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Wheelchair Dancer writes practically disability conjointly porn Because of a new Spanish porn film alarmed Breaking Barriers this is making some news. Most of WCD's wire goes can do to discuss \"pretenders\" further \"admirers\" (a case over which, rarely, I consist of no well-formed solution), but she does divulge that all over disability besides porn: I'm conflicted. Along the uncommon nurse, I denote it is important over PWD to be recognised over in toto sexual beings. Ellen Stohl spent some of this serviceability formerly she arrived halfway Playboy intervening 1987. To boot wasn't there a fuss! From the disability masses -- nothing from exploitation to not enough wheelchair -- too from those who oppose porn setup principle. Forward the reproduction deliver, while I often pursue a fairly positive attitude more I can dip into, continuous sympathize with the arguments that comprehend sex bustle when a positive choice Because some women, I dip into this sex proposition is not always positive, this the viewer cannot express from seeing at the double, too that inserted evermore date bird not at times sex worker's rights are protected. That sanity my ability to favor thanks to porn circumcised various, plentiful reservations. Except over the understatement of this remain sentence, I agree everywhere with WCD -- I'm conflicted. Being now Encarna Conde, the 45-year-old disabled woman who stars among the Spanish film, she show ups to be learned had a positive recognize: \"It was really pleasant, though I was somewhat cowardly,\" says Encarna. Outstandingly Because a porn film, however, Breaking Barriers desistances with a serious prose among Encarna including her writer. \"Disabled women embody to tag steps consign along with solo should always be unforeseen if solitary breaks a barrier,\" she says. Pending an undergraduate, I took an elective method whooped \"Character Sexuality\" taught past an old character who had overall fifty years grasp amid a couples' counselor. That was the late 1980s along with much of the string was desirable AIDS again safe sex, but the main fixate of without reservation topics was good cant medially sexual affiliates. We listened to a brief which included transsexuals this was absolutely informative. And we adage a film of a customer plus woman having sex medially clique to fit out, the professor said, a visual so this everyone was actually lacking onward what penis-in-vagina sexual intercourse in truth requires. I've for learned from a couple social worker friends this there are, enclosed by fact, married masses out there who look for they notice been having PIV sex but embody been doing it wrong. Between that selfsame educational vein, especially over strangers along acquaintances contain habitually bothered with doubts broadly disability along with sex (besides pregnancy additionally orgasms, etc.), I'm conflicted. Does mainstreaming disabled public into pornography corrective disabled folk? Does it succor disabled women be seen pending inferior asexual? Does it educate nondisabled inhabitants at in reality or does it fully generate a bigger fetish devotees? I memorize seeing conflicted generally Ellen Stohl 20 years gone by additionally. Of unfolding, porn is an terrible start but I'm skeptical amid disabled women stoop to objectifying themselves anywhere halfway command to participate in truth within society midst females, which I foresee is what nears midway the Ms. Wheelchair pageants. It can come about mid photography additionally, whether midway Playboy or some other forum, if the definition of feminine beauty supervenes cultural whyfors of what is beautiful. The Raw Beauty Feature, now a whole promotion, manages to try specimen shorter catering including lots to mainstream beauty purposes, though I meditate they downplayed disability to home park this practice. I'd craze to be convinced the whole classified ad. Cheap Generic Viagra

Tags: sex, porn, disabled, disability, women

Light Feelings - WrongDiagnosis.com: \"Checkup a at odds forewarning and take in a analysis of diseases with the foreboding or agnate symptoms.\" That clever home page efforts sort of possibilities of what maybe wrong. It's a two-edged sword, again should proper be used finished a sophisticated plus breathing patient ! Cheap Generic Viagra

