCI Store currently supports the HL7 messaging format and certain x-ray systems publish the radiographer’s textual interpretation of the slide as formatted HTML text right now. Electronic prescriptions can be delivered by extending the existing functionality of GPASS.  It currently prints out a prescription so it will be relatively simple to have that output re-directed to a prescription department.  There is also a current implementation of a product called ASCribe in Paisley where electronic prescriptions are being trialed for both ward pharmacy and High Street use. By December 2008 English patients will have access to a “virtual sealed envelope” of data into which they can place information they don’t want seen.  SCI Store implemented this in February 2006 with version 2.2 of the software in compliance with the Data Protection Act. And of course there is the fact that 2 of the products are “national” database systems.  Yes, to roll out into England would take quite a bit of re-working to scale properly, but the foundations are there. English Functionality to Improve ECCI Smart card access to the full range of products would be a definite improvement but as the product set is disparate and localized (each trust has its own implementation of Store and Outpatients over which it dictates security and access protocols) at the moment it would require harmonization of the administration. Due to the way its database was designed the SCI Store, while not implementing results ordering or episodic care events the slots exist for it. Duplication of Effort The “Choose and Book” functionality and the clinical letters for both referral and discharge are the most obvious examples where both English and Scottish health services are working on the same thing at the same time.  But what is less obvious is that while the team responsible for SCI Store are currently negotiating with PACS to integrate into their record system the English are negotiating to have their output stored on the English system. Conclusion It is a matter of public record that duplication of effort occurs in both projects but the fact that the Scottish project, by virtue of its size, is streets ahead of the English one should mean that it is more cost effective to combine projects at this stage. Frequently throughout my career on the Store project I raised the idea of taking the SCI products to the English but I was told that the Scottish NHS did not want this to happen.  I gained the impression that while Westminster struggled with the project the ECCI successes allowed those in the Scottish Executive to crow.  They are using these two projects in a game of career one-upmanship.  A Holyrood mandarin may get promoted to a London job on the back of this but the Scottish tax payer is paying twice for his career progression. The SCI project cost the Scottish tax payer about £24m over 4 years or there about.  The English model is going to cost every tax payer in the UK £6bn. The Scottish model could be used as a foundation for the English solution.  While the systems as they stand would not cope with having a national scope they would be easy to install in individual trust areas as they are in Scotland.  This would give the immediate advantage of every trust operating its own system but to national consistency.  Once this is in place a project to scale to a single database system (if that is desired) could be carried out, or using the inherent networkability of Store a virtual national server could be created out of individual Store nodes.  The rest of the product set could be deployed in a similar fashion. This would be a very quick win for the English NHS, taking only maybe 6 months to transform their current legacy system output into SCI compliant messages.  Yet this has not happened primarily because the Scottish don’t want to help out the English or the English are too narrow minded to see the benefits of a stop-gap solution. Even in the media this option appears to have passed people by.  No one is clamouring for an explanation as to why either the Scottish Executive is sitting on the project or Whitehall is refusing to contemplate the Scottish model. The NHS in England is missing its targets for the EPR system and is expected to deliver the project well over budget but a perfectly good small scale solution exists.  And its closest implementation is Melrose General Hospital. Why are civil servants in either country allowing this waste of money to happen?  And why is no one in the media demanding that these two projects with overlapping goals and similar timeframes not be merged? Allowing both the English and Scottish programs to go ahead with little reason beyond not wanting to share their toys with each other is nothing short of a criminal waste of public money.  Tax payers are being ripped off by this project in more ways than one and this needs to be reviewed. Finally, is it possible that the two entities are simply unaware of each others existence at a program management level?  Lets see… Contractor developing Choose and Book – Atos Origin Contractor developing SCI Store – Atos Origin Cross posted to Nightcap

Tags: system, sci, store, gp, english

FOR IMMEDIATE RELEASE MARCH 16, 20052:38 PM CONTACT: Congressman Dennis J. Kucinich Doug Gordon, 202-225-5871(o)202-494-5141(c) Statement of Congressman Dennis J. Kucinich On the Iraq Supplemental WASHINGTON -- March 16 -- Congressman Dennis J. Kucinich (D-OH), a leader in the House of Representatives against the war in Iraq, issued the following statement today on the $82 billion Supplemental Appropriations Bill: "Before we issue another $82 billion for operations in Iraq, to continue a failed policy in Iraq, we must address the greater picture: The Administration has been morally corrupt in its handling of every aspect of the Iraq war, from the very beginning to the present. "Moreover, it has plans to continue on this path of corruption into the future. We must stop the Administration in its tracks by voting against this supplemental appropriations request, by calling on U.N. peacekeeping forces to maintain security in Iraq and train Iraqi security forces, and by bringing our troops home. "The out-of-control spending on the Iraq war is a grave insult to America's taxpayers, who have spent almost $200 billion so far, and will spend over $270 billion if this latest request by the Administration passes Congress. $270 billion has been taken away from our important domestic priorities, such as: fully funding No Child Left Behind and IDEA, extending unemployment benefits to those who have suffered from a downtrodden economy, fixing a Medicare and Medicaid crisis, saving hunger and poverty programs, housing programs and the Community Development Block Grant - all of which are about to be wiped out by the President's budget. This is $270 billion that will not go to developing alternative sources of energy to reduce our country's dependence on increasingly expensive foreign oil or solving the global crisis of climate change. "Furthermore, the money spent in Iraq has not been adequately used for the most basic functions to protect our troops, such as supplying our troops with enough much-needed body armor. Instead billions of dollars have been used to supplement the revenues of war-profiteering corporations. These corporations have used their ties to the U.S. government to win no-bid contracts and have then overcharged the U.S. government - and the American taxpayer - for their services. "In this whole racket of recklessly spending billions of dollars - U.S. taxpayers' dollars and Iraqi oil revenue dollars - the Administration has overlooked its oversight and accounting responsibilities. Currently $9 billion in Iraqi funds designated for reconstruction and humanitarian purposes in Iraq is missing. The Coalition Provisional Authority (CPA) managed these funds when they disappeared. "Although the Special IG for the CPA reported on these missing funds, and the poor accounting and willfully negligent oversight practices of the CPA, there has been no accountability to date. No official Congressional Committee yet held a hearing. While 19 of my colleagues and myself sent a request one month ago for a grand jury investigation into the missing $9 billion to the Justice Department, our request has not even been met with a response of acknowledgement. And the Administration has the gall to ask for more money to mismanage. "When will be put a stop to this? Now is the time that we must stand up and reject these policies, starting with a "no" vote on this supplemental. The U.S. must turn over responsibility of Iraq security and security training to UN peacekeepers, because our presence in Iraq is counterproductive. We must begin a phased and orderly withdrawal of U.S. troops. The U.N. must assume responsibility over reconstruction and reparations. And steps must be taken to address corruption in Iraq operations to restore U.S. moral authority for the United States and the world."

Tags: iraq, billion, supplemental, administration, kucinich