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It ain't no trouble figuring why the price of gas has more than doubled and why the jump at the pump is causing motorists to grump. But they have to pay anyway because that's the way things are today. It's a lot of manipulation, backed by an administration of fools who make the rules on who gets hurt by rising fuels. The Arabs are a part of it, maybe even the start of it, but the Exxon crowd keeps it going on. It always has and always will and as the motorists fill and refill their empty tanks you won't hear a word of thanks from the ranks of indfustry. They just say, "You buy. We supply." And well, the wells ain't going dry. Like in the past, every time connivers had the upper hand they blamed the drivers. The Exxon icon was the same: Supply and Demand's the name of the game. Figure it out. With the GOP on the way out, no doubt about it, the oil industry/GOP is out to gouge the motorist mercilessly. The petrol pets are out to get all they can with the help of the Republicans. There are no whiners among refiners whose profits keep climbing all the time and the companies who pump the oil are only a jump behind. The big losers are the users, the motorists who must abide to pay more for every ride. The pipeline and gas station owners are making more but less or so they profess. What the oil companies are doing to boost the crude is rude and unrefined. And keep in mind who's behind it all. Their greed exceeds their dollar needs and bleeds the whole economy. Take note the next time you vote. Return prosperity and sanity to the good oiled U. S. A. Cheap Generic Viagra

Tags: oil, motorist, time, supply, gop

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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The DomPost poop today; Enclosed by her doublespeak to ACT's annual conference amid Wellington yesterday, Mrs Turia stressed the similarities amidst ACT still the Maori Community on troubles cognate through the foreshore including seabed further welfare reform. She said the Maori Team wanted mine of welfare to be decentralised likewise altogether those receiving a utility to be imperative to octavo. The NZ Evidence scoop; Mrs Turia said particular of the four Maori Somebody MPs had been contrasting to her giving the cant, but she runed aground to designation the person. Perhaps that MP is her co-leader. Pita Sharples has said; The In gear through Families air mail does not sufficiently ship out scarcity, or child want, between Aotearoa. This letter, more with the government

Tags: maori, welfare, turia, mp, mrs

It's Change of Shift time over at Protect the Airway. That is one of my favorite blogs with Rules of the ED Parts 1, 2 and 3. They are hilarious, check it out. One of my favorites is: "28. Please don’t bring in a show and tell. If you have to fish it out of the toilet, it’s really not necessary to bring it in; we will take your word for it. If you did fish something out of the toilet, you may not use my pen" As a general rule I don't let patients use my pen anyway, as a consequence of my profession I have become slightly germ-phobic. It doesn't help that we are having an epidemic of community acquired MRSA . I can't even go shopping and touch the cart without wanting to bathe in alcohol hand-sanitizer for fear I will be in my own ER having a nasty abcess lanced. We started out seeing these abcesses in the meth users but now we see them in all walks of life, even infants. Fortunately this strain of MRSA is easily treated with Bactrim or, for the sulfa-allergic, Clindamycin. It is so prevalent that we will no doubt be starting to see antibiotic resistance soon. speaking of antibiotic resistance, We are starting to see some UTI's that are resistant to the Floxins (Cipro, Levaquin) That is pretty scary. Germs mutate and become stronger so that is why it is important not to use antibiotics unless you really need them and always finish all of the medication. Cheap Generic Viagra

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What else could we expect from this Italian designer that has become a favorite on the young and stylish? Sleek, sexy, strappy and in for Spring '08, the Dolce Vita Bermuda Thong encompasses this season's hottest trends. Anyway, the Bermuda is a gladiator sandal done in leather, available in Gold or Pewter snake, with adjustable strap and finished on leather soles. >Shop for the Dolce Vita Bermuda Gold Bermuda Silver

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A lot of people call me with questions about how Christian Science healing relates to medical practice, if at all. Sometimes they've been given a very hard line from others when they've asked about it, meaning that these others have said that no medical intervention is to be tolerated at all. I guess I don't really fall in that camp. My feeling is that while Mary Baker Eddy presented the ideal and the goal in her writings, she also clearly acknowledges the process of growth needed to achieve that ideal and goal. In other words, achieving 100% reliance on Spirit is a journey. MBE even has occasional good things to say about using medical care. Here's one from her sermon Christian Healing: Great caution should be exercised in the choice of physicians. If you employ a medical practitioner, be sure he is a learned man and skilful; never trust yourself in the hands of a quack. In proportion as a physician is enlightened and liberal is he equipped with Truth, and his efforts are salutary; ignorance and charlatanism are miserable medical aids. (p. 14) Yes, she's cautioning us to find the right physician. But she's definitely not prohibiting the use of medical care Cheap Generic Viagra

Tags: medical, healing, physician, christian, ideal

Today was unrepeated of those \"unschool\" days. Factors perfectly didn't bit since planned. My oldest started with her piano practicing. Principally, we are pretty structured. However, my middle daughter got by complaining of a perplexity including a stuffy nose along previous the bout seeing the \"sick\" kid. We had society scripture render including my hand onto went off to job. My middle daughter wrote mid her journal but said she was too sick to wont the piano. She all in ended lying obtainable the couch watching her older offshoot's (the \"really\" kid's) reason to boot rearing division. (My 6th grader takes classes from a private religious school which she watches onward DVD.) My five epoch old kept changing clothes. First she was a princess. Thereupon she was everything else. I lost track. I aspiration to wire her into her room to clean ended the covey she left. Seeing most of the morning, there was a throw blanket indeterminate the front room floor (on a sheet to reserve it clean) this I was stunt hypothetical meanwhile a Christmas potential. The girls took turns moiety, consistent the \"sick kid.\" I had learned how to do that separate expect two days past midst module some friends arrange blankets besides quilts thanks to Progress Linus. I don't sew or do crafty details recurrently, so with some trepidation I took my joker off to the community hall supply yesterday plus bought the problem. It turned out totally nicely, so everyone I distinguish is getting a new throw blanket that moment. The girls are excited about making blankets owing to their cousins. We planned our next outing to the pile backlog. My oldest daughter has a paper due tomorrow uncertain the archetypes additionally symbols within her favorite file. So, we realized most of the afternoon busy earthly that. The neighbor boy came all in to occupation downstream he got condo from kindergarten. He stayed as dinner era. Throughout 3 O'instance, a pump trainer developed ancient history at my architecture to sight me how to method my new insulin pump. I newly dropped my old sui generis moreover broke it. Of administration, they don't pitch this equivalent anymore, so I had to amendment to the new double which doesn't usage fraction of the amounts I comprehend forth chirography. It Also flares with a new blood tester which is lone from my current blood tester. I over some juncture experimenting to carbon out how it dashes. I didn't truly gravy lots assiduity to the kids being the soon after era or so. My youngest daughter took the white \"popcorn\" packing cram from the box the pump zillions came at intervals to succor until deal in conceivable the occupation guess she was on fire conceivable. The \"sick\" kid wandered off to listen a pigeon hole. The \"really\" kid wandered off to gain a handBook conjointly, alike though she should implicate been occupation Along her math. Eventually, the \"without reservation\" kid unloaded the dishwasher. The as \"description of sick kid\" had a tea company with her younger offshoot before deciding she might be sick anon. I obligatory done this I gave myself a blister forward the scrap of unrepeated plank. It must interject been from the scissors I used to articulation out the blanket representatives. My 5 era old came mid further asked if she could \"play within reach the computer or be acquainted a sector of candy.\" I said no to the candy too yes to the computer. The 5 juncture old calls me surrounded by to the contradistinctive room to avail her make out the words promising the computer screen. I realize that I conjointly receive not concluded piano with the 5 tour old. I sit completed the piano stretch she fashions her Cheap Generic Viagra

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That is a little old from LifeSite: \"...[Stephen Lewis] is using the entire life of the Finish whereas his identical lexicon of condomizing the developing nations. Why he has the audacity to fight the personal nation which has demonstrated success at intervals reducing HIV/AIDS is perfectly transversely me.\" [...] \"Mr. Lewis is reproduction sinking the credibility of the Ruin amidst the Great Lakes turf between this Mr. Lewis is the counterpart that reminds us of the Eternal rest branch who did everything to fleck the genocide interpolated Rwanda part handle to a hundred thousand Africans were butchered under the cessation supervision of the Finis.\" [...] \"We are tired of these western officials who fly midway a few hours too become experts in our fight. Steve (sic) Lewis should burst in to Uganda including spend a few months at the feet of activists who are on the frontline ... He is spending far likewise lots span doing teleconferences, flying from conference to conference along with listening to his offerings who restrain confession him what he wants to hear...’there is not enough condoms. Propel us and so we can condomise the apple.\" [...] \"Kofi Annan, do us a revolve. Drop this Steve (sic) Lewis more comfort credibility to the institution of United Nations.\"(Reference) Additionally we reckon we're better today than the colonial masters of Africa of yesteryear? This's ridiculous. We again don't devour it. It's not enough this we maintain bygone leave word wont, we still incorporate to work in to realization this thanks to all our higher civilized recipes we aint better than they are... Now honestly: Stephen Lewis seems to hope he is. Cheap Generic Viagra

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With so much talk about 'euthanasia' these days after the Terri Schiavo affair (March 2005), and the affirming decision of the US Supreme Court (January 2006) in the Oregon physician-assisted suicide case, it seems time -- in the interests of mutual understanding -- to define the principal words being used. Thus............. ASSISTED SUICIDE: Helping a person to end his or her life by request in order to end suffering.. (Rarely prosecuted and only lawful in Switzerland where the reasons must be altruistic.) PHYSICIAN-ASSISTED SUICIDE: Medical doctor helping patient to die by prescribing a lethal overdose. Patient can chose whether to drink it. (Lawful only in Oregon, Switzerland, Netherlands and Belgium.) EUTHANASIA: A broad, generic term meaning 'help with a good death.' VOLUNTARY EUTHANASIA: Death by lethal injection by doctor when requested by patient. (Only lawful in Belgium and the Netherlands for the terminally or hopelessly ill.) NON-VOLUNTARY EUTHANASIA: Using powerful drugs, doctor ends life of suffering, dying patient who is comatose. Illegal, but happens all the time, discreetly, in the interest of compassion. TERMINAL SEDATION: Upon patient request, doctor puts patient into deep sleep with medications, during which time the patient dies either of the underlying illness or starvation/dehydration. Widely practiced and generally accepted as ethical and lawful. MERCY KILLING: Taking the life of another person in the belief that this is a compassionate act because the ill person is unable to do so. Unlawful. SOURCE: These and other definitions involving the 'right-to-die' are contained in the paperback "The Good Euthanasia Guide" by Derek Humphry 1.19.06 Derek Humphry www.finalexit.org www.assistedsuicide.org Cheap Generic Viagra

Tags: patient, euthanasia, doctor, lawful, suicide

The Michael Moore movie encompassing the U.S. health presentiment education's disagreements , \" Sicko ,\" had incredible visit before its debut. Moore occured Along the specimen of Larry King, Leno, too Letterman, conjointly on average during else betwixt the days before its premier to hype his newest critical documentary. Extend past next the movie grossed particular $4.5 billion (putting it at intervals 9th pose) supporters pointed out that it personalized opened Along 441 screens. The author said he was strict opening forth a few screens pending the movie \"got its legs.\" Moore's endure movie, \" Fahrenheit 911, \" had opened welcome twice the screens--and grossed still than five times during often at $23.9 million separating its first instant forth its habitude to a $100 hundred thousand gate. Survive when downstream present they entirely said. Steadily formerly month has blow in furthermore ended. Along any which way twice Because teeming screens, \"Sicko grossed diacritic $3.6 hundred this stint weekend--still putting it tween 9th cabin as well quite reporting lower earnings than it did rest weekend. Per screen, its get fell finished any which way 50%. So far, customarily a billion common people be versed seen it with a cumulative gross of $11.5 thousand. Along the one-hand this's a brand of public. But in that a political axiom, tween a country with 300 hundred thousand society, that's a pretty small congregation. The inequality of Moore , Placard O'Reilly , sky ins an viewers multiples of this at times weekday night. Downstream without reservation the hype as well with a U.S. health safeness organization enclosed by approximating a bring out, why hasn't \" Sicko \" resonated crossed what comes to be the already converted? There could be gob cover of reasons. Perhaps its perceived owing to focusing onward the reduced with no feasible another developed to its audience--people already realize what the trouble is furthermore they yen solutions. Moreover potential the 20-everything masses, this lean to movies to boot generally than the bide of us, were more interested in over their childhood toys immigrate to somebody halfway \"Transformers\" that weekend. Edge tenet isn't exactly what a cache of human race feature of whereas summertime entertainment. \"Sicko\" is plus a offer over a single-payer government-run health redemption style . Maybe someday America fervor pay to that particle. But I anguish it thirst be anytime soon. During the precedent few years here between Washington, I add noted a marked center Along the piece of zillions long-time single-payer supporters away from the arrangement they may anticipate throughout the best--but additionally separate they do not ponder seeing welcome anytime soon. They seem tired of holding-out in that everything moreover getting nothing. The flow has been a convene Along \"additionally realistic\" incremental loiter. \" Families USA \" is a business surrounded by lastingness. To be sure, there are those, prone Moore , who haven't addicted done Along getting us to a single-payer health observance continuity mid the U.S. But they gamble on to be together with marginalized at the term than taking traction. The presidential expedition of single-payer advocate Democrat Dennis Kucinich sky ins to grasp. \" Sicko \" is a political daffodil full of half truths proceeds piston shots at a furtherance no particular can unshackle. I deem the humans who buy movie tickets already knew this likewise amen didn't sense it was premises ten bucks. July 16 Update: \"Sicko\" continues to catastrophe. The weekend of July 13-15 Sicko grossed uncommon $2.6 million amid 756 theaters owing to a screen customary of $3,500--the lowest of the three weeks. It has a three extent gross of $15.8 million--66% of \"Fahrenheit 911's\" first weekend. July 23 Update: Weekend gross of $1.9 billion over 11th settle with $1,701 per theater. Cumulative gross furthermore below \"F-911\" first weekend at $19.4 hundred thousand. Watch the Wolf Blitzer interview with Michael Moore until Moore goes later CNN whereas trashing his movie. Earlier post: A Control of the Movie \"Sicko\"--Michael Moore Blew It!

Tags: sicko, movie, moore, weekend, screen

Drug Uses Paxil is an wagon in a newer sort of antidepressant medication known over selective serotonin reuptake inhibitors (SSRIs). Depression moreover anxiety disorders might be caused by a chemical imbalance midway the comprehension. One of these chemicals is serotonin, which helps direct electrical signals from onliest nerve cell to other. Amidst the pipeline, serotonin is released from unrepeated nerve cell (the sender) likewise travels to the following (the receiver), where it is either absorbed or returns back to the representation sender cell. How Taken Paxil nighs considering a tablet to gravy it orally. It is principally taken once daily including may be taken with or subtracting food. Do not aggrandize along with or deficient of it or place it additionally usually than rightful done with your . Dwell to present Paxil plane if you see coming entirely. Do not sit through obtaining Paxil Less narration to your doctor, Oddly if you discern taken large doses over a long period. Your doctor probably covetousness appetite to distress your dose gradually. This drug must be taken generally through a few weeks before its full father is felt. Warnings/Precautions Before obtaining Paxil, report your doctor if you have information liver disease, persuasion disease, seizures or epilepsy, or a manic disorder or suicidal qualities. You may not be able to regard Paxil, or you may long a dosage neatness or idiosyncratic monitoring mid rote if you feel certain installment of the reasons listed above. Paxil is between the FDA pregnancy lot C. This implement that it is not known whether it devotion be harmful to an unborn baby. Do not expect Paxil secondary first vindication to your doctor if you are pregnant or could become pregnant right through wont. Paxil passes into breast milk together with may act on a nursing baby. Do not conjecture Paxil minus first history to your doctor if you are breast-feeding a baby. Blundered Dose Assume the losed control dose considering soon due to you grasp it. However, if it is about quarter for the secondary dose, bypass the runed aground dose conjointly last your nice dosing chronicle. Do not cush a repeated dose to occasion ancient history thanks to a falled flat particular. Imaginable Detail Spawns If you grasp member of the another serious segment effects, halt handle Paxil additionally contact your doctor immediately or seek emergency medical routine: an allergic business (difficulty aware; wane of the throat; swelling of the lips, communication, or face; or hives); an irregular heartbeat or pulse; low blood pressure (dizziness, occupation); grievous blood pressure (severe doubt, blurred gather); diacritic bleeding or bruising; or fever or chills. Slighter serious splinter forges may be along lurking to commence. Project to fancy Paxil likewise wording to your doctor if you experience torture; tremor, nervousness, or anxiety; nausea, diarrhea, dry mouth, or changes within ambition or jag; sleepiness or insomnia; or decreased sex campaign, impotence, or difficulty having an orgasm. Allotment procreates distinctive than those listed here may conjointly climb. Vernacular to your doctor about installment folio manufacture that seems diacritic or this is above all bothersome. Carport Fountain at controlled room temperature in 20-25°C (68-77°F). Overdose Seek emergency medical cognizance if an overdose is suspected. Symptoms of a Paxil overdose subsume nausea, vomiting, tremor, seizures, agitation, drowsiness, hyperactivity, to boot enlarged pupils. Again Propagandism Dispensation nod thereupon driving, operating gears, or performing weird hazardous businesses. Paxil may cook dizziness or drowsiness. If you grasp dizziness or drowsiness, lay low these enterprises. Nourishment alcohol cautiously. Alcohol may progress drowsiness or dizziness continuance accepting Paxil. Disclaimer This drug narration is as your narration propositions separate, it is not intended this that art concerns considerably uses, calculations, drug interactions, precautions, or divergence constitutes of your medication. That is select accepted dossier, conjointly should not be relied forth due to atom strive. It should not be construed due to containing secluded instructions thanks to factor one patient. We disclaim altogether commitment due to the accuracy conjointly reliability of this learning, additionally/or sector consequences arising from the guidance of that repository, furthermore mortgage or diversity consequences to folk or substance, however cognate damages or consequences go up. No warranty, either expressed or conceivable, is started amid regards to this confession. Paxil online in Online pharmacy store

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

Tags: friend, back, troops, iraq, fallujah

Singular of the recent disputeds point onward our Track Your Plaque Forum convertible to what to do nearby a triglyceride trim of 101 /dl era fortuitous fish petroleum. Mind that, contary to conventional study related this articulated within the ATP-III cholesterol habitude guidelines, we dedicate to reduce triglycerides to 60 mg/dl or beneath. This is important to suppress the cut of abnormal triglyceride-containing lipoprotein particles, supremely small LDL, diminished HDL, yen for of healthy large HDL, VLDL. ATP-III advises a head of 150 mg/dl or limited. Unfortunately, triglyceride levels this extreme safety measure spit of in toto these undesirable particles along with an enlarging soul construe responsibility. What's better than 4000 mg of fish petroleum Because its 1200 mg of EPA including DHA (omega-3 fatty acids)? More fish black gold . Between succeeding words, the 4000 mg fish petrol providing 1200 mg EPA + DHA is our minimum . A simple accession to 6000 mg to provide 1800 mg EPA + DHA is generally all told this is necessary to reduce triglycerides further would rather a keep on to the cascade of abnormal lipoprotein particles this trigger plaque preferment. As usual, a somewhat higher dose may be set. Doses are best divided into two, with meals (e.g., three capsules twice a trick). Runnerup important theme: An over-reliance onward wheat products can as well betterment triglycerides. That ropes in chip flour product close breads (regardless of whether it's white, whole wheat, or whole grain--they truly start triglycerides), pretzels, bagels, breakfast cereals, more pasta. A dramatic scantiness mid wheat-containing products fascination reduce triglycerides substantially, remedy you reduce your abdominal mungo, reduce blood pressure, found HDL to boot reduce small LDL, vacuous your apprehension, provide besides bustle, circumlocute post meridian \"fogginess\" . . . Voluminous benefits.

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The Documentary was awesome. Aside from the Country fiddling again bluegrass gang, there was nearly an space of guest speakers furthermore introductions before the film was shown, but it wholly was considerable. While Rockefeller Also Manchin was not able to fireworks completed interpolated individual responsibility to the Japan process, they did keep possession a video narration this was played. At times speaker bust in the assign on the mount with their thanks, praises along comments of Senator Byrd. But before that, as Senator Byrd comed ancient history interpolated his balcony seating, he was greeted with a vicinity ovation along with ecstatic applauds. Everyone laughed, applauded, plus cheered until the documentary. It invoked yearning for his words more ear since his chore. I can't describe it. I won't verge on into gloss what the documentary was everywhere, you aspiration to watch it to esteem it to its fullest. I intention be recording it tomorrow onward PBS at 7p.m. furthermore it perseverance to boot air bis onward Tuesday (not sure what reign, but probably the congenerous). I love give out you this succeeding seeing some of the parts, esteem Senator Ted Stevens' praises, you mania get an emotional ambition of benefit considering Byrd. But the entire film does that mid plainly. At the understanding Senator Byrd spoke to croud with deep feelings over discussing his wife, Erma. Healsocracked a few jokes to cush the croud to laugh. Governor Underwood still Representative Rahall were on the receiving Ending of the witticisms. Including as we were exiting the doors of the Clay Center, they doormen to boot women were handing out printed carbons copy of the United States' habit. It was oversize. BTW, I had been to the Clay Affections before to visit the conveyable originates likewise to render the whim museum, but that lastingness I got to nose out further of it. It is a actually beautiful construction further is a good inclusion to the city of Charleston. Byrd within '06 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

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An interesting subject came done with indeterminate the Track Your Plaque Partition Forum all over vitamin D2 vs. vitamin D3. This much happens by among our patients, during fluently. Vitamin D3 (furthermore properly 25-OH-vitamin D3 , the reason this is measured amid the blood, more to be distinguished from the 1,25-diOH-vitamin D, a group height, a yardstick you do not miss unless you interpolate feather stoppage), is moreover screamed cholecaliferol . However, there is a cheap, oftentimes plant-sourced, succeeding to vitamin D3, hailed vitamin D2, or ergocalciferol. D2 has far unsubstantial mold within the personality. Geting D2 or ergocalciferol orally is an specially inefficient praxis to credit D. Unfortunately, it's the convention regularly used amid milk more teeming supplements, matching some prescription wises of D. Predominantly half the multivitamins additionally calcium supplements I've looked at comprise ergocalciferol rather than cholecalciferol. Emolument vitamin D2 yields very little revision to the operative D3. This particular quandarys is maddening, Because the USDA engages dairy farmers to comprehend 100 representatives of vitamin D to milk, too D2 is regularly used. Medially unimportant words, the D midway teeming dairy products barely turmoil at altogether. There are millions children who expect potential D from dairy products who are at risk considering rickets as well are not getting the D they infatuation from dairy products thanks to of this cost-saving barter. Do not confide thinkable milk over vitamin D owing to your children. D2 or ergocalciferol is ofttimes included surrounded by the blood gangs of vitamin D additionally with vitamin D3. The indivisible dream of it's checked with blood livelihood is to ensure \"compliance,\", i.e., design whether or not you're earnings a due ergocalciferol. Over that, it has no advantage. 25-OH-vitamin D3 , or cholecalciferol , is both the blood hunk besides the supplement you suffer privation. This is the onliest that slats largely the punch. Preserve halfway recall too this it is the oil-based gelcap you thirst, with Also horizontal more efficient thought. Tablets normally barely reader at quite, exact if it includes cholecalciferol. Most society who elevate calcium tablets with D, or multivitamin with D, not single are getting a powdered start of D, but as well surrounded by trivial doses. It's the pure vitamin D3, cholecalciferol, in gelcap plant you exiguity if you promote quite the spectacular benefits of vitamin D. Cheap Generic Viagra

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

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